Text book of veterinary medicine

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H. R. CLEVELAND,

VETERINARY SURGEON

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V\/ebster Family Library of Veterinary IVleclicifM
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TEXT BOOK

VETERINARY MEDICINE

JAMES LAW, F.R.C.V.S,

Director of the New York State Veterinary College
Cornell University, Ithaca, N. Y.

VOL. I

ITHACA

PtTBLISHED BY THE AUTHOR

1896

Cop_vright by

JAMES LA \V

1S96

PRESS OF

INDRUS ii CHURCH

ITHACA, N. Y.

PREFACE.

THvURING a long experience in teaching veterinary medicine
-L^ and surgery in Cornell University, the author felt the urgent
need of a compend on the subject, written from the American
standpoint and having special reference to the American live stock
industry. This led to the production of the Farmer's Veterinary
Adviser, which has been well received, and has, up to the present,
passed through ten editions in the United States, besides the un-
authorized editions published in Canada and Great Britain.

In entering upon a larger field as Director of the New York
State Veterinary College, and professor of medicine and sanitary
science, he aims at producing a work which will meet the needs
of the American student and practitioner. The special phases of
animal pathology in America, the diseases peculiar to our soil,
and the parasites that prevail here, but are unknown in Europe,
demand consideration from the American point of view. The
special features of our breeding, grazing and feeding industries,
and of the dairy, over our great extent of territory, and the
varying influence of soil, water, climate, altitude and traffic, the
scope and limitations of our interstate traffic, and our special rela-
tion to the old world in the matter of meat products, combine with
other conditions in demanding a somewhat different treatment of
the subject from that which we find in European publications.
Then, too, the recent extraordinary advances in the field of
bacteriology and sanitary science, which have virtually revolution-
ized modern medicine, and are an earnest of .still greater advances
in the near future, demand a work which shall, as far as pos-
sible, .set forth the present advanced status, and thus lay a solid
foundation to intelligently follow, if not to lead, in the imminent
advance. As a contribution to this, the present volume, the first
of a series, is offered to students, practitioners and scientists by
their friend.

The Author.

New York State Veterinary College,

Cornell University.

October, 1896.

VETERINARY MEDICINE.

OBJECTS AND METHODS OF STUDY.

Pathology — general — special. Morbid anatomy. Pathological chemistry ;
Disease. Health. Death — Somatic — partial — necrosis. Syncope. Apuoea.
Asphyxia. Coma. Death from old age.

The principles and practice of Veterinary Medicine should em-
brace all that is known of the causes, nature, symptoms, preven-
tion and cure of disease in domestic animals. Incidentallj^ it in-
cludes diagnosis and prognosis.

Pathology is the science which tells of the causes, and nature
of disease, and the functional and structural changes by which it
is characterized. In modern usage the term pathology is under-
stood to refer to the intimate nature of disease, but this neces-
sarily involves an enquiry into its sources and the predispositions
to its occurrence ; its phenomena whether in changes of function
or structure ; and its results in the form of perverted function,
structural changes, degenerations, dependent disorder, etc. The
field of pathology is further divided into general pathology and
special patholog3^

General Pathology treats of disease processes in their generic
form, and as they appear in many different diseases. Thus
inflammation and fever are the prominent phenomena in a great
many different diseases which differ in their seats, their causes,
manifestations and results. Inflammation and fever are therefore
subjects of general pathology. Similarly all forms of degen-
eration— fatt3^, fibrous, calcic, amyloid, etc., are disease processes
found in many different organs and under very varied conditions
and they are accordingly included in general pathology. Hj^per-
trophy and atrophy are also possible in every organic tissue irre-
spective of kind or seat, they belong therefore to this particular
field.

2 Veterinary Medicine.

Special Pathology on the contrary is confined to a particular
disease and not only elucidates the causes, phenomena and results
of such disease, but seeks to do this in such a way as to differentiate
this malady from all others however closely related to it. Thus
inflammation of a bone is known under the general name of
osteitis, this may be due to a great variety of different causes, and
each would have its own special pathology. The osteitis of
simple mechanical injury is essentially different from the osteitis
of rheumatism, of purulent infection, of tuberculosis, of actino-
mycosis. So with the inflammations of every other tissue. Each
ma3^ suffer from a variety of inflammations, springing from dif-
ferent causes, attended with characteristically unlike tissue
changes and tending to different issues, and every one of these
forms has therefore its own special pathology.

General Pathology may be said to deal with typical disease
processes to a large extent irrespective of the individual disease
in which they may appear, while Special Pathology deals with
the morbid phenomena which distinguishes the individual malady
from all other diseases however closely allied to it.

Pathological (Morbid) Anatomy deals with structural
changes, the cause, the accompaniment or result of disease.
The.se morbid changes are microscopic or macroscopic. Both con-
stitute morbid anatomy, but the microscopic alterations come
under the spacial name of morbid (pathological) histolog3^

Pathological Chemistry is that branch of pathology which
treats of chemical changes produced by disease in the blood,
lymph, tissues, secretions and excretions. It demands a previous
knowledge of the condition of these tissues and fluids in health,
in the particular genus of animal and under the .same dietary and
environment. Physiological Chemistry is therefore an essential
prerequisite to pathological chemistry, just as anatomy, physi-
ology and histology are indispensable to the appreciation of path-
ology and morbid anatomy.

Disease is an injurious deviation from the normal function or
structure. The morbid process resulting in disease is usually in
the nature of a modification of the normal or physiogical condi-
tion, so that it is often difficult to set the exact limits of health
and disease. What is a purely physiological process under given
conditions, would b^ distinctly pathological under others. The

Objects and Methods of Study. 3

free kidney secretion of cold weather and the profuse perspiration
of a hot season are both purely physiological and in the main
balance each other. Each under its special environment fulfills
an essential work in eliminating from the system toxic materials
which would prove hurtful if retained, and thus each is not only
physiological but beneficial. If, however, they occurred, not in
this mutually compensatory manner, but simultaneously in this
profusion, they might well be dreaded as morbid conditions.
Again if either were to occur apart from its normal causative en-
vironment, if for example the polyuria appeared in hot weather
and the perspiration in cold, the phenomenon might fairly be-
called pathological. In any case if the excessive secretion in-
duced a lowering of the general tone of health the process would
be essentially a morbid one. In pronouncing therefore upon a
morbid process one must take fully into account the correspond-
ing physiological process, the attendant conditions, and whether
the result is injurious or otherwise.

The same is true of structural changes. What under given
conditions would be essentially a morbid structure, might under
other conditions be a simple adaptation to an unwonted environ-
ment, and a means of protection from injuries that would other-
wise accrue. Excessive growth of cuticular tissue in the epithe-
lioma, wart or corn is injurious and essentially pathological, while
the callus on the camel's knee or the workman's palm is purely
protective and physiological. The local development of a mass
of fatty tissue in the average man or beast is a disease, but the
tendency to the uniform deposition of fat in the connective tissue
of the improved breeds of meat producing animals, is the happy
culmination of a long continued and skillful selection and regi-
men, without which the live stock industry of today would be a
grievous failure. To constitute disease, therefore, modified func-
tion must be permanent, and not simply a compensating increase,
decrease, or other change, and it must be in some way injurious
to the animal economy. Similarly to constitute disease modified
structure must be other than a simple protection or beneficial
change, it must not be a simple evolution in the nature of accom-
modation to the environment but it must be a cause of injury to
function or a distinct deformity.

Health may be said to be the harmonious exercise and mutual

4 Vctermary Medicine.

balance of all the bodily functions, and any interference with
such mutual exercise or balance may be said to constitute dis-
ease. But as health passes into disease by insensible gradations,
there is of necessity an extensive borderland which often cannot
be allotted to one condition or the other, but which must often be
left a disputed territory.

Again certain animal constitutions are innately strong and ro-
bust, while others are weak and feeble, yet the delicacy of the
latter cannot be set down as actual disease, and by maintaining a
due balance between the functions, a fair measure of health and
even long life may be secured.

Death as the result of disease may be €\\y\<tx partial or somatic.

Partial or local death may be molecular as in ulceration, or
it may affect an organ or part of an organ, as in necrosis, spha-
celus, or sloughing. Somatic death is a loss of vitahty of the
entire body and is manifested by a complete cessation of the bod-
ily functions, including that of nutrition. Usually the arrest be-
gins with one of the great vital processes, in advance of the oth-
ers, and thus in different cases, we have death beginning at the
hearty at the lungs, and at the brain.

Death from syncope or fainting, begins at the heart, which
loses its irritability or contractility, or is seized with a tonic
spasm. If there has been lack of contractility, the heart is
found after death in a flabby, soft condition, and quite frequently
filled with blood. If heart-spasm, it is contracted, firm, and
empty or nearly so. Syncope may result from severe nervous
shock (emotional), from the electric current, from insolation, or
from heart sedatives like chloroform, or nicotine. It may, how-
ever be but the culmination of a gradually advancing debility,
from exhausting diseases, from fatty degeneration of the cardiac
muscles, or from starvation, or anaemia. Again the exhaustion
coming from profuse haemorrhage, or from violent over-exertion
is a cause of fatal syncope.

In death beginning at the lungs (apnoea, asphyxia, or suffo-
cation), the blood failing to receive oxygen and to give up its
carbon dioxide is unable to maintain the various functions of the
body and the arrest of the other vital processes speedily follows.
The arrest of the respiratory process may occur from nervous
shock, but more commonly it results from choking, strangula-

Objects and Methods of Study. 5

tion, drowning, or the action of irrespirable gases. In diseases
of the heart and lungs it is liable to occur from the obstruction of
the pulmonary circulation and from the depression of the respira-
tory nervous centres. After death the lungs are found gorged
with dark red — almost black — blood, which likewise distends the
right heart and systemic veins, and all mucous and serous
membranes have a dark red, congested aspect. When breathing
has been arrested by mechanical violence there are, first, active
contractions of the respiratory muscles, but no loss of conscious-
ness ; then as the brain becomes charged with venous blood, con-
sciousness and volition are lost and convulsive movements ensue.
Later still there is no respiratory effort nor convulsions, but the
heart continues to beat for two or three minutes longer.

In death beginning at the brain (Coma) the sensory func-
tions fail first, as evidenced by drowsiness, stupor, or complete in-
sensibility, while the movement of heart and lungs are still tem-
poraril}^ continued. Pressure on the brain by a fractured bone
or blood clot, or in cases of violent congestion or the rapid growth
of tumors, usually operates in this way. It may also result from
the direct action of certain poisons, like opium, belladonna, or
chloroform, or the ptomaines or toxins of bacteria. Causes acting
on the brain may, however, lead to death by syncope or asphyxia
when the nerve centres presiding over circulation or respiration
are the first to feel the full effects of the pressure or poison.

Death from old age, with a gradual failure of the natural
processes of nutrition and tissue-growth, and the occurrence of
atrophy and various degenerations of the organs is not a common
occurrence in domesticated animals, so that it may be dismissed
without further notice.

Actual somatic death is marked by the cessation of breathing
and pulse, the dilated pupils and semi-closed eyelids, the coldness
and pallor of the visible mucous membranes and skin, and the
clenching of the jaws with slight protrusion of the tongue. Yet
these symptoms may be present in S3^ncope and it may even be
impossible to detect the beats of the heart, though the subject still-
lives. Pressure of the finger on a white portion of the skin or on
a mucous membrane may give a further indication. If the in-
dentation made by the finger is slowly effaced and if the blood
again slightl}^ reddens the part the presumption is against death.

6 Veterinary Medicine.

Even this is not infallible, since by pressure of gas in the internal
cavities or deeper blood vessels, the blood may be forced back
into the surface capilliaries giving an appearance of circulation,
after actual death. On the other hand any exudation or oedema
will retain the imprint of the finger even in life. The general
relaxation of the muscles and their lack of response to electric
stimulation, and the setting in of cadaveric rigidity, and later still
of putrefaction give more conclusive evidence of dissolution.

ETIOLOGY : CAUvSEvS OF DISEASE.

Causes— simple — complicated : Proximate ; Remote : Predisposing — race,
genus, family, heredity, individual, environment, food, age, sex, tempera-
ment, idiosyncrasy, debility, plethora, interdependence of organs, embolism,
mechanical influence. Exciting causes, intrinsic, extrinsic, inherent, ac-
quired, heredity, dentition, heat, cold, atmospheric conditions, electricity,
moisture, dryness, dust, darkness, light, soil, food, water, inaction, over-
exertion, mechanical causes, poisons, — mineral — vegetable — animal, mi-
crobes, contagious, infectious, epizootic, enzootic, sporadic, panzootic,
zymotic, mediate contagion, bacterial poisons.

The causes of disease are simple or complicated, and in the
latter case a single factor may be altogether harmless unless asso-
ciated with another which also may have been innocuous alone.
For example : the infecting germ of glanders (Bacillus Mallei)
is harmless to the ox which lacks the predisposition to the dis-
ease : — feeding buckwheat is harmless to the dark-skinned ani-
mal, but is injurious to the white-skinned, if exposed to sun-
shine :— the chicken can bear with impunity exposure to cold or
to the bacillus anthracis, but it cannot endure these two etiologi-
cal factors combined. It follows that one cannot predict the
same result from the same cause in every case. Yet with all con-
current conditions the same the result will follow with mathemati-
cal certainty. This will serve to illustrate the value of thorough-
ness in etiological knowledge, as the basis of a sound pathology.

Etiology is primarily divided into proximate and remote.
Remote causes are again divided into predisposing and exciting.

Predisposing Causes are such as induce a condition of the
system or of a particular organ or group of organs which renders
them specially susceptible to a disease. This may be a character-
istic of the race ox genus of animal, thus the genus bovis alone
suffers from lung plague, the genus equus from dourine, and
ruminants from Rinderpest. It may be a family trait, (^heredit-
ary) hence we .see certain families of both men and cattle cut off
by tuberculosis, while other adjacent ones largely escape. It may
be an individual peculiarity , thus some subjects have a congeni-
tal insusceptibility to a given disease, from which others of the
same family suffer, and one who has passed through a self-limit-

8 Veterinary Medicine.

ing disease like measles, cowpox or anthrax is rarely attacked a
second time. Again predisposition may be due to environment
as when we find herds in damp and exposed localities obnoxious
to rheumatism, and horses in dark mines exposed to specific oph-
thalmia. It may be the result of food as when the flesh-fed fox
or rat resists anthrax and the farina-fed one falls a ready victim.
Age may predispose, early youth being remarkably susceptible to
parasitism and bacteridian infection, and old age to fractures and
degenerations. Sex is inevitably a cause of limitation of disease
as the females and males can only suffer from disease of their
respective sexual organs. Again of diseases common to both
sexes certain nervous and digestive disorders are common in con-
nection with gestation, and certain calculous diseases in connec-
tion with the long and narrow urethra of the male. Tempera-
ment has a marked influence, thus the sanguineus or nervous
race-horse or hound shows a marked predisposition to diseases of
the heart, lungs and brain, and to a sthenic type of inflammation
and fever, while the heavy lymphatic draught-horse has a pro-
clivity to diseases of the lymphatics and skin. Idiosyncrasy is
closely allied to temperament, but the condition may be less
manifest, and the peculiarity is only recognized by the results, as
when a man is poisoned by sound fish or raspberries. Debility
whether from deficiency or poor quality of food, on the one hand,
or from overwork, filth, dampness or disease on the other must
be looked upon as strongly predisposing to certain diseases, such
as tuberculosis and glanders. Plethora which charges the blood
and tissues in a different way with effete organic products, lays
the system especially open to certain diseases like black quarter
in young cattle, and parturition fever in cows. Disease of one
organ often predisposes another organ through interdependence
of function, as when torpid or congested liver leads to portal and
intestinal congestion, diseased teeth to digestive disorder, im-
perfect haematosis to kidney trouble ; in other cases blood clots or
bacteria from one pathological centre may be arrested in the blood
vessels of a distant organ and start new foci of disease (embol-
ism, metastasis) ; in still other cases the impairment of the
healthy function in one organ acts injuriously on another, as
when emphysema or other disease of the lungs forces the blood
back upon the heart causing dilation with atrophy of the walls.

Etiology : Causes of Disease. 9

PrevioiLs disease in a tissue leaves for a time an impairment of
structure and function which may become the essential predis-
posing cause of the effective operation of a morbific factor. Me-
chanical action on a part may predispose to disease, as for ex-
ample, by reducing its circulation and nutrition and thereby di-
rectly impairing its power of resistance to other inimical agencies.
Not infrequently a pus microbe lies deep in the cuticle or even in
the tissues without harm, until there occurs a bruise, or a bony
fracture when it at once develops a focus of purulent infection
(abcess).

Exciting Causes are the immediate causes of particular dis-
eases. Like the predisposing causes they may be intrinsic or
extrinsic, and the first may be inherent or acquired.

Among inherent causes are certain of those already named as
predi-sposing causes, but which have come to be forcible enough
to develop disease without the intervention of any other observa-
ble factor. Thus a hereditary monstrosity (redundancy or de-
fect), will appear in successive generations without any apparent
additional cause. The appearance of white calves in herds of
black cattle, after the whitewashing of their stables shows a
similar hereditary operation though the result is not in this case
pathological. The birth of blind foals from blind sires or dams,
or of foals with distorted feet from mares suffering from severe
chronic foot lameness are true pathological sequences, in which
the exciting cause is hereditary and operates during intrauterine
life. Deyitition, as an attendant on early life is often a directly
exciting cause, from direct injury by entangled or retained teeth
that should have been shed, by fever aroused by the active local
changes, or imperfect mastication or insalivation leading to con-
sequent indigestion ; in puppies and kittens convulsions are not
uncommon as a result.

Extrinsic Causes are such as operate through the environ-
ment. Heat, if excessive and prolonged, relaxes and exhausts
the system and exerts a direct influence on the process of sangui-
fication so that it may become the direct cause of a variety of
diseases. As the result of extensive burns, dangerous congestions
of internal organs are liable to occur, a nd even the prolonged
heat of summer often superinduces hepatic and gastric disorder,
diarrhoea and dysentery. Fat cattle in uncovered cars or yards

lo Veterinary Medicine.

under a hot sun and with no breeze suffer extensivel_v from in-
solation, the temperature of their bodies rising to iro° to 112°
Fah. and even higher. Cold is equally potent. With a temper-
ature below zero Fah., the iron bit will freeze the baccal mucous
membrane, and cause extensive erosion of the mouth. The cold
of salted snow or ice will freeze the feet, causing sloughing of the
skin above and around the coronet and shedding of the hoofs, and
predisposing to fatal septic infection of the wounds. On the system
at large, cold causes retrocession of the blood upon the internal
organs, and endangers the occurrence of acute disease in any
structure which is already debilitated or otherwise susceptible.
The nervous effect of the chilling of the skin is often the unbal-
ancing factor which sways the scale in favor of disease, which the
system was able to resist until this disturbing element was intro-
duced. The sudden chill from pas.sing out of the warm barn into
the frosty air, from plunging into icy water, from standing in cold
rain or sleet, from standing in a draught of cold air especially
when perspiring, is a fruitful source of many diseases. In the
cow, lying with the udder on a cold stone may be the starting
point of mammitis. The effect of sudden chill is well exemplified
in the great prevalence of diseases of the respiratory organs at the
change of the seasons in spring and autumn when the vicissitudes
of temperature are greatest, and the system unprepared by habit,
to bear the sudden change. Again it must be noted that expos-
ure to cold has a tendency to cause disintegration and .solution of
the red blood globules, and that certain animals are especially
susceptible to this influence. The condition of the atmosphere is
often a direct cause of disease as when charged with offensive or
irritating gases, the result of decomposition of organic matter,
with sewer or ces.spool emanations, with deleterious gases from
chemical works, telluric sources, or fires. A low state of health,
a local irritation in some part of the air passages, or even a speedy
asphyxia may be the outcome of such atmospheric conditions.
Again the presence of solid particles of a more or less irritant,
septic or infecting kind prove the .starting point of various
diseases. The stone cutters' phthisis, and the sand granule
ophthalmia are familiar examples of the irritant, which often acts
through the dust of the highway. Of the infecting particles we
have the germs of cattle lung plague, of infective ophthalmias.

Etiology : Caiiscs of Disease. ii

and of tub2rculosis carried with the dry dust and inhaled. Of
toxic agents borne on the atmosphere we see the compounds of
arsenic, mercurj- and lead. Moisture and dr>-ness of the air in-
duce respectively a lymphatic constitution and low tone of health,
and a nervous constitution and a tendency to neurosis, ophthalmias,
and skin diseases. The pressure of the atmosphere has a pro-
found effect on animal health as seen in the extreme troubles
of the heart and circulation in the diving bell, and the respirator^*,
haemorrhagic and brain affections of high attitudes. A low bar-
ometer is attended by nervous disorders (neuralgia) (S. Weir
Mitchell). Surgical operations do best with a high or rising bar-
ometer (Adinell, Hewson). The electrical tension of the atmos-
phere shows familiarly, in man, in the feeling of heaviness, dull-
ness and malaise that precedes the bursting of a thunderstorm
and the relief that follows its termination. To this influence
many of the domestic animals are incomparably more sensitive
than man, as witnessed in the disposition of swine to hide in their
pens or under litter on the approach of the storm, the nervous
disturbance even to abortion of certain ewes which are heav)- in
lamb, and the great discomfort and even piteous cries of some
domestic felines on such occasions. The greatest electric tension
is seen in the drier climates, where the air, robbed of its moisture,
proves a poor conductor and equalizer, and the positive and nega-
tive electricity get stored up separately in air, cloud and soil. The
presence of ozone. in the air, as a habitual concomitant of electric
discharges, has been supposed to be a disturbing influence, since
it is distinctly irritating to the mucous membrane when present
in excess, but such excess apart from its artificial production is
highl}- improbable. As habitually- met with it is antiseptic and
health giving. Darkness alwaj's deteriorates the general health,
producing bloodlessness and pallor. Light is usualh' invigorat-
ing, 3-et bright sunshine falling upon the eyes from a window in
front of the stall, or in the open air when the face is turned up by
an overdraw check rein, or reflected from white dust and, above
all, from snow, will often induce inflammation and blindness.
Soils are often potent etiological factors. Dense, damp, cold, un-
drained soils, are habitually covered by a stratum of cold air,
saturated with moisture, which greatly lowers the vital stamnia.
Damp clays, and waterlogged soils of various kinds, rich in

12 Veterinary Medicine.

organic debris, are the natural homes of various pathogenic
microbes, such as those of ague, anthrax, milk sickness, actino-
mycosis and yellow fever. Well drained sandy or gravelly soils
are usually healthy, unless they contain a great excess of decom-
posing organic matter. Again soils with an excess of alkaline cr
other mineral matter may prove deleterious, and those on the
magnesian limestone often harbor the poison of goitre, and cretin-
ism, and favor the occurrence of urinary calculus. Faulty food
and feeding in the domestic animals are chargeable with many
diseases. Stock often fall off in condition, in the hands of one
feeder, when the same food given with regularity and judgment
by a more careful feeder would keep them in the highest health.
Hay and grain which is musty and filled with cryptogams and
their products, are common causes of disorder of the stomach, the
kidneys, the nervous system or of general nutrition. Smut and
ergot at certain stages of their growth or grown under given con-
ditions cause nervous disorders, abortions, and gangrene of the
extremity. A long list of vegetable poisons may mix with
fodders, and animal poisons with the food of the Carnivora. A
number of standard fodders may be poisonous at certain stages of
growth, as partially ripened perennial rye grass, millet, Hun-
garian grass, vetches, etc. Water and deprivation of water are
fertile causes of illness. Ruminants cannot chew the cud when
deprived of water, hence impaction of the first and even of the
third stomach with fermentations, tympany and other disorders.
Horses suffer more from a full drink of water after a feed of
grain, the unchanged albuminoids being carried on into the in-
testines, and both gastric and intestinal indigestion induced.
Sheep suffer fatal fermentations after drinking the alkaline water
of the Plains ; cattle have diarrhoea and dysentery from seleni-
tions, or from stagnant and putrid water ; and the water from the
dolomite is the usual channel of the goitre poison. Certain germs
like the plasmodia of malaria, and comma bacillus have their
natural home in impure water, and others like anthrax bacillus
survive in the mud and silt at the bottom of wells, ponds, and
rivers and enter the system in the water. Compulsory rest in a
stall often induces torpor of liver and bowels, general muscular
debility, and fatty degeneration especiall}^ of the liver and heart.
A few months of the swill feed, hot atmosphere and absolute rest

Etiology: Causes of Disease. 13

in a distillery stable usually ruins cattle for stock purposes.
Overexertioyi on the other hand is prolific of illness. Exhaustion
of the muscles, congestion, inflammation, cramps, congested
lungs, heart failure or rupture, apoplexies and other haemorrhages
are among the resultant maladies. Auto-poisoning is another re-
sult shown in equine hsemoglobingemia, and the fever of leuco-
maines. The excessive development of sarcolactic acid from
muscular work may render an insusceptible animal susceptible to
the anthrax bacillus. Mechanical causes would include overexer-
tion, in the production of strains, fractures, and other injuries.
They would also include impaction by foreign bodies, calculi, and
ingesta, friction of folds of skin or by harness and other objects
and pressure which leads to absorption and atrophy. To these
must be added poisons of vegetable, mineral and animal origin
and the niicrooiganisms which act as injurious ferments within
the animal body. These will be treated more fully later on. Of
the microorganisms it may be said here, that they are almost cer-
tainly the cause of all transmissible diseases. These diseases are
variously named on the basis of different ideas. They are
enthetic, that is implanted as a seed is planted in the ground to
grow and multiply. They are zymotic or fermentative because
the essential cause multiplies and is propagated like a ferment.
They are contagious because propagated by contact mediate or
intermediate. They are infectious when transmitted, not alone
by contact but through the atmosphere. They are epizootic be-
cause they tend to attack animals generally or a given genus or
family of animals generally when these are exposed to the infec-
tion. They are enzootic when confined to the animals in a given
locality, the soil or conditions of which are favorable to the pres-
ervation of the germ in pathogenic potency, or to the production
of a special susceptibility in the animal system. They are
sporadic when each case occurs without an}'^ casual relation to
another. They are called panzootic when they attack all
animals without apparent preference. The term panzootic is also
used to describe those recrudescences of a disease or cycles of
exalted pathogenesis which are observed in contagious diseases,
which frequently last for years and again give place to a period
of benignancy. Such cycles, of malignancy and benignancy, may
be due to modified environment acting either on the disease-germ
or the animal system, or on both simultaneously.

14 Veterinary Medicine.

The terms enthetic, zymotic, and contagious best express
modern views of the nature of these maladies. The terra infec-
tious when used to express a gaseous or otherwise intangible
(unorganized) body, or influence transmitted through the air,
necessarily excludes the particulate, living, self-propogating germ
upon which the transmissibility of the disease depends. A chem-
ical, electrical, or other body or influence generated outside the
animal body, cannot well be conceived of as reproducing itself
within the animal body but must act like any other ectogenous poi-
son, according to the size of the dose and the frequency of its ex-
hibition. This might create an enzootic disease but would lack all
the qualities of a contagious affection since it could not spread
from a victim when taken elsewhere and turned among animals
which would prove equally susceptible if placed within the infect-
ing area. Suppose on the other hand we apply the term infectious
to diseases in which the levity of the particulate living germ al-
lows of its being inhaled into the body of the susceptible animal,
the case becomes one of simple mediate contagion, the air acting
as the intermediate bearer.

The term zymotic conveys a clear idea of the method of in-
crease of the disease germ in the body by the ordinary process of
generation. The old doctrine of fermentation by a continuous
change, due to contact with dead fermenting matter, as an inflam-
mable body continues to burn by contact with the incandescent
portion, has been definitely disproved by the investigations of
Pasteur and others, and today we must recognize that every fer-
mentation is the result of the propogation and vital activity of
living organisms. This does not ignore that the chemical prod-
ucts or enzymes which are constructed by the vital activity of the
microbes, will dissolve or transform organic matter, but in the
absence of the microbe no such enzyme can reproduce nor mul-
tiply itself and its action must therefore be exactly limited by its
amount. The living germ itself is therefore the one effective fac-
tor, by which the contagious disease may be maintained and
propagated. In its turn the living germ can only come from a
pre-existing living germ. To the scientist of today the doctrine
of spontaneous generation is a thing of the past and the aphorism
omnis ovum ex ovo is dominant. The argument drawn from the
saccharizing of starch in the germinating seed by the operation of

Etiology : Causes of Disease.

15

diastase is inapplicable, as the diastase is produced by the living
cells of the germinal part of the seed, which are thus the coun-
terpart of the disease germ. No such glycogenic action occurs in
the seed that has been boiled or otherwise robbed of its vitality.
So with the arguments drawn from the ptyaline of the saliva, the
pepsin of the gastric juice, and the tr3^psin of the pancreatic
juice ; each of these is the product of the living cells of the gland
by which it is secreted, and cannot increase its own substance in
the absence of these cells. Like the enzyme of the bacteridian
ferment, these gland products can break down or digest certain
organic matters, but in all alike, the only source of the chemical
solvent is the living bacterium or gland cell from which the par-
ticular product is derived. The toxins of a virulent liquid, after
the sterilization of the latter may still produce most of tli2 lesions
and morbid phenomena of the disease, but, although death were
to ensue, the body of the victim would not be infecting to other
susceptible animals. The parallel between the funitions of the
secreting animal cells and the disease germs may thus be put in
tabular form :

Living Source. Chemical Product,

Salivary gland cells = Ptyaline

Result.
= Starch changed to

Sugar.
= Albuminoids chang-
ed to peptones in
acid solutions.
= Albuminoids chang-
ed to peptones in
alkaline solutions.
Toxin: Enzyme = Morbid phenomena.
Contagious disease.
Further consideration of pathogenic microorganisms will be
found in connection with contagious diseases.

Peptic gland cells = Pepsin

Pancreatic gland cells = Trypsin

Disease germ
Disease germ

MEDICAI. DIAGNOSIS.

Means of diagnosis. Usual health of the subject. History of the attack.
Objective symptoms, interdependent disease, fever, diseases that may be
confounded, subsidiary disease, diagnostic signs, organ involved, patholog-
ical test injections, course of disease, sporadic or zymotic, result of treat-
ment.

Diagnosis is the determination of the seat and nature of a given
di.sease and its distinction from other morbid conditions. Its im-
portance to the practitioner cannot be overestimated as it occu-
pies the piv^otal position between causes, nature, morbid phenom-
ena, and symptoms on the one hand, and prognosis, prevention,
and treatment on the other. Unless the conclusions are sound as
to causes, nature, lesions, and symptoms, there can be no certain
diagnosis, and without a correct diagnosis, prognosis, prevention,
and treatment can have no intelligent or vScientific basis. The
practitioner who finds a dropsical condition and who is satisfied to
pronounce it drop.sy and institute treatment is abusing his trust.
He must find whether this drop.sy results from disease of the kid-
neys, heart, blood-vesssls, lymphatics, liver, lungs, bowels, or the
structures in which it is shown ; whether it is due to parasites or
imperfect sanguification or to other morbid conditions, before he
dare prescribe treatment and predict results. So in every other
affection ; the failure to make a correct diagnosis opens to the
practitioner many doors of error, and he is happy indeed if he
can escape the injuring of his patient.

In seeking a sound diagnosis we must attend to the following
among other indications :

ist. The habitual state of health of the subject. The genus,
breed, age, environment, habits, (pet dog, watch dog, hound,
sheep-dog, ox, bull, cow, milch cow, sheep in the field or
housed, pig in pen or at large, diet, regimen, water, race horse,
draught horse, work, exposure, etc.) as well as the personal
equation of temperament, idiosyncrasy, heredity, etc., must all
be carefully con.sidered.

2d. The history of the present illness as to its apparent cause,
mode of invasion, duration and progress.

3d. The objective symptoms by which it is manifested. All
that can be ascertained in the way of symptomatology, local and

Medical Diagnosis. 17

general, the probable existence of interdependent disease, and all
actual structural lesions and disorders of function should be
thoroughly investigated. As supplementary to the more promi-
nent objective symptoms any fever or other constitutional disorder
must be sought for ; a mental list must be made of the diseases
which resemble this one, and these must be excluded one by one
by careful attention to the differential symptoms ; other diseases
which are probably subsidiary to this, should be similarly, investi-
gated and excluded ; any really diagnostic sign of the suspected
disease must be carefully established and the diagnosis finally
placed on a solid foundation. The di.scovery of a constitutional
(febrile) disease to which a distinctive name can be given is by
no means the end of the diagnosis ; the structural lesions of the
disease may be largely localized in an unimportant organ where
they may remain circumscribed without compromising life, or
they may be seated in a vital organ which will render the disease
grave to the last degree or necessarily fatal. For example : An-
thrax of a den.se, dr}^ part of the skin may be a mild local disease ;
anthrax of an internal organ is usually fatal. Kvery local com-
plication therefore, should be as carefully diagnosed as the con-
nected constitutional disorder.

But diagno.sis cannot always be certain. In the early stages
of certain fevers two forms may be as yet indistinguishable and a
day or two may be required to develop differential .symptoms. In
some occult forms of disease all differential symptoms may fail
us. A method of diagnosis which has hitherto been applied only
to tuberculosis and glanders is manifestly capable of much wider
application, to diseases attended with a febrile reaction. This
consists in a hypodermic injection of a minimum dose of the ster-
ilized and filtered products of the culture of the disease germ,
which produces no effect on the healthy .system but causes febrile
reaction or local inflammation, or both, in the diseased. This will
be treated more fully under the respective diseases.

In connection with such a method, but above all when no such
resort has been had, the ob.scure case should be seen frequently,
the course, duration, and termination of the disease should be
noted, also its tendency — sporadic or epizootic, and finally the re-
.sult of treatment. This last resort may often secure diagnosis
and cure at once as when a course of iodine cures an obscure ac-
tinomycosis.
2

SYMPTOMATOLOGY. SEMEIOLOGY.

Definition. Symptom. vSigii. Constitutional symptoms— local, object-
ive, subjective, direct — idiopathic, indirect — symptomatic, premonitory.
Anamnesis. Position. Movements. Decubitus. Acute. Chronic. Fe-
ver. Sthenic. Asthenic. State of limbs, muzzle, nose, snout, palmar-
pad, hoof, bill, digits, mouth. Thermometry. Normal temperature, in
doors, in field, at work, in hot season, in nervous subject, in thirst, in
youth — age, starvation, plethora, cold, sleep, rest, stimulants, suppressed
perspiration, eliminants, antipyretics. Fever temperature, morning, even-
ing, transient elevation, persistent rise, sudden fall — collapse, crisis. Fatal
elevation. Rise during defervescence. Pulse. Respiration. Skin, star-
ing coat, pallor, coldness, dryness, harshness, mellowness, pliancy, hide-
bound, yolk, clapped wool, scurfy, lesions, itchiness, tenderness, loss of
hair, emphysema, anasarca, sweat, sebum. Expression, life, dullness,
paralysis, dropsy, jaundiced, eye, discolorations, photophobia, amaurosis,
pinched face. Nasal mucosa, red, violet, etc., nodules, polypi, osseous dis-
ease, pentastoma, oestrus, discharge from teeth — sinuses — actimomycosis —
tumors. State of the bowels, kidneys, nervous system.

The usual basis of diagnosis must be a clear and intelligent
observation of the symptoms of disease. A symptom is an ap-
preciable evidence of disease. A symptom however may indicate
illne-ss, without affording the means of diagnosis, while the term
sign is often used for a pathognomonic symptom — one by which
the disease can be identified. Used in this sense a sign may be
said to be a diagnostic symptom.

1. Constitutional Symptoms are such as affect the entire
system, like a rise of body temperature, or a shivering fit.

2. Local Symptoms are confined to a definite area as red-
ness, tenderness, .swelling, ulceration.

3. Objective Symptoms incltide all that can be recognized
by the senses of the observer. These alone are available in deal-
ing with the lower animals.

4. Subjective Symptoms can only be felt by the patient
himself, as pain, giddiness, cold, heat, blindness, numbness.
Such symptoms are therefore only obtainable from the human
patient who can tell how he feels. In the lower animals they
can only be matter of inference, thus pain may be inferred from
lameness or wincing on pressure, and giddiness from unsteady

Symptomatology . Semeiology. 19

gait. Tli2 fact that the veterinarian is restricted to objective
symptoms renders his task a specially difficult one, yet this has its
compensation, as this very restriction tends to train the observant
practitioner to greater skill.

5. Direct Symptoms (idiopathic) are those which are con-
nected with the seat of disease, as the redness, exudation, and
swelling of inflammation.

6. Indirect (sympathetic, dependent) Symptoms are ob-
servable at a distance from the actual disease : — as when headache
attends on dyspepsia, or lameness in the right shoulder upon dis-
ease of the liver.

7. Premonitory or precursory symptoms precede the diag-
nostic symptoms of some diseases, thus dullness and languor
often heralds an approaching fever, and the strangles of young
horses is often preceded by a general unthrifty appearance, poor
appetite and indisposition to exertion.

In observing symptoms as in other things, some have far greater
natural ability than others, but in all a careful training will do
much to develop and improve the power and habit. A most im-
portant thing in such habits is the strict maintenance of a system,
not to be followed as a cast iron rule but to be constantly kept in
mind and .strictly carried out except when sound judgement and
experience show it to be unnecessary.

Anamnesis. As a rule the first thing to be learned about a
patient is his history, and personal and hereditary characteristics.
What are his general health, temperament, previous attacks,
hereditary predisposition, environment ? Is the site of the build-
ing, its condition as regards soil, springs, drainage, structure,
ventilation, light, cleanliness such as would favor any particular
disorder or class of disorder? Is the patient in high, low, or
moderate condition, robust or debilitated, alert and lively or dull
and stupid ? Have other animals suffered recently, or at a cor-
responding season, or under similar conditions in apparently the
same manner? How long has the patient suffered, were there
any premonitory indications of illness, what were the first symp-
toms, and what symptoms have followed up to the present ?
Has there been any change of food, water or management that
might throw light on the cause ? Has there been any change of
weather or unwonted exposure to cold, storm, overwork, com-

20 Veteriyiary Medicine.

pulsory abstinence or enforced retention of some secretion ? If
a female is she pregnant ?

Having exhausted this method, using such Hues of inquiry as
promise good results in the particular case, the veterinarian is
prepared to bring his own powers of observation to bear more
directly.

Position and movements will often furnish valuable data.
The horse which lies on his ribs, stands obstinately in chest
diseases, or whenever there is much interference with breathing.
The ruminants and carnivora on the other hand which lie on
their smooth or padded sternum, can breath with comfort in this
position and only stand up persistently in the worst cases. The
habit of .standing day and night is also characteristic of anchylosed
back or loins in the solipede. Roached back may be natural, or
the result of overwork and slight sprains or injuries of the loins,
of anchylosis, of intestinal or renal inflammation, or of certain
injuries to the limbs. The extension of the head on the neck
may suggest sore throat, chest disea.se, tumors around the throat,
abscess (fistula) of the pole, sprain or .spasm of the extensors of
the neck, disease of the axoido-atloid joint, tetamus, or cervical
rheumati.sm. Dropping of head and neck might suggest paresis,
mechanical injury to the levator muscles or cervical ligament, ex-
treme debility, or prostration from a profoundly depressing fever or
poisoning. Inability or indisposition to back, might indicate
sprain or fracture of the back, anchylosis, laceration of the sub-
lumbar muscles, paresis, cerebral or spinal inflammation, soften-
ing or other lesion, tetanus, laminitis, dislocated patella and
certain other affections. Swaying or unsteadiness in walking
or turning would similarly .suggest .sprain or fracture of the back,
paresis and other nervous and locomotor injuries. The soli-
pede with peritonitis arches the back and draws the hind feet
forward under the belly, with impacted colon or obstruction to
urination he will often stretch with fore limbs advanced and
hiud limbs retracted. The mode of decubitus may be significant.
With peritonitis, enteritis, metritis or acute nephritis or hepatitis
the solipede lies down slowly and with caution : with spasmodic
colic he throws him.self down as if reckless of possible injury.
Lying well up on the costal cartilages and .side of the breast bone
suggests a slight affection of the air passages ; lying on the side,

Symptomatology . Semeiology . 2 1

disease of other parts. Rolling on the back may indicate simple
intestinal spasm, but also blocking by intususception, impaction,
volvulus or otherwise. Sitting on the haunches may suggest a
similar trouble or it may imply ruptured stomach or diaphragm.
The dog may sit on his haunches in health, or with dyspnoea in
acute affections of the respiratory organs, asthma and heart af-
fections. Decubitus on the belly with hind legs extended back-
ward, may imply paraplegia, or acute inflammation of the abdom-
inal organs. Lying with the nose in the flank or turning the
head toward the flank, though a normal position of rest, often in-
dicates abdominal suflfering. Turning of the head to one side
may, however, suggest injury, spasm or rheumatism of the cer-
vical muscles, or disease on the corresponding side of the brain.
Animals, at liberty, lie more frequently on the side on which the
heaviest internal organs are lodged, thus ruminants, pigs, and
dogs rest on the right (the side of the liver) though in cattle with
1 heavily loaded rumen the condition may be reversed. Decub-
itus on the abdomen, with the limbs extended and abducted im-
plies profound nervous disorder or shock.

Habitual decubitus often indicates severe suffering in legs or
feet. Resting one limb more than another implies injury to that
limb. Standing with the pastern of one limb more upright than
the others has the same meaning. Extension of one fore foot in
advance of its fellow with flexion of the pastern and fetlock de-
notes suffering in the posterior part of the foot or in the flexors.
Flexion of carpus and fetlock without advance of the foot prob-
ably bespeaks injury to shoulder or elbow. Inabilit}^ to bear
weight on the fore limb, without knuckling at the knee, should
call for examination of the olecranon and joints especially the
elbow. Inability to extend the carpus should lead to investiga-
tion of the flexor muscles and tendons, the joints and the heel.
Movement of the hind limb without flexure of the tarsus would
suggest injury to that joint, the stifle or the flexor metatarsi
tendon. Inability to extend stifle and hock, should demand ex-
amination of the tendo-Achillus and olecranon, of the triceps ex-
tensor cruris and of its nerves.

Atrophy of a muscle or group would require scrutiny of its
tendons and its nerve and blood supply.

INIore precise indications of injury of the locomotor system must,
be found under surgery.

22 Veterinary Medicine.

After posture, the general or constitutional disorder may claim.
attention. Is the illness acute or chronic? Is fever present?
Has the animal had a rigor? Does the coat stare in patches
(along the spine) or generally ? Is there perspiration ? Is there
full, clear, somewhat congested eye (sthenic) or drooping lids
over a dull brownish sclerotic (asthenic). Are the lower parts of
the limbs and other extremities cold, and the roots of the horns
or ears hot ? Is there significant heat and dryness of the muzzle
(ox), nose (dog), snout (pig), palmar-pad (carnivora), hoof
(solidungala, bisulcates), bill and digits (birds) ? Has the mouth
the hot burning feeling of fever ? Finally is the temperature as
indicated by the thermometer abnormally high ? To estimate this
with any degree of certainty one must be well acquainted with the
normal temperature.

Normal temperature. As taken indoors under ordinary con-
ditions, the normal temperature taken in the rectum may be :
fowl, 107° — 110° F. ; swine, 103°— 106° F. ; goat and sheep, 103°
— 104° F. ; ox, ioo°— 102° F. ; dog, 99°— 100° F. ; horse, 99°—
99.6° F. Ranging in the fields, at work, or on forcing or stimu-
lating feeding, it may be 1° higher than when at rest indoors. A
whole herd may be raised 2° by a three miles drive in warm
weather. In our summer heats a rise of 1° is common. In ner-
vous animals any change in management ma}^ raise the tempera-
ture, for example, 1° to 2° after failure to water at the usual time,
or from retaining the milk in the udder when the milker had been
changed. Young animals are normally .5° to i° warmer than old
ones though more sensitive to the action of cold. Half starved
animals, when put on abundant and nutritious food may have a
rise of 1° or more. Females in heat, in advanced pregnancy and
at the time of parturition are usually 1° to 3° above the natural
temperature. Among the agencies lowering, temperature are :
cold, (1° to 2°) ; sleep, (1° to 2°) ; rest ; starvation ; alcoholic
and other circulatory stimulants which fill the cutaneous capillaries
and thereby cool the whole mass of blood ; suppression of insen-
sible perspiration (retention of waste matters) as by varnishing
the skin which lowers the temperature to 25° ; purgatives and di-
uretics (1°) ; certain drugs like antipyrin, acetanilid, etc., which
act on the heat producing centres and retard metabolic changes.

Temperature in disease. Comparative temperatures should

Symptomatology . Semeiology . 23

be taken at the same hours on successive days, bearing in mind
that the morning temperature is usually slightly lower and the
evening one slightly higher. Where possible both morning and
evening temperature should be taken. With elevated tempera-
ture, repeat sooner to see that it is not transient. A transient
rise of 1° to 2° is unimportant. A permanent rise of 2° or 3° in-
dicates fever. A sudden additional ris^ of several degrees in the
progress of fever is grave. A persistence of the high evening
temperature to morning shows aggravation. A persistence of
the low morning temperature to the evening bespeaks improve-
ment. A sudden extreme fall to much below the normal (4° or
5°) indicates collapse. This is usuall}' attended with other symp-
toms of extreme prostration and sinking. A sudden considerable
fall to near the normal, without untoward attendant symptoms,
may indicate a crisis and a more or less speedy improvement may
be hoped for. This sudden fall often attends the period of erup-
tion of certain exanthemata, as cowpox, horsepox, sheeppox,
aphthous epizootic, etc. A sudden extensive fall of temperature
may result from some transient accidental cause, as a prolonged
deep sleep, a hemorrhage, the relief of constipation, or of enuresis.
A sudden ri.se may supervene on such suppressed function or
other cause of nervous irritation or on toxin poisoning, but it does
not persist more than twelve or twenty-four hours after the cessa-
tion of the morbific cause.

A rise of 10° or 12° above the normal standard is usually
promptly fatal.

A continued high temperature indicates persistent disease, and
a considerable rise during defervescence implies a relapse and in
the absence of any error in diet or nursing is grave.

Pulse. Before the introduction of the clinical thermometer,
the indications furnished by the pulse were held to be of the high-
est value. Though largely superseded by the usually more re-
liable thermometer, yet they should not be discarded, but em-
ployed as symptoms corroborative of the thermometric indications.
In many cases the pulse will furnish criteria, when in the absence
of fever, the heat of the body will tell of nothing amiss. This is
especially true of diseases of the heart, the large blood vessels,
and of the nervous sj-stem, and in cases of poisoning. For special
indications furnished bv the pulse, see disea.ses of the heart.

24 Vetef'inary Medicine.

Respirations. The morbid activity or inactivity of the respi-
ration, its modified rythm, the pathological significance of the al-
tered breathing sounds and of the superadded sounds, the indica-
tions furnished by percussion, palpation, mensuration, succussion,
sneezing, snorting, yawning, cough, moan, grunt, stertor, dis-
charge, etc., afford material of inestimable value to the diagnosti-
cian. See under diseases of the chest.

Skin Symptoms. The erection of the liair of carnivora in
rage or fear implies a profound nervous disturbance, and a simi-
lar erection (staring coat) in the larger herbivora especially, im-
plies a corresponding nervous disorder, due however to a different
cause. The pallor and coldness of (white) skin and extremities
the retrocession of blood toward the internal organs, the contrac-
tion of the involuntary muscles of the hair bulbs, the sense of
cold, and the actual shivering all come from the fundamental
nervous disorder. The loss of lustre and gloss in the hair and
the dryness, rigidity and mobility (mellowness) of the skin im-
ply lack of nutrition. The mellow feeling of the skin under the
pressure of the finger, soft and yielding by reason of the lax
connection tissue and fatty layer in the thrifty animal, is in
marked contrast with the dry, hard, tough, unyielding hide
firmly adherent to the parts beneath (hidebound), which denotes
the unhealthy or unthrifty animal, or from the thin, attenuated,
mobile, bloodless skin of the debilitated subject, the victim of
lung, liver, or intestinal worms. In sheep in parallel conditions
there is a lack of yolk in the wool, which is dry, lustreless and
brittle and often flattened (clapped) on the skin. In fowls ruf-
fling of the plumage indicates the nervous disorder and chill.
The skin may be scurfy in conditions of low health or in con-
nection with the presence of vegetable or animal parasites. Ring-
worm has excessive scurf, and tends usually to a circular form,
and to complete shedding of the hair from the spots. The hairs
split up before dropping. In acariasis there may be scurf, scab,
abrasion and sore of many kinds, but the outline is not neces-
sarily circular, nor strictly limited, isolated hairs remain even on
the bare patches, and itching is extreme as shown by the move-
ment of the body and especially of the lips or foot when the part
is scratched.

The hair may be freely shed during convalescence from debili-
tating diseases, a condition that must not be confounded with

Symptomatology. Semeiology . 25

the yearh' shedding of the winter coat and the moulting of birds,
which is a perfectly normal process. Yet even the spring shed-
ding and the growth of the new coat makes a great drain on the
system, and must always be taken into account as a probable
cause of derangement of health.

The lesions of the skin in the different cutaneous affections
must be remanded to the special chapter on skin diseases. The
following however may be named as having a general bearing.

Emphysema may be due to a local wound, (elbow, trachea,
rib); it may indicate black quarter, or it may occur sub-cutane-
ously in cattle without marked impairment of health.

Anasarca, from diseased blood, heart, liver or kidneys is de-
noted by swellings, often painless, or a general infiltration which
pits on pressure. It often shows primarily in the lower parts of
the hind limbs. Warty looking elevations must be carefully dis-
criminated, having in mind primarily papilloma, tubercle
(grapes), actinomycosis, condyloma (in dogs), cancer, melanosis.
The secretions of the skin (sweat, sebum) may be suppressed,
or in excess, producing at times a special odor, as in thrush and
canker of the horse, cowpox and sheep-pox, and rheumatism.
Before death the cadaveric odor may be marked, and attracts
crowds of flies to the victim.

Fades. The countenance may be expressive. Between the
bright, full, clear, prominent eye of health, and the dull, sunken,
lifeless, semiclosed eye of serious disease the contrast is extreme.
The drooping lids (ptosis) may be paralytic and even unilateral,
in which case drooping ear, and flaccid lips and alse nasi com-
plete the picture. With paralyzed lips there is usually drivelling
of saliva, and dropping of half chewed morsels in the manger
and stall. The eye may show dropsical lids in kidney or liver
disease and in anaemic conditions like distomatosis in sheep. It
may show the upper lid b^nt at an angle in recurrent ophthalmia
of solipedes. The mucosa may be red in ophthalmia, yellow in
jaundice, dusk}- brown in Southern cattle fever, anthrax, cere-
bral meningitis, and other fevers attended with destruction of red
globules and liberation of their hsematin. The pupils may be
all but closed in internal ophthalmias, or widely dilated and ir-
responsive to light in amaurosis. The iris may lack its normal
lustre or may be distorted or torn in various ways from adhesions.
Opacities of the cornea, lens, or vitreous may be recognized.

26 Veterinary Medicine.

The facial muscles may be flaccid and devoid of expression in
palsy, and prostrating diseases ; they may be firm, giving the
bright, intelligent look of health ; or they may be painfully
drawn in the agonized expression of spasmodic colic or enteritis.

Nasal Mucosa. The pituita is bright red in sthenic fevers,
simple acute coryza, strangles, laryngitis and inflammation of the
larger bronchia. It assumes a violet hue in capillary bronchitis,
pulmonary congestion, glanders, and petechial fever. Petechise
appear in the last named affection, and in a number of bacteridian
diseases, such as anthrax, swine plague, hog-cholera, the red
fever of swine etc. ; a yellow tinge in shown in jaundice. Millet
like or pealike nodules, or elevated patches, and ulcers show in
glanders and may be felt by the fingers. In cattle hard millet-
like nodules appear in a chronic coryza with hypertrophy of the
mucosa. The orifice of the lacliry mo-nasal duct, seen in the
horse on the floor of the chamber at the friction of the mucosa
with the skin of the false no.stril and in ass and mule on the
outer ala near the upper commissure, is sometimes plugged with
inspissated mucus. Among other lesions of the nasal chamber
may be named polypi — soft and calcareous, — thickening and ob-
struction in purpura hsemorrhagica, osteoporosis and hypertrophy
of bone, and parasites — pentastoma denticulata (in the horse and
dog), and the larva of the oestrus (in .sheep and buffalo). Dis-
ease of the upper molars and abscess of the fronto-maxillary sinus
may be manifested by swelling beneath and on the inner side of
the eye, foetid discharge from the nose, and obstruction of the air
current. Dullness on percussion will show the filling of the
.sinuses. These conditions must be carefully differentiated from
actinomycosis, sarcoma and other morbid growths in the same
situation.

Costiveness with foetor and lack of the normal color in the
stools may suggest liver torpor or inflammation, while fatt}' stools
may suggest pancreatic disea.se. The uneasy movements of colic,
should lead to a careful investigation of the chylo-poietic organs
(see digestive organs). Weakness of the hind parts, tenderness
of the loins, and altered condition of the urinary discharge .should
demand a close enquiry into the .state of the kidneys and bladder.
Satyriasis or nymphomania would suggest disease of the ge7ier-
ative organs or the nerve centres that preside over them. The
same is true of impotence, sterility and abortion.

Syjnptomatology. Semeiology. 27

In eruptions on the skin (erythema, eczema, pustule, squama)
a cause may be found in the local action of heat, friction, or other
direct irritant, but in the absence of any such manifest cause, an
enquiry should bs made into the functions of sanguification,
digestion, urination and the action of the liver. It may further
suggest parasitism (ring worm, phthiriasis, fleas, acariasis, ver-
minous disease, etc. )

Symptoms of nervous disorder are too numerous tO be here
traced to local lesions. Motor paralysis of one limb may, how-
ever, suggest injury to its motor nerves, to the same side of the
spinal cord, or of the oppo.site half of the cerebrum. Paraplegia
almost always indicates injury to the cord. Senory paralysis of
one .side may depend on disease of the opposite corpus striatum.
The animal moves in a circle when a tumor (coenurus in sheep)
exists in the roof of the lateral ventricle presumably pressing on
the ganglia on its floor. An animal rolls on its axis when there
is a lesion of the median cerebral peduncles, of the supero-ex-
ternal portion of these peduncles, of the posterior part of the ence-
plialon, or of different parts of the hemisphere. Amaurosis sug-
gests disease of the corpora quadrigeminia. I^oss of coordina-
tion of muscular movement usually implies some lesion of the
cerebellum. Vertigo may imply disease of the encephalon (con-
gestion, anaemia, inflammation, dropsy, haemorrhage, tumor,
abscess) ; it may be disease of the internal ear ; it may be diges-
tive disorder connected often with cryptogamic poisoning ; it may
be heart disease with obstruction of the jugular veins ; it may be
parasites in the nasal sinuses ; or it may be disease of the eye.
Coma occurs in most congestions and pressures on the encephalon,
and like vertigo in poi.soning by alcohol, solanine, monoxide of
carbon, etc. In acting on any ganglionic centre the agent may,
according to its degree, operate positively or negatively, produc-
ing spasms, or paralysis as the case may be. As in the case of
other visceral affections the specific diseases must be referred to for
particular symptoms.

For the more precise points in diagnosis, including chemical,
phy.sical, electrical and instrumental methods, etc., the reader is
referred to the special diseases.

PROGNOSIS.

Definition. Demands on the veterinarian, the question of economy.
Basis of Prognosis. Cause of the illness, internal or external, vital or non-
vital organ, enzootic, fatigue, infection, in one or two symmetrical vital
organs, regular or irregular in its course, persistence, relapse, complications,
effect of treatment, appetite, temperature, pulse, breathing, youth, age, de-
bility, previous disease, breeding, climate, season.

Prognosis is a more complicated question for the veterinarian
than for the ph3\sician. The latter must pronounce on the
malady, whether it is likely to follow a regular or irregular
course, whether it will last short or long, whether it will be
curable or incurable, and if curable whether recovery would
be complete or partial. For the veterinarian there is in ad-
dition the question of economy. The veterinary patient is,
as a rule, of value, only if he can be rendered sound, and a
partial recovery may be even worse than a fatal result, since the
subject remains as a ruinous charge on his owner. The veterin-
arian must pronounce on the prompt and perfect curability of the
case, on the outlay that will be requisite for treatment, on the de-
preciation which will be entailed on the patient, and whether, in
certain lesions that do not harm the carcase, it would not be more
judicious to butcher the subject. The physician is expected to
do the best he can for life and health, and even a very imperfect
recovery brings him a mead of gratitude. The veterinarian on
the other hand must be an expert not only on disease, but on
animal values, and if his treatment, however skillful it may be.
results only in the prolonging of the life of an useless animal,
the owner may charge him with imposing upon him an unneces-
sary outlay. The soundest judgment and highest skill are often
necessary to secure the interests of an employer in such circum-
stances. In certain cases the recommendation to destroy is of
much more value to the employer than the most skillful, and par-
tially effective, curative treatment. On this basis, the reputation
of a skillful man may be securely built. He can deceive no one
if his prediction of recovery is not justified, while if he advises
destruction and the patient recovers, he is at once discredited.

Prognosis. 29

To give a sonud prognosis the practitioner must have a thor-
ough knowledge of pathology, he must have acute powers of ob-
servation, and he must be quick to appreciate every point that
makes for or against the patient in the particular case.

The causes of the trouble must be carefully considered. Are
they transient or permanent ? Are they removable or irremova-
ble ? x\re they external or internal ? As a rule an internal
cause is the more redoubtable. Some lesions are necessarily fatal,
as a needle penetrating the heart or an attack of rabies or milk
sickness. Is the cause an enzootic one? If so can the patient be
removed from the locality ? Is it a fatigue fever or an infectious
one? Is it a simple inflammation or an infecting one? The lat-
ter are usually much more grave. In case of contagious disease,
can its propogation be prevented? Is it of a fatal or non-fatal
type? Is it situated in a tis.sue favorable to a fatal exten.sion,
(anthrax in lung) or in one unfavorable (anthrax in the tip of
the tail) ? Disease in a single vital organ like the heart is neces-
arily much more grave than in one of a symmetrical pair (kid-
neys, lungs) one of which can carry on the functions. The reg-
ular progress of the disease and especially an uninterrupted im-
provement, following on a critical perspiration or urination, is a
good prognostic sign, whereas unevenness of temperature, pul.se
and respiration, with temporary aggravations of the general symp-
toms, should demand a less hopeful prognosis. The persistence
of the malady is also an unfavorable indication. A relapse after
partial recovery is a serious indication unless due to some obvious
and easily removable cause, and unless the former convalescent
condition is .speedily restored on its removal. A complication is
a serious indication whether it consists in an embolism, or new
centre of the same disease, or the supervention of a second dis-
ease upon the first. The .system has ju.st so much more to con-
tend with and the very .supervention of the second focus or malady
argues a special su.sceptibility, debility, or lessened power of re-
sistance.

The prompt success or entire insucce.ss of treatment proves val-
uable.

The preservation of appetite, the slow, uniform descent of the
temperature, and the improvement of pulse and breathing are
among the most valuable indications.

30 Veterinary Medicine.

Something may be deduced from the condition of the patient.
If very young or old, debiHtated by over-work, bad or insufficient
food, previous disease, or any other cause, the prognosis is less
hopeful, as it is also as a rule, during gestation, in the parturient
state, or if abortion ensues. A hereditary predisposition to the
malady in question is equally unfortunate.

Climate may be an important factor. Thus liver diseases are
far more to be dreaded in a damp tropical or semi-tropical region,
and rheumatism and catarrhal affections in winter and in cold
northern localities. Acclimatization should also be considered.
The bovine animal, raised on the Gulf Coast is likely to make a
good recovery from Southern Cattle Fever while the northern
beast would almost certainly die.

All in all the question of prognosis cannot always be judiciously
decided at a first visit, and for the sake of his own reputation, it
is well that the practitioner should give only a qualified opinion
at first until he can certify himself as to the probable outcome of
the disease.

PROPHYLAXIS. PROPHYLACTICS. PREVENTION.

A test of public sentinieut. Soil. Water. Exposure. Buildings. Local
hygiene. Breeding. Diet. Work. Harness. Ventilation.

With adv^ancing knowledge of veterinary medicine the subject
of prophilaxis is steadily assuming a more important place, and
especially in the classes of enzootic and epizootic diseases. In-
deed for the fatal infectious diseases of animals one can fairly esti-
mate the medical intelligence of the people by the extent to which
therapeutic treatment is still allowed. With economy as the
great central object of veterinary medicine, the problematical re-
covery of the few can never balance the assured preservation of
the many. But this subject belongs to contagious diseases to
which the reader is referred.

In enzootic affections, improvements in soil, water, exposure,
buildings, and other local unhygienic conditions, are the final
ends to be sought, according to the particular nature of the pre-
vailing disease.

So in sporadic diseases the correction of faults in breeding,
hygiene, diet, water, work, harness, exposure, buildings, venti-
lation, etc., are called for in different cases as will be noted under
the individual diseases.

31

THERAPEUTICS. TREATMENT.

Defitiilion. Mechanical and Medicinal Therapeutics. Adaptation to each
case of disease.

The tiltimate object of all medicine is to prevent disease or
when it cannot be prevented, to cure. The term therapeutics
covers all measures applied with curative object. Therapeutics
are naturally divided into Mechanical and Medicinal. To me-
chanical therapeutics pertains the whole domain of surgery. Me-
dicinal therapeutics has to do especially with internal medicine.
Each of them, however, encroaches more or less on the other.
Modern surgery is essentially aseptic or anti.septic, and antisepsis
is secured by medicinal agents. In medicine when cups are ap-
plied we adopt an essentially mechanical treatment. Both meth-
ods then must remain open to physician and surgeon. Another
and no less important branch of treatment which is open to phys-
ician and surgeon alike is diet and general hygiene. The same
care must be given to the use of these in the treatment of disease
as in its prevention, and in many cases a judicious use of the.se
may almo.st entirely obviate the necessity for medicine.

It would be useless to enter here into the subject of therapeu-
tics. Suffice it to say that the choice of a .system and of individ-
ual agents must be determined by the particular conditions of the
case, its cause, and nature, the strength, vigor, and genus of the
patient, the organ involved, the extent and stage of the disease,
the existence of a relapse, or complication, and all other circum-
stances that would affect the action of the remedy. Specific state-
ments mu.st be made with the several diseases.

32

HYPEREMIA. CONGESTION.

Definitiou. Forms, active — arterial, passive — mechanical — venous. De-
termination of blood. Causes of active congestion. Vaso-raotor nerves.
Lesion of spinal cord ; or of sympathetic nerve. Reflex irritation. Cen-
tral cause. Physiological hyperaemia. Medicinal hypersemia. Bacteri-
dian (toxic) hyperemia. Arterial obstruction. Thrombus, tumor. Cold,
chill. Removal of pressure. Cardiac hypertrophy. Symptoms, bright
red color, swelling, dropsy, migration of cells. Rise of local temperature.
Tenderness. Altered function. Causes of passive congestion. Obstructions
in the lungs, heart, veins. Diminished force of circulation from age, de-
bility, arterial disease, distance from the heart, decubitus, vaso-motor dis-
order. Gravitation— hypostatic congestion. Tumors. Paresis. Symp-
toms. Cyanosis. Distended veins. Coldness. Transudation — watery.
Haemorrhage. Thrombus. Hyperplasia. Atrophy. Postmortem lesions.
Treatment. Remove Cause. Correct injurious gravitation. Correct any
fault in blood pressure. Derivation. Constringe or support part. Mas-
sage. Electricity. Improve general health.

Definition. An excess of blood in a part. It is distinguished
from inflammation by the absence of that tissue reaction, which
leads to or constitutes the special phenomenon of that morbid pro-
cess.

Hypersemia is divided into active or arterial and passive, me-
chanical or venous. A capillary form has also been described
but usually capillary congestion is seen in both the arterial and
venous types.

I. Active or Arterial Determination of blood. In this
form the arteries are dilated under a direct nervous influence.
Causes. In all the regular functions of the body, the flow of
blood is under the direct control of the vaso-motor nerves which
proceed from the spinal cord, through the branches of the sympa-
thetic to be distributed with the blood vessels. The hard pulse of
pleurisy is due to rigid contraction of the constrictor muscles under
the action of the vaso-motor nerves, and the blush of shame is due
to their relaxation. Some claim an active dilatation of the arte-
rial muscular coats, others look more simply upon the dilatation
as a mere yielding of the coats under the blood pressure, when
the constrictor muscles are relaxed. This vaso-motor paresis may
be induced : ist, by any lesion of the spinal cord. 2d, by the

3

34 Veterinary Mediciyie.

cutting of a sympathetic trunk, that of the abdomen, for example,
which leads to active congestion of the abdominal viscera, or the
section of the cervical sympathetic which leads to watering of the
eye, sweating, congestion, and scabbing on the corresponding
half of the face. 3d, by reflex irritation through the sensory
nerves, as in congestion through friction, heat or cold to the skin,
or that resulting from excessive use of an organ such as the
mammary gland. 4th, by causes acting directly through the
brain as in emotional blushing or the facial congestion of violent
rage.

Physiologically we see the operation of this nervous control in
the congestion of the gums during dentition, of the .salivary glands
during mastication, of the stomach and bowels during dige.stion,
of the womb during gestation, of the mammae at parturition, and
of erectile organs in copulation.

Medicinal agents act in the same way, opium or alcohol pro-
ducing active dilatation, and belladonna and ergot causing active
contraction of the arterial walls.

Bacteridian poisons act in the same way, tuberculin and a num-
ber of others causing active dilatation.

The obstruction of one artery by thrombus, tumor, or ligature,
causes increased tension in the collateral branches coming off just
above and an active congestion in the parts to which these are
distributed. While this is directly due to increased local pres-
sure, it is also an instance of the lack of balance between the blood
pressure and the resistance of the vascular walls. In this case
there is increase of pressure, in the other a diminished resistance.

If there is a superficial anaemia, as from cold or chill, there is of
necessity, an internal hyperaemia. This contributes to the pro-
duction of internal congestions and inflammations, though the
seat of election of such inflammation is usually determined by the
nervous sympathy between the part chilled and the deeper organ
affected.

Another cause of congestion is the lessening of pressure by the
parts surrounding the vessel. Thus in cupping, there is prompt
cutaneous congestion, and a similar result occurs in pericardium,
pleura, or peritoneum on the withdrawal of the liquid of hydro-
pericardium, hydro-thorax or ascites.

Another cause of congestion is found in hypertrophy of the

Hyper-czmia. Congestion. 35

heart and increased force of the blood flow (blood tension) . In
such cases those organs become congested in which there is some
previous debility or disease of the blood vessels.

Symptoms and results. The symptoms are a bright vermillion
redness, tension or swelling, heat and tenderness. Pulsation is
stronger in the vessels leading into the part, secretions tend to
increase but may give place to a serous effusion or haemorrhage.
The bright redness is attributed to the rapid circulation of the
red globules which have not time to give up their oxygen to the
tissues. It is sharply circumscribed where the affected arterioles
have no free anastomosis with those of neighboring parts, diffuse
where anastomosis is abundant, and when on the skin it is liable
to rise in knots or buttons as in urticaria. When pressed the
redness entirely disappears unlike the redness of inflammation.

The swelling may be due to the simple turgescence of the blood-
vessels, but also often to transudation of serum as in and around
the cow's udder at parturition. The occasional migration of
globules, and their escape through minute lacerations in the vas-
cular walls add alike to color and turgescence.

The elevated temperature, (rising sometimes 3° C.) in the con-
gested area, is attributed to the more active circulation, and Schiff
prevented its appearance after section of the cervical sympathetic,
by tying the carotid and vertebral arteries on the same side.

The tenderness of the congested parts varies inversely as the
looseness of texture and the facility for swelling. It may be
scarcely perceptible in the mammary region, and intense under
the horn or hoof.

The functions in the congested organ are often seriously in-
terfered with, secretions appearing in excess or entirely altered.
When the congestion lasts it may cause li3^pertrophy, induration
or hyperplasia, these are however rather sequels than lesions of
the condition. Simple congestion is usually quite transient, and
if prolonged, often merges into inflammation.

II. Passive or Venous Congestion. In this there is no ex-
cess of blood entering the part, but the regular supply is delayed
in the veins by some obstruction, and these vessels and, later, the
capillaries are gorged with black blood.

Causes, ist, Mechanical obstruction to the onward flow of
blood, as in the case of disease of the lungs hindering the flow of

36 Veterinary Medicine.

blood from the right heart ; disease of the right heart allowing a
reflux of blood into the veins ; or pressure by tumors or other-
wise on the great or small venous trunks. If in the heart or
lungs the whole systemic venous system becomes the seat of pas-
sive congestion ; if in a single venous trunk then only the parts
the venous radicles of which are tributary to this. We find ex-
amples of this in phlebitis, in compression by the swellings of
strangles, in the result of a bandage or ligature tied round a limb
at some distance from its extremity, and in the compression of
the iliac veins by a gravid womb.

2d. Diminished force of the blood current in the veins, as from
old age or great debility and especially from weakness of the
heart's action. Also from disease of the arterial coats which im-
pairs their tonicity. The force being too weak to force the blood
actively through the capillaries and veins, it becomes imduly
charged with carbon dioxide and other products of tissue waste,
so that nutrition suffers and the walls of the capillaries lose their
vital force. This condition is aggravated in the hind limbs by
the distance from the heart, and the dependent position, and in
decubitus by the compression of the vessels of the limbs. Also
by injuries to the vaso-raotor nerve supply as oedema appeared
in the hind limb after tying of the femoral vein in animals the
abdominal sympathetic of which had been cut, but not in animals
in which this nerve was left in its normal condition (Ranvier).

3d. Gravitation in weak states of the circulation must be looked
upon as a cause of venous congestion. This is seen in the ex-
amples of hypostatic congestion and oedema seen in the lungs and
other internal organs in low conditions and in the advanced stages
of debilitating diseases, and in certain cases of stocking of the
limbs in horses.

4th. Valvular insufficiency of the left heart and tumors or
aneurisms interfering with circulation through the aorta, cause
passive congestion of the pulmonary veins and oedema of the lung.

5th. Tumors and diseases of the liver determine passive con-
gestion of the portal system and ascites.

6th. Passive congestion is very liable to take place in an organ
the functions of which are impaired as in a paralyzed part. In
this the hypersemia may start in the capillaries and extend to the
veins or even to the arteries.

Hyperczviia. Congestion. 37

Symptoms and results. If on a mucous membrane or white
skin the color becomes dark red, or violet (cyanotic) with evident
distension of the capillaries and veins, the latter of which may-
stand out as knots or cords, there is an appearance of swelling or
enlargement and sometimes coldness of the part. Soon the wa-
tery part of the blood transudes in excess, constituting dropsy,
with increased swelling and pitting on pressure. On the mucous
surfaces it determines an abundant serous secretion. The color
is deepened by the escape from the vessels of red globules as well
as white. The transudation contains little albumen and only
exceptionally fibrine. In connection with the marked deoxidation
and high carbonisation of the blood, the nutrition of the part is
largely arrested together with the functions, secretory, motor or
otherwise. The imperfectly nourished vessels may give way,
leading to haemorrhage, or nutrition may be definitely arrested
producing moist grangrene or ulceration. Sometimes a thrombus
is formed in a congested vein. The changes in the affected
organs depend much on the degree and duration of the hyperae-
mia. If slight and lasting it causes permanent induration and
thickening, from connective tissue hyperplasia as frequently seen
in the hind limbs of the horse. In case of blood transudations
the altered coloring matter gives the various shades of gray,
brown or black. If long continued the organ may shrink and
atrophy occur from defective nutrition and contraction of the
fibrous hyperplasia.

In making post mortem examinations mistakes may be made
through the occurrence of changes after death. Thus a hyperse-
mia which was quite considerable during life may virtually disap-
pear through the contraction of the arterial and capillary coats
forcing the blood on into the veins. A minute point of extrava-
sation here and there may be the only macroscopic lesion left.
Again a marked venous and capillary hypersemia in a dependent
part of the body or of an organ may be entirely due to hypostatic
conditions, the blood having settled into the lowest part of the
vessels since the death of the animal. To avoid this source of
error one must always carefully note the position of the carcass
after death. Under other circumstances the superficial veins and
capillaries may fill up with blood through the occurrence of de-
composition and the evolution of gases in the internal cavities,
which empty the splanchnic and parietal vessels by compression.

38 Veteri7iary Medicine.

Treatment. The general principles of treatment may be stated
thus : ist. Remove the cause of the hyperaemia if possible,
especially any mechanical cause ; 2d. Secure the influence of
gravitation in favor of the return of blood to the heart ; though
not so available in animals as in man, it is of great value in con-
gestions of the head, ears, tail, and to a less extent of other
parts ; 3d. Correct any fault of blood-pressure, excess or defi-
ciency, which may act so as to cause active or passive hyperaemia;
4th. Establish derivation by cupping, leeches, fomentations,
pediluvia, sinapisms, etc. ; 5th. Apply cold, astringents, bandages,
to empty the hyperaemic vessels, or kneading, rubbing, or elec-
tricity, to hasten the flow of blood ; 6th. To improve the quality
of the blood and general health, in plethora by low diet, purga-
tives and diuretics, in anaemic or debilitated conditions by iron,
bitters, nourishing food, fresh air, sunshine and exercise.

It is especially important to check passive congestion in febrile
diseases, and mechanical congestion at an early stage of its pro-
gress (Roberts).

INFLAMMATION. PLOGOSIS. PHLEGMASIA.

Definitions. Relations to active byperaemia. Redness. Heat. Pain.
Swelling. Forms : in vascular tissues : in non-vascular. Changes in tissiie
elements. Death of cells. Cloudy swelling. Granular degeneration. Cell
proliferation. Karyokinesis. Embryonic cells. Amoeboid functions.
Migration of leucocytes. Red cells escaping. Changes in innervation.
Vaso-motor disorders. Fever. Changes in circulation. Contraction of
capillaries, dilatation, rapid flow, tardy flow, stasis, oscillations, thrombus,
collecting of white globules in periphery of current, migration of leucocytes,
blood plates, and red globules, massing of red globules, exudation, soften-
ing of the capillary walls, nutrient artery more rigid and transmits more
blood, heart contracts more forcibly, increase of fibrine, ncrease of waste
products. BufFy coat, physiological causes. Microbes. Ptomaines.
Toxins. Chemiotoxis. Phagocytosis. Polynuclear and mononuclear leu-
cocytes. Exudates, unlike dropsies. Mucous exudate. Serous exudate.
Fibrinous exudate. Blood exudations. Croupous exudation. Chyliform
exudate. Results and Products. Resolution. Deletescence. Metastasis.
New formations. Suppuration. Pus microbes. Pus. Healing by ist in-
tention. Healing by 2nd intention, granulation. Granule corpuscles. In-
terstitial neoplasia. Degenerations in lymph. Fatty degeneration,
melanotic. Softening. Ulceration. Gangrene.

Inflammation has been variously defined as "perverted nutri-
tion," as a " protective reaction of the organism against irritant
agents " and in other terms that express at once too much and too
little, without actually defining the morbid process. Older defini-
tions dealt with the manifest disorders of circulation, of innerva-
tion or of tissue change too often exalting the importance of one
set of changes at the expense of another and thus giving in the
main a one sided view of the morbid process.

Some modern bacteriologists are inclined to refuse the title to
any morbid process that is not caused by the presence of microbes
or their toxic products. To them the changes occurring in an
aseptic wound or in a simple fracture in process of healing are
purely reparatory and partake no more of the nature of inflamma-
tion than do the developmental changes in the growing embryo.
While to a large extent true, this exclusive view implies excep-
tions, since if the chemical poisons derived from the bacteria can
develope inflammation, the same must be admitted as possible for
chemical irritants drawn from other sources.

39

40 l^eUrinary Medicine.

As a matter of fact inflammation, occurring as it does in ver\-
different tissues, vascular and nonvascular, fibrous, cellular,
jmrenchymatous, etc. , and in connection with a great variety of
irritants, must be held to include a large group of morbid pro-
cesses, bearing to each other a strong family relationship and re-
semblance, and yet differing in man\' important details. Each
irritant (heat, cold, electricity, chemical irritant, incised, punc-
tured, lacerated or contused wound, rupture, fracture, foreign
body, parasite, microbe, toxin, etc.,; has its own special charac-
ter and mode of irritation ; each tissue has its own special method
of succumbing or reacting and its own amount of blood supply ;
and each system and organ has its own native or acquired power
of resistance and reaction.

Inflammation agrees with active h3-i)ersemia in the tendency to
dilation of the vessels and an increased flow of blood to the part or
if the irritated part is nonvascular like the cornea or articular
cartilage, then to the parts adjacent. It differs, however, in the
more active cell proliferation, and in the nature of the Hquid
transudation which is richer in albumen fibrine. cells and phos-
phates. Abstractly the inflamed part retains very active vital
processes, trophic and exudative, but these, are largely changed
from the normal and are, it is claimed. per\-erted, yet they pre-
side over the processes of cell growth and decay, the removal of
injured or useless tissue, and later, over the building up of new
material, and repair of loss. Active h^peraemia on the other
hand is mainly a circulatory disorder, and when it advances so as
to determine changes in the cells and tissues it is held to have
merged into inflammation.

The term inflammation (from inflammo. I set on fire ) , is sugges-
tive of the local heat of the inflamed part, just as fever ( febris)
indicates an elevation of the temperature of the bod\- at large.
Celsius enumerated the features of robor. calor, dolor and tumor
(redness, heat, pain and swelling i which have come down to our
own time as at least suggestive of inflammation. But any diag-
nosis, based on these alone, would be today woefulh' inadequate.
Redness occurs in the transient blush, heat in the febrile state,
though no inflammation can be recognized, pain is present in
neuralgic and other ner\-ous affections, and swelling in dropsy and
ttmior. On the other hand redness is entirely absent, for a time,

hiflamation. Plogosis. Phlegmasia. 41

after the outset of infiainniation in nonvascular tissues (cornea,
articular cartilage ) , the heat of the inflamed part may be actu-
ally' lowered when there is much exudation around the capillary
vessels and lessened flow of blood, pain may be absent in some
circumscribed inflammations of the lungs, and swelling is not at
first visible in the inflamed cornea or compact bony tissue. These
phenomena which are so common in inflammation and, in general
so characteristic of it, cannot therefore be accepted as infallible
evidence of its existence, nor can their absence be held as abso-
lutely imph'ing its nonexistence.

Forms of Inflammation. This morbid process might be
divided almost indefinitely according to the organ invaded, the
cause, and type, yet it will be more convenient to deal with it
generically and notice inflammation in nonvascular and vas-
cular tissues re.'=pectively, and the different types of granular
degeneration, exudative inflammation and croupous inflam-
mation. It will be requisite further to notice an acute and a
chronic type.

By dealing first with the changes in the anatomical elements of
the tissues and in the innervation, we shall virtually cover the
phenomena observed in nonvascular tissues, and later the changes
in connection with the circulatory system will give the additional
characteristics of inflammation in vascular tissues.

CHANGES IN THE TISSUE ELEMENTS.

Death of cells and tissue By the application of an irritant
(acid, heat, etc.,) a certain thickness of tissue with its enclosed
cells is killed, and a thin layer of necrosis is usually produced.
This does not constitute inflammation, but it acts as a foreign
body, often septic, in producing inflammation in the parts
adjacent.

Cloudy Swelling, Granular Degeneration. This may occur
in the inflamed area surrounding the necrosed tissue in the seat
of a burn or other injury, it is exceedingly common in the cells
of inflamed parenchymatous tissue (liver, kidney), in the muscle
of the heart, in the ga.stro-intestinal mucosa, in febrile affections
and in poisoning with arsenic, phosphorus, or mineral acids. The
gross appearance of the tissue is that of swelling, with a dull

42 Veterinary Medicine.

gra3'ish color and a loss of its normal translucency. The cells of
the affected organs are seen under the microscope to be tilled with
small albuminous granules which may be so abundant as to com-
pletely conceal the cell structure. The granules are insoluble in
ether, but disappear under acetic acid. This condition of the
cells is often associated with the exudative forms of inflammation.

Cell Proliferation and Change. In the nonva.scular organ
attacked by inflammation the multiplication of tissue cells and
their resumption of amoeboid movements is a constant phenome-
non. Virchow insi.sted on the fundamental relation of the cell to
the morbid process, and Goodsir and Redfern showed the rapid
increase of the cells of articular cartilage in attacks of arthritis.
There is first a sensible increase of the nucleus of the cartilage
cell which shows a more extended and deeper staining in carmine
or aniline ; then by a special method of division (karyokinesis)
the cell and nucleus divide in two ; by a .similar process these
divide in four and so on in regular order. Meanwhile the carti-
laginous substance becomes softened and finally dissolves and dis-
appears, leaving in the place a mass of closely aggregated cells.

In the nonvascular transparent cornea, the membrane of Des-
cemet, the epithelium of serous membranes and in the epidermis
a similar cell multiplication occurs, also in the lateral cartilages of
the horse's foot.

To follow the indirect cell divi.sion by karyokinesis, we must
note the cell as a semi-solid ma.ss, formed of protoplasm and
nucleus, each having as its framework a network of exceedingly
fine inter-crossing filaments, much finer in the nucleus than in
the cell protoplasm. The nuclear filaments stain with hsematoxy-
lon and safranin and are called chromatin threads. The inter-
vening non-staining material is achro??iati7ie. The nucleus has a
membraneous envelope in two layers, of which the inner only
stains. When about to divide two poles are formed in the cell
protoplasm opposite to each other and near the nucleus the fila-
ments concentrating to the poles. The chromatin threads in the
nucleus thicken, become convoluted, split and nuiltiply, and draw
into their substance the chromatin layer of the envelope. Next
the chromatin threads form long loops directed toward an achro-
matine centre or pole like a star, and this is followed by the pro-
gressive division of the star-shaped mass into two equal parts.

hifiamation. Plogesis. Phlegmasia. 43

Finally they separate, together with the cell protoplasm, forming
two daughter cells.

This cell proliferation under the action of an irritant is com-
mon to the vegetable kingdom in which galls, and tumors are
formed in this way. It is a remarkable feature of these multi-
plying cells that they not only lose their power of developing the
tissue in which they formerly lay, and have all their vital powers
devoted to proliferation, but they acquire the amoeboid power of
their ancestors, the embryonic cells, which they further resemble
in size. Indeed these cells are freely spoken of as embryonal
cells, and the tissue formed by their massing together as embry-
onal tissue, and there is a widespread impression that they revert
entirely to the form and characters of the embryonic cell. In
some respects, however, they are unlike. The modified tissue
cell of inflammation presents a nucleus of horseshoe outline, or
after division of the nuclei they together retain this semi-circular
outline ; it has the power of actively digesting the adjacent tis-
sues as the embryonic cells do not, and again it does not possess
the power of differentiation into widely different tissues as does
the early embryonic cell. It may be called a reversion, in the
direction of the embryonic cell, however, since it reacquires a
number of its functions.

Migration of ^vhite blood cells. This is another, and in vas-
cular tissues the main source of the great cell accumulation in the
inflamed tissue. This process was observed by Waller in 1846,
but was given its true importance through the later observations
of Cohnheim. The migration takes place through the walls of
the capillaries and veins only, and the migrating cells are largely
of the poly-nuclear variety of leucocytes. These remaining ad-
herent to the inner wall of the blood vessel may be seen to have
a small portion of their substance projected through the wall and
appearing as a small buttonlike projection on the outer side.
This gradually increases, while the remaining portion of the cell
on the inner side of the wall correspondingly decreases until the
whole cell is lodged in the tissue outside the vascular wall. The
time occupied in passing through is very varied. It may be
wholly accomplished in half a minute, and again hours may be
required for the complete passage of a single leucocyte. The ex-
planation of this migration has been sought in the supposed

44 Veterinary Medicine.

existence of stigmata (openings) in the vascular walls (Arnold),
in the effect of the blood pressure within the inflamed vessels,
in softening of the vascular walls and, in the contractility of the
leucoc}' te which is strongl}^ attracted by the pressure of certain
bacteria and other irritants (chemiotaxis). The migrated leuco-
cyte assumes in the tissues the same habit as the altered tissue
nucleus. It multiplies rapidly, assists in the solution and removal
of the inflamed tissue, contests the ground with infective microbes
(phagocytosis), and subserves the purpose of assisting in building
up new tissue, or of degenerations.

Red Cells. The red blood globules follow the active current
in the centre of the blood vessel, yet a few of these also become
adherent to the softened walls and pass through them (diapede-
sis). When stasis of blood takes place in the vessels, they be-
come packed more closely with red globules which then pass out-
ward into the tissues in much larger numbers.

Changes in innervation. As shown under hypersemia the
vaso-motor system of nerves exerts a potent influence on the circu-
lation and is largely instrumental in bringing about circulatory
disorders. The increase in the number and force of the contrac-
tions of the heart, and the rigid contraction of the walls of the
arteries proceeding to an inflamed part, are distinctly the result of
a reflex nervous action. The implication of the second eye when
one has been violently inflamed from a mechanical injury is
another example of this kind. The loss of power of the vaso-mo-
tor nerves is however even more characteristic. Experimentally
the cutting of the cervical sympathetic or crushing of the superior
cervical ganglion causes congestion and finally inflammation of
the structures on that side of the head ; the crushing of the semi-
lunar ganglion similarly affects the abdominal viscera ; and the
cutting of the pelvic plexus, the structures of the hind leg. The
contraction and dilatation of the inflamed capillaries is largely
a nervous phenomenon. A certain number of irritants, like
warm water, mustard, or ammonia cause contraction followed by
dilatation of the capillaries, while others like dilute mineral acids,
alkalies, chloroform, or sodium chloride and sugar in concen-
trated solution produce dilatation at once. Some poisons act vari-
ously on different parts, eucalyptol causing dilatation of the arteries
and contraction of the veins, while corrosive sublimate causes con-
traction of the arteries and dilatation of the veins.

Inflamation. Plogosis. Phlegmasia. 45

So with certain microbian toxins. Introduced into the general
circulation they produce active congestion or inflammation in the
seat of colonization of the microbe from which they were derived,
as witnessed in the use of tuberculine or mallein. Finally the
chill and febrile reaction which attends on extensive inflammation
is essentially a nervous phenomena in its inception and progress.

Changes in the circulation. The usual changes in the
bloodvessels of the inflamed part may be thus succinctly stated :
I. Contraction of the capillary vessels of the affected part and
hastening of the current of blood through them. 2. The suc-
ceeding dilatation of the capillaries and the slowing of the blood
stream, vhich still flows uniformly throughout the diseased tis-
sue. 3. The flow of blood becomes irregular, at points tardy,
and at others oscillating or even recoiling between the pulse beats
when it has been forced into a vessel already blocked by coagulum.

4. In the still pervious vessels the red blood globules occupy the
centre of the vessel where the current is rapid, while the white
globules roll slowly along the inner surface of the walls where
the current is slow and become adherent to the walls and station-
ary, while the general current rolls on. This is a direct abstrac-
tion of the white globules from the circulating blood and greatly
favors the coagulation of the blood in the capillaries. The blood
plates equally collect in the periphery of the vessel and escape.

5. The adherent white globules migrate in large numbers through
the capillary and venous walls into the tissues. The red globules
migrate to a less extent at first. 6. Small coagula form in the
affected capillaries, forming minute red points which cannot be
pressed out by the finger. 7. The red globules in the area of
stagnation back of these capillary emboli adhere to each other by
their flat surfaces and form rolls which pack into the vessel and
are enveloped in a fibrinous clot. 8. The liquid part of the blood
rapidly exudes into the tissues leaving the red globules relatively
much more abundant in the liquid which remains inside the ves-
sel. 9. The walls of the capillaries become softened and allow a
readier transudation of liquor sanguinous, and escape of the glob-
ules through the walls of the vessels. 10. The arteries leading
to the inflamed part have their muscular coats more rigid aud un-
yielding and transmit much more blood than the corresponding
artery leading to the healthy part. 11. The heart is equally

46 Veterinary Medicine.

roused to more rapid and often more forcible contractions, which
modify the pulse both in number and rytlim. 12. The circulating
blood is found to have received a great increase in the fibrine for-
mers, the fibrine in the shed blood amounting to 6, 8, or 10 parts
per 1000 in place of 3 parts as is normal. The contraction of
this causes a depression on the surface of the clot. 13. The red
globules become viscous and adhere together by their fiat surfaces
to form rolls, which precipitate much more rapidly than single
globules and leave the coagulated blood with a straw-colored up-
per stratum (buffy coat). 14. Increase of waste products, urea,
uric acid, hippuric acid, etc.

Other changes in the blood are alleged, like lessening of the al-
bumen, as balancing the increase of fibrine, and lipsemia, but
the constancy of these in all cases of inflammation is uncertain.

By way of comment and explanation of the above changes in the
circulation the following may be advanced : The primary con-
traction of the capillaries is by no means a necessary condition of
inflammation, and contractions and dilatations within certain lim-
its occur in health and as a purely physiological act. The dilata-
tion of the capillaries and the increased flow of blood to the part
are related to each other as in part cause and effect, yet both are
due to a reflex act from the seat of irritation which inhibits con-
traction in the capillaries and determines a more rigid contraction
in the walls of the arteries running to the part. A rigid inelastic
vessel of the same calibre and under the same pressure transmits
more liquid than the one with elastic walls. The movement of
the white globules to the walls of the vessel depends in part on
their levity, light bodies passing into the outer slow moving layer,
which is less dense, from the central stream where the force and
density are greater. The epithelial cells of the intima undergo
cloudy swelling and are often detached, allowing the readier mi-
gration of the globules through the openings of the lymphatics
and the softened and friable walls. When the capillaries are
blocked the pressure necessarily increases on the arterial side, fa-
voring laceration of the friable walls and the escape of minute
masses of blood. The formation of the buffy coat is characteristic
of the normal equine blood ; in inflammation it becomes more
abundant. In the other genera a buffy coat apart from inflamma-
tion may be shown in : (a) ansemia or oligocythaemia in which

Inflamation. Plogysis. Phlegmasia. 47

the blood is deficient in red globules ; (b; in plethora in which
there is an excess of blood solids ; (c) in pregnancy in which
there is an excess of white and small red globules ; (d) in violent
exertion or over-excitement, in which the blood has circulated
with extraordinary rapidity. The all-sufficiency of the tissue
cells in determining inflammation may be deduced from the fol-
lowing experiment. A ligature is tied around a frog's thigh so
tightly as to arrest circulation, and the leg amputated above the
ligature ; mustard is then applied to the web of the foot and a
blister ri.ses precisely as though circulation continued.

MICROBES, DIAPEDESIS AND PHAGOCYTOSIS.

The role of microbes in inflammation is much greater than
was formerly supposed. It is now demonstrated that a large class
of inflammations are directly caused by the colonization of mi-
crobes in the tissue and by the local irritation caused by their
ptomaines and toxins. We must also admit the direct action of the
latter on the heat producing and vaso-motor nervous centres, as
a factor more or less potent in different cases in the causation and
maintenance of inflammation. No less important is the relation
of the microbe to the migration of the globules and the subsequent
results of the inflammation. This influence microbes share with
certain chemical agents. Migration maj^ be greatly checked even
in inflamed parts by the hypodermic or intravenous injection of
sulphate of quinia, eucalyptol, salicylic acid, or iodoform. Some
have thought these acted by a chemiotactic attraction, but quinia
is otherwise found to repel the leucocytes. Their action on the
leucocytes or capillary walls is problematic.

Chemiotaxis is that power by which a microbe or any element
attracts or repels the leucocytes. When it attracts the chemio-
taxis is said to be positive, when it repels it is negative. Among
negative chemiotactic agents are quinia, solutions of sodium chlo-
ride (109^), and potassium salts, lactic acid, alcohol (lo^c), chlo-
roform, glycerine, jequirity, and bile. To some agents, (creatine,
creatinine, allantoin, peptone, phlorydzine,) leucocytes are indif-
ferent. To gluten, wheat casein, pea legumin and the great
majority of pathogenic microbes, leucocytes are positively attract-
ed. As microbes exercise a great influence in producing local in-

^8 Veterinary Medicine.

flammation, so they are important factors in procuring an abun-
dant emigration of leucocytes. Some of the most fatal of micro-
bian diseases, like fowl cholera, repel leucocytes, and the benefit
of their defensive work is to a large extent lost. The toxins of
the chemiotactic microbe filtered from the bacteria exert the same
influence as the living bacteria, as shown by Gabritchevski, Mas-
sart and Bordet.

But chemiotaxis may be exerted from within the bloodvessel as
well as from without. Bouchard, Massart and Bordet have .shown
that a tube containing a culture of bacillus pyocyanus, introduced
beneath the skin of a rabbit attracts in a few houi-s a great num-
ber of leucocytes. But if, immediately after its introduction, ten
cubic centimetres of a sterilized culture of the same bacillus are
injected into a vein, very few leucocytes enter the tube inserted
under the skin. The chemiotaxis seems to operate in this case
from within the blood, and the desires of the leucocytes are satis-
fied without leaving the vessel. It would seem that in such cases
the migration and protective work of the leucocytes is best ex-
erted at the outset of the illness and before the toxic products
have been poured into the blood in any quantity, whereas in the
advanced stages when the blood is charged with ptomaines and
toxins migration and phagocytosis would be likely to be limited
and ineffective. The same consideration would forbid the use of
drugs that check migration in all cases of attacks by microbes for
which leucocytes have a positive chemiotaxis.

Phagocytosis is the act by which the leucocytes englobe and
dissolve the invading microbe. By its amoeboid movement the
leucocyte flows around, and envelopes the microbe for which it has
a positive chemiotaxis, and then begins the struggle of vitality
between the two living germs. If the poison (leucomaine anti-
toxin,) and digestive ferment (enzyme) of the leucocytes are
more deadly to the invading germ, than its ptomaines, toxins and
enzymes are to the leucocyte, the white cell comes off the victor,
and recovery takes place, but if the converse obtains the triumph
is on the side of the microbe. As a rule much depends on the
more or less deadly nature of the products of the invading mi-
crobe, on the numbers of the germ, the rapidity of its prolifera-
tion, and the consequent amount of its toxic products thrown into
the system, on the one hand : And on the other the potency of

Inflamation. P/ogosis. Phlegmasia. 49

the chemiotaxis of the leucocyte for the invading germ, the num-
ber of white cells that emigrate into the inflamed tissue and en-
gage in the work of phagocytosis, and on whether the particular
animal system and its white cells have sustained a previous at-
tack by the same germ and has thereby been educated to produce
a greater amount of the defensiv^e proteids (leucomaine, anti-
toxin, enzyme) than it naturally would (acquired immunity).

Even with an abundant emigration of the leucocytes into the
inflamed or invaded tissue, a number, greater or less, are usually
destroyed by the bacterial poisons and pass into degeneration or
liquefaction, as in the formation of pus, and yet the attacking germ
may be overcome, destroyed and devoured by the rapidly increas-
ing survivors. In general terms the migration of the cells is in
inverse ratio to the susceptibility of the animal to the microbe or
the disease which it causes.

The positive and negative chemiotaxis, which determine phago-
cytosis or prevent it, may be seen in the action of the leucocytes
toward the germs of two diseases, to one of which the animal is
susceptible and to the other of which it is not. Thus the leuco-
cytes of the pigeon take in the bacillus anthracis and suffer noth-
ing apparently, whereas the same white cells of the dove are re-
pelled by the bacteria of fowl cholera which are not therefore
found in their interior.

The leucocytes that migrate from the bloodvessels are in the
main, the most numerous, (the neutrophile or polynuclear) form ;
the mononuclear leucocytes with horseshoe shaped nucleus also
migrate but in much fewer numbers and are as a rule less oc-
cupied in phagocytosis. At the same time, these two forms may
show each a preference for a particular microbe, the polynuclear
cell sometimes devouring one which the mononuclear cell rejects,
and the mononuclear cell taking in one which the polynuclear re--
fuses.

The small round white cells (lymphocytes) and the eosinophile
leucocytes take no prominent part in phagocytosis.

EXUDATION.

In inflamed vascular tissues one of the most important results
is the exudation. This is not, however, a mere transudation of

50 Veterinary Medicine.

the liquid parts of the blood, as takes place in drops)', but it is to
a large extent a selective process determined apparently by the
condition of the capillary walls, and the nature of the inflamma-
tion is stated according to the character of the exudate. The
dropsical effusion contains little albumen, fibrine or cell forms,
and does not coagulate. The inflammation exudate contains
abundance of fibrine, cells and other solids and coagulates spon-
taneously in contact with inflamed tissue, or when removed from
ths body, by reason of th2 transforming leucocytes. Inflamma-
tory exudate usually contains 6 to 8 per cent, of solids whereas
the normal canine lymph contains 4 to 6. The exudate varies
not only in different inflammations, but in successive stages of
the same inflammation. The exudate may be mucous, .serous,
fibrinous or hsemorrhagic.

Mucous Exudate. In inflammation on a mucous or synovial
surface the inflammatory exudation, mingled with the more or
less altered secretion of the mucous glands, and the epithelial cells
and leucocytes forms a viscid fluid, rich in mucin, and character-
izing the mucous or catarrhal inflammation. The nature of the
discharge varies greatly, the serous character predominating at
the start of the inflammation, and a thick, opaque creamy or semi-
solid muco-purulent material appearing as the disease advances.
It contains filaments of precipitated mucin insoluble in acetic
acid or alcohol and cells in all stages of change from the exuda-
tion leucocyte and mucous cell to the pus corpuscle, the latter be-
ing characterized by its bipartite or tripartite nucleus rendered vis-
ible by contact with weak acetic acid.

Serous Exudate. This consists of the liquid elements of the
blood with only a limited amount of fibrine formers and conse-
quently little tendency to clot firmly. The presence of fibrinogen
however serves to distinguish it from the liquid of mechanical
dropsy, as does also the greater quantity of cells and nuclei of
common salt and phosphates. It is usually straw colored in
mass, but is sometimes slightly opalescent by reason of the num-
bers of cells and floating filaments of fibrine. Serous exudations
take place in the early stages of inflammations (as in catarrh) and
in inflammations of serous membranes (pleura, peritoneum,
joints), in strong, vigorous subjects. They constitute the liquid
contents of blisters whether raised by medicinal irritants, chafing,

Inflamatio7i. Plogosis. Phlegmasia. 51

or heat. They clot under heat and nitric acid with a firmness
proportionate to the amount of albumen.

These effusions are dangerous by reason of their interference
with the functions of organs by pressure as with the dilatation of
the lungs, the movements of the heart, the action of joints, or the
integrity of the brain or spinal cord. When the causative disease
has subsided they are usually speedily reabsorbed, the cells pas-
sing into the lymph vessels, or becoming degenerated, liquefied,
and absorbed. Yet serous effusions often remain as permanent ac-
cumulations. For the blood staining of serous effusions and their
clearing up, see under pleurisy.

Fibrinous Exudate. This is characterized by the amount of
fibrinogen and fibro-plastin in its composition and by the compar-
ative absence of leucocytes. It oozes through the vessels and co-
agulates in the tissues or on the surface of inflamed serous or mu-
cous membranes. The more liquid part separating from the co-
agulum escapes from the free surface or accumulates in the lower
part of the serous cavity. The coagulation is doubtless caused
by the fibrine ferment derived from the rapidly proliferating cells
and degenerating leucocytes. It usually occurs promptly in or
on an inflamed tissue, but in contact with healthy structures only
(as in a serous sac) it may remain fluid for an indefinite length
of time. This exudate constitutes the false membranes that form
on the pleura, pericardium or arachnoid, the coagulum of fibrin-
ous pneumonia, and the plastic lymph on the surface of a granu-
lating wound. It is especially injurious by reason of its envelop-
ing organs (lungs, heart, bowels, iris) and subjecting to perma-
nent compression by reason of its contracting, also by binding
them to adjacent structures by false membranes. In coagulating
it becomes first fibrillar then granular and finally undergoes mo-
lecular degeneration (Cornil and Remvier), or development into
new tissue (Paget). When organized it usually takes the form
of the adjacent tissue from which its trophic cells are derived.
Thus in divided tendons, in serous membranes and in granu-
lating wounds it is fibrous, and between the ends of a broken bone
it is osseous. If however, the adjoining tissue is a highly organ-
ized one, like nerve or muscle it may be replaced by a simpler
(fibrous, osseous).

Fibrinous inflammations are especially found in connection
with inflamed fibrous tissues and in strong vigorous subjects.

52 Veterinary Medicine.

Blood Exudations. In all inflammations there is some mi-
gration of blood globules (red as well as white) but seldom in
quantity sufficient to stain the tissues materially. Minute ruptures
of the capillary vessels are not uncommon, with punctiform clots
in the tissues, but extensive escape of blood is mainly seen in
penetrating or contused wounds of the loose, subcutaneous con-
nective tissue, and in infective inflammations (anthrax, Rinder-
pest, swine plague, petechial fever, malignant catarrh, snake-
bites) with destruction of blood globules or extreme changes in
the walls of the capillaries. Newly formed vessels in friable neo-
plasm are subject to blood effusions. In acute inflammations of
serous membranes the exudate is usually of a dark port wine hue
at first. In such cases it may pass in succession through all the
stages of dark red, brick red, yellow, reddish, and chocolate color,
before becoming milky and finally transpareut.

Croupous Exudate. Croupous inflammation usually occurs on
or near a mucous surface and is characterized by an exudation
consisting mainly of fibrinous material entangling white cells,
epithelium, a few pus corpuscles and some form of bacteria. In
true diphtheria of children this is the Loffler bacillus, in the pseudo-
diphtheria, attending on scarlatina, etc., it is streptococcus pyoge-
nus, in the diphtheria of calves it is bacillus diphtherise vitulorum,
and in that of chickens and pigeons it is the bacillus diphtheriae col-
umbarum (Ivoffler). Pseudomembranous inflammations therefore
constitute a group agreeing in the nature of the exudate but
differing essentially in the cause. This difference in the cause
has a most material effect on the course and gravity of the disease.
One form like true diphtheria in man not only extends into the
tissues, and tends to necrotic changes, but also poisons the nerve
centres by the toxic materials absorbed inducing troublesome
paralysis, while another like croup of children establishes a vio-
lent but essentially superficial disease and when that recovers it
leaves no ulterior ill effects elsewhere.

A Chyliform exudate has been noted in peritonitis in the dog
the milky whiteness being due to fatty granules.

RESULTS AND PRODUCTS OF INFLAMMATION.

As nearly all inflammations have significant exudations it is
well to follow these in their subsequent progress through reab-

Inflamation. Plogosis. Phlegmasia. 53

sorption and removal, development into new tissues, necrosis,
suppuration and ulceration.

Resolution. If an inflammation, slight in character and with
only a moderate exudation, subsides and is followed by a rapid
liquefaction of the cells and fibrinous coagula and a reabsorption
of the exudate, so as to leave the part in its primary healthy con-
dition structurally and functionally, it is said to have terminated
by " resolution.'' If this occurs with extraordinary rapidity it is
said to have ended by ' ' delitesceyice. ' ' This is not always an unal-
loyed good, as often in delitescence, coagula and infecting material
ma}^ be carried on by the circulation, to block the next set of
capillaries in its course and set up new centres of inflammation.
This is one form of ' ' metastasis'' ' though a more definite metasta-
sis is in rheumatism where the disease attacks one joint to-day
and a distant one to-morrow.

Inflammatory New Formations. Of the growths in lymph
there are two principal kinds : first, the plastic, fibrinous, granu-
lar or inolecidar / and second, the aplastic or corpuscular. The
first form tends to develop into new structure, the second to dis-
integrate and decay. The tendency to one or other form depends
largely on the strength or weakness of the system's health, on the
deficiency or excess of corpuscles in the exuded fluid, and on the
distance of the latter from living tissues and blood supply. Much
also depends on the predisposition of the genus, the tendency to
suppuration in lymph being in a descending series from horse, ass,
and mule, through ox and .sheep, to dog, pig, and finally, the
bird, in which latter suppuration is quite exceptional.

Suppuration. In inflammations of a high type, in those oc-
curring on the skin or mucous membranes in which there is an
extraordinary increase of nuclei and embryonal cells, and in lymph
thrown out in excess at one point, so that its central parts are far
from vascular tissue and nourishment, the cell elements undergo
a rapid increase and degradation into pus-corpuscles, and its solid-
ified intercellular Ij'mph undergoes granular decay and liquefaction
into pus

While the above conditions are favorable to the formation of
pus, the process of suppuration must now be recognized as an in-
fective process due to the propogation of bacteria (mainly chain
forms — Streptococcus pyogenes — cluster groups — Staphylococcus py^

54 Veterinary Medicine.

ogenes — and rod forms — Bacillus pyogenes). These or other bac-
teria are found in the pus of acute abscesses, and when absent in
chronic abscesses are to be considered as having perished since
the abscess was recent and active. Inoculation of a rabbit with
an excess of the pus of an acute abscess produces general puru-
lent infection (pyaemia) and early death ; from a medium dose an
abscess is produced ; while from a small dose there is no effect
whatever. In the latter case the bacteria are overcome and de-
voured by the abundance of vitally potent white blood-globules
and tissue cells. This pus-forming action of these bacteria ex-
plains the great difference in results in wounds exposed to the air
and those in the interior of the body and far removed from air and
its floating bacteria. A broken bone, with no wound in the skin
and little injury to parts around the- fracture, is readily repaired
without any formation of pus, if merely kept still and immova-
ble ; whereas a broken bone, continuous with a wound through
the skin, always tends to form pus or become otherwise infected,
and is extremely dangerous even to life. The tendency of every
open sore is to form pus on its surface but this may be arrested
and avoided by preventing the access of germs, or by a free
use of disinfectants aiid a covering which shall arrest and filter
out the germs. Similarly in an abscess, evacuation followed by
the injection of disinfectants, without the formation of any per-
ceptible permanent opening to the outer air, will put a stop to the
pus-formation. The subjection of an inflamed part to the control
of tliese pus-forming bacteria is dependent on the lowered vitality
and power of resistance of the inflamed tissues, and of the white
cells of their circulating blood.' Healthy parts can successfully
resist them, though they are constantly present in surrounding
air and on objects, but in this as in all other cases, of bacterial
infection, so soon as the tissue is injured, inflamed and lowered
in its power of vital resistance, the pyogenic bacteria assail it suc-
cessfully. Hence, too, the more abundant exudations of lymph,
the centres of which are farthest removed from the healthy tissues
and from nourishment, are the most prone to suppuration. That
the germs can make their way to such deep-seated exudations in
the substance of solid tissues is to be accounted for by their grad-
ual advance through the inflamed and weakened structures from
the adjacent skin or mucous membrane, or in some instances by

Lifiamation. Plogosis. Phlegmasia. 55

reason of their presence in small numbers in the blood. It is
further noteworthy that those animals in which suppuration does
not occur readily are such as have a special power of resistance
to some other organic poisons. Thus the hog, which is supposed
to be proof against snake-bite, is also, to a large extent, proof
against the pus-forming bacteria.

Pus. This is a white, or yellowish-white, creamy-looking
product, composed of a clear, transparent fluid, rendered opaque
by numerous floating pus-corpuscles. These pus-corpuscles have
the same size as the white globules of the blood (a-jVo^ to 3-roTr
inch) and are peculiar in that each shows within it three or more
nuclei, which become visible on the addition of a drop of water
or acetic acid. Each of the common embryonal cells found in
the inflamed tissue usually contains two nuclei, the indication of
the active increase by division into two, but when the supply of
nutriment is checked the nuclei continue to divide, while the
cells remain unchanged, and thus every cell comes to contain
several nuclei in addition to fatty granules, and constitute pus-
corpuscles.

When pus is formed in a well-maintained system and tissue,
the outer layer of the lymph is developed ' into a fibrous sac in-
closing the liquid pus and constituting an abscess. In an un-
healthy system, or when "the inflammation depends on some
injurious poison, like that of erysipelas, this sac may not be
formed, and the pus, burrowing into and between different
organs, destroys the connections and substance — diffuse siippiira-
tion. When an abscess has formed in soft tissues its investing
sac shrinks as it assumes the fibrous character, and the confined
pus being incapable of compression, presses the membrane out-
ward on the side in which the surrounding tissues are most loose
and least resistant, hence, usually, though not always, in the
direction of the skin ; the soft tissues become absorbed and re-
moved in the track of the advancing pus ; and, finally, the latter
reaches a free surface and escapes. Thus, an abscess usually
bursts through the skin, but also, at times, through a mucous
membrane into the lungs, bowels, etc., or through a serous mem-
brane into chest, abdomen, etc. When an abscess is formed in
bone or dense fibrous tissues which press equally on all sides, it
may remain imprisoned for months and years after all inflamma-

56 Veterinary Medicine.

tion has subsided, constituting an indolent or cold abscess. When
the imprisoned pus is inclosed by thick fibrous or resistant tissues
at all points but one, it will make its way along the narrow pas-
sage of yielding tissue, but as the resulting outlet is constricted,
long, and tortuous, the contents cannot readily escape through it
nor the walls of the abscess contract so as to expel the confined
pus, and the latter goes on forming and discharging through the
narrow outlet for months or years. This is a fistula or sinus.

Healing by Adhesion or First Intention. When a clean-
cut wound has the blood staunched and its lips brought together
without exposure to the air (or contact with pyogenic germs),
they adhere at once and heal without pus or almost any apprecia-
ble formation of new tissue. Here the lymph thrown out on the
cut surfaces agglutinates them, and the cells, multiplying, form a
thin layer of embryonic tissue which gradually develops into a
fibrous structure and repairs the breach without any perceptible
scar.

Healing by Second Intention. Granulation. When a
wound has caused destruction of tissue, or when a simple incision
is left exposed to the air, the breach is filled up by new tissue
through the process known as granulation. The superficial layer
of lymph thrown out on the raw surface becomes oxidized and
degenerates into pus, while the deeper layers become solid, fibril-
lated, the seat of cell-growth, and are finally transformed into a
fibrous structure. New blood-vessels form in loops in the devel-
oping lymph and constitute the bright-red granulation-points
which cover the raw surface. The fibrous tissue into which the
lymph is transformed undergoes gradual contraction in develop-
ment, and thus, day by day, the edges of the adjacent healthy
skin are drawn in. so as to cover the wound more or less per-
fectly, and a slight scar only is left when healing has been
accomplished.

Granule Corpuscles and Masses. This is another de-
generative transformation in lymph and, is seen mainly in in-
flamed glands and brain and lung-tissue. The cells found in the
exuded lymph are made up of granules t¥to¥ i^^^h in diameter,
and besides these, large, irregularly shaped masses of granules
are extended along the capillary blood-vessels. After the lymph
has coagulated these granular masses soften and liquefy prelimi-

InflamatioJi. Ploq^osis. PJilegmasia. 57

nary to re-absorption and removal, and the restoration of the tis-
sue to a healthy condition. When in excess this softens and dis-
integrates the tissues, leading to permanent loss of substance.
S&& graimlar degeneration.

Interstitial Development of Lymph into Tissue. This
is equivalent to what takes place in the formation of the sac of
the abscess or of granulation-tissue. The liquid lymph in coagu-
lating, becomes fibrillar, and the cells and nuclei of the adjacent
tissue, having an abundant supply of blood and nutriment, multi-
ply first as simple, rounded embryonic cells, then deposit around
them new tissue, becoming elongated, spindle-shaped, branching,
etc. , and thus get imbedded in a fibrous material of their own
formation. These new formations are usually of a low type of
organization, like white fibrous tissue or bone, and hence, al-
though breaches in the higher structures like muscle, nerve, gland,
skin, are filled up, it is usually only by the drawing together of
the remaining healthy parts by these new formations without the
restoration of any of the original tissue which has been destroyed.
The cicatrix (scar), alone is made up of new material.

Lymph developing in this way may undergo any degeneration
to which normal tissues are subject. Thus it may undergo black
pigmentary (jnelanotic) degeneration, it may become impregna-
ted with lime-salts (^calcified), it may wither up into a hard gcla-
tiniform or Jiorny mass, or it may undergo /«//)' degeneration.

Fatty degeneration is the most common form, and consists in
the excessive deposit of fatty granules, first in the cells which
are in excess or badly nourished, and next in the adjacent tissue,
the normal elements of which are replaced by fatty granules.

Softening is an almost constant result of inflammation. The
exudate infiltrates and separates the tissue elements, destroying
their cohesion ; the liquefaction of these elements impairs this
still further, and the more or less perfect transformation of the
tissue into embryonic tissue entails the loss of its rigidity and
power of resistance. Thus the inflamed brain-tissue may become
a mere pulp, and the inflamed bone may be cut with a knife.

Ulceration is closely allied to softening. On the surface of a
sore there is an excessive exudation of l3miph, which loosens and
disintegrates the layer of lymph that is already in process of de-
velopment, and also a part of the tissue beneath. The cells in

58 Veterinary Medicine.

thsse parts fail to develop naturally and to build up good tissue ;
they become fatty, die, and together with the tissue in which
they lie, break down and pass off as a pulpy debris. Thus the
sore constantly deepens and widens, or at least refuses to contract
and heal. It is usually the result of bacterial infection.

Gangrene or death of a part is another effect of inflammation.
It results usually from the cutting off of the blood-supply through
the obstruction of the blood-vessels ; by the pressure of excessive
exudation in unyielding structures, as in bone, or under the hoof ;
by implication of the inner coats of the blood-vessels in the in-
flammation, when the contained blood will clot and obstruct
them ; or by blocking with the blood-clots that have been formed
at a distance and washed on in the blood-current to be arrested
when they reach vessels too small to admit them. lyike suppura-
tion, gangrene is associated with and often caused by a bacterial
growth. The dead mass remains as an irritant, and is slowly
separated by the formation around it of embryonal tissue, granu-
lations and pus. A second form is molccnlar gangrene, in which
the cells and minute elements of the tissue die, and are cast off,
leading to phagedenic (eating, extending) sores, as noted above
under Ulceration. When gangrene occurs on an exposed surface,
that may be altered from the normal color into shades of yellow,
brown, green, red, or black, according to the amount of blood and
the stage of decomposition, and may be cut without pain, if the
subjacent parts are not pressed upon ; it may be soft, may pit on
pressure, may crackle under the hand from the evolved gases of
decomposition, and may be covered with blisters (^phlyctenai) with
red, grumous liquid contents {inoist gangrened ; again, it may be
white, as after freezing, or it may be dark-colored, dry, and
horny, as from ergoti.sm {dry gangrene^.

FEVER.

Definition. Symptomatic. Idiopathic. Symptoms. Contagion. Incu-
bation. Premonitory symptoms. Chill, rigor. Reaction, hot stage. De-
fervescence. Crisis. I/ysis. Natural temperature. Fever temperature.
Retention of water in the system. Production of waste materials. Typhoid
condition. High fever, low, hectic. Treatment in vigorous subject, in
weak one. Regimen. Solipedes. Ruminants. Carnivora. Drink. Rest.
Clothing. Air. General and local bleeding. Cupping. Warm baths,
tepid, compresses, derivatives. Cold. Diaphoretics. Laxatives. Diuret-
ics. Sedatives. Alkalies. Antipyretics. Stimulants. Tonic refrigerants.
Tonics. In low fever. No depletion. Judicious elimination. Stimulants.
Refrigerants. Antiseptics. Diet. Local treatment of inflammation. Cold.
Astringents. Antiseptics. Warm applications. Stimulating embrocations.
Blisters. Firing. Massage. Suppuration.

Definition. Whether occurring as an accompaniment of in-
flammation or independently of it, fever is an unnatiiral elevation
of the temperature of the body, the direct result of an excess of
destructive chemical change in the blood and tissues, and more re-
motely of disordered nervous function.

Of all extensive inflammations fever is the constant result and
accompaniment, rising as the inflammation rises or extends, and
subsiding as the inflammation .sitbsides. It also occurs as a dis-
tinct affection, as in all the infectious diseases, as the result of a
specific irritating poison in the sj'stem, and then is the manifesta-
tion of the disease, while a local inflammation may or may not be
present as a special secondary feature of the malady or as an ac-
cidental complication.

Symptoms of Fever. Fever is marked by certain definite stages,
each of which has its own special manifestations. In the cases
due to a specific disease-germ, or contagium, the.se are, however,
preceded by a period of latency or incubation in which no symp-
toms whatever are manifest, but during this time the germ is
rapidly multiplying in the .sy.stem, and it is only when it has
gained a certain increase that it disorders the nervous system,
wastes the ti.ssues, raises the temperature of the bodj^ and induces
the other phenomena of fever. The same may be said to hold in
the fever attending on inflammation. The slight and circum-

59

6o Veterinary Medicine.

scribed inflammation is at first productive of no fever, and it is
only when it gains a certain extent that the nerves and nutrition
are disordered so as to bring about a feverish condition.

Premonitory Symptoms. These usually last but a few hours
and are often entirely absent or unnoticed. There is a lack of
the customary vigor and spirit, an indisposition to exertion, a loss
of clearness and vivacity of the eye, a manifest dullness, with
hanging of the head, and frequent shifting of the limbs as if
fatigued. Appetite is less sharp and ruminants chew the cud less
heartily or persistently.

Cold Stage. These are soon succeeded by the chill, rigor, or
shivering fit, in which the hair, especially that along the back,
stands erect (staring coat), the skin is cold and adherent to the
structures beneath (hidebound), the extremities (legs, tail, ears,
horns, nose) are cold, and the frame is agitated with slight tremors,
or even a shivering so violent that a wooden floor or building is
made to rattle. The back is arched, the legs brought nearer togeth-
er (crouching), the mouth is cool and clammy, the breathing hur-
ried, the pulse weak, and it may be rapid, but with a hard beat,
the bowels costive, and the urine higher colored than natural.
The temperature of the interior of the body, taken by a thermo-
meter in the rectum, is already found above the normal, the ex-
cessive destruction of tissue having begun, and the blood driven
from the cooler surface, and accumulating in the hot interior, at
once favors tissue-change and maintains the extra heat thereby
produced. In cattle the end of the tail is soft and flaccid from
this stage onward. The cold stage lasts a few minutes, or one or
two days in different cases.

Hot Stage. The hot stage appears as a reaction from the chill,
the contraction in the minute vessels of the skin giving place to
dilatation, so that the whole surface, including the extremities,
becomes hot and burning, but still dry and parched. The burn-
ing is especially noticeable in the more vascular parts, like the
roots of the horns and ears, the muzzle or snout, the mouth, the
hoofs, the bare parts of the paws in carnivora, and the mammae
(udder) in suckling animals. The mucous membranes lining the
nose and mouth become hot and red, the breathing freer, but not
less rapid, the pulse softer but accelerated, appetite (and rumina-
tion) greatly impaired or lost, thirst great, costiveness increased.

Fever. 6i

urine diminished and of a higher color, the flow of milk greatly
impaired or entirely arrested, and the dullness and prostration
greatly increased.

The hot stage lasts longer than the cold one, usually persisting
until death or convalescence. It may alternate with chills
throughout the whole course of the illness, and in the fever of in-
flammation the interruption of the hot stage by a chill usually im-
plies either a considerable extension of the inflammation or the
occurence of suppuration.

Defervescence. The decline of the fever may take place by a
sudden reduction of the body temperature to the natural standard,
or near it, and a sudden and general improvement in the symp-
toms (cri.sis), or by a slow improvement from day to day through
a more or less tedious convalescence (lysis).

Fever Temperatiwe. A temporary rise of one or two degrees is
unimportant, but a permanent rise indicates fever. A rise of ten
or twelve degrees is usually fatal. A sudden fall to or below the
natural, unless with general improvement in the symptoms indi-
cates siiiking. A similar fall, with a free secretion (perspiration,
urination, relaxed bowels) and general improvement in symp-
toms, betokens recovery. For normal and febrile temperature see
Semeiology.

Retention of tvater in the fevered system is as significant as the
elevated temperature. The patient drinks greedily but all the se-
cretions are arrested or diminished, and liquids go on accumulat-
ing in the system. The sudden bursting forth of secretions
(especially sweating) implies that the fever has, at least tempo-
rarily, given way.

The production of waste matters in the system is necessarily pro-
portionate to the amount of tissue destroyed. This appears in
the blood mainly as urea, the organic acid of urine (hippuric in
herbivora, uric in carnivora), together with phosphates, sulphates,
and chlorides. These thrown off by the urine give it its high
density. If not thus thrown off they remain as poisons in the
circulation and bring about that prostrate, sunken, debilitated
condition which characterizes the advanced stages of all severe
and continued fevers — the typhoid condition. This is not to be con-
founded with the specific typhoid fever, in which a special fever
germ expends itself, mainly on the bowels, and that runs through

62 Veterinary Medicine.

a regular course. The typhoid cojidition is that state in which an
animal system, already greatly weakened by a severe disease, and
perhaps further prostrated by a specific disease-poison, is subject-
ed to a species of poisoning by the retained chemical products of
the waste of the tissues.

Types of Fever. These are as characteristic as the types of in-
flammation, and of the same kind. The strong type of fever
which attends on an acute inflammation in an otherwise healthy
vigorous system, is spoken of as a high or iyiflatiimatory fever.
The weak type which occurs in a broken down or debilitated sys-
tem, or in connection with the action of a specific disease germ,
or with the saturation of the system by waste chemical products
is known as low, typhoid (better typhous^, or adynamic fever.
That form which persists in the utterly debilitated .system, where
the power of assimulation is practically lo.st, is known as hectic.

TREATMENT OF INFLAMMATION AND FEVER.

Treatment will be guided very largely by the type of the at-
tendant fever. If that is of a high type, with a hard, full, rapid
pulse, bright red mucous membranes, a clear eye, and well sus-
tained strength in a strong, vigorous animal, what is known as
antiphlogistic (depleting, depressing) treatment is admissible at
the outset. But in many cases with a low type of fever, a weak,
rapid pulse, pallid, yellow, or livid mucous membranes, a coated
tongue, a dull or sunken eye, much depression and prostration,
swaying on the limbs in walking, pendant head, ears, eyelids and
lips, and varying and irregular temperature of the limbs, etc. ,
such measures are forbidden from tl^e first, and tonics and stimu-
lants are demanded from the outset. Between the two extremes
there are many grades, which demand a judiciously adjusted in-
termediate treatment. The general principles only of each char-
acteristic form of treatment can be here formulated, it being un-
derstood that no two cases can be most advantageously treated in
precisely the same way, but that according to its special grade
each case will demand its own specific management applied ac-
cording to the skill of the physician.

Regimen. An antiphlogistic diet will consist in a moderate or
very sparing amount of non-stimulating food of easy digestion

Infla^nmation, Fever, Treatment. 63

(wheat bran or oil meal in warm, sloppy mash, carrots, turnips,
beets, potatoes, apples, pumpkins ; fresh, tender, green grass or
in winter a little scalded hay, may be taken as examples). Riim-
inants should have no food necessitating chewing of the cud ;
thus the roots, etc., should be pulped or boiled, and hay and
even grass must be interdicted until rumination is re-established.
When food is absolutely refused for days in succession well-boiled
gruels of oat-meal, barley-meal, linseed-meal, bran, etc., may be
given from a bottle or by injection. Dogs and cats should have
only vegetable mush (unbolted flour, barley, or oat-meal) with
just enough beef-juice to tempt the animal to eat a little. Milk
with an admixture of oxide of magnesia, or even lime-water is
often at once palatable and cooling. Drink should be pure water,
cool, if kept constantly fresh before the animal, but warmed to
something less than tepid if supplied only at long intervals, so
that the thirsty patient is not tempted to drink to excess and chill
himself. Rest in a clean, well-aired building, free from draughts
of cold air and with a southern exposure, is desirable, especiall}'
in winter. The best temperature is usually sixty degrees to sev-
enty degrees, especially in inflammations in the chest, and ex-
tremes of temperature are to be avoided. Clothmg will depend
on the weather. In warm weather it may be often discarded,
while in winter it should always be sufficient to obviate the access
of chill and consequent aggravation of the disease. Whenever
the atmosphere can be kept warm only at the expense of impurity
it is better to secure the comfort of the patient by the requisite
clothing than to subject him to impure air. As the extremities
are the first to suffer from cold, loose flannel bandages to the
limbs are often imperative.

Remedies. General bleeding, a great resort of our fore-fathers,
has been long all but discarded from modern practice. To-day it
is rarely resorted to, except to save from an urgent and extreme
danger, as in the plethoric cow merging into parturient apoplexy,
or the fat and overdriven horse, gasping for breath and life, in
general acute congestion of the lungs. There are other cases of
extensive acute and dangerous congestions, especially in a strong,
vigorous, and plethoric patient, in which general bleeding in ben-
eficial in warding off threatened death ; but sound, discriminating
judgment is necessary to its safe employment. When resorted to

64 Veterinary Medicine.

at all, the blood should be drawn from a large orifice, in a full
stream, to secure the desired depressant effect with the smallest
loss of blood, and the patient should be kept especially quiet and
apart from all excitement which would tend to counteract the
sedative action.

Local bleeding is more extensivelj' applicable than general, as
it usually effects the same purpose without the permanently weak-
ening effect. It acts in two ways, first, by emptying and con-
tracting the vessels in the skin over the inflamed organ, it solicits
a sympathetic contraction of the capillary vessels in that organ
itself, and thus inaugurates a progress toward recovery ; and
sscond, by so much as it draws blood to the surface it diminishes
the blood-pressure on the deeper inflamed organ, and affords a
better opportunity for the restoration of the healthy circulation
and function. Local bleeding may be practiced by simple scarifi-
cation or leeches, or better, by cupping with or without scarifica-
tion. To apply leeches, the skin must first be shaved. To cup,
it must at least be greased. As a cup, an ordinary large drink-
ing-glass may be used, the air contained in it being driven out by
a lighted taper, and then the taper being withdrawn, the mouth
of the cup is instantly and accurately applied on the skin and
held there, until, as it cools, it draws up the skin within it and
clings like a sucker. A number of these may be applied accord-
ing to the extent of the inflammation, and, if desired, they may
be removed, the part scarified, and the cup reapplied. The cup-
ping usually effects more than a mere local attraction of blood ;
it very commonly causes a free circulation in the whole skin, a
generally diffused warmth, and even perspiration. Thus we may
secure the derivation of blood from the inflamed part, the cooling
of a large mass of blood in the extensive cutaneous circulation,
the cooling of the entire system by the return of this blood inter-
nally, the elimination of injurious waste matters through the
skin, the lowering of the febrile heat and tension, and a better
functional activity of all the organs of the body.

Similar good results are obtained from all remedies that induce
surface warmth and vascularity and a free secretion from the skin.

Warm baths, for animals to which they can be applied, abstract
blood temporarily from the inflamed internal organs, diminish the
blood-pressure, and really cool the system, beside securing elimi-

Inflamuiation, Fever, Treatment. 65

nation from the skin and other secreting surfaces. They may be
commenced warm (80° F.) and gradually cooled down to 65° F.
after the skin has become freely active. In the larger quadru-
peds, in which the warm bath is too often practically impossible,
the same revulsion of blood and warmth to the skin may be se-
cured by rags ivrung out of hot (^almost scalding') water, wrapped
tightly round the body, covered with two or more dry blankets,
and kept tightly applied against the surface by elastic circingles.
The legs may be rubbed with straw wisps till warm, and then
loosely bandaged, or applications of red pepper, ammonia, or
mustard, may be made prior to bandaging. In place of hot water
rugs, bags loosely filled with bran, chaff, or other light agent,
heated to 1 10° F. , may be applied round the body, or, where it is
available, a Turkish or steam bath may be resorted to. These
hot cutaneous applications, to produce glow and perspiration, are
especially valuable in the chill that heralds a violent inflamma-
tion, and if that can be suddenly checked by this means the in-
flammation will often be warded off, or at least rendered slight
and easily controllable. After perspiring for half an hour the
patient may be gradually uncovered, rubbed dry, and covered
with a dry, warm blanket. If the skin is still glowing, a slight
sponging with cool or cold water may beneficially precede the
rubbing and drying.

Cold Baths. In cases of very high fever a full cold bath
(68° F.) may be employed for fifteen minutes, and repeated as
often as the temperature rises. In many cases of parturition
fever in cows great benefit accrues from sponging the body with
cold water and allowing it to evaporate from the burning skin.
In the extreme fever of heat apoplexy (sunstroke), with a tem-
perature of 110° F. and upward, a strong current of cold water
from a hose directed on the head and body often gives the best
results. In ordinary fevers in large animals the cold pack will
often serve a good purpose. Wring a blanket out of water (cold
or tepid, according to the height of the fever and the strength
and power of reaction of the patient), wrap it round the body,
cover it with several dry blankets so that no part is exposed, and
keep the whole in close contact with the skin by elastic circingles.
In fifteen minutes the skin should be glowing and perspiring, and
in half an hour the wrappings should be removed, a little at a
5

66 Veterinary Medicine.

time, the parts rubbed dry and covered with a dry woolen blanket.
It may be repeated as often as the fever rises.

Diaphoretics. Besides these remedial methods of inducing a
revulsion and glow in the skin with perspiration, medicinal dia-
phoretics may be resorted to. Among these may be included
copious drinks and injections of warm water, acetate of ammotiicr,
ayitimony, ipecacuan, or pilocarpi?i, or one of the sedatives, aconite
veratum, or opium, etc. Many a threatened acute inflammation
has been to a great extent cut short and nipped in the bud— the
stage of chill — by warm clothing, active hand-rubbing, and such
an apparently unscientific nauseant as tobacco.

When the preliminary stage has passed and the hot stage of the
fever has set in, cooling and eliminating agents are especially
called for.

Laxatives. In many cases, and especially in those with marked
constipation or bowels loaded with indigestible materials, a laxa-
tive is beneficial. For the horse, aloes, or, often better, sulphate
of soda, and for cattle or sheep, the latter, or Epsom salts, will at
once remove an irritant, cool the general system, draw off much
blood and nervous energy to the bowels, and secure a considerable
depletion and elimination from the intestines. For swine, dogs,
and cats castor-oil or salts may be used, and for fowls castor-oil.
If the mucous membranes are yellow, the tongue furred, and
faeces scanty, hard, and foetid, a dose of calomel (horse or ox,
one drachm ; sheep or pig, one scruple ; dog, three grains ;
chicken, one-half grain) with tartar emetic (horse or ox, two
drachms ; sheep, twenty grains ; swine, one-half grain ; dog,
one-fourth grain ; chicken, one-eighth grain) may be given and
followed in ten hours by one of the laxatives named above.

Diuretics. In the absence of any manifest disorder of the di-
gestive organs, the laxative may be omitted and refrigerant diur-
etics resorted to. Acetate of ammonia or potassa, nitre, tartrate
of potassa, carbonates of potassa or soda, may be used along with
sedatives.

In cases of infectious disease with poisoning by ptomaines and
toxins the elimination of these by the bowels and kidneys is of the
greatest importance.

Sedatives. Of the sedatives, aconite, bromide of potasium, ver-
atrum, hyoscyamus, or chloral hydrate may be used according to
the special indications.

Inflammation, Fever, Treatment. 67

Alkalies. Resolvoits. When the organ inflamed is a serous
membrane in which dangerous adhesions or other functional dis-
orders are likely to occur from newly formed false membranes,
their formation should be counteracted as far as possible by the
free use of alkalies (carbonates of soda, potash, or ammonia,
nitre, iodide of potassium, muriate of ammonia, etc.), and in the
same conditions excessive effusion should be controlled by free
action on the kidneys.

Antipyretics. To reduce the febrile temperature and especi-
ally, when caused by the ptomaines and toxins of bacterial infec-
tion, agents like acetanilid, antipyrin, exalgin, analgene, benzan-
ilid, salicylate of soda, and quinine have been largely employed
and will usually lower the temperature several degrees in a few
hours. They nearly all depress the vital forces, or hinder repar-
atory processes, so that their use is to be carefully guarded.
Quinine which is less depressing than the others hinders migration
of the leucocytes and thus stands in the way of successful phago-
cytosis. With a dangerously high temperature they may be tem-
porarily admissible, but they should be suspended as soon as pos-
sible. In all ordinary cases they are probably better avoided. A
judicious use of the cold or tepid bath, or of wet compresses is in-
comparably safer and more generally applicable.

Stimulants. When the disease results in great prostration or
when symptoms of septic or ptomaine poisoning set in stimulants
are often required to sustain the flagging heart and circulation.
These may be alcoholic, ammoniacal, etherial, camphor, digitalis,
etc.

Tonic Refrigerants. Later, when both inflammation and fever
have been somewhat reduced, temperature, breathing, and pulse
rendered more moderate, eye clearer, and even appetite perhaps
slightly improved, the sedatives may give place to refrigerating
tonics, such as mineral acids (nitric, muriatic, sulphuric, or phos-
phoric), in combination with bitters (quassia, cascarilla, calumba,
gentian, salicin), without as yet the suspension of refrigerant di-
uretics. Thus for the horse the following : Recipe : Pharmaceu-
tical nitric acid, two drams ; infusion of gentian, ten ounces ;
nitrate of potassa, two ounces. Dissolve. Give one ounce every
six hours.

Li Cotivalesce?ice. When convalescence has fairly set in, the

68 Veterhiary Medicine.

fever has subsided, and there reinauis merely some debiHty with
a remnant of the inflammatory exudation to be removed or
organized into tissue, or when an abscess has developed and burst,
the tonics must be even more freely given, the mineral acids may
even give place to preparations of iron or cod-liver oil, and the
diet must be made increasingly liberal. But throughout the
whole progress of the disease the bowels should be carefully
watched. Costiveness may quickly undo all that has been gained,
hence any indication of this should be met by laxative food
(boiled flaxseed, etc.), or, this failing, by injections or laxatives.
Similarly, if a freer action of the kidneys seems to be necessary
for elimination of waste matters or to reduce fever, diuretics
should be continuously kept up.

Treatment of Adynamic Infi^ammation and Fever. In
treating low asthenic or ady^iamic itiflamviation all depression and
depletion is to be carefully avoided. Even laxatives must be em-
ployed with extreme caution. If absolutely necessary it is best to
give them in small (half) doses and supplement their action by
liberal injections of hot water. Elimination of waste matter from
the blood and system is still to be sought, but it must be by stim-
jilating diuretics (sweet spirits of nitre, carbonate, acetate, or mu-
riate of ammonia, digitalis), and direct stinndants and tonics must
be given from the first (ammonia, wine, strong ale, whisky,
brandy, ether, gentian, calumba, nux vomica). For thehor.se
the following may serve as an example : Recipe : Sweet spirits
of nitre, four ounces ; sulphuric ether, two ounces ; tincture of
gentian, ten ounces ; digitalis, one dram. Mix. Dose, two
ounces in a pint of cool water four times a day. When there is
great debility and prostration ammoniacal and alcoholic stimulants
must be given freely, while if the fever heat rises very unduly
the cooling diuretics (citrate, tartrate, or acetate of potassa, or
nitre, etc.), and even sedatives (bromide of potassium, hydro-
bromic acid, chloral hydrate, salacin, salicylate of soda), must be
resorted to. If there is any indication of a special depressing poi-
son in the system, or of the absorption of septic or other noxious
matter from a wound, antiseptics (hydrochloric acid, or salicylic
acid, sulphite of soda, quinia, or chlorate of potassa) may be ad-
vantageously added to the prescription.

In these cases of asthenic inflammation, as in the advanced and

Inflamuiation, Fever, Treatment. 69

debilitated stages of sthenic inflammation, the diet should be as
good as the patient can digest. Boiled oats, barley, or flaxseed,
rich, well-boiled gruels, and beef-tea (even for herbivora,) may
frequently be resorted to with advantage.

Local Treatment of Inflammatio7i. In all forms of superficial
inflammation the local treatment occupies an important place.
The persistent application of <r<?/^ (coldwaterin a stream, ice-bags,
freezing mixtures) will sometimes overcome the tendency to in-
flammation or arrest it. This is especially sought when a violent
inflammation (as in a wounded joint) threatens to destroy an im-
portant organ. If adopted, it must be persisted in, as if it is sus-
pended too soon the reaction is likely to make matters worse than
ever. Cold astringent applicatio7is have a similar tendency.
Sugar-of-lead, one-half ounce ; laudanum, one ounce ; water, one
quart, may be kept applied by means of a linen bandage. The
water may often be advantageously replaced by extract of witch-
hazel. If the inflamed part is superficial the lotion may be made
antiseptic (carbolic acid, one dram ; or sulphurous acid solution,
five ounces ; water, one quart). Hot applications, fomentatio7is,
poultices are nearly always appropriate but they should be made
antiseptic to prevent bacterial development. When adopted they
should like cold ones be kept up as continuously as possible.
These soothe alike the superficial and deeper parts, the latter
through sympathy, producing first a relaxation of vessels and tis-
sues, and later a contraction of the former attended by pallor of
the surface. They greatly favor suppuration when that is already
inevitable, though in other cases they may obviate it by checking
at an early stage the acute inflammatory process on which it de-
pends. Any bland agent that will retain heat and moisture
will make an excellent poultice, though fllaxseed-meal is the type
of a soothing demulcent application. Very slight inflammation
may be successfully treated at the outset with a stimulating em-
brocation (alcohol or camphorated spirit), yet in the more violent
type of acute inflammation all local excitants tend to aggravate
the disease. In these violent forms the activity of the disease
should be first abated by local soothing and general sedative meas-
ures, and then the part over the inflamed organ may be safely
treated with a stimulating liniment or even a blister. In such
cases the liniment first acts as a derivative of blood and nervous

yo Veterinary Medicine.

energy from the inflamed part, and later and still more beneficially
by securing in it a sympathetic healing process, like that set up
in the skin. It is further probable that the absorbed albuminoids,
which have been modified in the congested part often exercis2a de-
cided effect on the inflamed tissue. In raw .sores where inflam-
mation has been .set up the granulations may become dropsical or
excessive, bulging beyond the adjacent skin Q.spro2cd Jies/i. This
should be repressed by touching it gently with some mild caustic
(lunar caustic),' so as to produce a thin, white film, and the re-
mote cause of the inflammation (often a local irritant) should be
sought and removed. In some unhealthy sores tending to exces-
.sive granulation, the compound tincture of myrrh and aloes may
be applied daily with great benefit. When the granulations be-
come excessive they may be scraped down to the level of the
.skin and then treated with an antiseptic (iodoform, boric acid,
acetanilid, aristol.

Blistering. In subacute and chronic inflammations and in
those acute forms in which the violence of the inflammatory
action has been already subdued by soothing measures, blisters
and other counter-irritants may be employed to counteract the
remaining inflammatory action. These act primarily by drawing
off blood and nervous energy from the inflamed organ to the
skin, and secondarily, by establishing a sympathetic healing pro-
cess in the diseased part, simultaneously with the work of recov-
ery in the skin, when the blister has spent its action. But if
applied above a part which is still violently inflamed, there is apt
to be serious aggravation, through this same sympathy
with the part .suffering under the rising of the blister. In this
way great and irreparable injury is often done through the lauda-
tions of particular blisters for the cure of given diseases, without
any reference to the stage or grade of such di.sea.se. The value
of a blister depends far more on the time of its application than
on the ingredients of which it may be composed.

Firing. This acts in nearly the same manner as a blister, and
demands similar caution in its application. It is especially avail-
able in subacute and chronic diseases of the joints, bones, and
tendons, and may be made more or le.ss severe according to the
nature and obstinacy of the disease. It is applied in points or in
lines at intervals of one-half to one inch, and penetrating one-

Inji animation, Fever, Treatment. 71

third, one-half, or entirely through the skin. The hotter the iron
the less the pain, but the greater* the danger of destruction of the
intervening skin by the excess of radiating heat. Hence the
contact of the heated iron with any one part must be judiciously
graduated to the heat of the iron and the delicacy of the skin,
and should not exceed the fraction of a second.

Massage, Rubbing. In chronic inflammation and even in some
acute forms, with considerable exudation, rubbing or massage is
of great value. It hastens the progress of the blood through the
veins, tends to restore the normal circulation in the stagnant or
partially obstructed capillaries, moves on the exuded liquids in
the lymphatic plexus, rend2ring the absorption more active, and
at once prevents the process of disintegration of the tissues and
obviates, the necessity for their solution and removal. This may
be largely accomplished by the use of the brush or rubber, or by
careful manipulation especially in the direction of the veins. If
the inflammation is near the surface the use of antiseptic and
deobstruent agents will heighten the good effect. Iodoform,
iodide of potassium, boric acid may serve as examples.

Suppuration. Abscess. The great variety of the causes and
forms of suppuration would forbid any extended notice of its
treatment in this place. It seems preferable to refer the reader
to the subject of p3"semid and the various surgical and medical
diseases in which suppuration takes place.

DISEASES OF THE RESPIRATORY ORGANS.

Importance of diseases of the respiratory organs — in horses and dogs.
Proclivity through over-exertion, through extent and delicacy of the mu-
cosa, through changes of temperature, through weather, through air pollu-
tion, through kind of diet, through change of latitude, through nervous
sympathy, through debilitation of the lung tissue, through suppression of
perspiration, through a high dew point, through bacteria and other germs,
through youth and change of habits.

These are among the most freqvient and grave of all affections
of the domestic animals. They are especially important however
in the case of animals that depend on the soundness of their wind.
In horses and dogs accordingly anj^ permanent injury to the or-
gans of respiration will seriously impair the value, not only be-
cause of the diminished usefulness of the affected animal, but also
because of the probable deterioration of their progeny. The
rapid paces demanded of these animals and the strain to which
the respiratory organs are subject are potent causes of respiratory
disorder. In all animals, however, the extent of the respiratory
surface and its extreme delicacy and tenuity especially predis-
pose it to disease. Hales estimates that the mucous membrane
covering all the air sacs and air cells is, in the calf, no less
than 250 square feet. As the chest of the horse is at least
double that of the calf, and as it contains much less connective
tissue, and is made up of minute air cells from j^^ — -^^q inch in
diameter and separated from each other by walls so attenuated
that the contained capillary blood-vessels are equally exposed to
the air on both sides, in two adjacent air cells, the estimate for
the average horse must be considerably above 500 square feet.
This membrane, incomparably the most delicate and susceptible
in the animal economy, is constantly in contact with the air in all
its variable conditions, and is necessarily affected by these varia-
tions.

The severe changes of temperature are not without their influ-
ence on this sensitive membrane. If these changes are sudden,
as for example in our northern states where the temperature will
var}' from 50° to 70° Fall., in a single day, the danger of injury
72

Diseases of the Respiratory Organs. 73

becomes imminent, and the lungs require to be strong indeed to
resist their eiEFects. Sudden transition from the hot close atmos-
phere of the barn or stable to the chilling winds of winter is
equalh' hurtful. But it is not alone the transition from warmth
to cold that is injurious. The general relaxation attendant on
the sudden change from a cold bracing atmosphere to one undulj'
hot is even more injurious. How frequently do human beings
suffer from colds as the result of a close sultry period at once su-
pervening on a clear cold one ? How extensively do chest dis-
eases prevail among horses brought from the clear pure atmos-
phere of the field, and shut up in close, hot stables ? Here, no
doubt, there is superadded the impurity of the too often infected
air, the change of diet, of exercise and of general care 3'et we
find that affections of the air passages are to a great extent in
ratio with the heat of the building. Hence their constant pres-
ence in dealer's stables where it is thought desirable to keep the
horses warm to hasten the improvement in the coat.

The suddenness of the transition is usually a principal cause of
injury. Where the climate changes slowly the animal economy
becomes habituated to it and resists successfully the injurious in-
fluences. Thus when spring merges gradually into summer and
autumn into winter, diseases of this kind are far less frequent.
But on the other hand a sudden and extreme variation of tem-
perature, whether in the ordinary course of the season or from a
wide change of latitude, is notoriously attended with diseases of
the air passages. Ayrshire, shorthorn and Jersey cattle, when
first imported into the Northern States of America, contract colds,
consumption and other chest diseases to a far greater extent than
the native races, though their progeny or even they themselves
after acclimatization, exhibit powers of resistance nearly equal to
the native stock. Sheep that have been shorn in midwinter or
early spring often repay the inhumanity of their owners by dying
of inflamed lungs. Southdown and Leicester sheep, sent from
England to the north of Scotland, demand at first the greatest
care to protect them against the increased rigor of the climate.
The army veterinary statistics of France show that horses trans-
ported from the southern parts of the country to the more northern
stations, suffer largely from pulmonary affections. But if the
change is effected slowly the requisite powers of resistance are

74 Veterinary Medicine.

acquired and the novel conditions of life cease to be injurious.
That this varied power of resistance is not confined to the higher
animals would appear from the experiments of W. Edwards on
cold blooded animals. He subjected them in winter and in sum-
mer respectively to a very low temperature and found that
whereas in summer their temperature declined 3° to 6° Cent., in
winter they had a greater resistance and barely declined y\ths of
a degree.

The action of cold on the surface of the body often leads to
morbid states of the air passages as the result of nervous sympa-
thy. A beast is subjected to a keen cold wind, is attacked with
shiv^ering, and inflammation of the chest supervenes. The result
is rendered more certain if the wind is associated with rain and
if the animal has been previously in a state of perspiration. A
heavy coat of hair, a profuse perspiration, and a cold draught
often combines effectively to produce respiratory disease.

It must be added that the chilling debilitates the nuclei of the
animal tissues, and les.sens their power of resistance to' noxious
influences. The excess of cold in the freezing of a part, is fol-
lowed by congestion and even violent inflammation with perhaps
sloughing after it has been thawed. The persistence of such
tissue debility is familiar to us all in the example of chillblains.
A less extreme application of cold affects the tissues and nuclei
less powerfully, but none the less surely. The increased liability
to disease of the chilled system is strikingly illustrated in the ex-
periment of Pasteur with anthrax. The chicken which had
proved refractory to an ordinary dose of anthrax virus, was
dipped in water at ordinary temperature until the heat of its body
was reduced, and then it fell an easj^ victim to the anthrax
bacillus. In the same way the person who recklessly exposes
himself to wet and chill falls a ready victim to intermittent or
yellow fever from which he would otherwise have escaped. De-
bility from another cause, such as bruise or laceration, favors
deep-seated invasion by pus cocci, and a resulting abscess, from
which the patient would have remained free, but for such
traumatism.

But the effect of cold is not confined to the sympathy between
the skin and respiratory mucous membrane, nor the revulsion of
the blood toward internal organs, nor to the debilitating of the

Diseases of the Respiratory Organs. 75

tissues. The application of cold coustringes the vessels and
lessens the freedom of the circulation and suppresses the normal
cutaneous exhalation. A somewhat .similar condition may be in-
duced by prolonged exposure to the rays of a burning sun, the
skin b2com2S hot, dry and rigid, and incompatible with the main-
tenance of the respiratory function. In either case there is a
retention of effete and deleterious matters in the circulation
which it was the function of the .skin to have eliminated. The
danger of such retention may be be.st exemplified by noting the
result of the complete repres.sion of perspiration in the remarka-
ble experiments of Fourcault and Bouley. The former covered
dogs and other .small animals with an impermeable varnish which
induced death after some days or in some cases in a few hours.
Bouley shaved three horses and covered the .skin with tar. There
resulted dullness, torpor, deep, slow breathing, weak and dimin-
ishing pulse, mu.scular tremors, manifest cooling of the body and
expired air, and deep violet color of the mucous membranes.
They died respectively on the seventh, ninth and tenth days. A
fourth horse covered with a layer of strong glue and then with
tar perished nine hours after the application. The bodies were
like those of animals that had died of suffocation. The mucous
membrane of the stomach and bowels was gorged with black
blood, the lungs violently congested — dark red and heavy — the
air-tubes filled with frothy material, and the lining membrane of
the heart had dark .spots of blood extrava.sation. It is no longer
then matter for surprise that temporary suppression of the insen-
sible perspiration should be followed by diseases of the chest or
abdomen, that extensive burns of the surface of the body should
be speedily followed by inflammations of internal organs or that
extensive and .severe cutaneous inflammations should be associated
with internal lesions.

Since the days of Hippocrates it has been universally acknowl-
edged that moist sea.sons and localities are less salubrious than
dry ones. As already observed moisture in a cold atmosphere
inten.sifies its effect. In a hot, close atmosphere it strongly con-
duces to putrefaction in dead organic matter, and the air becomes
loaded as a con.sequence with noxious gases, and in its lower
strata with bacteria in a .state of active growth. This condition

76

Veterinary Medicine.

is most intense in close, unventilated stables, and manifestly
operates in both predisposing to and exciting those diseases of
the chest and other parts, so frequent in such places. Winds raise
and carry such germs, but also sooner rob them of virulence.
(See Zymotic Diseases). Susceptible, young animals, newly
housed, usually suffer the most severely from these injurious con-
ditions. Often in their case frequent, extreme and sudden
changes, and great atmospheric impurity, are combined with a
diet to which they have been hitherto altogether unaccustomed.
In young horses there are superadded the exertions — too often
extreme — connected with training or work. There are the heats
and chills, the soaking perspiration and the frigid winds and rain,
the general exhaustion, but particularly the overwork of the
respiratory organs, each of itself calculated to superinduce disease.
Percivall justly remarks that among young horses, newly stabled
and put to work, the prevailing diseases are "catarrh, sore
throat, strangles, bronchitis, pneumonia and pleurisy." His
tables of the diseases attacking the horses of his own regiment
(ist Ivife Guards), are so instructive that I here reproduce them :

A TABLE (COMPILED FROM EXTRACTS FROM A "REGISTER OF SICK HORSES"
LIMITED TO A GIVEN PERIOD) SHOWING THE COMPARATIVE AGES AT
WHICH HORSES APPEAR MOST DISPOSED TO CERTAIN ORGANIC DISEASES.

No. of
Patients
Under 5

Years.

No. in

Their 5th

Year.

5 Years v ears ana

and Upwards

Under 10. ^ut under

No. 20
Years and; Total.
Upwards.'

Disease of the lungs
Disease of the bowels.
Disease of the brain
Disease of the eyes .

20 50

40 j 70

5 i 14

70 I 35

[Q 300

20 1 J 60

2 27

5 ! 150

It will be seen that nearly one-half of the sicknesses, occurring
among the horses of the regiment, were chest diseases, and that
nearly three-fourths of these were in animals under five j^ears
old, or in those newly purchased from the country.

The subjoined table shows the relative prevalence of disease in
different months of the year, deduced from the Register above
referred to :

Diseases of the Respiratory Orgatis.

77

Disease of the
IvUngs.

Disease of the Disease of the Disease of the
Bowels. I Brain. Eyes.

January . .
February . .
March . . .
April . .
May ...
June .

July. . . .
August . .
September .
October . .
November .
December .

Totals

208

35

r35

In thi.s table the extraordinary prevalence of lung diseases in
spring and autumn is very noticeable. There only remains to
notice the number of deaths occurring in the same regiment from
pulmonary and other di.seases.

Deaths from pulmonary disease 77

Deaths from other diseases (Glanders and Farcy

and accidents excepted) 57

It is thtis seen that though individually less dangerous than
many affections of the abdomen, brain, etc., yet by reason of their
greater frequency chest diseases induce the greatest mortality
among this class of stock.

In treating of the diseases of this class of organs they will be
sub-divided according as they affect the Jiose, the throat, the
neck, and the chest.

DISEASES OF THE NOSE.

EPISTAXIS. BLEEDING FROM THE NOSE.

Epistaxis as a primary and secondary affection. Causes — mechanical,
over exertion, blood pressure, new formations, diseased mucosa, disease of
the nasal venous plexus, disease of heart or lungs, in blood diseases, in
hsemorrhagic constitution, in bacteridian diseases of the respiratory organs.
Symptoms. Often one nostril, blood bright, red, clotted, sneezing, (not
retching, acid, nor cough). Treatment. Mechanical, astringent, cold,
plugging in solipedes and other animals : haemostatics.

As a primar}' affection this occurs more freqtiently in the horse
than in any other domestic animal, though as a symptomatic dis-
ease .it is common in all farm animals.

Causes. The most common causes are mechanical injury of
the Schneiderian membrane, violent congestion of this membrane
during extraordinary^ excitement or exertions, as in coughing, in
a closely contested race, in a trying hunt, in drawing heavy
loads, cspeciall}' if uphill and with a tight collar. It may coin-
cide with congestion of the brain acting to some extent as a vica-
rious discharge, or with the formation of new structures as poly-
pus, or cancer, in which, from the looseness and friability of their
texture, the vessels readily give way. The softened membrane is
equally liable to laceration or rupture during the progress of in-
flammation and particularly when fibrinous (croupous) exudations
arebiing detached. In all thes2 cases animals of a strong, vigor-
ous constitution and with a full or plethoric habit are most liable
to be attacked. Various congestions of the mucosa in diseases of
the heart or lungs are additional causes. Disease or injury of
the cervical branch of the sympathetic nerve, and varicosity of the
pituitary venous plexus must be accepted as occasional causes.

Epistaxis is also met with in states of general weakness and
with deteriorated blood, as in anaemia, in the course of various
fevers and in those hemorrhagic constitutions in which the altered
blood appears to find an easy passage through the debilitated or
ruptured coats of the bloodvessels. Thus it is seen in the so-
C3\\&d purpura hemorrhagica in the horse, in small-pox in sheep,
78

Diseases of the Nose. yg

in anthrax, and in szai?ie piaoue and hog cholera, //eri fig records
the case of a number of pigs suffering from a scorbutic affection
and which bled profusely from the nose. In bleeders (haemo-
philia; and in leucocythaemia it is liable to appear.

The ulcerations of the mucous membrane occuring in glanders
and chrojuc catarrh have proved exciting causes of the hemorrhage.
Lastly the intense heats of summer and prolonged exposure to
the direct rays of the sun induce a general relaxation and a deter-
mination of blood to the surface which rouses to activity the lat-
ent tendency.

Symptoms. The bleeding, usually from one nostril only, falls
in a succession of drops, (rarely in a stream), collects in clots
around the nostril, and bespatters surrounding objects as it is ex-
pelled forcibly in sneezing. It is usually of a bright crimson hue
or, in fevers or poisoned conditions of the blood, of a dark or
blackish color. It is distingui.shed from pulmonarj- hemorrhage
by the absence of cough and of a frothy condition, and from
bleeding from the stomach by the absence of the blackened clots
and acid odor which indicate the presence of the gastric juice.

It is usually to be further distinguished from these in all ani-
mals, save .solipedes, by the absence of blood in the mouth.

Treatment. Nasal hemorrhage often stops spontaneously, but
if the discharge is profuse or long continued, and especially in
weak or ansemic conditions it must be treated energetically. Care
should be taken, however, to ascertain first, whether it is not
vicarious of some other and more dangerous condition like cere-
bral congestion.

The head should be placed in an elevated position by tying it
up to the rack, and cold water or ice kept applied over the head
and neck. Matico powder may be blown into the affected nostril
during inspiration, or a solution of alum (4 drachms to i pint of
water) or other astringent may be thrown in by means of a
syringe. A tablespoonful of peroxide of hydrogen thrown into
the nose with an ordinary syringe will give immediate relief.
(Gillette.)

Plugging the affected nostril with a pellet of tow covered with
matico, tannin, tincture of chloride of iron (i:io or 20) or other
astringent may be employed when other means fail. By means
of a cord attached to the plug it may be withdrawn after all dan-

8o lacier inary Medicine.

ger is past. In solipedes, if both nostrils must be plugged, wrap
the tow around two elastic caouchouc tubes and introduce these,
or in the absence of these perform tracheotomy.

Any tendency to recurrence may be met by the internal admin-
istration of gallic acid (horse and cow J^ — i drachm), acetate of
lead (horse and cow Y2 — i drachm) or, in ansemic conditions, tinc-
ture of the perchloride of iron (horse and cow ^-3 oz.) in water.

RHINITIS. CORYZA. NASAL CATARRH. COLD IN
THE HEAD.

Coryza in the horse : Causes, wet, cold after perspiration, damp climate,
stable, soil, new buildings, hygroscopic building materials, youth, age,
poverty, nervous sympathy, local irritants, iodine, specific disease poisons.
Symptoms, dry congestion, watery discharge, muco-purulent discharge,
eyes involved, chill, fever, circulatory and breathing disturbance, defeca-
tion, urine, glandular swelling. Inflammation of the sinuses, the severe
effects. Duration in slight cases, in severe, in sinus complication. Treat-
ment, hygienic, nursing, dietary, steam, sulphur dioxide, febrifuges, in-
sufflation, electricity, solvent, antiseptic, stimulant.

Under this head will be considered simple inflammation of the
nasal mucous membrane. This disease might be considered as a
mild febrile affection with the local manifestation in the nose, but
it is more convenient to treat of it here as a malady of the nasal
chambers.

CORYZA IN THE HORSE.

The chief causes are exposure to wet and cold and especially
when the subject is exhausted and the skin relaxed and covered
with perspiration. In these circumstances a piercing wind, a
cold drizzling rain, or a draught in the stable is particularly dan-
gerous. Sudden alternations of temperature and especially a
change to a warm stable when the general effect is aggravated by
the impurity of the atmosphere and the irritant emanations from
dung and urine. Damp climates are more injurious than those
that are clear, dry, and bracing, and so are equally damp stables
whether the moisture is due to the nature of the soil, such as a
cold impervious and undrained clay, or of the building which,
from its newness, may retain a dangerous amount of moisture in
the plaster, or because of the hygroscopic properties of the build-
ing materials which draw moi.sture from the surrounding soil.
It mainly attacks young horses after they have passed out of the
hands of the breeder or dealer, and have been placed in new con-
ditions of life alike as regards feeding, stabling and work. Old
and ill-conditioned animals are more susceptible than the strong
. fi 8i

82 Veterinary Medicine.

and vigorous, and the changes of the coat in spring and autumn
prove strong predisposing causes. Nervous causes are potent in
causing engorgement of the erectile tissue covering the turbinated
bones, and local irritants, like septic dust, lime, ipecacuanha, pollen
of certain plants, smoke, and irritating fogs may precipitate it.
Iodine in large doses produces temporary catarrh. The weakness
of the mucosa from a previous attack predisposes to a second.
Occasionally the disease sweeps over a country, as.suming the
form of an epizootic when it may perhaps be preferably con-
sidered as a catarrhal fever, strangles or mild type of injlueiiza,
which see.

Symptoms. \\\W\q. milder forms oi coryza the symptoms may
be almost exclusively local, consisting in redness and dryness of
the membrane lining the nose and sneezing, .soon followed by the
bilateral discharge of a thin transparent watery liquid, succeeded
by a turbid flow (epithelial cells in excess) and after two or three
days by a thick, white, flocculent, puriform fluid (suppuration
diapedesis). With the supervention of the purulent discharge,
comes an abatement of the local inflammation and the freer the
discharge the greater usually is the relief obtained and the more
rapid the recovery. The eyes are usually red' and watery and
sometimes the eyelids are swollen. This implies the continuity
of the inflammation through the lachrymo-nasal duct, and the
obstruction to the flow of tears into the nose.

When constitictional disturbance exists a rough or staring coat
appears as one of the first symptoms, the sneezing is more violent,
the nasal mucous membrane is more reddened and swollen, the
eyes more dull, sunken and watery, the mouth hot and clammy,
the tempei'ature of the body raised, the pulse more frequent and
having a sharper beat, the impulse of the heart may often be felt by
applying the hand to the chest just behind the left elbow, the ap-
petite is fastidious and the secretions of the bowels and icidneys are
diminished, the latter being denser and more highly colored, from
the absorption of irritating or infecting matters the glands under the
throat are swollen and the swelling of the mucous membrane may
be such as to impair breathing and even to threaten suffocation.
In severe cases in which the inflammation extends to the nasal
sinuses there is heat and tenderness over the forehead and the
pain and weight are manifested by the pendent head and the red

Rhinitis. Coryza. Nasal Catarrh. Cold in the Head. 83

sunken, watery eyes and tumefied eyelids. When it extends to
the throat, the cough, the difficulty in swallowing and the local
tenderness on handling are characteristic.

Course. With the occurrence of suppuration, improvement
commences and if the inflammation does not extend beyond the
nasal chambers, and if it is not kept up by a repetition or con-
tinuance of the cause the disease will have terminated in recovery
in eight or ten days. For ulterior consequences in bad cases see
chronic catarrh, conjiuictivetis, abscess of the nasal sinuses, laryn-
gitis, stomatitis, staphylitis.

Treatment. In slight cases the simplest treatment only is re-
quired. Place the animal in a dry, airy, loose box, clear of
draughts, and with uniform temperature of 55° to 60° Fah,, if
obtainable. In the cold season blanket warmly, and hand-rub
and loosely flannel bandage the legs. Feed on sloppy bran mashes
only and add half an ounce to an ounce of powdered nitrate of
potash daily. Give fresh water ad libitum, solicit the action of
the bowels b}^ giving injections of warm water three times a day,
and encourage the nasal discharge by causing the patient to in-
hale steam for half an hour or an hour twice daily. This may be
done by giving scalded bran in a nose-bag or by keeping the head
over a bucket containing hay with boiling water poured over it,
the steam being meanwhile directed by a bag open at both ends
one of which is fixed around the animal's nose and the other
round the mouth of the bucket. As a local astringent, tonic and
antiseptic the fumes of sulphur (burned behind the animal and no
more concentrated than can be breathed with comfort) will do
much to cut short the attack. It is more soothing if combined
with steam. Shut doors and windows, add a few drops of alco-
hol to some pinches of sulphur and burn on paper laid on a clean
shovel or piece of sheet iron, When enough has been used ex-
tinguish by covering with a cup or other object. Repeat several
times a da3^ Under this treatment recovery may be completed in
three or four days.

In severe cases attended with fever, besides the above a dose of
laxative medicine may be given (three or four drachms of aloes),
with this precaution, that if the fever is of a low type or the
malady epizootic, half the dose only can be safely allowed (2 dr.)
on account of the danger of superpurgation. The nostrils must

84 Veterinary Medicine.

be more assiduously steamed and linseed tea may advantageously
replace fresh water as a beverage. If there is much sv^^elling and
tenderness of the glands a poultice should be applied to the
throat and between the jaws, and sulphur fumes as advised above,
or anodyne astringent insufflation powder may be resorted to.
Morphia chlorate two grains, bismuth nitrate, six drachms and
finely powdered gum arable three drachms may be blown into the
nostril during inspiration, or the astringent anodyne injection
advised below for chronic catarrh may be used. Cocaine spray
is often very helpful, or the same agent may be used in the liquid
form on cotton wool inserted in the nasal chamber. If this is
without effect a weak continuous current of electricity will cause
constriction and give prompt relief. It may be repeated every
few hours. In the absence of this the emanations from a weak
solution of ammonia or from carbonate of ammonia may be used.
In cases with excessive and persistent muco-purulent discharge,
with presumptive infection from outside sources, or in the young,
from the diseased maternal passages, insufflation with calomel,
painting with a two grains to the ounce solution of nitrate of
silver, or injection with some other germicide may be resorted to.
In case the fever is of a low type, liquor of the acetate of am-
monia (4 ozs.), sal-ammoniac (^ oz.), or even carbonate of am-
monia {yT, oz.), may be given several times a day, with sweet
spirits of nitre (>^ oz.) and tincture of gentian (i oz.) Alco-
holic stimulants are often used. Inhalations of iodine and iodide
of potassium with ether and chloroform are often successful.

SIMPLE CORYZA IN CATTLE.

Coryza mild in cattle. General treatment. Coryza in sheep from expo-
sure, intemperate seasons, clipping. Acute and chronic. Wholesale treat-
ment in flocks. Coryza in pigs. Coryza in dogs, simple, secondary.
Treatment, food, laxative, febrifuge, nauseating, expectorant, antiseptic,
gaseous, electric.

This is usually a very simple malady when confined to the
nasal chambers, and not of infective origin. When, on the
other hand, it attacks the sinuses it becomes a disease of extreme
gravity. (See Catarrh of the Sinuses). Symptoms are as seen in
the horse, but the discharge may be overlooked because of the
animal licking it out with his tongue. Treatment does not essen-
tially differ from that laid down above, and recovery may be ex-
pected in seven or eight days. If a laxative is wanted give from
one to two pounds Epsom salts.

SIMPLE CORYZA IN SHKEP.

Coryza is usually slight and is manifested by sneezing and run-
ning from the nose. It occurs in animals clipped or badly shel-
tered during the more inclement seasons. In the worst cases the
discharge becomes persistent and emaciation ensues so that it is
necessary to interfere. Valuable animals may be treated on the
same principles as oxen, and in the case of large flocks by shelter
in a warm, dry, cleanly and airy place and fumigations of steam
and the fumes of burning sulphur repeated daily, together with
nourishing diet, such as boiled barley or other grain, and quarter
ounce doses of nitre and common salt.

CORYZA IN THE PIG.

Hogs are not very subject to this disease and are easily treated
by warm, sloppy food, and as a laxative three or four croton
beans, according to size, powdered and given in the aliment.

CORYZA IN DOGS.

Dogs are rarely the subjects of simple coryza, though it is
constant in distemper. It sometimes proves troublesome in pup-

85

86 Veterinary Medicine.

pies and old dogs. A laxative (>^ — i ounce castor oil) may be
followed in strong and v^ery feverish cases by tartar emetic {% —
^ grain) three times a day. Spraying or sponging the nose with
a weak solution of chlorate of potass, common salt, or potassium
permanganate \\\\\ greatly relieve. Inhalation from burning sul-
phur, or from carbonate of ammonia, or both may be used when
sponging or spraying is diflQcult. In inveterate cases, the weak
electric current sent through the cheeks, or the insufflation of
acetanilid, iodoform or calomel may be tried. As a rule, salt-
peter in five grain doses, given in the water, will prove helpful,
and in weak conditions wine, tincture of gentian or nux-vomica
may be used.

CHRONIC NASAL CATARRH. NASAL GLEET.
OZCENA IN THE HORSE.

Chronic catarrh in horse, simple form, loss of tone, inflammation, nature
of discharge, glandular swellings, differentiation from glanders. Treat-
ment, astringent, tonic, stimulant, hygienic, locally astringents, antiseptics,
injections.

A chronic discharge from the no.se is often seen in the horse as
a sequel of coryza or sore throat, or as an attendant on other
affections of the upper air-passages, and the different conditions
productive of this SN-mptom may here be noticed.

1ST. SIMPLE NASAL CATARRH. XASAL GLEET. OZCENA.

In long standing coryza the nasal mucous membrane becomes
relaxed, fails to acquire its lost tone and continues to pour out a
mucopurulent product. This is really a persistence of inflamma-
tion of a low type, under the influence of which the membrane
secretes pus in place of its normal mucus. The discharge is
white, thick, creamy, has little tenacity, and flows uninterrupt-
edly. There may be slight enlargement of the submaxillary
glands, and if the case is of long standing and the patient in low
condition sores maj' appear on the raucous membrane. The.se
ulcers are di.stinguished from those of glanders by the absence of
the unhealthy angry aspect and excavated borders of the latter,
by the absence of the small nodular deposits on the mucosa, by the
less viscid natttre of the secretion, and by the absence of submaxil-
lary swellings,or if the.se exist, by their being less nodular, less in-
durated and le-ss firmly attached to surrounding parts. The coinci-
dence of ulcers and submaxillary .swellings is always, however, mat-
ter for the gravest suspicion, and such cases should, as a rule, be
subjected to the mallein test. (See Glanders and Farcy).

Treatynent. In simple nasal catarrh, due alone to the relaxation
of the mucous membrane, the internal use of tonics and the local
application of astringent solutions to the nose rapidly restore the
parts to a healthy state.

Among stimulants, cubebs, cayenne pepper and copaiba have a

88 Veterinary Medicine.

stimulating and styptic effect on the mucous membrane and each
of these has been successfully used in such cases. Cantharides,
in five- grain doses, have proved even more successful, (Vines,
Percivall) . Sulphate of Copper in drachm doses in mucilage night
and morning has proved very efficient (Sewell, Percivall). Arsen-
iotis Acid has been employed with still better results. The dose,
of five grains may be intimately mixed with a scruple of bicar-
bonate of soda and given daily in food.*

But the most efficient tonic in these cases is arseniate of
strychnia. Its good effects may be secured by combining with
the above mentioned powders of arsenious acid and bicarbonate
of soda, half a drachm of powdered nux vomica for each dose.f
These powders will usually be taken in food, and may be contin-
ued for a month, or until the discharge ceases.

In all cases the general health must be carefully attended to.
Keep the patient in a dry, clean, airy building without draughts
of cold air ; give moderate exercise in the open air ; and good
grooming ; and allow nutritious food of mildly laxative properties,
— as occasional bran mashes and roots in winter and succulent
gra.sses in summer.

Local Applications. These are the most important remedial
measures and usually of themselves succeed in reestablishing a
healthy condition.

The agents proving most useful are of an astringent nature and
in obstinate cases one may be substituted for another as the last
appears to lose its effect. Sulphate of Zinc or Sulphate of Copper
in the proportion of half a drachm of either to a quart of water,
may be used, or if there is much foetor, a solution containing a
drachm each of carbolic acid and carbonate of potash in a quart of
water is to be preferred. In either case the addition of an ounce

*In giving this agent, any redness or watering of the eyes, or colicy pain
should be carefully watched for, and when these premonitory symptoms of
poisoning are noticed the medicine should be at once suspended to be com-
menced a few days later in smaller doses.

t Whenever nux vomica or its alkaloids, strychnia or brucia, are given, in-
creased irritability and nervousness should be carefully watched for and
especially any involuntary twitching of the muscles. On their appearance
the agent must be suspended and commenced a few days later in half the
former doses.

Chronic Nasal Cataorh. Nasal Gleet. Oza^na in the Horse. 89

of pure glycerine renders the lotion at once more soothing and
more efficient. The solution must be rendered tepid before in-
jecting it, to obviate the irritation attending on the contact of a
cold fluid with the delicate membrane of the nose. Among other
agents may be named creolin, creosol, creosote, acetate of lead,
potassium permanganate, and .silver nitrate. Peroxide of hydro-
gen may be used either as injection or in spray.

The mode of injection is a matter of no small moment. It has
been done in some instances by means of a large syringe but the
irritation attendant on such a process is an insuperable objection
to its use. A better instrument is that introduced by Profes.sor
Rey of Lyons. It consists in a tube bent on itself at an angle of
35" .so as to form two arms of inequal lengths. The longer fif-
teen inches in length, one and a half in diameter and widening
into a funnel at its free end ; —the shorter about five inches long
and tapering towards its free end where its aperture is only two-
thirds of an inch across. The instrument is made of block tin or
extemporaneously of gutta perclia. Over the shorter arm is
placed a tightl}' fitting leather ring four and a half inches in di-
ameter on which is applied some wet tow to adapt it to the no.stril
and effectually close it. The nose having been drawn in .so as to
place the head in a vertical position, the short arm of the instru-
ment is introduced into the affected nostril, and the liquid being
gently poured into the long arm rises slowly in the nose until it
is filled and the liquid flows from the nostril on the opposite side.
In introducing the tube care must be taken that it may not irritate
the inner wall of the nose on the one hand, nor pass into the
blind pouch, known as \.\\q. false nostril, on the other.

The greatest gentleness and tact are requisite in thus injecting
the nostrils, though in troublesome animals it is sometimes neces-
sary to resort to blindfolding or even to the application of a twitch
on the ear, or finally to strapping the animal (head included) to a
smooth firm vertical surface (operating table).

COLLECTION OF PUS IN THE NASAL SINUSES.

Nasal Siiuises, position, orifice, suppuration, symptom?, treatment, tonics,
astringents, antiseptics, trephining, significance of the fcetor, mode of re-
covery.

In severe corysa the nasal sinuses become implicated as shown
by the intensity of the symptoms, the prostration, the hanging
head, and the heat and sometimes tenderness between the eyes
and immediately beneath them on the side of the upper jaw.
These sinuses are large spaces filled with air, situated between the
superficial and deep plates of the bones of the face and opening
into the nostrils by a narrow orifice in the upper part of the nasal
chambers. When pus is largely formed in these it fails to flow
out as rapidly as produced, parts with a portion of its liquid ele-
ments, increases in consistency and sometimes even undergoes de-
composition, so that the discharge from the nostril has a putrid
odor.

The most distinctive symptoms of this form of nasal gleet are
obtained by percussing the sinuses, and in those cases in particu-
lar in which the accumulation is confined to one side of the head,
the contrast between the two sides is unmistakable. By gently
tapping the forehead with the middle finger from one eye to the
other the flat solid sound on the diseased side is easily distinguished
from the clear drum-like resonance on the healthy one. By tap-
ping on the bone beneath each eye and just above the -ridge on the
side of the upper jaw, the difference between the two sides will be
recognized in the same way. In some old-standin'g cases increas-
ed tenderness and slight bulging of the bones over the affected
sinuses are often superadded to the other symptoms. The eye on
the affected side is usually retracted so as to seem smaller.

Ti'eatment. In some cases the use of tonics and astringent in-
jections as recommended for thetreatm2nt of ozoenav^WX prove suc-
cessful, but more usually it is needful to open and inject the si-
nuses.

For this the following articles are required : scissors, a knife,
forceps, a trephine or circular saw from half to three-fourths of an
inch in diameter and a whalebone or metallic prob.
90

Collect io7i of Pus in the Nasal Sinuses. 91

The horse is thrown and made fast with the diseased side of the
head uppermost. A point is then selected on a Hne drawn between
the centres of the two eyeballs and an inch to one side the median
line of the forehead ; the hair is closely removed with the scissors,
and a semi-circular flap of skin over an inch in diameter is dis-
sected from the bone and turned back toward the poll. The tre-
phine is next applied on the bone and a circular portion, having
been cut through, is pulled out by the forceps, when the imprison-
ed pus will commonly ooze from the opening. A second point is
chosen just above the lower end of the bony ridge of the upper
jaw already referred to and opposite the third molar tooth, count-
ing from before ; the hair is removed as before, a flap of the skin
raised upward and backward and the bone trephined to open the
second sinuse. The point of election for this orifice is more im-
portant than that of the first. If it is too near the eye the lower
part of the sinus, which is separated from the upper by an imper-
forate bony plate, is not opened and may continue to keep up the
discharge from the nose. If on the contrary it is made too low
down, the lower sinuse only is opened and the upper being im-
perfectly washed out from the wound in the forehead will keep up
the discharge. Either then this plate must be struck with the
trephine or it must be afterward perforated to secure a favorable
result. Theprob introduced by the wound in the forehead should
further appear at the lower orifice.

The cavities are to be washed out first with clear tepid water,
and thereafter daily with an astringent solution such as that used
for injecting the no.se. If the discharge does not escape freely by
the lower orifice its exit may be facilitated by drawing a tape
through the sinuses, from the upper to the lower, and retaining it
there by a knot on each end.

Marked fcetor of the wound will usually indicate necrosis at the
edge of the wound, and demands the use of bone forceps or chisel
to remove the offending bone.

A cure is affected by the restoration of the membrane to its nat-
ural state, or in other cases by the filling up and obliteration of
the cavity by granulation.

ABSCESS OF THE FAI.SE NOSTRIL OR TURBINATED
BONES.

Structure of turbinated bones : suppuration or abscess, obstructed breath-
ing, treatment, puncture, plugging, injection, trephining.

The turbinated bones are two fragile bony structures attached
to the outer wall of each nasal chamber. The posterior half of
each bone closes the corresponding nasal sinuse ; the anterior
half is rolled upon itself as a sheet of paper might be, and is ac-
cordingly open along one side. In this latter a collection of pus
may result from severe inflammatory action and the resulting dis-
charge may become somewhat chronic. The flow is greatest after
the nose has been raised, from the pus having previously gravitated
into a sac in the lower end of the bone. The pus may moreover
pass backward into the larnyx from the raising of the head and
induce a violent fit of coughing. Sometimes the inflammation
has extended to the bones covering the nose which are bulging
and tender. The thin turbinated bone gives way under the dis-
tension, bulges into the nose, and often stops the passage of air
through that side. This symptom and the appearance of the
swelling cause a close approximation in symptoms to nasal poly-
pus. The facts that it supervened on a severe coryza, that it fluc-
tuates on pressure if within reach of the finger, and that pus es-
capes when it is punctured, exclude the idea of polypus.

Treatmeiit. Puncture of the abscess inside the nose, plugging
and dail}^ astringent injections will usuall)' rapidly cure. Gamgee,
Jessen and others, recommend trephining of the bone above the
nose and washing it out daily, adding that an extensive removal of
the bone will correct any existing bulging and deformity.

92

NASAI. DISCHARGE FROM CARIOUS TEETH, ETC.

Ulceration into sinus from caries, loss of molar, overgrown molar.
Foetor, tenderness. Foreign body in the nose.

In cases of a diseased molar tooth in the upper jaw, food
getting firmly impacted in the hollow space, irritates the pulp in
the fang and the adjacent bone until the progress in ulceration
reaches the nasal chamber or sinuse and a nasal discharge is
established. If an upper molar tooth is lost the molar formerly
opposed to it in the lower jaw grows out and sets up the same
train of symptoms. In all cases then in which nasal gleet is as-
sociated with much foetor and with difficulty in eating, a careful
examination of the teeth should be made. (See Diseases of the
Teeth).

FOREIGN BODY IN THE NOSB.

Professor Gamgee records the destruction of an animal for glan-
ders in which the cause of the discharge was afterwards found to
be a physic ball coughed up into the posterior part of the nose
and firmly impacted there.

93

COLLECTIONS OF PUS IN THE GUTTURAL POUCHES.

Structure, position and opening of pouches, inflamed by extension.

pastur-
landu-

S}-mptonis, discharge intermittent with pendent head, swallowing, p
ing, cough, roaring, dyspnoea, inhalation of food, parotid swelling, gl
lar enlargement. Nature of contents. Treatment, pasturage, blister, ton-
ics, irrigation, puncture, injection.

Though this is commonly a restilt of severe sore throat or
strangles, yet as it catises a chronic discharge from the no.se liable
to be confounded with those properly due to diseases of the nasal
chamber, it is noticed in this place.

The guttural pouches are two mucous sacs peculiar to solid
footed animals. They lie .side by .side above the throat, and in
direct contact with the lower surface of the .superior bones of the
head and the first bone of the neck. They are properly speaking
dilatations of the Eustachian tubes which in all animals establish a
communication between the pharynx and the middle ear.
The opening into the pharynx is at the anterior extremity of the
pouch and close to the posterior opening of the nostril, hence the
discharge takes place chiefly or exclusively when the head is
lowered, since gravitation then favors the escape of the fluid.

Frequently implicated in severe sorethroat the walls of the gut-
tural pouches pour out pus as readily as other mucous membranes
in a .state of inflammation. As the escape of this product is hin-
dered alike by the narrowness of the orifice and, in the elevated
position of the head, by gravitation, it frequently becomes im-
prisoned and inspissated and proves a permanent source of irrita-
tion and discharge. In the early stages the contents are glairy
with whitish or yellowish clots ; later they are creamy, caseous
or even cretaceous. The mucosa, at first red, congested and tume-
fied, becomes in chronic ca.ses, hard, thick, ptickered and adher-
ent to adjacent structures. It sometimes ulcerates and the con-
tents escape in mass, through the pharynx and nose, or externally
behind the angle of the lower jaw. In the last case water swal-
lowed may escape through the opening. More commonly the
ptis remains pent up, and thickens, and may dry and roll into
round or oval pellets from the tiiovenients of deglutition. The dis-

94

Col/cdio/is of Pus in the Guttural Pouches. 95

charge may be arrested for weeks or months when such masses
block the outlet.

SyDiptoms. The nasal discharge is intermittent or irregular,
being often partially or wholly suppressed by keeping the head
elevated, and reappearing or becoming profuse when it is lowered.
Feeding from the ground, nibbling roots, or pasturing increases
the discharge, as the dependent position of the outlet, the jerk-
ing and shaking of the head and the movements of deglutition all
favor its exit. Swelling of the parotidean region, a flatness in-
stead of resonance on percussion, and the flattening and dis-
charge and sometimes gurgling by manipulation are characteris-
tic. There is cough, roaring during active exertion, sometimes
dj'spnoea, and, in bad cases, food may be drawn into the bronchia
with serious and even fatal results. When the orifice is blocked
and the pouch filled with gas the elastic swelling and resilience
are characteristic, and pressure may flatten it with a gurgling
sound. These symptoms, serve to differentiate it from peripharyn-
geal abscess. The submaxillary lymphatic glands are usually
swollen but less than in glanders and not so hard.

Treatment. In mild and recent cases in which the contents of
the pouch have not yet become thick and dry, a cure may be
effected ; in winter b)^ feeding the animal from the ground and
largely with roots ; a7id in summer, by turning out to gra.ss. In
either case the matter is allowed to escape almost as soon as
formed and the irritated membrane tends to resume its healthy
functions. This result will be favored by giving a course of
tonics as recommended in simple ozcciia, and the application of a
mild blister to the throat.

Should this fail an operation must be resorted to. Gunther, of
Hanover, uses an instrument in the form of a tube a yard long,
half an inch in diameter, slightly curved for two inches at one
end which is blind, and having an orifice on one side close to this
extremity. This tube having been introduced through the cham-
ber of the nose on the affected side and its curved end having
been carried into the narrow opening of the Eustachian pouch,
tepid water is pumped in and the pouch thoroughly cleaned out.
Astringent solutions are then employed. The introduction of the
tube is, however, a very difficult operation and one quite impossi-
ble to any one who has not the most accurate knowledge of the
parts in question.

^G Veterinary Medicine.

A second mode of operating is by external incision. For this
purpose are wanted scissors, knife, artery forceps, iron probe bent
in the form of the letter S, and a tape. The horse having been
thrown and fastened and the head extended, the hair is removed
from a surface in front of the prominent border of the first bone
of the neck, and an incision made between this border and the
parotid gland. The incision is made immediately beneath a
tendon which may be felt as a flattened cord crossing the border
of the bone in its upper third, and it should be carried downward
one and a half inches parallel to the margin of the bone. In this
preliminary stage the operator has to carefully avoid injury to the
parotid gland and the posterior auricular artery and vein. The
skin and fascia having been divided the index finger of the left
hand is pushed inward and forward until the prominent angle of
the large cornu of the hyoid bone is felt, together with the
muscle (stylo-hyoid) inserted into this bone above the angle
referred to. The next step is importajit since crossing on the
inner side of this muscle and bone at their point of union is the
(internal carotid) artery which becomes subsequently enveloped
in a fold of the membranous wall of the guttural pouch. The
slightest variation in the position of the artery may here prove
fatal unless the greatest caution is used. With the knife guarded
by the index finger of the right hand the muscle is cut through
from behind forward and the pulsation of the artery felt for be-
neath. Avoiding its position the knife, with its cutting edge
turned forward and its point directed toward the horse's nose, is
pushed through the walls of the sac. The curved prob is now
introduced and carried downward until it is felt beneath the skin
just behind the angle of the lower jaw. This may be safely cut
down upon with the knife as important parts (vessels and nerves)
have been turned aside by its pressure. A tape attached to the
prob is now drawn through the pouch and retained by a knot on
each end. Tepid water must be injected through the lower orifice
daily for three weeks, astringent antiseptic injections thrown in
occasionally and the horse fed from the ground. At the end of
this period the tape may be removed, and the wounds allowed to
heal. During the course of treatment it is always advisable to
change the tape several times by cutting the knot off one end of
the old one, stitching the new one to it and drawing it through.

Collections of Pus in the Guttural Ponchcs. 97

Puncture of the pouch at its lozver part is a very simple opera-
tion when the accumulation of pus is abundant and chronic.
The distended pouch gravitates downward largely separating the
parotid from the deeper vessels and nerves, and finally fluctuates
toward the lower end of the gland. In extreme cases it even
opens and discharges. When fluctuation can be felt the sac may
be incised with a bistuory or abscess knife and treated like a com-
mon sore. Opening with a pointed or olive-shaped cautery has
the advantage of checking haemorrhage and securing more per-
fect drainage. When there is no fluctuation the incision must be
made just beneath the lower border of the parotid, the parotido-
auricularis being first cut through, then the gland dissected from
the deeper parts when the distended sac can usually be felt and
opened. If not felt at once it can easily be reached by a careful
dissection upward through the loose subparotidean connective
tissue, with the finger nail or handle of the scalpel. A free open-
ing may be made and the wound injected daily with a weak
antiseptic solution.

ABSCEvSS OF THE FAI,SE NOSTRIL.

In young horses as the result of injury from the bridle or
severe coryza, a circumscribed swelling sometimes appears on the
outer flap of the nostril, at first firm, hot and tender, with a sur-
rounding pasty infiltration, then forming into a tense elastic
ovoid mass, the size of a pigeon's or chicken's egg. It may be-
come chronic and remain for an indefinite period comparatively
insensible to touch and only slightly interfering with the move-
ments of the nostrils. As soon as the elastic tension betrays the
presence of pus it should be evacuated by a free incision made
from inside the nostrils and the wound plugged with medicated
tow and allowed to heal by granulation.

NEOPLASMS IN THE HORSE'S NOSE.

Nasal fibrous polj'pus, connection, form, size, bony distortion, obstructed
breathing, abrasion, ulceration, sloughing, sub-mucous polypus, structure,
degeneration. Symptoms, sneezing, snuffling, discharge, palpation, bony
swelling, tenderness. Treatment, forceps, hook, ecraseur, knife, saw.
Actinomycosis. Sarcoma, Carcinoma. Consistency, structure, fcetor,
glandular swelling. Treatment. Recurrence. Fatty tumors. Bony tu-
mors : cancellated or compact tissue, localized or extended. Cysts.
Strougyli. Angioma. Varicosity. Color, obstruction to breathing, haem-
orrhage, cicatrization.

These are cssentiall}- surgical diseases yet as they induce
Chronic Catarrh they may be profitably noticed here.

I. Fibrous Nasal Polypus. These are connected to the mu-
cosa by a pedicle or broad base, and vary in size from a pea to a
mass which fills the entire nasal chamber, projects from the nos-
trils and presses outward the septum and facial bones. At times
they weigh one or more pounds. They may cause whistling or
rattling in breathing, or may completely obstruct the passage of
air on the affected side. In time they may cause bulging or even
attenuation and perforation of the bony walls, projecting through
the hard palate or on the face. Sometimes the surface becomes
the seat of granulation, ulceration, or sloughing, causing more or
less foetor. The large polypi make their main growth forward
and backward, moulding themselves to the form of the chamber,
and displacing the turbinated bones. They commence to grow
under the mucous membrane and as they grow and become more
loosely attached they carry this as an outer covering and pedicle.
When incised they show a structure of interlacing bundles of fi-
bres, with cell elements more or less abundant, according to the
rapidity of growth. Gravitz found amyloid degeneration of the
walls of the blood vessels and mucous follicles and of the fibres.

Symptoms are difficult breathing, snuffling, a smaller cur-
rent of air on the affected .side, or none, sneezing, a watery, puru-
lent, bloody, or foetid discharge, and the appearance of the poly-
pus when the nasal chamber is examined in a good light. If be-
yond reach of vision the polypus may often be felt by the finger.
Care must be taken not to mistake the red, angry surface of the
.98

Neoplas)?is in the Horse's Nose. 99

turbinated bones in Catarrh for a polypus. If beyond the reach
of the finger, the flat sound on percussion of the nasal and frontal
bones on the affected side, and the persistently diminished flow
of air may serve for diagnosis. Tenderness shown on percussion
is common to this and abscess of the sinuses.

Treatment. The horse having been cast with the diseased side
uppermost and the head turned to the light, the tumor is seized
with the fingers, the forceps, or hook, and drawn gently outward.
The chain of the ecraseur may be passed over it and slowly tight-
ened upon the pedicle until it is cut through. This will usually
obviate any laceration of the turbinated bones and consequent
bleeding. In case of serious haemorrhage check by cold water,
ice, the actual cautery, or by plugging. Polypi with a broad base
may be removed with a prob-pointed knife, curved on the flat,
and furnished with a long handle. The mass is seized with a vul-
sella and detachment made by passing the knife with the concave
side toward the tumor. In cases where the tumor cannot be seen
or reached some have resorted to slitting up the outer wall of the
nostril as far as the angle of union of the nasal and maxillary
bones, care being taken to make the incision outside the upper
end of the cartilage of the ala nasi. If too high to be satisfactorily
reached in this way the nasal or frontal bone may be trephined
over the body of the tumor as indicated by the flatness on percus-
sion, and the operation performed through the opening thus made.

II. Actinomycosis. Though much more common in cattle
than horses, yet the occasional occurrence of this in the face of
the solipede must not pass unnoticed.

III. Sarcoma and Carcinoma. These are found growing
from the periosteum, or even starting in the cancellated tissue and
projecting into the nose, where they give rise to symptoms like
those of fibrous polypi. Being much softer in texture and more
liable to ulceration and degeneration they are likely to cause a
much more offensive discharge. There is also more tendency to
the implication of the submaxillary lymphatic glands. The only
treatment is surgical and recurrence is always to be feared. (See
Disea.ses of the Orbit.)

IV. Fatty Tumors of the nose are described by Roll and Gurlt
as existing on the septum and in the sinuses. Being simple, they
can be removed with great confidence as to nonrecurrence.

loo Veterinary Medicine.

V. Osseous Tumors of the Nasal walls. These are de-
scribed by Roll as osteophytes in the maxillary sinus in chronic
catarrh, and by Gamgeeas osteomata attached to the outer wall
of the nasal chamber, which had to be detached by saw and bone
forceps. I have found these latter of a soft porous structure easily
detached by the knife, and in other cases dense and requiring,
chisel, saw and forceps. In one instance the tumor grew from a
dense hypertrophy of the maxillary bone which could not be
entirely removed because the molar alveoli were implicated.

VI. Cysts named by Roll and others as present in the mucosa
of the ethmoid cells in solipedes often contain larva of the
strongylus armatus.

VII. Angioma may be but an exaggerated development of the
abundant venous plexus and erectile tissue on the surface of the
turbinated bones. There appears to be at other times an actual
increase of the vascular tissue. As might be expected it has no
abrupt margin, but gradually shades off into the healthy tissue.
The prominent centre has a bluish red or brownish hue. It ob-
structs breathing, is apt to bleed under violent exertions in
draught, or in contested races, and readily ulcerates with a bloody
discharge. If it subsides and heals, it is followed by a whitish
puckering like the so-called cicatrix of glanders.

CATARRH OF THE FRONTAI. SINUSES IN CATTI.E.
CATARRH FROM TRAUMATISM.

Extent of sinuses in cattle. Causes, blows, unequal teams, locking horns,
fracture. Pathology. Congestion, exudation, suppuration, swelling and
closure of outlet, prostration, fever, agalactia, septic infection, ulceration,
exclusion of oxygen. Symptoms. Crimson haemorrhage, disturbed breath-
ing, appetite, rumination, position of head and eyelids, percussion and
temperature of forehead, fever. Chronic form. Slow progress, emaciation,
anorexia, facial expression, hide, discharge, breath heavy or foetid. Dura-
tion. Prognosis. Lesions in sinuses and glands. Treatment. Cold irriga-
tion, icebags, elevation of head, laxatives, diuretics, dehorning, trephining,
injections, astringent, antiseptic, blister, tonics.

The gravity of this affection is a consequence of the great ex-
tent of the delicate mucous membrane which lines the frontal
sinus. This cavity not only occupies the whole forehead from
beneath the eyes up to the frontal crest, but extends, in the ma-
ture horned animal, into the tapering bony process which forms
the basis of support for the horn. The mucosa is rendered all
the more extensive by the numerous pillars and septa that pass
from the outer bony plate to the inner, giving great strength to
the part for purposes of offense and defence. Inflammation of
this membrane is usually the result of blows on the horns, and
these are much more common among working oxen than dairy
cows. The immediate cause is violent contact with the yoke
when the head is lowered at pasture, and from blows of a club in
the hands of the driver. In countries where the yoke is a broad
padded board hung from the horns and resting on the forehead
traumatic injuries are much more common. The active and vig-
orous animal gets the greater part of the work, and the wrench
and jar may induce haemorrhage and catarrh. If the yoke is ill-
made or badly fitted the case is worse. The blows sustained by
horn or forehead in an ordinary fight, may also be the cause, and
a partial or complete fracture of the bony support is especially
hurtful when the detached horn is replaced so as to close in the
cavity. Blows on the frontal crest are also dangerous.

^\\Q pathology of the disease consists in an inflammation of the
mucosa of the sinus, and the filling of that cavity with blood or,

lOI

I02 Vcierhiary Medicine.

later, with a muco-purulent fluid, the escape of which is prevented
by the closure of the nasal outlet by swelling. This of itself pro-
duces violent headache and much nervous disorder as witnessed
by the drooping head, closed eyelids, prostration, high fever,
anorexia, and in cows suppression of the milk secretion. But
there is reason to believe that this is aggravated by the septic
germs, which inspired with the air, were already present in the
sinus, and which in the comparative absence of oxygen, in a rich
culture medium and in contact with injured and debilitated tissues,
assume an enhanced pathogenic role. This may serve to explain
the ulceration of the mucosa of the sinus found in subjects that
have suffered for some time. It further explains the notorious
fact that the free access of air (oxygen) to the inflamed sinus is
one of the most helpful therapeutic measures.

Symptoms of the Acute Form. When the disease is traumatic
the first symptom is usually a haemorrhage from the nose, the
blood being of a bright crimson. Respiration is hurried, and ap-
petite diminished, yet rumination may be imperfectly performed.
The bleeding may be repeated for days in succession, but the ox
is still capable of work. On the fifth or sixth day there is com-
plete anorexia, rumination ceases, the head sinks resting on the
manger or soil, the ears droop forward and downward, and may
be swollen. The head inclines to the affected side, the corres-
ponding horn is intensely hot, and the eyes are closed. Light
percussion of the forehead on the affected side gives pain, and the
sound elicited is flat and dull as compared with that from the op-
posite side. The temperature of the body rises 2° or more, the
pulse becomes frequent, full and hard and the impulse of the
heart abnormally strong. Costiveness, partially suppressed and
high colored urine, and dry hot muzzle betray the fever. Unless
relieved the chronic form may supervene.

Symptoms op the chronic form. When this comes on
slowly, working oxen get emaciated, lose appetite, have the eyes
dull and sunken, and the lids drooping, the coat rough and star-
ing and the skin harsh, dry, and lacking in pliancy, the head is
carried low when out of the yoke and, after shaking the head and
sneezing, a glairy, slightly foetid matter escapes from the nostril.
The breath is foetid and appears to be offensive to adjacent cattle.

This may continue for months with no other change than a

Catarrh of the Frontal Simiscs in Cattle. 103

more constant nasal discharge, and increasing emaciation and
weakness.

Prognosis. This is favorable for the acute disease at the outset.
But if no relief is furnished it is liable to go on to a fatal issue.
Even the chronic form is curable unless the subject has alread}'
become hopelessh'- weak and debilitated.

In fatal cases the sinuses are found to be filled with a glairy
fluid and the mucosa thickened and raw or ulcerated. There
may be enlargment of the pharyngeal lymphatic glands, and there
may be attendant pharyngitis.

Treatment. The patient must have absolute rest and cold
water irrigation or icebags applied to the head. The bowels may
be opened by a saline, or a diuretic administered. If the head is
persistently dropped it may be kept moderately elevated by a
halter tied to a higher point. Should there be no relief at the end
of twenty-four hours, no time should be lost in securing free ad-
mission of air to the cavity. Cruzel advises to saw off the horn
at its base, as the one certain method of securing prompt improve-
ment and speedy recovery. If a horn and its bony support have
been broken off the}' should be at once removed and the head
turned up to evacuate the accumulated glairy fluid from the sinus.
From an apparently hopeless condition a few hours will suffice to
restore an appearance of good health. If the horn has not been
broken and it is desirable to save it, the bone may be trephined
in front of the root of the horn and the liquid evacuated, or less
effectively and more painfully the horn may be bored at its root
by a large gimlet.

If no haemorrhage has taken place and if active treatment has
been adopted at the outset recovery may be complete in two or
three days, but if the disease has been ushered in by a haem-
orrhage which recurs several days in succession, amputation of
the horn or trephining will be demanded. In chronic cases this
should be followed by astringent and antiseptic injections and a
blister may be applied to the throat or the side of the neck. In
these cases too a course of mineral tonics is desirable.

CHRONIC CATARRH OF CATTLE.

Catarrh, chronic, summer aggravation, thickened, roughened, mucosa,
discharge, twigs in nose. Question of parasitism. Treatment, remove
causes, antiseptic astringents.

A remarkable form of chronic catarrh with summer aggrava-
tion exists in some of the hilly districts of New York but has not
received such study as to enable us to .state its true nature.

One or two in a large herd will have a loud snuffling breathing,
which ma}^ subside so as to be entirely overlooked in winter, but
reappears when put to pasture in the spring and continues in a
marked form throughout the warm weather and until after the
animal is returned to winter quarters. There appears to be little
or no fever nor constitutional disturbance except what comes from
the obstructed breathing, and the yield of milk may be unchanged.
The symptoms would indicate a purely local disease. Yet so few
are attacked out of a herd that it cannot be actively contagious.

On close examination the nasal chambers are found to be nar-
rowed, there is manifest thickening of the mucosa, and its sur-
face feels rough and uneven, with miliarv elevations. There is
of course more or less glairy discharge. If the examination is
made about midsummer, the finger introduced into the nose will
usually detect the ends of twigs that have been introduced into
the cavity and broken off. When withdrawn these may prove
individually from four to eight inches long, and some force may
be required to extract them. In winter these are often absent,
having been apparently dropped one by one. The absence of
these sources of irritation sufficiently accounts for the manifest
improvement during the colder months. In spite however of the
wdnter remissions the disease tends to a steady advance year
by year. While nothing definite is known of its pathology, the
occurrence of this disease in given localities, its manifestly local
natttre, and its persistence wdien once established would suggest
enquiry as to the possible exi.stence of parasitism, bacteridian or
otherwise.

Until further discovery treatment can only be of a general na-
ture. Removal of the foreign bodies from the no.se, pasturage
where there is no brush to replace them, soiling when clean pas-
tures cannot be found, and the use of astringent and antiseptic
agents by insufflation or injection would be indicated.
104

MALIGNANT CATARRH OF CATTLE.

Local causes. Debilitation. Polluted air. Poor diet. vSymptoms, gas-
trointestinal, fever, lacryniation, turbid aqueous, photophobia, congestion
of mucosse, generally disturbed circulation, breathing, depression, heat of
forehead, buccal petechite, epithelial desquamation, abrasions, ulcers, abor-
tion, albuminuria, local swellings, shedding of horns, dropsy, dyspnoea.
Lesions, in nasal mucosa, subcutem, cerebral, dark blood. Prognosis.
Treatment, antiphlogistic, laxative, diuretic, tonic, locally steam, antisep-
tic, astringent, trephining.

This disease occurs chiefly in cold damp n.arshy localities where
the vital power is impaired or in cold situations exposed to severe
north and east winds. In the wet cold seasons of spring and
autumn it is especially prevalent. According to RycJmcrW. rarely
attacks old cows but prevails among young cows and oxen. In
the south of France on the contrary it appears chiefly in the hot
season (June and July) and is attributed to suppressed transpira-
tion. It prevails especially however in herds kept in small filthy
stables, low in the roof, hot, close and badly aired. (Festal).
In New York it appears in cattle on black muck pastures and in
Minnesota on the dried up ponds.

Symptoms. Diarrhoea is a common premonitory symptom aris-
ing from the irritation of the intestinal canal as it is soon followed
by some degree of costiveness, the dung becoming dark colored,
firm and scanty. Diarrhoea reappears later. The coat stares or
the beast actually shivers ; the head is depressed ; the roots of
the horns and the forehead are hot ; the eyes are sunken, swollen
and red, suffused with tears, turbid in their anterior chamber
(aqueous humor) and intolerant of light ; The muzzle dry and
hot ; the mouth hot but moist with abundant saliva ; the mucous
membranes of the mouth, nose and vagina have a bluish red color ;
the pulse is rapid and more or less full or hard ; impulse of the
heart weak ; the breathing is accelerated, the respiratory sound is
heightened in intensity and a cough is frequent. Temperature
104° to 107° F. The urine is scanty and high colored. The
surface of the body is alternately hot and cold, and after some
time a watery fluid begins to distil from the nose.

At the end of twenty-four hours the symptoms are intensified

105

io6 Vcteritiary Medicijie.

or altered. The eyelids are more swollen and the flow of tears
more profuse ; the nasal discharge becomes slimy, and streaked
with blood, and accumulations take place in the frontal sinuses as
indicated bj^ the increasing heat of the forehead and the dullness
on percussion. In the mouth appear dark red spots, from blood
extrava.sation, over which the epithelium sloughs off leaving raw
unhealthy .sores. The appetite entirel}^ fails ; dung and urine are
passed painfully and with effort, and abortion frequently takes
place in pregnant cows. The urine is albuminous with cell forms,
and casts. The limbs appear rigid and it pains the animal to move.

From the fourth to the .sixth day the ulceration appears on the
mucous membrane of the no.se which has often a claret color, and
the nasal di.scharge becomes again more watery and irritating.
The muzzle is swollen and a dropsical infiltration appears beneath
the jaws which extends along the neck to beneath the thorax and
into the limbs. Portions of the nasal mucous membrane now
.slough off, and similar sloughs are often seen on the skin of
different parts of the body ; the .secreting structures of the horns
and hoofs even participating so that tlie.se are ea.sily detached or
.shed. Saliva flows profu-selj- from the lips, a fetid watery
diarrhoea succeeds the con.stipation, the drop.sy becomes nearly
general and death occurs on the eighth, ninth or tenth day of the
illness. Convulsions and .symptoms of suffocation may precede
death.

In a post mortevi section the principal lesions are found in the
nasal cavities and .skin. The areolar tissue in both is the seat of
an abundant serous infiltration, which has taken place into the
deeper layers of the .skin as well, rendering it thick, hard and
unyielding. Besides the sloughs and ulcerations on the skin and
mucous membranes, false membranes have been met with, on the
lining membrane of the mouth and air passages. The ulcers in
the no.se have in many cases reached the bone, and from the
abundant infiltration and softening, the membrane is easily
stripped from the walls of this cavity and of the sinuses. The
general infiltration appears to have reached the brain, which is
described as softened and having an undue amount of liquid in
its cavities. The blood contained in the vessels is dark colored
and numerous patches of extravasation are visible on the mucous
and .serous membranes as well as in the interior of organs.

Malii^nant Catarrh of Cattle. 107

Unless the malady can be controlled in its early stages it usually
proves fatal. Patients that recover after it has been well devel-
oped at times retain its effects in permanent blindness or palsy of
the hind limbs.

Treatment. Barly and vigorous antiphlogistic measures are
strongly recommended by French and Italian veterinarians.
Gelle and Ercolani advocate the most copious bleedings. Festal
insists that all other measures are useless when this is neglected.
Before adopting free .sanguineous depletion the history of his
practice was a record of deaths, whereas later his losses were in
cases where from a failure to recognize the disease at the outset,
from the exi.stence of diarrhoea, from the patient being pregnant
or from a fear that the milking properties might be impaired,
bleeding was deferred. He pushed the bleeding to the extent of
causing acceleration of pulse, quickened breathing and heaving
of the flanks, to effect which sixteen pounds had to be abstracted
on an average. If this were done early the engorgement of the
muzzle had usually greatly diminished if not entirely disappeared
in the course of seven or eight hours thereafter. The alleged
benefit is probably largely due to elimination.

Less heroic treatment is now generally adopted. An active
purgative (one and a half pounds Epsom salts) may be given
even though apparently contraindicated by the premonitory
diarrhoea, and a further useful derivation may be obtained by
applying active friction or even .stimulating embrocations to the
legs.

Steam with or without sulphur dioxide may be inhaled as for
ordinary eoryza and cold water or ice kept applied to the forehead.

Nitre in ounce do.ses daily or liquor of the acetate of ammonia
in three ounce doses may be given after the purging has ceased.
Or drachm do.ses of hydrochloric acid with bitters may be given
thrice a day in at least a pint of water.

Where the na.sal discharge persists after the .subsidence of the
other .symptoms the sinu.se should be trephined in front of the
horn, and tepid water and mild a.stringent and antiseptic lotions
injected until a healthy action has been established. Change to
a dry, well drained pasture or building is desirable for both treat-
ment and prevention.

CONTAGIOUS DISEASES OF THE NOSE.

The.se are omitted here to be treated under that heading.

PARASITIC DISEASES OF THE NOSE.

Among these may be named :

LEECH BITES.

Form of wound, leeches in posterior nares, discharge of blood, mucus,
sneezing, snorting, dysphagia, anorexia, unthriftiness, ansemia. Treat-
ment, removal, sodium chloride, tar fumes, ether on sponge.

Though it more commonly attacks the mouth and hps yet the
leech (Hirudo Decora) will sometimes fasten itself inside the
nose when that is plunged in water. Its bite is to be recognized
by its triangular shape. When taken in by the mouth it may
fasten itself in the posterior nares where it is difflcult to recognize
its presence. In the anterior nares it can be readily discovered
and removed, but in the posterior nares it may maintain its hold
indefinitely. There appear in the nasal discharge streaks or clots
of blood which may also show at the corners of the mouth.
Sneezing, snorting, and difficulty of deglutition, may draw atten-
tion to the trouble, and in protracted cases signs of anaemia, in-
appetence, unthriftiness and general weakness. The most
effective treatment is to remove the leech with the fingers, but as
they cannot always be reached in this way, an injection of a
strong solution of common salt may be used. Blaise succeeded
by burning tar under the nose twice a day, and Louvigny by in-
troducing a staff bearing a sponge soaked in ether.

COCCIDIAN CATARRH IN RABBITS.

Coccidia in rabbit's nose, etc., inflammation, fatality. Treatment, sul-
phur dioxide.

Zurn describes a contagious catarrh of rabbits caused by the
presence in the mucosa of the nose, pharynx, Eustachian tubes
and middle ears. of myriads of coccidia. They create acute irrita-
tion and prove fatal in many cases. Embedded in the mucosa
they are difficult to reach with medicinal agents, yet the free para-
sites may be destroyed by frequent fumigations with sulphtirous
acid, or by spraying or injecting the nose with its solution.
1 08

IvARVA OF CEvSTRUS OVIS (GRUB) IN THE NASAL
SINUSES OF SHEEP.

Season of attack by fly, bibernation, botfly of sheep, mode of attack,
embryo, defensive acts of sheep, habitat of larva, mature larva, its exit,
chrysalis in soil, its transformation. Symptoms, sneezing, snuffling, rub-
bing of nose, lachrymation, unsteadiness, discharge, respiratory digestive
and febrile disturbances, emaciation, septic action. Lesions, larva, conges-
tions of mucosa, brain. Treatment, warmth, errhiue, parasiticides, mechan-
ical extractors, trephining, injections. Prevention, newly turned furrow,
quicklime, tar. Other larva in nose.

Sheep are especially subject to the attacks, in summer and
autumn and in warm sunny barns even in winter, of the CEstrus
(Cephalemia) Ovis, the larva of which hibernates in the na.sal
sinuses or ttirbinated bones.

The sheep-bot-fly is only about four lines in length, of a light
yellowish or slightly brownish gray hue, hairy, with dull black
transverse lines on the upper surface of the thorax, and a lighter
color on the abdomen where the black lines are more broken.
The transparent, colorless wings extend beyond the bod}- : wing-
lets are long and cover the poisers : abdomen is formed of five
rings.

They appear during the whole summer hiding away in walls,
stumps and grass, unless when pairing or pursuing the sheep to
deposit their young. The mode of attack is difficult to follow on
account of the small size, gray color and rapid flight of the fly and
fear and .shyness of the sheep. It cannot be doubted, however,
that they approach and drop on the margin of the nostril, the
larva previously hatched from the egg. The old authors describe
the deposition of the egg on the margin of the nostril and its
prompt hatching by the animal heat, but the observations of
Brown, Kelly, Cockrill, Riley aud Ormerod abundantly prove
that the fly is viviparous. Cockrill obtained no less than 300 live
hatched larvae from one fly caught while pursuing a sheep.

The sheep seek to avoid the fly by resorting to dry dusty roads
where they lie with the nose clo.se to the ground, or they .stand
with the nose close to the soil and between their fore legs. At
109

no Veterinary Medicine.

other times they will collect in a dense phalanx with their heads
directed toward the centre of the mass and held low so that the
fly cannot reach them. The moment the fly touches the nose they
shake the head, stamp with the feet, and gallop off with the nose
close to the ground, looking from side to side to see if the fly pur-
sues and frequently smelling at the grass as if apprehensive of
other flies hidden there. If such appear they instantly turn and
scamper to other parts of the field or take refuge in a dry dusty
place or gravel bank.

The young larva when deposited on the nostril speedily makes
its way up and takes refuge in the cavities of the turbinated bones
and the frontal and maxillary sinuses, where it passes the winter
feeding on the mucus and the purulent discharges determined b}'
its presence. When mature it leaves the nose and assumes the
chrysalis form in the soil.

The mature larva is narrow anteriorly, broad behind : its
upper surface is prominent and rounded, lower surface fiat, and
furnished at the anterior of each ring after the third, with a series of
pointed tubercles or spines : the cephalic end bears the buccal or-
gans directed downward, and bearing two great hooks connected
with the hard framework of the pharynx and recurved downward,
backward and outward ; mouth small ; antennae thick and short
placed above the buccal organs : the inferior part of the last ring
projects beyond the upper portion and is furnished with two
nodules with intervening spines : pentagonal patches of stigmata
on the last ring : very small anterior stigmata between the first
and second rings. The color is white with brown spines, stig-
mata and transverse striae. Length seven lines to one inch.

When dropped from the nostril in the course of summer they
pass into chrysalis in one or two days ; and after a residence of six
or eight weeks in the soil emerge as the perfect fly.

Morbid Symptoms Caused by the Larvae in the Head.
Grub in the Head. These bear a close relation to the number
of larvae present. If there are only two or three no trouble may
result. If many there is muco-purulent discharge from the nose,
sniffling breathing, frequent sneezing and snorting expelling mu-
cus and even blood ; shaking of the head ; rubbing of the nose
on the fore legs or other objects ; weeping eyes ; and occasional
unsteadiness of the gait.

Larva of CEstrus Oris in the Nasal Sinuses of Sheep. 1 1 1

In the worst cases the respiration becomes sighing, wheezing or
even snoring ; the mouth open ; head pendent ; appetite fails ;
a dull, apathetic condition ensues with grinding of the teeth roll-
ing of the eyes, and, rapidly advancing emaciation.

Fatal cases are not uncommon but most frequently the larvae
reaching maturity are dropped and health is promptly re-estab-
lished. Septic poisoning from decomposition of dead larvae and
debris is a dangerous complication.

Lesions. These consist in the presence of the larvae in the
sinuses, with violently congested, purple ulcerated mucous mem-
branes and collections of pus. The mere presence of the grub
is not conclusive as the majority of the sheep harbor two or three
from October to June.

Treatment. It is advised to place the sheep in a warm building
to encourage the parasites to come out of their recesses and then
introduce some agent to destroy them or to induce their expul-
sion by sneezing. The value of the hot building is probably
hypothetical unless the larvae are approaching maturity. The
following agents are used : — moderately strong solutions of salt,
vinegar, carbolic acid, creo.sote (i part to loo parts of water), or
carbonate of ammonia, lime water, snuff, or even such irritants as
quick lime, oil of turpentine or hellebore. These last must be
used with caution as they are liable to induce fatal inflammation
of the air passages though no larva is present.

By passing a feather up the nostril twisting it round and then
\Vithdrawing it some grubs can usually be withdrawn and there
is no harm in first dipping the feather in some of the milder
agents mentioned above. But the larvae in the sinuses can never
be reached in this way.

In dangerous cases it is best to trephine the outer plate of bone
covering the frontal sinuse and wash out freely with tepid water,
lime water, or benzine. The operation may be performed close
in front of the root of the horn if there is one, or to the inner side
of the lower part of the eye if there is not. A semi-circular flap
of skin is to be turned upward and backward sufficiently large
to allow the use of a trephine \ inch in diameter, which is to be
used as for Qcnurus Cerebralis. The opening being made the
sinuse is to be syringed freely for some time until the parasites

I r 2 Veterinary Medicine.

come from the nose in the stream of Hquid. The wound heals
very prompth'. In the absence of a trephine use a gimlet.

Prevention. Some turn up a furrow in the pasturage, in which
the sheep may burrow their noses and evade the fly, others lay
down quicklime in covered boxes which has the further advant-
age of inducing sneezing and favoring expulsion of the entering
parasites. But perhaps the best plan is to procure a log and bore
a number of holes in it with a two inch augnr ; place salt in the
holes and smear their margins with tar, and renew it often. The
sheep then takes a protective dressing with every lick of salt.

CEstrus Purpureus (Brauer) is a species which infest the nose,
etc., of the Syrian sheep, and Cephalemia Maculata (Wedl)
one which infests the nasal chambers of the Egyptian buffalo and
camel.

NASAIv CATARRH IN DOG AND HORSE FROM LIN-

GUATAIvA (PENTASTOMA) TAENIOIDES.

RHINARIA TAENIOIDES.

Form. Family. Habitat when mature, and immature. Development.
Symptoms, sneezing, discharge, irritability, ill-temper, shaking the head,
rubbing nose, parasites in discharge. Treatment, injections, trephining.
Prevention.

This parasite has a worm-like body, but is closely allied to the
mites and belongs to the Arachnida. It differs from the mite in
having but four short limbs retractile and protractile and fur-
nished with sharp claws. The body is thickest toward the ante-
rior end and prolonged and narrow posteriori}^ ; marked by about
90 rings ; head rounded off abruptly, mouth broadly open, with
a horny lip ; integument with numerous openings or stigmata
(respiratory) ; male 7 lines long by a line broad in its anterior
part genital orifice on the front part of the abdomen in the median
line ; female 3 to 4 inches long, by 3 or 4 lines broad anteriorly ;
genital opening at the end of the tail. Reprodiictio7i oviparous.

Habitat. Nasal chambers and sinuses of the dog, wolf, goat,
and horse.

Pentastoma De7iticulata. The young partially developed P.
Taenioides. Has all the rings except the two first, garnished with
fine sharp recurved spines ; legs more slender with accessory
booklets ; length 2 lines ; breadth \ line.

Habitat. Cysts in the lungs, liver, mesenteric glands, etc. , of
the hare, porpoise, goat, sheep and other mammals, not excepting
man.

Development. Eeuckart found that the adult Pentastomata
copulate in the nasal chambers, as many as half a million of eggs
being fertilized in a single female ; that these eggs are discharged
with the nasal mucus and falling on vegetables are taken in by
herbivora ; their shells are digested and destroyed in the stomach,
and the liberated embryos perforate the intestinal walls and en-
cyst themselves in various organs. The encysted embryo varies
from -lo to -^ inch in length, is rounded and blunt anteriorly but
very thin posteriorly with the tail slightly curved toward the ven-
tral aspect. It is several months before the feet, cutaneous spine
and generative organs are developed, and during this period it
8 113

114 Vetermary Medicine.

undergoes several moultings. Finall}- it leaves its cj'st and ma\'
live free in the cavities in the body of its host, and if it does not
escape from the body it finally constructs a new cyst and then
dies. If the host is eaten by a carnivorous animal the liberated
pentastomata reach the nose either from the lips or pharynx and
in a few months more acquire their complete development. They
must reach the nose of the horse by their presence in the food or
water.

Symptoms Caused by the Pentastoma. No morbid symptoms
have been traced to the young encysted condition of the parasite.
Yet it would not be surprising if their presence in large numbers
in the mesentric glands and liver should give rise to troubles of
assimilation, sanguification, biliary secretion and the like. Fre-
richs says they are more common in the human liver in Germany
than echinococcus, but adds that they have no clinical importance.

In their mature condition however they cause considerable irri-
tation and nasal discharge when present in large numbers. In
dogs there is running from the nose the discharge containing an
abundance of the ova, restless, fretful habits, sometimes a mor-
bid readiness to bite, frequent shaking of the head and rubbing
of the face.

The treatmetit would be to trephine the sinuses and inject lo-
tions impregnated with creosote, carbolic acid or naphtha. From
the danger to man of becoming infested it is important to ascer-
tain the true nature of any nasal discharge of the dog especially
in countries like Germany and Egypt in which this parasite is
common.

Prevention . Deny raw offal of herbivora to dogs.

AFFECTIONS OF THE THROAT.

Sore throat, Angina, Cynanche — is a generic name applied to a
series of inflammatory affections of the various structures about
the throat. If the larynx is specially inflamed the disease is
known 2i's, laryngitis, if \\\^ phary7ix , as pharyngitis, if there are
exudations forming false membranes it is croupous or diphtheritic,
or if associated with some general febrile affection, it takes its
name accordingl}-, influenza, strangles, distemper, or scarlatina,
as the case may be.

I.ARYNGITIS IN THE HORSE.

ANGINA LARYNGITIS, CYNANCHE LARYNGEA, ETC.

Causes, mechanical, cold, irritants, extension, diet, close stables, infec-
tious disease. Symptoms of acute form, head extended, throat swollen,
tender larynx, cough, in early stage, after exudation, wheezing in inspira-
tion, dysphagia, fever, oedena glottidis, spasms, dyspnoea, successive dis-
charges. Lesions, tumefaction, softening, friability, redness (ramified or
not), erosions of mucosa, oedema. Course, duration, sequelae, cough,
roaring. Subacute form, chronic form, in old debilitated animals, in those
reined too tightly, in those which perspire with difficulty or bear heavy
coats. Symptoms, local, in breathing, cough, effect of cold air, or water or
of dust. Sequelae, ossified cartilages, roaring, emphysema, bronchiectasis.
Treatment, hygienic, soothing, sheepskin, compress, poultice, mustard,
sulphur dioxide, laxative, neutral salts, expectorant, sedative, derivative,
tracheotomy, vpith trochar and cannula, with scalpel, tracheotomy tubes.
Insufflation, injection. In chronic laryngitis, electuaries, mustard, deriva-
tives, astringents, caustics, tonic inhalations.

Causes. These are the ordinary causes of chest diseases. As
special causes may be noted severe compression of the larynx as
in roughly and repeatedly coughing an animal ; the sudden con-
tact of piercing cold air, of irritant gases, powders or liquids
with the membrane, and the rapid, forcible and continuous cur-
rent of condensed air through the glottis during severe exertion.

Among the general causes the most fruitful are the high feed-
ing, hot, close stables, heats and chills, and other circumstances
attendant on domestication. L,aryngitis may be an extension
from coryza, pharyngitis, bronchitis or pneumonia. It may
further be but a local manifestation of influenza or strangles,
contagious pneumonia, etc. The disease is acute, sicbacute, or
chronic.

Symptoms of acute fonn. All acquainted with horses can
recognize the general symptoms of sore throat. The nose is
elevated and protruded to avoid compression of the larynx ; it is
carried stif9.y for the sama reason. There is some swelling around
the throat or beneath the root of the ears. If the cartilages of
the larynx are compressed between the finger and thumb, or if
pressure is made in the median line below upon the connecting
115

Ii6 Veterinary Medicine.

crico-thyroid membrane the patient instantly coughs and throws
up the head to avoid a repetition of the suffering. This tender-
ness of the larynx to touch is peculiar to laryngitis and serves to
distinguish it from pharyngitis. The cough is at first very hard
and painful and only gives way to a soft mucous type when a free
mucous exudation puts an end to the tense, thickened and dry
state of the mucous membrane. The inspiratory act is accom-
panied by a whistling or deep bass sound, particularly after the
slightest exertion. This may be heard at times during expiration
as well, though not invariably so. Sometimes the animal drops
the food from his mouth after mastication, because of the pain
attendant on swallowing, but this is really a symptom of coexist-
ing pharyngitis, and its absence implies the nonexistence of that
complication. There is usually a slight pasty swelling between
the branches of the lower jaw.

There are besides the general symptoms of fever more or less
marked, such as increased temperature, accelerated pulse, red in-
jected eyes and nose, slightly hastened breathing, the expiration
being effected by a double lifting of the flank as in broken wind,
etc.

In two or three days in favorable cases exudation takes place
from the mucous membrane, the cough becomes softer and less
frequent, the local tenderness decreases and the general symptoms
subside.

If otherwise the symptoms may become more intense, and
breathing may get loud and difficult in connection with thicken-
ing and rigidity of the mucous membrane, or a serous exudation
into it and beneath it (oedema glottidis) which by closing the
glottis renders breathing almost impossible. The same distress-
ing symptoms may arise from spasm of the larynx excited by the
inflammatory action. As arising from thickening or infiltration
of the membrane these symptoms may come on comparatively
slowly, but in the case of spasm they appear suddenly and have
periods of intermission, reappearing • on succeeding days and
usually at the earlier part of the night. In such circumstances
the loud, noisy breathing is heard at a considerable distance, the
horse stands obstinately .still, the fore feet apart, his elbows turned
out to allow a firm action of the chest, the flanks working
laboriously, the head low, the nose protruded, the nostrils widely

Laryngitis in the Horse. 117

dilated, the mouth open, the eyes standing out from their sockets
red and wild looking, and the face constrained and pinched, the
whole expression being that of intense agony from impending
suffocation.

Lesions. In cases where death has supervened, perhaps in
connection with another disease, the laryngeal mucosa, especially
on and above the glottis, is soft, tumid, friable, with ramified or
uniform redness and petechial spots. The epithelial layer may
be softened, disintegrated and shed, leaving pointed or larger
erosions, which are, however, usually superficial. In case of
oedema glottidis the mucosa and submucosa are thickened by an
abundant exudate which may extend to the connective tissue out-
side the larynx as well. In aggravated cases there may be dark
red or brownish red discolorations of the mucosa.

Course, Duration. Fortunately these aggravated forms of the
disease are rare and unless the patient perishes during such an
attack or the inflammation extends down toward the chest,
laryngitis rarely proves fatal. Its duration is from twelve to
fifteen days. Its extension to the lungs may be suspected when
the extreme tenderness of the throat subsides without any corres-
ponding improvement in the health. Examination of the chest
will then rarely fail to detect the presence of disease.

But although sore throat is rarely fatal its effects are not unim-
portant nor trivial. It occasionally merges into a chronic form,
with a hacking cough, tenderness to pressure and an increased
liability to other diseases of the air passages. More frequently
it is followed by wasting and fatty degeneration of the larj^ngeal
mu.scles and the horse becomes a confirmed roarer. In all cases
it leaves a greater susceptibility to a second attack.

Sub-acute Laryngitis. This form has been chiefly seen in
young animals and up to eight years old. At the outset its symp-
toms are moderate but as it is usually associated with serous effu-
sions in and around the mucous membrane the symptoms above
mentioned as indicating imminent danger of suffocation may sudden-
ly appear and life can only be preserved by opening the trachea.

Chronic Laryngitis. This maj^ follow the acute form or it
may come on independently and by slow degrees. It may ac-
company nasal catarrh, or chronic bronchitis. Old animals
which have had heavy draught work and repeated attacks of sore

Ii8 Veterinary Medicine.

throat, are frequent subjects of it, and as Fergusson has
pointed out it is most prevalent among horses whose throats have
been compressed by the inconsiderate use of the bearing rein.
Reynal has observed it often in horses that are sweated with diffi-
culty, and in those which remain long wet from the length and
thickness of their winter coats.

Symptoms. When acute laryngitis passes into the chronic form
all the symptoms subside except a slight nasal discharge, the
cough, tenderness of the larnyx, and roaring. The cough is
dry, short, and hacking, rarely soft, and is heard mainly when
the animal feeds, when he leaves the hot stable for the cold air,
and after drinking cold water. During exercise, it is equally ex-
cited, the cough becoming harder, and the horse extending his
head and neck as if to disengage some body from its throat. The
subject may in nearly all other respects maintain the appearance
of vigorous health.

CoTirse, etc. This disease is liable to prove obstinate and if of
old standing, often incurable. Unless checked, the continued con-
gestion and irritation of the larynx, the frequent, hacking cough,
and the consequent violent distension of the lungs bring about ex-
tensive and irreparable structural changes. Among these may
be mentioned ossification of the cartilages of the larnyx ; paraly-
sis of the left laryngeal nerve with wasting of the muscles to which
it is distributed, and roari^ig ; dilatation of the bronchial tubes,
and permanent distension and rupture of the air cells (emphyse-
ma, broken wind, heaves).

Treatment. Aatte form. Unless in the very mildest cases un-
accompanied by fever, repose is essential. If available, a roomy,
clean, dry, and airy loose box should be allowed, care being taken
to avoid draughts of cold air and to secure a soft equable temper-
ature neither too hot nor too cold. Blankets should be used and
even flannel bandages applied loo.sely to the legs if the weather is
cold, or, if there is any tendency to chills and shivering. The
nostrils must be steamed as directed iox coryza. A piece of sheep-
skin with the wool turned in may be tied around the throat and
up to the ears. In very acute cases a linseed meal poultice or
wet pack may be applied to the throat, while in the milder forms,
a mustard poultice or a lotion of Spanish flies or other stimulant
may be employed. Unless the malady has an epizootic type, with

Laryngitis in the Horse. irg

prostration and a weak, rapid pulse, the bowels may be opened
by a laxative (3 or 4 drachms, aloes), and the water or gruel the
animal daily drinks should contain j4 to 1 ounce nitre. As an
expectorant the patient may take salammoniac i oz. daily in the
drinking water, or this agent may be evaporated from a clean
chafing dish every two hours and inhaled. Or he may take car-
bonate of potash or soda, or iodide of potassium. If the cough is
troublesome, half a drachm of Dover's powder may be given thrice
a day or i grain chloride of apomorphine ever}'- hour. Bromide
of potassium or sodium may also be resorted to. Inhalations or
spray of sulphurous acid, or vapor of oil of turpentine and insuf-
flations of calomel may benefit as local applications. The diet
must be confined to sloppy bran mashes, cut roots, or boiled bar-
ley, or oats. Hay should be withheld in the more acute cases un-
til improvement appears. Under treatment such as the above and
even without the medicinal part of it, the great majority of cases
will do well.

In cases attended with high fever with strong full pulse and
bright red nasal membrane, the purgatives and diuretics are espec-
ially called for, and the former should have their action encour-
aged by frequent hot water injections. Twenty drop doses of the
tincture of aconite repeated four times a day, or ten drops every
three hours, will be further useful.

When the symptoms are of such a type as portend the access of
paroxysms of threatened suffocation, bleeding has been strongly
recommended, but unless resorted to in the first twenty-four or
forty-eight hours is rarely admissible. Also in weakened constitu-
tions and when the fever is of a low type, with small, weak pulse
and general dullness and prostration, the temporary relief obtain-
able from blood-letting will not often counterbalance the danger of
increasing weakness, and the loss of recuperative power. In all
such cases the application of a strong mustard poultice for several
hours in succession, until an abundant effusion has taken place,
into the skin and beneath it, has often the best effect by virtue of
its depletive and derivative action. Active friction of the limbs
to improve their circulation and increase their temperature is also
useful.

Tracheotomy. When suffocation becomes imminent not a
moment mu.st be lost in performing tiacheotomy. This operation

I20 Veterinary Medicine.

is always available in threatened suffocation from obstruction to
the passage of air in the nostrils and throat.

Different methods of opening the windpipe have been resorted
to. One is by means of a cannula and trochar at least three-fourths
of an inch in diameter and about five inches long and with two
large oval orifices in the middle of the cannula, and on opposite
sides. This is made to transfix the windpipe with its investing
skin and muscles from side to side in the middle of the neck, care
being taken to pass it in the interval between two adjacent carti-
laginous rings. The trochar is now withdrawn and the orifice
in the cannula corresponding to the interior of the windpipe, the
animal is enabled to breath freely through the tube. The can-
nula has only then to be secured in its place by a tape carried round
the neck.

The more common plan is by introducing a tube through a circu-
lar opening made in the trachea. For this operation are needed,
sissors, knife with a thin narrow blade, needle and thread, and
tracheotomy tube. The common tube is about an inch in di-
ameter, four to five inches long bent upon itself so as to fit into
the trachea, and furnished with a flat shield to slits in which cords
may be attached to fix it in its place. A second variety is only
long enough to reach into the windpipe. It is provided with a
flattened shield externally and from its inner extremity projects
downwards at right angles a plate curved so as to adapt it to the
form of the interior of the trachea. There is an additional plate
to fit into the upper part of the tube, provided with two lips pro-
jecting from it at right angles ; the outer lip is screwed to the
shield after the tube has been introduced into the wind pipe and
the inner lip is thus fixed inside the ring of the trachea, immedi-
ately above the opening and effectually prevents any displacement
of the tube.

In operating the animal is kept standing with the head as nearly
as possible in the natural position. The hair is removed from the
skin beneath the windpipe between the middle and upper thirds
of the neck. The skin having been rendered tense, (without dis-
placement) by the fingers and thumb of the left hand, an incision
is made in the median line from above downwards, for about two
inches and is carried through the muscles so as to expose two
rings of the trachea. The needle and thread are passed through

Lary7igitis in the Horse. 121

the membrane connecting the two rings, and with the knife a
semicircular piece of cartilage is cut from each of the two adjacent
rings. The thread in the connecting membrane prevents them
from being drawn in by the rush of air. It only remains to intro-
duce the tube and fix it in position.

Not only does tracheotomy obviate immediate danger of suffoca-
tion, but by removing the source of irritation in the continuous
and forcible rush of air through the narrowed and inflamed tube,
and in securing for the blood a freer aeration and a purer consti-
tution it often induces a rapid change for the better ia the charac-
ter of the inflammatory action. The wound may be daily cleansed
and dressed with sodium hyposulphite.

Some veterinarians following the example of Bretonneau and
Trousseau have treated sore throat from the first by what is called
the abortive treatment. For this purpose a long whalebone prob
with a pledget of tow firmly attached to its end and covered with
powdered alum is introduced through the mouth into the pharynx
and larynx even. Violent paroxysms of coughing are induced,
but cures are affected in from two to five days. Under Delafond's
treatment calves and foals recovered in twenty-four hours. A
more modern method is to inject a solution by means of a hypo-
dermic syringe inserted between the upper rings of the trachea.

Milder treatment such as the inhalation for an hour several
times a day, of the fumes of burning sulphur and water vapor
will be found generally successful. The air should be impreg-
nated with sulphur fumes only so far as can be breathed without
inducing coughing on the part of the patient. Such measures
should not divert attention from the necessity for general care, a
control of diet, clothing, air, the state of the bowels, nor from
local external applications to the throat.

Treatment of Chronic Laryngitis. The patient should have
a loose airy box with an equable temperature. The avoidance of
work and exposure must be sought for the time. Green food,
cut roots, boiled grain, or bran mashes, with little or no hay, or
other dry food, must be given. The bowels must be regulated.
An electuary compound of linseed meal, molasses, and a drachm of
belladonna extract to every tablespoonful of the mixture, may be
given to the extent of a tablespoon ful smeared on the inner side
of the cheek twice daily. A mustard poultice to the throat has

122 Veterinary MediciJie.

often a good effect. Light firing over the lar^-nx is sometimes
beneficial.

If secretion is defective and cough hard and dry chloride of
ammonium, carbonates or bicarbonates of soda, potash or ammon-
ium or borax, in solution or in gaseous form, may be given, the
various bitters being at the same time drawn upon as tonics. If
secretion is excessive, with a loose gurgling cough, astringents are
indicated like ferric sulphate or chloride, (^ dr.), or they may
be applied as spray : alum or iron alum five grains to the ounce,
zinc .sulphate or sulphocarbolate two grains to the ounce, .silver
nitrate one-half grain to the ounce. These may be introduced
through the nose with the head elevated, or in small genera
through the fauces. Tar, oil of tupentine, creosote, carbolic acid
or eucalyptol may be inhaled from hot water.

PHARYNGO— LARYNGITIS IN CATTLE.

Susceptibility. Causes, symptoms, cough, salivation, wheezing, lach-
rymation, muzzle dry, tender throat, dysphagia, disturbed innervation and
circulation, hyperthermia. Duration. Abscess. Treatment, laxative,
local treatment, lancing

Cattle are less subject to sore throat than honses. The skin
appears less sensitive to the influences of cold and heat. The ox
is not subjected to the same severe exertions. It is rarely seen to
sweat, the moisture pa,ssing off from the surface as insensible
perspiration only. The disease, however, recognizes the same
causes as in the horse, though these are manifestly less injurious.

Symptoms. The disease usually affects at once the larynx and
pharynx so that the symptoms are somewhat modified. In the
simplest form there is only a small, hacking cough, a flow of
saliva from the mouth and some loss of appetite but no fever.
In more acute cases the breathing is loud and wheezing, the
cough, soft and rattling, is followed by a free discharge of mucous
from the mouth, the nostrils and eyes are red, the muzzle dry,
the pulse accelerated and full, the throat tender to the touch, and
swallowing difficult, part of the food and drink being rejected
through the nose. If the larynx is chiefly involved the loud

Laryngitis in Sheep. 123

noise in breathing is the predominant symptom and sometimes
almost the "only one.

Course, etc. The cough and other symptoms are usually mod-
erated with the access of the abundant secretion on the second or
third day, and recovery is perfect on the eighth to the fifteenth.
If abscess results, to which there is a far greater liability than in
the horse, it may not burst till the twentieth day and the case is
correspondingly protracted. This should be carefully distin-
guished from the deposits of tubercle which take place around
the throat in cattle. In rare cases the disease becomes chronic.

Treatment does not differ from that advised for the horse ex-
cept in the greater safety of purgatives which must in this case
be saline (Epsom or glauber salts one to two pounds), and in the
greater ease with which local treatment can be applied owing to
the shortness of the soft palate. When abscess forms it must be
encouraged by poulticing and opened with the knife or lancet as
soon as it points.

I.ARYNGITIS IN SHEEP.

Infrequency. Causes, damp lands, storms, close buildings, clipping.
Symptoms, cough, sneezing, discharge, snuffling, oral breathing, tender
throat. Treatment, ventilation, warm water vapor, sulphur dioxide, salines.

Sore throat is fortunately even more rare than in the larger
ruminants. It occurs chiefly where this animal, constituted to
feed on the dainty grasses of the dry mountain side, is kept on
cold, marshy ground and exposed to frequent cold, wet blasts.
Sheep suffer also from hot, close, filthy buildings in winter, and
from unseasonable clipping.

The symptoms are frequent coughing and sneezing, running
from the nose, working of the jaws, and breathing through the
open mouth as being easier than through the plugged nostrils.
The larynx is tender and may be swollen.

Treatmeyit is- usually confined to ventilation and cleansing of
the fold, frequent fumigations with water vapor from the spout
of a boiling kettle, and with sulphur fumes, and giving tepid
farinaceous gruels or mashes containing sulphate of soda in the
daily proportion of two pounds to each hundred head of sheep.
Sal ammoniac may be given in food or drinking water.

LARYNGITIS IN PIG.

Frequency. Causes, wet, cold pens, exposure, withholding liquids.
Symptoms, prostration, dullness, cough, fever, swollen throat and neck,
dyspnoea, dark mucosa, sloughing of epithelium and epidermis, general
petechia?, foetid breath, great prostration. Lesions, gangrenous patches
on pharynx and fauces, ulcers, infiltrations. Treatment, hygienic, dietetic,
emetic, laxative, poultice, bandages, locally, astringent, antiseptic, caustic,
tonic.

Sore throat is common in some localities when pigs live in
herds.

Causes. Chiefly faulty hygiene. Exposed, cold and wet pig-
geries, cold blasts for which the pig has an extraordinary aver-
sion, and the deprivation of liquids in warm, dry .seasons are
frequent causes.

Symptoms. These have been described by M. Pradal, who
divides the disease into three stages, evidently dealing with an
infectious malady. The first stage is marked by loss of appetite,
dullness, slow, listless movements, a tendency to hide under the
litter ; low, hoarse grunt and cough, the last aggravated by mov-
ing the animal ; pain in swallowing ; red, sunken eye, and con-
stipation. If there is no improvement on the second or third day
it merges into the second stage. This is characterized by a still
hoarser grunt, painful, hard hacking cough, difficult breathing,
especially in the sunshine, and a rapidly increasing swelling of
the throat, soon extending to both ears and as far down as the
breast bone. This engorgement feels soft and pasty though firm,
tender lumps may be felt, indicating the approaching formation
of abscess. It is so abuudant that suffocation may ensue in the
course of forty-eight hours. If the progress of the swelling is
not arrested it soon passes into the third or gangre7ioiis stage.
The breathing is more hurried ; the mouth open, the protruded
tongue of a bluish black color, the cough followed by a contin-
uous rattle, the head unsteady, swallov/ing impossible, and the
swelling extends to the side of the face and beneath the chest.
The swollen surface is cold and livid ; the bristles easily detached ;
it is bedewed by a sero.sity which exudes from it, and portions of
the dead skin tend to detach themselves. The mouth and throat
124

Laryngitis i?i Pig. 125

participate in the gangrene, the breath, saliva and nasal discharge
is fetid, and the epidermis peels, off. The snout, ears and skin
generally assume a bluish black hue, the prostration is extreme,
the creature lying constantly on its side ; the pain ceases and in
one or two days death ensues, preceded by a state of comparative
calmness.

On opening the throat after death the mucous membrane is en-
gorged and thickened, bears various hues of black, blue, livid
and green, and breaks dov\^n into a pulpy mass under slight pres-
sure. The surrounding (pharyngeal) muscles even are impli-
cated in this change. In the earlier stages there is only engorge-
ment with blood of the tonsils and the mucous membrane of the
pharynx and larynx ; serous infiltration of the surrounding
parts, and often the presence of inspissated mucus resembling
false membranes or of ulcers on the surface.

Treatment. In the earlier stages, hygienic measures alone
may suffice to check. A warm, dry, comfortable piggery, emol-
lient and astringent drinks, such as sheep's head broth, oatmeal
and other gruels acidulated with vinegar or buttermilk, an emetic
(six grains of tartar emetic) ; a dose of physic (four croton
beans powdered and given in the food, or from two to three ounces of
castor oil), and if the patient will permit it a flannel bandage or
piece of sheepskin round the throat. If the symptoms are more
threatening it is recommended to bleed from the ears and tail ; to
apply a linseed meal poultice round the throat to hasten the
formation of abscess, or in the absence of such indications to em-
ploy a mustard poultice made with spirits of turpentine, or rugs
wrung out of boiling water, to the same part. I^ocal astringent
and caustic applications to the throat are the most promising, ap-
plied by means of a whalebone prob as recommended for other
animals, the mouth being held open by a noose round the upper
jaw. Sodium sulphite, silver nitrate, potassium permanganate,
hydrochloric acid diluted, and tincture of iodine, may be em-
ployed.

When the gangrenous stage has been reached all treatment is
useless.

LARYNGITIS IN THE DOG.

Sore throat is chiefly seen in pampered pets and in hunting
dogs, as the greyhound. In the latter class it is the result of
chills, a cold ducking when heated, cold damp kennels, etc. It is
sometimes almost the only manifestation of distemper.

Symptoms. Dullness, impaired appetite, a slight cough becom-
ing more frequent and paroxy.smal. These paroxysms give rise
to accelerated and panting breathing, and if severe, to the ejection
of a glairy yellow (bilious) material from the stomach. There is
also running from the nose and frequent sneezing. The dull
muffled bark has led to the supposition of i-abies but it has no re-
semblance whatever to the characteristic cry of rabies while be-
ginning like an impulsive bark merges into an agonized and
baffled howl. Accelerated pulse, elevated temperature, reddened
fauces and swollen tonsils are marked symptoms.

Sometimes a short, dry cough obstinately remains after the
disease has apparently subsided.

Treatment. Attend to general comfoi't, steam the nostrils, give
a laxative if costive, and follow with iodide of potassium or sal-
ammoniac (5 grains) repeated thrice daily. Apply a mustard
poultice to the throat.

PHARYNGITIS. SORE THROAT.

Causes. Symptoms, larynx insensible, tender parotid and sub maxillary
swelling, cough mucous, difficult swallowing with gurgling, liquids re-
turned by nose, baccal mucosa hot and red, salivation, chronic cases.
Treatment, medicated drinks and electuaries.

ANGINA PHARYNGEA. CYNANCHE PHARYNGEA.

Inflammation of the pharynx ow^es its existence to the same
causes as Laryngitis.

Symptojus. The general symptoms being like those of Laryn-
gitis, the specific and distinguishing ones only will be here
noticed. The larynx is not tender to the touch nor is cough
126

Pharyngitis. Sore Throat. 127

thereby excited. The gl'Unds beneath the root of the ears (paro-
tids) are swollen and tender and cough is induced by handling
them. The intermaxillary glands are enlarged. The cough is
loose and followed by the ejection of glairy materials by the mouth
and nose. Food and drink are swallowed with difficulty and eflfort,
dry grain or hay is often refused, or dropped from the mouth, after
it has been chewed, to avoid the pain of swallowing. Deglutition
is accompanied by a gurgling sound caused by the abundant secre-
tion in the pharynx. In swallowing liquids a portion is often re-
jected by the nose. The mouth is hot, red at its back part, and filled
with fetid saliva: which often drivels from between the lips in the
coarser breeds of horses. The fever varies according to the in-
tensity of the inflammation. This disease is rarely serious, and
improvement is manifested, by a free discharge from the nose of
a white opaque color, by the ability to swallow without pain, and
the better appetite and general appearance. Collections of pus in
the Guttural pouches may result from pharyngitis. See Chronic
Nasal Catarrh.

Reynal has seen chronic cases of this disease due to : ist, frac-
ture of the large branch of the hyoid bone ; 2nd, Laceration or
ulceration of the soft palate ; and 3rd, an abscess of the pharyn-
geal mucous membrane.

The treatmoit does not differ materially from that of laryngitis
except in the greater value of soft food, mucilaginous and acid-
ulated drink and of electuaries v>'hich act on the throat as they
dissolve. Subjoined is a formula :

Recipe : Extract Belladona, four drams ; potassium iodide, one
ounce ; sodium hyposulphitis, three ounces ; mellis, five ounces.
Mix. A desert spoonful to be smeared on the inside of the cheek
thrice daily.

CROUP.

Croup : croak. Acute laryngitis, with spasms and perhaps pseudo-mem-
branes. Relation to diphtheria. Causes, low, damp localities, exposure,
youth, form of inflammation. Symptoms, onset sudden, crowing inspira-
tion, hard cough paroxysmal, fever, larynx sensitive, dyspnoea in paroxysms
or intermittent. Complications. Duration. Lesions, intense congestion,
false membranes on larynx, fibrinous. Treatment, fomentations, ether,
chloroform, chloral hydrate, laxative saline, sedative, derivative, surgical,
water vapor, calomel, caustic, stimulants, tonics. Croup in sheep and
horse.

CROUPOUS LARYNGITIS. PSEUDO- MEMBRANOUS LARYNGITIS.

Name and Definition. The word croicp by which this disease
is known over the whole of Europe and a great part of America
is, essentially Scotch, and is familiarly used in the I^owlands of
Scotland to .signify — to croak. The disease consists in an acute
inflammation or high vascular irritation of the larynx, associated
with spasms of its muscles and commonly though not invariably
with a firm layer of exudation on the surface of the mucous mem-
brane. In some cases undoubtedly croup is but a form of the
contagious pseudo-membranous affection diphtheria, the germs of
which grown on a surface freely swept by continuous currents of
pure air, retain too much of an aerobic habit to penetrate deeply
into the tissues. (See Authors, " Malignancy mitigated by
Oxygen," Medical Record, 1881, p. 673). It does not follow,
however, that croup is always due to even a weakened germ. So
far as yet appears it may develop independently of any particular
pathogenic germ, from some violent local irritant in a predisposed
subject. Croup therefore may be treated here as a presumably
noninfectious di.sease. Being a very rare disease in horses its
manifestation in ruminants will first be noticed.

CROUP IN THE ox.

Causes. These are not well understood. L,ow, damp situations

would seem most liable, especially if the animals are much exposed

at night. So far indeed as can be ob.served it arises from the same

causes as laryjigitis. Age affects its development. Croup is

128

Cronp. 129

mostl}'' seen in animals between six months and a j^ear old, and
rarely in those over five or six years of age. The specific cause
of the formation of false membranes and of spasms of the laryn-
geal muscles is a mystery, but to these the susceptible constitution
and tissues of young animals appear to predispose. No mere
grade of inflammation from the slightest hypergemia to the high-
est type of inflammatory action is of itself sufficient to arouse the
special phenomena. All of these are seen everywhere but croup
may be said to be confined to certain localities and ages.

Symptoms. Unless it supervenes on a pre-existant attack of
catarrh, croup is usually as sudden in its outset in the lower ani-
mals as in man. An extremely hard croupy cough, or loud,
crowing, difficult breathing, loudest in inspiration, is usually the
first symptom and appears to seize the animal in an instant and
without the slightest premonition. This is closely followed b}-
intense fever, full, hard pulse, 80 to 100 and upward per minute,
increase of bodily temperature sometimes to 107.5° F. , costive-
ness and high colored scanty urine. The throat is excessively
tender, the slightest touch giving rise to violent paroxysms of
coughing, during which the eyes redden and protrude from their
sockets, the veins of the skin are gorged, the tongue, dry and livid,
is protruded and small portions of the contents of the stomach and
white shreds of false membrane are occasionally brought up.
Sometimes in the intervals of coughing as well the mouth is con-
stantly open and the tongue protruded and partly covered by a
frothy but tenacious mucus. Suffocation appears imminent in
many cases and the beast may perish suddenly in this way. On
the other hand the threatening symptoms may be present only at
certain periods of the day and may be moderated remarkably at
others, especially at early morning. If complicated by any chest
affection the symptoms are more urgent and the issue more com-
monly fatal. If associated with a low type of fever, a small, weak
pulse, and much prostration, as it tends to be if it continues sev-
eral days without relief, it has a more fatal tendency. The same
may be said of its occurrence epizooticall3^

Duration. Croup will often run its course and prove fatal in
twenty-four to forty-eight hours. Improvement is manifested by
the cough becoming less convulsive and painful, by the ex-
pulsion through the mouth of shreds of false membrane, and by
return of spirits and appetite.
9

130 Vctermary Medicine.

Postmortem Appearances. If the animal has died suffocated, the
lungs and right side of the heart will be gorged with blood ; if in
a stupor (coma), attendant on brain poisoning with venous blood,
the veins will be specially engorged. The mucous membrane of
the larj'nx has a more vivid arborescent redness than in ordi-
nary laryngitis but the special feature is the presence of false
membranes. These layers of exuded material are almost confined
to the air passages. They may extend to the soft palate and nose
in an upward direction and to the trachea and bronchial tubes in a
downward, but they rarely exist in the mouth, pharnyx, or gullet
like the false membranes of diphtheria.

Characters of the false membranes. These are gra)' or yellow-
ish white, though they may be reddened in patches or streaks.
They vary in consistency from that of glairy mucus to a firm layer
as of dense fibrine, and become more adherent as they are of old-
er standing. Sometimes they are partially detached, the free end
of the shreds floating in the larynx. The deep or attached sur-
face presents redness in points, in streaks, or as ramifications very
visible if the membrane is held up between the eye and the light.
They vary in thickness from half to a line. Delafond has found
these membranes in the lower animals to be mostly formed of fi-
brine, with a little albumen, and traces of alkaline and earthy
salts.

Trcatinent. This must be prompt and energetic. Wet cloths
as hot as the hands can bear, wrapped around the throat and neck,
and replaced as they cool, will usuall}^ arrest the spasm. If this
fails ether or chloroform by inhalation or chloral hydrate by in-
jection may be employed with caution. The action of the bowels
must be secured by salines (sulphate of soda yi to i lb) or oil
(linseed oil Yz to i pint) and injections of warm water. Sulphate
of soda should be thereafter given in half ounce doses twice daily,
or nitrate or acetate of potass may be substituted. They are
advantageously given in linseed decoction and may be combined
with laudanum, (>^ ounce), belladonna, or other agent to check
the spasms.

A blister (mustard poultice) should be applied at first either to
the throat or breast, the windpipe being left untouched lest
tracheotomy .should be required. Similar applications to the legs
are useful.

Cro2ip. 131

If suffocation appears imminent tracheotomy should be at once
performed Csee under L,ar3'ngitis). This operation has been de-
preciated because of the late period at which it has been employed,
when the patient was already past all hope, but the resulting
wound in the neck is more than counterbalanced by the greater
freedom of breathing and the better aeration of the blood which
tends to obviate the justly dreaded low fever. It often leads to a
rapid diminution of the spasms and laryngeal irritation.

Agents applied directly to the inflamed mucous membrane are
often requisite. The air of the building should be rather warm,
equable and moistened by water vapor, if that can be conveniently
done. Calomel or alum powder may be frequently introduced
into the larjmx by means of a whalebone prob and sponge as
spoken of under laryngitis, or a solution of nitrate of silver (10
grains to the ounce of water) may be applied several times a day.
These not onl)' hasten the removal of false membranes but
counteract their production. The}' produce violent and convul-
sive coughing at first and have to be used, carefully. Delafond
blew in such agents through an opening made in the windpipe.
They may be injected with a hyperdermic syringe. In prostrate
conditions it may be necessary to resort to stimulants (wine whey,
carbonate of ammonia) and tonics (gentian, Peruvian bark).

CROUP IN SHEEP.

According to Roche Lubin croup is sometimes observed in
spring in lambs and hogs. The common cause is ' ' the shutting
up of the animals for the whole twenty-four hours in a hot con-
fined place, the floor of which is covered by a fine dust, and the
air loaded with the same, owing to the jostling of the sheep to-
gether, the effects being intensified by the weight of the fleeces."

The disease is manifested by constant working of the jaws, ex-
treme tension of the neck, abundant salivation, respiration hur-
ried and whistling, extreme pain and threatened suffocation when
the slightest pressure is made on the throat, and refusal of all
food liquid or .solid. The weak, hacking, convulsive cough is
associated with the discharge of a whitish glairy mucus by the
no.se until the third or fourth day when false membranes may be
expected.

132 Veterinary Medicine.

Treatment is like that for the ox, medicine being given in
about one-fifth of the doses.

CROUP IN THE HORSE.

The rare cases of croup in foals and young horses appear due
to the same general causes as in ruminants. M. Riss records two
cases, and Bonley one from breathing smoke when the straw of
the stable had taken fire. The suddeness of the attack, the spas-
modic symptoms and the duration of the disease and the treat-
ment do not differ materially from those given for the ox.

PHARYNGEAL AND LARYNGEAL POLYPI.

Pediculated tumors. Dyspnoea through change of position, operation by
ecraseur, snare, or cricoid incision.

Tumors of varied structure developing in or beneath the muco-
sa of pharynx or larynx often become slowly detached until they
hang by a loose pedicle, and having much latitude of movement
they may at times slip between the arytenoid cartilages or even
into the glottis producing the most urgent or even fatal dyspnoea.
Pediculated tumors in the posterior nares lead to the same acci-
dent. In one case of multiple small tumors on the pharyngeal
mucosa of the horse, the largest and loosest, attached to the front
of the epiglottis, was occasionally displaced into the larynx
threatening instant asphyxia. One such attack supervened on
the opening of a suppurating guttural pouch by the writer, neces-
sitating prompt tracheotomy. A time was set for the removal of
the polypus, but the tracheotomy tube having been accidentally
displaced during the preceding night the patient died of suffoca-
tion. Dick mentions a polypus growing from the interior of the
larynx and causing loud roaring. Such tumors may be removed
by operating with the ecraseur through the mouth, or by a snare
passed through a long narrow tube and used to seize and twist
through the pedicle. If the polypus grows from the laryngeal
walls, it may be best reached by incision through the cricoid
cartilage and crico-thyroid membrane as in the operation for
roaring.

DYSPNCEA IvARYNGEA. ROARING. HEMIPI.EGIA
EARYNGEA.

Generic name for common symptom. Low and high notes. Grunter,
roarer, whistler, piper, highblower. Pace or effort develops. Causes :
of temporary roaring, inflammations, abscess, phlebitis, choking, dropsy,
petechial fever, phlegmons along vagus. Causes of inveterate roaring,
paresis of left recurrent laryngeal nerve, fatty degeneration of left arytenoid
muscles, fracture of facial bones, polypi in air passages, chronic thickening
of mucosa, foreign bodies in passages, tumors of lymph glands, abscess of
guttural pouches, pseudo membrane, laryngeal ulceration, ossification, dis-
tortion, fracture of cartilages, action of forcible inspiration, leading on left
side, deep origin of reccurrent nerve, effect of chest diseases and violent
heart action, examples of morbid conditions impairing innervation. Le-
sions in muscles, and nerves. Facial palsy, poison (chick vetch, winter
vetch, lead, fungi, moulds). Intermittent roaring. Hereditary roaring.
Symptoms, grunting when coughed or threatened, heavy draft, galop, noise,
larnygeal tremor, cold as a complication, roaring with expiration, lesions.
Treatment, its use. Prevention, avoid breeding roarers, bearing reins,
chick vetch, lead. Tonic medication, caustic to mucosa, firing, setons,
iodine, pad nostrils, tracheotomy, arytenectomy, electricity.

This is the name of a symptom rather than a disease. It im-
plies a sound made in breathing in connection with some contrac-
tion of the air passages. The term is however usually reserved
for those conditions in which the sound results, from chronic dis-
ease or malformation, the noise attendant on laryngitis and other
acute diseases being rarely spoken of as roaritig. In neither case
does the noise indicate more than that there is some impediment
to the ingress and egress of air through larynx or trachea.

The pitch of the note varies exceedingly with the causes that
prodtice it and with the hurried nature of the breathing. There
have thus arisen the epithets of grunter, roarer, whistler, high-
bloiver, piper, trumpeter, ivheezer, etc. The most common dis-
tinctions are those of roaring and whistling. The r^(a;r<?r produces
a loud deep basso .sound in in,spiration, the larynx or windpipe
being only slightly narrowed while the whistler or piper produces
a shrill blowing or sibilant noise because of the greater constric-
tion of the passage. The term grunter is derived from the facts
that a roarer usually makes a grunting noise when struck or
threatened with a cane, and that when the tipper cartilages of the
133

134 Vetcrijiary Medicine.

windpipe are pinched between the finger and the thumb the re-
sulting cough is prolonged and somewhat like ^g-runt. A wheczer
is usuall}- suffering from spasmodic contraction of the bronchial
tubes, from broken wind or from chronic bronchitis. A high-
blower s\\o\AdL never be spoken of in the same connection, as the
noise is made from a playful flapping of the false nostrils or soft
palate and disappears when the animal is put to the top of his
speed. It is from confounding highblowing with roaring that
Eclipse and other brilliant performers on the English turf have
been erroneously pronounced roarers.

The noise produced by the roarer is not heard while he stands
quiet, nor many cases even during a short trot or gallop. Such
horses are in consequence often sold at the hammer and the pur-
chaser is grievously disappointed to find that what he thought a
sound horse is absolutely useless for the purpose for which he de-
signed it.

Causes. Before noticing the symptoms of roaring a considera-
tion of the causes will be useful to enable the reader the better
to understand the signs by which the different forms are mani-
fested.

Causes of temporary roaring. Whatever impedes the cur-
rent of air causes roaring. Hence inflammatory diseases of the
nose, throat, windpipe or bronchial tubes ; abscess of one or the
other of these parts ; inflammation of a jugular vein and pressure
on the trachea or vagus nerve by the resulting swelling ; choking;
the swelling in the neck consequent on the cutting open of the
gullet for the relief of choking ; thickening of the nostrils from
dropsy, loss of a jugular vein, purpura hemorrhagica etc. ; and
swellings pressing on the vagus nerve, and which may be situated
at the base of the brain, in the neck or in the anterior part of the
chest. Also temporary infiltration of the laryngeal mucosa.

Causes of inveterate roaring. The one great cause of roar-
ing and that which sustains the disease in nineteen cases out of
every twenty is paralysis of the left recurrent nerve of the larynx
and wasting of several of the arytenoid muscles on that side. It
may be well, however, first to notice the less frequent causes and
wind up with this more common one. ist, Fracture with distor-
tion of the nasal bones and narrowing of the nasal passages
(Gamgee). 2nd, Polypi and other tumors of the nose, pharynx,

Dyspncea La>'yngca. Roaring. Hemiplegia Laryngca. 135

larynx, windpipe or bronchi. 3rd, Chronic thickening of the
nasal mucous membrane, the result of inflammation. 4th, The
presence of foreign bodies in the nose, as for example balls
coughed up from the pharynx. 5th, Hering records a case re-
sulting from the closure of the posterior opening of one nasal
chamber by a membrane. 6th, Cancerous or melanotic deposits
in the lymphatic glands above and to each side of the pharynx
and larynx. 7th, Distension of the guttural pouches by inspis-
sated pus. 8th, Chronic thickening of the mucous membrane of
the larynx consequent on inflammation. 9th, The formation of
a projecting fold of the mucous membrane or of a new production
(false membrane) in the windpipe as the result of inflammation.
Such false membranes have been known to become detached at
their median part and remain attached at their two extremities thus
constituting a band stretching from one side of the windpipe to the
other. loth. Ulceration of the membrane of the larynx particularly
on the projecting folds circumscribing the glottis, i ith, Ossifi-
cation of the laryngeal cartilages and loss of their elasticity. 12th,
Distortion of the cartilages of the larynx, most commonly from
unduly tight reining and pulling the nose in toward the chest.
In such cases the cartilages of the larynx and those of the wind-
pipe adjoining being compressed slide within each other, and the
enclosed edge projecting within the air tube materially diminishes
its calibre. 13th, Fracture of one or more rings of the trachea.
This usually results from blows, as in running the neck against
the back of a cart or wagon. The cartilaginous rings are usually
broken at their median part in front and being retained together
by the investing elastic tissue which enables the pieces to move
on each other as by a hinge, and being approximated by the con-
traction of the trachealis muscle above, the ring is flattened from
side to side and the channel for the passage of air correspondingly
decreased. This flattening can be easilj^ felt by the hand in the
living horse. 14th, A peculiar congenital distortion of the
trachea caused by the curling in of one end of each cartilage of
the windpipe and the straightening out of the other. This occa-
sionally proceeds so far that the gullet is lodged in the interspace
overlapped and hidden by the free ends of the cartilages, the di-
ameter of the windpipe being proportionately diminished. Dis-
tortions and fractures are usually overlooked by veterinarians but

136 Veterinary Medicine.

from the frequency with which the author has met with them in
his dissection he is convinced that they deserve greater attention
than has been awarded them. 15th, Percivall records a case of
inveterate roaring in which, even tracheotomy having failed to
cure, the patient was destroyed and the kings found to be exten-
sively consolidated, many of the air tubes having been so com-
pressed as to be almost impervious. I have known a case of
roaring from the presence of a pedunculated tumor in the lower
end of the windpipe where it divides to enter the lungs, and the
same result may ensue from the partial obstruction of the bron-
chial tubes by masses of tenacious mucus in chronic bronchitis.

1 6th. The immediate cause of roarijig in the immense majority
of cases is the paralysis and fatty degeneration of certain
muscles on the left side of the larynx. The muscles supplied
with motive power by the left recurrent laryngeal nerve
(Crico-arytenoideus posticus, Crico-arytenoideus lateralis, thyro-
arytenoideus, and the left half of the arytenoideus) are those
constantly and exclusively affected, while those supplied by the
siiperior laryngeal nerve (Crico-thyroideus, hyo-thyroideus and
hyo-epiglottideus) remain unchanged. The left recurrent nerve
is also wasted and considerably attenuated as compared with that
on the opposite side. The modus operandi of this paralj^sis and
wasting in the production of roaring is beautifully seen when the
upper part of the windpipe is laid open so as to expose the in-
terior of the larynx in laryngectom\^ The triangular opening of
the glottis is seen fairly dilated while the muscles are relaxed in
the act of expiration. As soon, however, as inspiration com-
mences the left arytenoid cartilage slides completely into the
passage, its lower border projecting so much to the right that it
forms a prominent crest extending beyond the median line and in
some cases closely approaching the right wall of the larynx, the
superior elastic and free border of the same cartilage meanwhile
gets drawn inward by the suction power of the air so as to block
up the passage still more. The closure of the glottis being thus
seen to be largely controlled by the current of inspired air, it be-
comes evident that any increase in the force of the current will
aggravate it and a decrease will lessen the extent of the closing
and alleviate the distress of breathing. This fact furnishes
a means of palliating the symptoms. (See treatment.) It ex-

Dyspncea Laryngea. Roaring. Hemiplegia Laryngea. 137

plains moreover why roaring should not be heard in quiet breath-
ing and why it should increase in force and in pitch as the
respiration becomes more and more hurried. It further accounts
for the noise being heard only during the act of inspiration, the
outward rush of the air in the expiratory act being of itself suffi-
cient to carry this valvular cartilage out of the passage and secure
a free and unimpeded current.

The paralysis and wasting of the left recurrent nerve and
muscles are in their turn due to verj- varied morbid states.

It may commence in the larynx from distortion of its cartilages
and inflammation of the mucosa, in which case the wasting of the
nerve is probably a result of its prolonged inactivity. This mode
of origin is strongly insisted on by Percivall, and no doubt occa-
sionally arises. Under this explanation, however, it is difficult
satisfactorily to account for its almost invariable occurrence on the
left side. The mere fact that the horse is habitually approached
on this side and more commonly turned toward it is a most in-
sufficient rea.son.

Even if admitted it utterly fails to explain the immunity of the
muscles supplied by the superior laryngeal nerve.

The fact that a horse has usually a hard and soft side of the
mouth and carries the head slightly to the latter is no better ex-
planation, as the tender side is not always the left.

More commonly the disease arises at some other point near the
origin or in the course of the nerve, and the changes in the larynx
follow as the consequence of deficiency or entire absence of
motor innervation. Many cases can be cited in which such an
origin was unquestionable, and on the hypothesis that this is the
true and constant history of the development of the malady, its
regular occurrence in the left side, and the absence of all signs of
wasting in the muscles supplied by the superior laryngeal nerve
are alike perfectly explainable.

Let it be noted that the vagus nerves (right and left) of which
the recurrent laryngeal are branches, originate from the base of
the brain, pass down the neck beneath the jugular vein in com-
pany with the carotid artery ; that on entering the chest the right
vagus nerve gives off its recurrent branch which proceeds at once
up the neck along the course of its parent trunk till its reaches
the larynx, to the muscles on the right side of which it is dis-

138 Veterinary Medicine.

tributed ; that the left vagus nerve on the other hand proceeds
backward in company with the left innominate artery as far as
the base of the heart, where on about the level of the space be-
tween the sixth and seventh ribs it gives off the left recurrent
nerve ; that this left recurrent nerve closely applied at its point of
origin to tlie great parent arteries turns round the posterior aorta
enclosing it in a loop, and gaining the lower end of the windpipe
follows its course to the larynx. It will thus be understood how
many chest diseases may implicate the left recurrent nerve, and
from which the right, which extends no deeper than between the
two first ribs, may be completely exempt. The frequent superven-
tion of roaring as a sequel of chest diseases receives in this an ample
explanation. Its connection with pleurisy becomes especially
probable, as the nerve lies in contact with the surface of the
pleura alike in its descending and ascending course within the
chest.

Finally the loop encircling the posterior aorta exposes the nerve
to constant stretching and shocks from the heart's action during
violent exertions and in excited states of the circulation generally.
Vaerst and Sussdorf show that the nerve is habitually flattened
between the posterior aorta and trachea, the effect being worst
when the heart's action is excited.

It remains to notice a few instances in which dissection estab-
lished the connection of interference with the nerve at some part
of its course and the existence of roaring.

(a.) Godine found in a roarer a tumor about the size of a
chicken's ^%%, pressing on the commencement of the pulmonary
artery. He attributed the roaring to the impaired circulation of
blood in the lungs by the pressure on the artery. Considering
that the tumor must have been precisely in the situation of the
left recurrent nerve at its point of origin, it becomes much more
probable that the symptom resulted from pressure on this nerve.

(b.) The elder Bouley found in one case a considerable engorge-
ment of the group of lymphatic glands in the anterior part of the
chest and through the centre of which the left recurrent nerve
passed.

(c.) Fergusson of Dublin dissected a roarer in which he found
besides some tumors of the lymphatic glands in the pelvic and
sub-lumbar regions, an indurated and enlarged gland about four

Dyspnoea Laryiigca. Roa?^i)ig. Hemiplegia Laryngea. 139

inches behind the anterior opening of the thorax. The recurrent
nerve between this and the larnyx was wasted so that its fibres
could scarcely be recognized, the laryngeal muscles on that side
were atrophied, and degenerated, and the glottis distorted and
partly closed. Fergus.son has in his description made the mistake
of writing the right for the left ; it is evident that the right recur-
rent nerve could not possibly pass through a tumor in the situation
described.

(d. ) Gamgee furnishes a drawing of an immense tumor filling
up the anterior part of the chest, pressing on the vagi and recur-
rent nerves and causing roaring.

(e. ) The Clinique of the Alfort Veterinary School furnishes
the following among other cases of roaring consequent on inflam-
mation of the jugular vein. A well-bred and very fast English
thoroughbred had been used for two 5'ears by his owner who was a
hard rider. In June, 1857, he was bled as a preventive (saignee
de precaution), supurative phlebitis was induced and was only
cured at the end of six weeks. When again put to work he
proved a roarer and was still affected when seen six months later.

In connection with this it may be noted that the swelling in
connection with the inflammation of the vein extends easil}^ to
the sub-jacent vagus and recurrent nerves, leading to their inflam-
mation, functional inactivity and atrophy. Bleeding is usually
done on the left side of the neck so that the paralysis and wasting
would still be on the same side. Happily with a more humane
system of treatment, accidents of this kind are less frequent than
formerl3^ Glockner furnishes a case which followed thrombosis
of the carotid.

(f) Reynal reports several cases in which roaring had occurred
as a sequel of inflammations and abscess about the throat, and in
which infiltrations or gray or yellow indurations had taken place
in the areolar tissue around the vagus nerve. As nothing is more
common than to find roaring resulting from severe sore throat,
parotitis, etc. , this may explain its occurrence.

Mandl first carefully examined the paralyzed muscles which pre-
sent to the naked eye a flattened and wasted appearance in marked
contrast to the full well-rounded forms or those on the opposite
side. They differ no less in color. In place of the deep red of
the healthy muscles those on the diseased side are of a yellowish

142 Vete7'inary Medicine.

same or even in a worse condition, the larynx meanwhile un-
naturall}' compressed between his narrow jaws and the nerve
compressed or the larynx distorted.

It must be added, however, that like some other acquired dis-
tortions or alterations roaring may repeat itself in the progeny.
Goodwin mentions an instance of it on the female side through
three successive generations of thoroughbreds. Of transmission
on the side of the male the following instance is noteworthy :
M. Liphaert, an extensive proprietor in lyivonia, bought a first-
class English thoroughbred stallion. His progeny were healthy
until he became a roarer at ten years old. All his foals, got after
this date, followed the sire in becoming roarers, and, it is impor-
tant to observe, almost all at the age of ten years.

Symptoms. These, of course, are manifest enough while the
animal is sufficiently excited to give rise to the noise. Certain
indications may be obtained even while the animal stands in the
stable. If cough is excited by pinching the upper rings of the
windpipe it is prolonged into a groan. If suddenly threatened
with a cane the abrupt inspiration which results is attended by a
grimt. The absence of these symptoms is not, however, suffi-
cient to establish the non-exi.stence of roaring. The horse must
be galloped or put to heavy draught to fully test the breathing
organs. Galloping up a steep hill is perhaps the best test. A
gallop over a recently ploughed field is about equally good. Soft
pasture land or an unpaved road is preferable to Macadam or
pavement. Galloping in a riding school on the soft tan is an
excellent measure as the sound is confined and the animal is
always within earshot of the examiner. The person examining
should either ride the horse himself or have a disinterested part}^
in no way connected with either buyer or seller, to mount him.
If the rider is in the interest of the seller he may contrive to
slacken the pace before he reaches the examiner, or by irritating
the horse may make it difficult to approach him immediately on
his being pulled up. If in the interest of the buyer he may suc-
ceed, by the u.se of a powerful bit, in drawing the horse's nose in
to the chest, or by compressing the larynx with a tight throat
latch he may produce noise in breathing when the animal is sud-
denly brought to a stand. Unless the course is up a steep hill or
over a ploughed field the horse should be galloped for from five

Dyspnoea Laryngca. Roarvig. He?uiplegia Lary^igca. 143

to ten minutes ; he should be then made to pass close to the ex-
aminer at full speed, and finally brought up suddenly by his side
and without any previous slacking of his pace. The ear should
be at once placed close to the nostrils, when the slightest abnor-
mal sound accompanying the inspiratory act will be at once
recognized.

Draught horses are sufficiently tested by driving them in a
heavy vehicle or one with the wheels dragged. By walking
alongside or keeping the ear near to the nostrils any harsh .sound
additional to the normal blowing noise of hurried breathing is
easily noted.

The finger placed on the larynx detects the strong vibratory
tremor, and Friedberger notes that the left arytenoid is much
more easily displaced than the right, increasing the stridor.

If the horse is, at the time of examination, the subject of a
cold, sore throat, or other acute disease of the air passages no
importance is to be attached to any noise made in breathing, but
he cannot be pronounced a sound horse until, this malady having
passed off, it is found on careful examination that no such sequel
has been left.

Among the most puzzling cases are those in which the roaring
occurs with periods of intermission. If the horse has been fed
for a short time on vetches this may account for its temporary
access, and unless the same feeding is again allowed a recurrence
is not to be looked for. If due to the occasional displacement of
a pedunculated tumor of the nose or pharynx and its interfer-
ence with the action of the larynx its existence may be recognized
by careful examination, diminished current of air through one
nostril, etc. But there remain some rare cases in which there are
no such appreciable causes, and yet the horse would be pro-
nounced sotind or unsound as examined at certain intervals. On
this subject more information is desirable.

The following varieties of roaring will be distinguished from
that of paralysis by the occurrence of the sound in both acts of
breathing (expiration and inspiration) : — distortions, tumors or
foreign bodies in the nose : — tumors about the throat, in the wind-
pipe or bronchi : — distortion of the windpipe, from tight reining,
fracture or congenital deformity : — and the presence of a false
membrane stretching across the windpipe.

142 Veterinary Medicine.

same or even in a worse condition, the larynx meanwhile un-
naturall}^ compressed between his narrow jaws and the nerve
compressed or the larynx distorted.

It must be added, however, that like some other acquired dis-
tortions or alterations roaring may repeat itself in the progeny.
Goodwin mentions an instance of it on the female side through
three successive generations of thoroughbreds. Of transmission
on the side of the male the following instance is noteworthy :
M. Liphaert, an extensive proprietor in Livonia, bought a first-
class English thoroughbred stallion. His progeny were healthy
until he became a roarer at ten years old. All his foals, got after
this date, followed the sire in becoming roarers, and, it is impor-
tant to observe, almost all at the age of ten years.

Symptoms. These, of course, are manifest enough while the
animal is sufficiently excited to give rise to the noise. Certain
indications may be obtained even while the animal stands in the
stable. If co2igh is excited by pinching the upper rings of the
windpipe it is prolonged into a groan. If suddenly threatened
with a cane the abrupt inspiration which results is attended by a
grtmt. The absence of these symptoms is not, however, suffi-
cient to establish the non-exi.stence of roaring. The horse must
be galloped or put to heavy draught to fully test the breathing
organs. Galloping up a steep hill is perhaps the best test. A
gallop over a recently ploughed field is about equally good. Soft
pasture land or an unpaved road is preferable to Macadam or
pavement. Galloping in a riding school on the soft tan is an
excellent measure as the sound is confined and the animal is
always within earshot of the examiner. The person examining
should either ride the horse himself or have a disinterested party,
in no way connected with either buyer or seller, to mount him.
If the rider is in the interest of the seller he may contrive to
slacken the pace before he reaches the examiner, or by irritating
the horse may make it difficult to approach him immediately on
his being pulled up. If in the interest of the buyer he may suc-
ceed, by the use of a powerful bit, in drawing the horse's nose in
to the chest, or by compressing the larynx with a tight throat
latch he may produce noise in breathing when the animal is sud-
denly brought to a stand. Unless the course is up a steep hill or
over a ploughed field the horse should be galloped for from five

Dyspnoea Laryngea. Roaring. Hemiplegia Laryjigea. 143

to ten minutes ; lie should be then made to pass close to the ex-
aminer at full speed, and finally brought up suddenly by his side
and without any previous slacking of his pace. The ear should
be at once placed close to the nostrils, when the slightest abnor-
mal sound accompanying the inspiratory act will be at once
recognized.

Draught horses are sufficiently tested by driving them in a
heavy vehicle or one with the wheels dragged. By walking
alongside or keeping the ear near to the nostrils any harsh sound
additional to the normal blowing noise of hurried breathing is
easily noted.

The finger placed on the larynx detects the strong vibratory
tremor, and Friedberger notes that the left arytenoid is much
more easily displaced than the right, increasing the stridor.

If the horse is, at the time of examination, the subject of a
cold, sore throat, or other acute disease of the air passages no
importance is to be attached to any noise made in breathing, but
he cannot hz pronounced a soimd \\oxsq. until, this malady having
passed off, it is found on careful examination that no such sequel
has been left.

Among the most puzzling cases are those in which the roaring
occurs with periods of intermission. If the horse has been fed
for a short time on vetches this may account for its temporary
access, and unless the same feeding is again allowed a recurrence
is not to be looked for. If due to the occasional displacement of
a pedunculated tumor of the nose or pharynx and its interfer-
ence with the action of the larynx its existence may be recognized
by careful examination, diminished current of air through one
nostril, etc. But there remain some rare cases in which there are
no such appreciable causes, and yet the horse would be pro-
nounced sound or unsound as examined at certain intervals. On
this subject more information is desirable.

The following varieties of roaring will be distinguished from
that of paralysis by the occurrence of the sound in both acts of
breathing (expiration and inspiration) : — distortions, tumors or
foreign bodies in the nose : — tumors about the throat, in the wind-
pipe or bronchi : — distortion of the windpipe, from tight reining,
fracture or congenital deformity : — and the presence of a false
membrane stretching across the windpipe.

144 Veterinary Medicine.

Examination by manipulation, auscultation and percussion
along the whole length of the air passages alike during rest and
after exercise, may enable one in unusual cases to recognize the
structural changes that give rise to roaring.

Treatment. This has long been considered as hopeless, yet pre-
servative and palliative measures are usually accessible, whilst even
cures can be effected in certain conditions.

Preventive treatment. First may be noticed the rejection for
breeding purposes of all animals possessing those conformations
of head, neck and chest already referred to as conducing to di-
sease of the air passages or distortion of the larynx or windpipe.
Equally ought all roarers to be set aside unless the exciting cause
is accidental such as fractures of the nasal bones, of the trachea,
the existence of polypi, etc. Stallions that make a harsh noise in
breathing from an accumulation of fat about the throat are not
necessarily objectionable.

The employment of the bearing rein so as to compress and dis-
tort the larynx is to be avoided. If bearing reins are used in
horses having short thick necks and badly set on heads and
especially with intermaxillary narrowness they should be passed
through rings in the cheek piece of the bridle or between the ears
and over the forehead (overdraw check) so that while the head is
elevated the nose may be projected forward after the Russian
fashion of equitation. This measure has indeed appeared to cure
several cases of roaring. I have met with fewer roarers in the
same number of horses in America than in England, and this 1
attribute to the better mode of using the bearing rein on this side
of the Atlantic.

The Chick Vetch ( Lathy rus Cicera) should be excluded from
the fodder of horses or used in small proportion only. In man it
is found to be injurious when it forms a twelfth part of the bread
used and gives rise to paralysis if it amounts to a third (Aitken).

Paliative and Curative treatment. Medicinal treatment will
prove useless in the great majority of cases : as for example in
paralysis and degeneration of the muscles, in ossifications, frac-
tures, or distortions of the cartilages, etc. , etc. Nevertheless where
there is merely thickening of the membrane of the larynx altera-
tive and tonic treatment may be successful especially if associated
with iodine ointment or active blisters applied to the throat. A

Dyspncca Laryngea. Roaring. Hemiplegia Laryngca. 145

case is reported by Diipuy in which a course of arsenic cured. In
Ihese cases as well as in those due to ulceration of the membrane
the application of caustic by means of a staff and sponge as ad-
vised in laryngitis may prove beneficial. In .some cases of this
kind the application of the firing iron to the region of the larynx
has an excellent effect. Setons have proved useful in some cases.

In cases due to tumors or enlarged glands pressing on the air
passages the internal u.se of iodine and other alteratives and di-
uretics, and the local applications of iodine, or mercurial ointments
or of blisters have been successful. Failing in this the tumors
may be removed with the knife when accessible.

If by auscultation the existence and position of a band of lymph
can be made out, tracheotomy may be performed and the band ex-
cised. Percivall with reason doubts the possibility of the diag-
nosis.

In cases due to distortion of the larynx from tight reining the
bearing reins should be dispensed with or rearranged so as to en-
courage protrusion of the nose, and the horse should be bitted to
the side chains or straps in the stall several hours daily so that
the head shall be elevated and the nose protruded.

When roaring depends on paralysis of the laryngeal muscles, a
mode of palliation may be adopted as practised by the London
omnibus and cab men. A strap is fixed round the nose supported
by a strap passing down the middle of the face and the cheek
piece of the bridle on each side and buckled beneath the chin.
On the inner side of this strap where it passes over the false nos-
trils is attached on each side a semiovoid pad which presses on
the flap of the nostril and regulates the entrance of air. The
principle on which it acts will be understood when we consider
that the paralyzed cartilage is drawn into the passage by the rush
of air and that the closure of the channel is more complete and
the roaring more marked in proportion to the force of the current.
The pads by lessening and regulating the rush of air into the lungs
thus leave the passage in reality more open and largely obviate
the difficulty of breathing and the noise.

In extreme cases with the structural lesion in the head, throat,
or upper two-thirds of the neck relief may be secured by trache-
otomy.

A more radical operation is that introduced by Giinther for the
10

146 Veterinary Medicine.

excision of the left arytenoid cartilage. As improved by Moller
and others this consists in an incision through the cricoid cartilage
and crico-thyroid membrane (or even the first rings of the trachea)
and the complete extirpation of the left arytenoid cartilage and
left vocal cord. The manipulations belong to surgery. The re-
sult is satisfactory in removing the violent dyspnoea in hurried
breathing and in very favorable cases in obviating noise alto-
gether. More commonly some stridor remains but not enough to
interfere with pace or with heavy draft. From my personal ex-
perience in performing the operation, I would recommend it in all
cases in which the obstruction is so great as to interfere with the
use of the horse on the track, or road, or for heavy draught. But in
slight cas2S, in which the disease causes little or no inconvenience
beside the noise, I would advise some less radical measure.

Another obvious line of treatment is by the use of electricity
locally and of strychnine internally. A weak current kept up for
fifteen minutes may be sent from the positive pole in the left jug-
ular furrow to the negative pole over the left side of the larnyx.
Strychnia in the dose of two grains may be given daily in the food
or in half that amount hypodermically over the left side of the
larnyx. This would be useful only in the early stages with little or
no fatty degeneration of the muscles.

CEDEMA GLOTTIDIS

Diseases Complicated by this. Seat, Abundance. Duration, Sequels,
Symptoms, sudden dyspncea, swelling of throat, pits on pressure, differen-
tiation from croup. Treatment, cold, ice, astringents, scarification, traclie-
otomy.

This is usually a complication of acute laryngitis, but it may be
a manifestation of other forms of locai disease — tuberculosis,
glanders, purpura haemorrhagica, pseudo-membranous inflam-
mation,— or it may be a result of a more distant affection, like dis-
eae of the heart, lungs, or kidneys. As a complication of local
.inflammation it consists in an excessive serous exudation into the
submucosa, around the base of the epiglottis and extending to the
whole larnyx and pharnyx. It may thicken the parts by half an
inch, causing complete closure of the glottis. In favorable cases
it may subside as rapidly as it rose, while in others it may result
in ulceration or abscess. The infiltration has usually a clear
watery a.spect, but is sometimes a dull red. When incised an
abundance of serum escapes mixed in certain cases with pus.

Symptoms. In the course of one of the above named affections
there comes on suddenly extreme dyspnoea, with stertorous
breathing, a suffocative cough, and intense anxiety. The stridor
is first with inspiration and later with expiration as well. The
eyes are bloodshot and protruding, the pulse small and rapid, the
movements uncertain, and the skin moist with sweat. There is
manifest swelling of the throat and manipulation leaves the im-
print of the finger.

When symptomatic of some distant affection it is at once slower
in its result and more persistent.

The local pasty swelling and the absence of any false mem-
brane suffice usually to distinguish it from croup which it so
closely resembles in the suddenness of its onset, and the violence
of its manifestations.

The less urgent cases may be treated b)^ application of cold water
or ice to the throat, and the injection of solutions of chloride of
iron or alum into the fauces. Or the throat may be painted with
tincture of iodine and rubbed with the palm to favor distribution
and absorption of the exudate. In dogs the mouth may be open-
ed widely and the dropsical membrane pricked at intervals to
drain off the liquid. In the most acute cases the prompt adoption
of tracheotomy is the only means of saving life.
147

LARYNGEAL HYPERESTHESIA. CONVULSIVE
COUGH.

Convulsive cough with visible lesions — without. Excitants, cold air, or
water, rough or dusty food, irritant agents inhaled or swallowed. Treat-
ment, hygienic, nerve sedative, expectorant, tonics, Muriate of ammonia,
Sulphur dioxide, silver solution, ferric chloride, alum, derivatives, elimina-
tion, aromatic, dietetic.

The chronic or paroxysmal cough may often be traced to the
presence of tumor, ulcer, local inflammation, or parasite, but in
some instances no local trouble is recognizable, the general health
remains good, and yet the throat is abnormally sensitive and a
cough or fit of coughing may be roused by pas.sing into the cold
air from a warm stable, by cold water in drinking, by inhaling
irritant gas, by the passage of rough or fibrous food, or by
handling the larnyx. There is undoubtedly a hyperaesthesia of
the larnyx and the horse and dog as being more exposed to severe
demands on the physical and nervous systems are especially liable
to suffer.

Treatment must be adapted to the conditions. Over- work,
damp unhealthy buildings, and all appreciable health depressing
causes must be corrected, and a course of iron and nux vomica
may be tried. Borax, bromide of potassium, and extract of hyos-
cyamus, made into an electuary with molasses or honey may be
smeared upon the molars four or five times a day. In obstinate
cases the inhalation of the fumes of burning salammoniac or sul-
phur, or the direct application to the larnyx of dilute solutions
of silver nitrate, ferric chloride, or alum may benefit. The throat
may be blistered by cantharides or mustard. Care should be
taken to keep the functions of bowels and kidneys normally ac-
tive, to protect the patient against cold and damp, and to give nu-
tritive but non-stimulating and easily digested food, as for the hor.se,
bran mashes, roots, grass or scalded hay, and for the dog pulped
flesh, soup and mush. Sometimes benefit can be obtained from
the vegetable aromatics and stimulants as eucalyptol, tar, turpen-
tine, balsams of Tolu and Peru, tincture of anise, fennel, etc.

148

INFECTIOUS DISEASES OF THE THROAT.

Infectious throat diseases. Parasites, Ivceclies. CBstrus larva. Chronic
sore throat. Mechanical removal.

Infections are in many respects the most serious affections of this
region but their consideration must be sought under strangles,
distemper, diphtheria, anthrax, actinomyco.sis, tuberculosis,
glanders, etc.

PARASITES OF THE THROAT.

Leeches. These taken in with the water will sometimes fasten
themselves on the walls of the pharnyx or even on the lips of the
larnyx, producing cough, sore throat, difficulty of swallowing,
bleeding from the nose (or mouth), or dyspnoea. They are to be
removed as recommended above under parasites of the nasal
chambers.

CEstrus Larva.. Bots. In horses and mules the larva of
the oestrus sometimes attaches itself to the mucous membrane of the
pharynx or even of the larynx producing chronic irritation, cough
and even dyspnoea. A chronic sore throat with nasal discharge,
occurring in autumn or winter, in the absence of fever or constitu-
tional disorder may be found to depend on these parasites and to
recover when these have been removed bv the hand.

GUTTUROMYCOSIS OF SOLIPEDES.

Aspergillus. Complications, ulceration, lesions of adjoining parts, food
in lungs, hepatization, gangrene. Treatment, by incision, sulphur dioxide,
iodine.

Rivolta and Bassi have found in the guttural pouches of horses
and a mule, an advancing ulceration of the mucosa partially cov-
ered with crusts composed largely of the mycelium , conidia and
spores of Aspergillus or a closely allied fungus. In the mule the
ulcer had opened into the carotid artery causing a profuse epis-
taxis. In the three horses there was dysphagia, and the food,
descending to the lungs, had caused pulmonary hepatization and
gangrene. The description of the ulcers led Raillet to infer the
existence of glanders and that the presence of the aspergillus was
accidental, rather than a causative factor. In parallel cases the
opening of the guttural pouch and injection with sulphurous acid
solution or dilute solution of iodine would be appropriate treat-
ment.

149

DISEASES OF THE CHEST.

Cough, its artificial production, precautions, character in different animals.
Cough in disease, strong, full, ringing, weak, short, broken, abortive, dry,
rasping, croupy, small, husky, soft, humid, rattling, mucous, paroxysmal,
sj^mpathetic, wheezing, roaring, whistling, grunt, moan. Expectoration,
nasal in horse, also buccal in other animals. Morbid expectoration, watery,
viscid, cloudy, flocculent, purulent, rusty, cretaceous, parasitic, foetid, vari-
colored, microbic. Expired air, warm, cool, vegetable odor, acid, foetid,
heavy. Respiration, number in health, alteration in disease, rapid, slow,
tardy, short, catching, quick, deep, labored. Position, standing, lying.
Pleuritic breathing, broken-winded.

Before describing specific diseases, it is needful to consider the
methods of physical diagnosis which enable the practitioner to
differentiate the diseases of the chest. Some of the following
remarks will bear equally on diseases of the nose and throat as
well.

COUGH.

The cough so varied in health and in disease deserves careful
practical sttidy. It can usually be excited in solipedes, sheep and
dogs by pinching the finst ring of the windpipe between the thumb
and first two fingers. In oxen it is best produced by compressing
the anterior part of the larynx. In old cattle it is difficult to pro-
duce coughing. In no animal should the attempt be made rudely
nor unnecessarily repeated, as it may tend to excite or to aggravate
already existing sore throat.

The cough of the healthy horse is sharp, /oiid and ri7iging, often
repeated two or three times and followed by a snort (clearing of
himself). It is weaker in young horses and shorter and drier in
the aged.

The usual cough of the ox is 7veak, dry, slightly hitsky awd pro-
longed.

That of the sheep, small, weak and dry.

That of the dog, also weak and dry.

A strong, full, deep, ringing cough is rarely heard in disease
except in slight irritation of the larynx. In such cases the larynx
is tender and slight handling or pinching develops the cough.
150

Diseases of the Chest. 151

A weak cough wanting in reasonance and heard only at a
short distance from the horse, is usually associated with chronic
chest diseases and the last stages of acute thoracic inflammations.

A short, broken or abortive cough is one which appears to
be suddenly cut short and suppressed, from the pain it causes. It
is seen in the early stages of inflammations of the serous mem-
branes of the chest or abdomen, when the quick rubbing of the
dry and inflamed surfaces of these membranes on each other
produces exquisite pain. It chara.terizes especially the debut of
pleurisy, pleuro-pneumonia and peritonitis. This cough is in-
frequent for the same reason that it is short.

A dry, loud, rasping, or croupous cough is peculiar to the
early stages of laryngitis, tracheitis and bronchitis, when the
membrane is swollen, tense and dry. It is equally met with in
diphtheritic and croupous affections implicating the larynx.

A small, weak, dry, husky cough without any rasping is
characteristic of broken wind (heaves) emphysema of the lungs,
asthma, or chronic bronchitis.

A soft, humid or rattling cough exists in the advanced stages
of laryngitis, bronchitis and pneumonia when the activity of the
inflammation has given way and a free exudation has taken place
from the mucous membrane. It is usually accompanied by a dis-
charge, in solipedes from the nose, and in other animals from
no.se and mouth.

A soft cough with a peculiar gurgling in the larynx is some-
times met with in croup.

A paroxysmal cough is one repeated five, ten, or twenty times
in rapid succession. It is common in chronic bronchitis, early
heaves, emphysema, verminous bronchitis and influenza. In such
cases it is ob.served chiefly when the subject is brought out to the
cold air, when he takes a drink of cold water, or when he has
just had some active exertion, or .some dusty or fibrous food.

A symptomatic cough is one due to diisease in some other
organs than the respiratory, and which irritates the air passages
through nervous sympathy (reflex action). It is commonly
small, short and dry. Inflammation or other disease of the liver,
indigestions and intestinal worms are occa.sional causes of symp-
tomatic cough. In the case of worms it may be loud, clear and
rineinsf.

152 Veterinary Medicine.

OTHER MORBID SOUNDS.

Besides cough may be noticed the wheezing breathing charac-
teristic of broken ivind, chronic bronchitis and asthma, roaring,
whistlijig, etc., as already described, and the sound between a
moan and grunt, produced in pneumonia especially in the ox.

EXPECTORATION.

This escapes almost exclusively by the nose in horses, because
of the length of the soft palate. It may come from the mouth of
other animals, especially when they cough. In the ox the dis-
charge from the nose is rarely seen because of his licking it out
with his tongue. Rattles (rales) in the larynx, trachea or
bronchia, enable us to ascertain the .source of such discharges.

The nasal discharge in acute catarrh, laryngitis or bronchitis,
is thin, clear, and sligiitly viscid, becoming thick, whitish and
fiocculent as the disease advances. It is yellowish, thick, floccu-
lent and intermixed with .shreds of false membranes in diphtheria
or in the croup of young foals and calves. It is clear, slightl}'
viscid and watery at the onset of bronchitis. At the debut of
pneumonia it is often reddish (rusty). It is bright, red, frothy
and bloody in haemoptysis. It is scanty, clear, watery, and con-
taining minute white fiocculi in pulmonary en.physema (broken
wind). It is white, thick, curdy, and devoid of vLscidit)' in
chronic bronchitis or when a pulmonary abscess is being emptied.
It is grayish, thick and fiocculent in advanced pneumonia in the
horse.

Cows in the advanced stages of pulmonary tuberculosis ex-
pectorate a yellowish, sticky matter containing minute hard
masses often cretaceous. Calves and lambs suffering from
strongyli in the lungs expel these in little pellets in the midst of
a thick white material.

The expectoration is fetid, dark red and grumous in gangrene
of the lungs.

In pulmonary tuberculosis and glanders the expectoration usu-
ally contains the respective bacilli.

Diseases of the CJicst. 153

CHARACTKR OF THE EXPIRED AIR.

The breath is sensibly warmer in' excited breathing, high fever,
.and acute bronchitis and pneumonia. It is cool in most chronic
diseases, in advanced consumption and hydrothorax. Its odor is
vegetable and acid in the acute indigestions of cattle, and fetid in
many chronic diseases of the air passages attended with destruc-
tion of tissue, or the escape of imprisoned pus, but especially
fetid in gangrenous sore throat or gangrene of the lung.

MODIFICATION OF THE RESPIRATION.

The number of respirations in a given time may afford valuable
indications in the horse but in the other domestic animals varia-
tion in number imports little. In the ox for instance, the respira-
tions in health may vary from twelve to eighty per minute,
according to the heat of the cowhouse, the plentitude of the
abdominal organs and other circumstances. So in the sheep and
dog slight causes, quite compatible with health, may cause the
breathing to become short, panting and hurried.

The young horse breathes ten to twelve times per minute, the
adult animal nine to ten. Any excitement accelerates. A horse
walked a few hundred yards had the respirations increased from
ten to twenty-eight per minute ; after trotting five minutes they
numbered fifty-two ; after galloping five minutes sixty-five.

Hurried breathii:g occurring independently of exercise, heat
of the atmosphere, or distension of the abdomen, is indicative of
fever, especially if associated with rapid pulse and increased heat
of the body.

Infrequent respiration appears in certain brain diseases in the
intervals between the more violent paroxysms, also in poisoning
by opium and other narcotics. Tardy or slow respirations
differ from those last noticed in the act occupying a longer time.
In infrequent breathing the act may be short, though there are
few respirations in the minute. This is likewise seen in brain
diseases and sometimes in broken wind. In the last case there is
double action of the flank, each act of expiration being effected
by two successive and distinct elevations of the flank.

Quick breathing in which the act occupies only a short time is
usually abruptly cut off, the inspiration terminating by a catch or

154 Veterinary Medicine.

jerk. It is significant of the early stage of pleurisy, and arises
from the desire to avoid the pain attendant on the rubbing together
of the inflamed surfaces during deep inspirations. It is further
seen in tetanos, peritonitis, perecarditis and pleurodynia.

Deep breathing with great lifting of the flanks and loins is
characteristic of water in the chest, and consequent inability to
inflate the lungs.

Labored breathing, which is at once hurried, deep, and with-
out intermission, is seen in severe laryngitis, croup, capillary
bronchitis, and pneumonia, in all cases alike from the difficulty
experienced in introducing into the lungs the requisite amount of
air. It is especially marked in double pneumonia, pleuro-pneu-
monia, complicated with effusion in the chest, and in old standing
broken wind with dilatation of the right heart.

In all such cases where there is much interference with the
aeration of blood, whether from obstruction to the circulation of
blood or a hindrance to the introduction of air, the horse invaria-
bly stands. The fact that he has lain down may be taken as an
indication that improvement has taken place. The peculiarity is
due to the sharp outline of the horse's sternum inferiorly so that
in lying down he is compelled to rest on his side and the whole
weight of the body tends to compress the chest. In the ox,
sheep, pig and dog, which can rest on the sternum, breathing
can be carried on with comparative ease in the recumbent posi-
tion, and these animals accordingly do not necessarily stand
except in very extensive and violent affections of the chest.

The occurrence of a short inspiration suddenly checked and a
prolonged expiration characterizes pleurisy, the check to the in-
spiratory act being because of the pain caused by dilating the
thorax.

The double lifting of the flank in expiration: — the act appear-
ing to be performed by two distinct and successive acts is one of
the most prominent symptoms of broken wind, but is not peculiar
to this disorder. In the horse it exi.sts in chronic bronchitis, dil-
atation of the right heart, old standing hydrothorax, and
diaphragmatic hernia. It is further frequent in the acute disea.ses
of the chest. In oxen it accompanies pulmonarj^ emph3'sema,
pulmonary consumption, dilatation of the heart, foreign bodies
in the heart, and dropsy of the pericardium.

Relative Position of the Lungs ^ Heart and Other Organs. 155

If accompanied by clear resonance over the chest, a permanent
wheezing noise heard over the ribs, and the small, weak wheezy
cough, it indicates emphysema (broken wind). If with strong
impulse of the heart against the ribs behind the elbows, venous
pulse in the jugulars, and modification of the second sound of the
heart, it bespeaks cardiac dilatation or other heart disease. If
with paroxysmal cough, white curdy nasal discharge and harsh
rasping sounds heard at the lower part of the trachea or along the
upper part of the lungs it betrays chronic bronchitis.

RELATIVE POSITION OF THE LUNGS, HEART AND

OTHER ORGANS IN THE DIFFERENT

DOMESTIC ANIMALS.

Relative positions of thoracic organs. Diaphragm, heart, lung, in horse,
ox, sheep, pig, dog. Palpitation.

The chest is that portion of the trunk closed in on each side by
the ribs, above by the bones of the back, below by the breast
bone, and behind by the diaphragm. It forms thus a cone flattened
from side to side anteriorly, and with its base, represented by the
diaphragm which slopes obliquely from above downward and for-
ward and bulges forward in the centre to a greater or less extent
according to the plenitude of the stomach and bowels. It results
from this arrangement of the diaphragm that a very thin layer of
lung only reaches to the posterior part of the chest, and that be-
neath this are solid and hollow abdominal organs which modify
the results of physical examination.

In the Horse the anterior third of the chest is covered later-
ally by the bulky and muscular shoulders so that it cannot be
satisfactorily examined. In the median line of the chest, at a
point corresponding to the third, fourth, fifth and sixth inter-
ccstal spaces, is lodged the heart. It deviates slightly to the
left side below and by virtue of a notch in the lower border of the
lung is enabled here to reach the surface and its beats ma)^ be felt
by the hand laid on the side of the chest just behind the left
elbow.

156 Vcterhiary Medicine.

In the Horse the diaphragm is attached by its outer border to
the last rib, and to the lower ends of all the asternal ribs, and the
extremity of the breast bone. A thin layer of lung accordingly
extends to between the two last ribs superiorly and down to near
the lower end of the asternal ribs. The subjacent abdominal
organs are arranged as follows : — On the left side, and counting
from below, the large intestines (double colon), the stomach and
spleen and a portion of the left lobe of the liver : — on the right
side, below, the large intestines, above, the liver and pancreas.
Of these the stomach and intestines frequently contain gases,
while the liver by its solidity gives a special solid character to the
right posterior part of the chest. The spleen is too deeply situ-
ated to affect much the results of a physical examination. The
greatest substance of lung is between the upper and middle
thirds of the thorax. The anterior third is inaccessible on
account of the shoulders, but more than usual may be reached by
raising the fore limb and drawing it forcibly forwards. The
space between the third and seventh ribs is occupied by the solid
mass of the heart, which especially modifies the result of physical
examination on the left side where a notch in the lung allows it
to approach the surface.

In the ox the diaphragm is only attached to the last rib for two
or three inches at its upper extremity ; it is fixed to the second last
rib as far down as about one-third of its length ; thereafter it is at-
tached in succession to the middle third of the third last, to the
lower third of the fourth last, to the lower ends of the next two in
succession and to the .sternum. The result is that the lungs do not
extend so far back relatively to the ribs as they do in the horse.
They are virtually absent from the last intercostal space, present
only in the upper third of the .second la-st, in the upper two thirds
of the third last and reach the lower third only in the space be-
tween the ninth and tenth ribs. The paunch alone occupies the
space beneath the asternal ribs on the left side, and the liver and
the solid mass of the omasum and abomasum that beneath the
right. The shoulders in fat improved beef breeds absolutely pre-
vent examination of the anterior third of the chest, though in
thin animals and dairy breeds and scrubs more of this may be ex-
posed by raising the fore limb than in the horse. The heart cor-
responding in position to the third, fourth and fifth intercostal

Relative Position of the Lungs, Heart and Other Organs. 157

spaces is more completely covered by lung tissue and does not
strike the left side so forcibly as in the horse.

In the sheep the lung extends to the last intercostal space,
nearly as far as its lower end and the heart is covered on the left
side as well as on the right by lung tissue. The shoulder is very
moveable and unless in very fat animals allows of an examination
of the greater part of the anterior third of the chest.

In the pig fat and indocility combine to defeat our purpose in
examination of the chest. If these can be obviated it is well to
know that the diaphragm is attached to the upper two-thirds of the
last rib, and to the next three in front above their lower third.

In the dog the diaphragm is attached to the upper two-thirds of
the last rib, to the lower third of the next and to the lower ends
of the two following and to the breast bone. The shoulders are so
mobile and the breast bone so thin that nearly all the chest may
be satisfactorily examined. The heart, covered on both sides
by lung, lies nearly horizontall}' on the breast bone, through which
' its position and bulk may be clearly made out by percussion.

EXAMINATION BY TOUCH.

Pressure by the fingers in the spaces between the ribs corres-
ponding to the pleura will cause flinching and perhaps grunting
in pleurisy. The same result will be seen in pleurodynia. In
hepatized lung and pleurisy with adhesions there is a diminished
sense of the movement felt in the intercostal spaces of the part in
health.

PERCUSSION.

Methods. Tissues as good and bad conductors of sound. Immediate,
mediate percussion. Bilateral symmetry and divergence. Effect of build-
ing, race, etc. Horse, left side, right. Ox, leftside, right. Effect of ist
and 3d stomachs, liver, etc. Sheep, diaphragm, heart. Pig, fat, lean, heart.
Dog, method. Birds, back, ribs. In disease, increase, decrease, absence of
resonance, in large area, in patches. Crack pot sound.

This consists in striking the walls of the chest so as to bring out
the resonance of the parts. In proportion as we tap gently with
the tip of the finger or strike forcibly with the closed fist will we
elicit the sounds from the superficial or the deeper parts of the
lung. Hence slight blows onl}^ must be used when the lung tis-
sue is thin, to avoid bringing out the resonance from the deeper
seated organs, and both must be resorted to when the lung is thick
to ascertain its condition at the various depths. Where a mode-
rate force is requisite the four fingers and thumb of the right hand
are brought together in a line and the weight of the hand as moved
from the wrist is employed to bring out the sound. The ribs be-
ing hard convey sound best from the deeper parts, and on them
percussion is usually made. Care should be taken not to mistake
the lesser resonance conveyed through the soft tissues of the in-
tercostal spaces for an indication of a diseased condition. In pro-
portion too as the ribs are covered with flesh or fat, the resonance
will be diminished and a stronger blow will be necessary to bring
out the sound from the lungs.

If the blow is made directly on the side of the chest the percus-
sion is called immediate \ if made upon an elastic solid body
(pleximeter) laid on the outside of the chest it is mediate. The
readiest and perhaps the best pleximeter is the middle finger of the
left hand which is to be applied flat upon the side of the chest to
receive the blow directed perpendicularly to its surface. In fat
or fleshy subjects it should be pressed firmly on the surface so as
to compress and condense the soft parts and render them better
conductors of sound. Some use flat pieces of ivory, silver, caouch-
ouc but in employing these the nails of the right hand must be
carefully pared, lest by striking the solid body they produce a
sound which interferes with the true pulmonary resonance.
158

Percussion. 159

In examining the chest the two sides should be compared and if
allowance is made for the dulness felt in the lower half immedi-
ately behind the left elbow caused by the position of the heart,
and the deadness of the sound on the last few ribs on the right
side where the liver is situated, any further deviation from a bi-
lateral symmetry of sound is indicative of disease. The general
resonance will be decreased by a full stomach which prevents the
full inflation of the lungs, and it will be increased if the animal
stands on a wooden floor with an empty space below. A short
statement of the degrees of resonance over the different parts of
the chest in the various races of the domestic animals in a state of
health may prove useful.

Horse. — Left side. In the upper third the resonance is full
behind the shoulder. It diminishes from the 13th rib backward
and from the decreasing thickness of lung the blows should be-
come less and less powerful. In this space forcible striking brings
out the drum like resonance of the abdominal organs.

In the middle third the sound over the 5th and 6th ribs is dis-
tinct but not full ; it increases to the nth rib and then decreases
to the last.

In the lower third a very slight resonance may be observed
over the 4th rib. ; over the 5th, 6th, and 7th, where the heart
approaches the surface the sound is dead ; while from this to the
13th rib a slight resonance may be made out.

Right side. The upper third resembles that on left side from
the shoulder as far back as the 13th rib behind which anything
above the gentlest blows brings out a drum like sound from the
large intestine (double colon) especially. This is clear when
that is distended with gas.

In the median third the resonance resembles that on the left
side. In the lower third it equally corresponds as far as the
seventh rib behind, which sound is dull because of the proximity
of the liver.

Ox. — Left side. The upper third is clear in sound from the
eighth to the tenth ribs, and behind this by gentle tapping to the
second last (twelfth). Forcible striking, however, brings out the
drumlike sound of the upper sac of the paunch which always
contains more or less air.

The middle third has a clear resonance as far as the .seventh

i6o Veterinary Medieine.

rib ; this diminishes to the ninth, behind which it is nsually
replaced by a dnlhiess due to the presence of food in the anterior
part of the paunch. By drawing back the hmb percussion may
b2 employed over the first and second ribs as well.

Ill the lower third the first two ribs can be examined and
a clear sound should be educed. On the fourth, fifth and sixth
ribs there is a full resonance, the heart being here covered
by lung tissue, contrary to the condition in the horse. From the
seventh the sound becomes duller and the dead sound from the
food ill the rumen characterizes the lower fourth of the ninth rib.

Right side. From the shoulder the resonance gradually de-
creases in the upper third to the eleventh rib, beyond which the
sounds obtained are only from abdominal organs. In the middle
third considerable resonance is met with over the first and second
ribs, it is very full and clear over the fifth, sixth and seventh,
whence it decreases and is quite lost behind the tenth. In the
lower third a clear sound can be elicited over the first, second,
fourth, fifth and sixth ribs ; this is lessened over the seventh and
eighth, and completely lost behind the ninth. Any but the
slightest blows over these three last ribs brings out the dull, solid
sound from the liver.

A very full paunch greatly increases the anterior convexity of
the diaphragm, and compresses the lungs into the anterior part of
the chest. If the contents of the rumen are solid the resulting
dullness on percussion might be mistakenly supposed to indicate
consolidation of the lung. This source of error must be care-
fully guarded against.

Sheep. Percu.ssion in the sheep differs from that in the ox
chiefly in the following particulars : The diaphragm being at-
tached to the last rib as in the horse, the diminishing resonance
of the lung may be traced as far back as in that animal. Thus a
pulmonary sound can be obtained in the upper third as far as the
last intercostal space, in the middle as far as the .second last, and
ill the lower as far as the fourth from the last. Over the lower
part of the fifth and sixth ribs on the left side the resonance is
remarkably clear owing to the great relative thickness of the
anterior lobs of the left lung which here covers the heart.

Pigs. In fat pigs the results are almost negative. In lean
animals the middle third on each side gives out a clear resonance

Percussio7i. i6i

behind the shoulder as far as the seventh rib, from which it
diminishes to the second last (thirteenth). The sound is less
clear in the upper and lower thirds. On the fifth intercostal
space below, and on the left side the sound is dull owing to the
exposure of the heart through a slight notch in the lung.

Dog. Percussion is very satisfactory in this animal because of
the amplitude of the chest, the thinness of its walls and the
small bulk of the abdominal organs. In the upper and middle
thirds on both sides alike the sound is clear and full as far back
as the seventh rib, whence it decreases to the last. In the lower
third a distinct but moderate sound marks the first eight ribs and
is equally clear on the right and left sides. The thinness of the
lung in its posterior part demands that percussion be effected by
the middle finger only, without any movement of the hand.
Unless the dog is very fat, good results may be obtained by per-
cussion over the first and second ribs, the shoulder blade and
breastbone.

Birds. In these and especially in the webfooted (ducks,
geese,) the sternum is so thickly covered by flesh that no result
can there be obtained. Beneath the wings, however, and upon
the back percussion through the medium of a small coin as a
plexi meter and with the middle finger alone, is valuable. Be-
neath the wing a clear sound may be drawn out over nearly all
the ribs and on the back over a less extent (two and a half to four
inches, according to size).

PERCUSSION IN DISEASE.

Increase of resonance without any perceptible modification in
character is usually partial and depends on the increased disten-
sion of the air cells of one lung, or part of a lung, to make up
for the loss of a part or a whole lung through hepatization or
pressure by false membrane or from water in the chest. If a part
of a lung is solid and impervious it gives a dull, dead sound, con-
trasting strongly with the increased clearness of the remain-
der. So with water in the chest, the clearness of the upper
parts contrasts unmistakably with the dullness of the lower. By
watching the advance or retirement of these symptoms the solidi-
fication of a lung and its process of clearing up, and the effusion

1 62 Veterinary Medicine.

of water in the chest and its removal may be equally traced
through all these stages.

If the increased clearness is confined to the upper, lower, or
posterior border of one or both lungs, the sound being natural
over all other parts, it indicates the existence of emphysema of
the lungs, a condition almost constant in broken-winded horses.

If the sound is drumlike over most of the lung it is due either
to extensive emphysema or to the presence of air as well as liquid
in the cavity of the chest. In the case first noticed there will be
the double action of the flank, the weak, dry, husky cough and
the wheezing breathing ; in the last there will have been the pre-
vious attack of pleurisy, and the application of the ear to the
chest will detect a splashing sound constant or heard only at in-
tervals or on rising. This should be carefully distinguished from
abdominal gurgling.

Diminished resonance, noticed over an entire lung, may bi^ due
to congestion or cedema of the lung, to the formation of a thick
false membrane over the inner surface of the ribs or to a false
membrane enveloping the lung and preventing its due distension.
Congestion will be distinguished by the blueness of the mucous
membranes and the presence of a crepitant sound heard on auscul-
tation. Pleurisy is known by the tenderness on percussion or on
pinching the intercostal spaces, and by the presence in many
'cases of a friction sound. The sound may be further lessened in
cattle by the deposit of tubercle on the inner side of the ribs, or
the extensive deposition of miliary tubercle throughout the sub-
stance of the lung.

Absence of resonance, the sound brought out by percussion
being similar to that obtained by practising it over the muscular
masses of the haunch, is always partial. It is due either to he-
patization or to water in the chest. Hepatization is distinguished
by its rarely affecting the lower thirds of both lungs at once, by
the presence of a crepitating rdle round the margin of the area of
dullness, and by the increased resonance and respirator}' murmur
over the sound parts of the same and the opposite lung. In water
in the chest on the other hand a friction sound and much tender-
ness precedes the dullness ; the tenderness continues and the dull-
ness reaches ths same height on both sides of the chest, in the
case of the horse. In the ox, water may exist on one side of the

Peraission. 163

chest only, but the tenderness on pressure and the absence of any
crepitation serve to distinguish the case from pneumonia. In the
smaller animals the position of the dulness may be altered by
turning the patient on its back as the water always gravitates to
the lowest point.

The presence of exten.sive deposits of tubercle, of cretaceous ma-
terial in tubercular cows and sheep, and the presence of large
cysts in the lung may give rise to dullness over a circumscribed
area. Such areas of dullness are usually multiple with sound lung
between.

A further modification known as the cracked pot sound is
sometimes heard in horses and cattle. It may be aptly repre-
sented by laying the palms of the two hands together in such a
way that they meet all round and leave an interval filled with air
right in the centre. The back of the one hand is then struck
against the knee when the noise of the air escaping gives the
characteristic sound. It occurs in consumption or in the ad-
vanced stages of inflamed lungs when a large tubercle or abcess
has burst into a bronchial tube and the resulting cavity opens
into this tube by a narrow orifice.

AUSCULTATION.

Mediate and immediate auscultation. Methods, quiet, normal chest
sounds, tubal, bronchial, vesicular, respiratory, cardiac. Juvenile respiratory
murmur. Horse, left side, right. Ox, left side, right. Accidental sounds,
rumbling, gurgling, crepitation, friction. Sheep, special features. Goat,
force, rig, Dog, Birds, morbid chest sounds. Increase, general, partial.
Decrease, general, partial. Absence. Bronchial sound in excess, in improper
place. Cavernous, amphoric, mucous sounds. Rales, sonorous, sibilant,
mucous, submucous, crepitant, subcrepitant. Creaking, metallic, tinkling,
gurgling, splashing, friction. Timbre of Cough. Palpitation. Mensuration.

This is a term used in medicine to denote the mode of exploring
an organ by applying the ear over the region in which it is situ-
ated and deducing the healthy or diseased condition by the sounds
heard. First employed by Lsennec in human medicine it was
qttickly availed of for the lower animals by Delafond and lycblanc.

Auscultation is mediate or immediate. Immediate Auscul-
tation is practised by applying the ear directly upon the skin,
either bare or covered with a handkerchief. In Mediate Aus-
cultation an instrument called a stethoscope is employed to con-
vey the sound from the surface of the body to the ear of ex-
aminer. The common stethoscope is formed of soft wood (cedar
or ebony) or of gutta percha, is from five to seven inches long
and a quarter of an inch in the bore. The end applied on the
skin is widened into a funnel three-fourths of an inch across at
the mouth ; the opposite end is flattened out to appl)' to the ear,
is about two inches in diameter and has a hole in the centre to
convey the sound. A flexible stethoscope is also used either with
one or two ear pieces and though less convenient in general than
the common variety possesses this advantage when the heart is
being examined that it conveys the sound without the impulse of
that organ.

In mediate auscultation the ear should be closely applied to the
surface, the right ear being used for the left side and the left ear
for the right, but a preference should always be exercised in
favor of that in which the sense of hearing is most acute. If a
handkerchief is used a single fold only must be applied, otherwise
164

Auscultation. 165

the two layers may rub on each other and produce distracting
sounds. In mediate auscultation . the instrument should be held
perpendicularly to the surface, accurately applied alike to the
skin and the ear, and pressed firmly on the surface to condense
the soft structures beneath the skin and render them more con-
ducting. If held by the hand care must be taken to avoid the
slightest movement of the fingers on the stethoscope, and long
hairs should be prevented from entering the tube as being likely
to produce additional sounds.

Among other points the following must be attended to in aus-
cultation. Avoid a position in which the animal can strike you
with its hind limbs. If necessary in irritable or ticklish subjects
have one fore leg held up. Select a quiet time and place, early
morning or night is usually best. Endeavor to protect the pa-
tient from the irritation of insects or the examinations may be
fruitless. Never auscultate over a contracting muscle ; the sound
of muscular contraction will prevent a correct result. If the
natural sounds are indistinct increase them by exercise. The
smaller animals are examined with the greatest facility standing
upon a table or held in the upright posture with the body resting
on the thighs or on the hind feet only. Birds can be held by the
wings which may be raised and drawn inward towards the median
line to expose the back and sides of the chest.

HEALTHY CHEST SOUNDS.

In all healthy animals two distinct sounds are heard over the
chest : — ^tlie tubal or bronchial sound, and the vesicular or
respiratory murmur. The bronchial sound caused by the air
sucking through the larger bronchi is best heard by applying the
ear to the breast over the lower end of the windpipe or to the upper
third of the chest immediately behind the shoulder. The respira-
tory murmur is clear and full in the middle third of the chest im-
mediately behind the shoulder. It is louder and more prolonged
in inspiration than in expiration and in the right lung than the
left especially in cattle and sheep in which the former is more
capacious. It is louder in young animals than in old, hence the
name of juvenile respiration applied by I^eblanc. In thin animals
it is better heard than in fat ones, the chest walls being thinner,
firmer, and more conducting. In animals of a nervous tempera-

i66 Veterinaiy Medicine.

ment like the English racer it is more distinct than in the Norman,
Clydesdale and other heavier breeds. Deep, broad capacious
chests emit a stronger sound than such as are shallow, narrow and
short. Exercise, fear or any excitement accelerating the respira-
tory act increases the sound. A full stomach , certain narcotics and
other depressing influences lessen it. Other things being equal
the sound is lower in cattle and sheep than in other domestic
animals.

Horse. The ear pressed strongly upon the breast where the
windpipe enters detects a strong blowing sound referable to the
lower end of the trachea and the bronchi. In young foals a
respiratory murmur is heard when the stethoscope is applied in
front of the shoulder, the limb being meanwhile drawn backward.
A similar murmur may be heard, but less distinctly over the
shoulder blade at this age.

Left Side. Behind the shoulder in the tipper third of the chest
the sound is loud and somewhat harsh, the respiratory murmur
being here supplemented by the noise of the air rushing through
the larger bronchia. From the 13th rib the respiratory sound is
alone heard and becomes weaker to the second last (17th).

In the middle third the respiratory murmur is moderately clear
from the 4th to the 6th rib, it becomes louder and clearer to the
9th from which its force gradually diminishes and is lost over the
16th. In the lower third over the 4th, 5th, and 6th ribs the re-
spiratory sound is replaced by the sounds of the heart, each beat
being distinctly divided into two sounds, the first dull and pro-
longed, the second short and quick. The respiratory murmur is
heard over the 7th and 8th ribs, is weaker on the 9th and lost
over the loth. In the middle and lower thirds but especially
towards the posterior part of the chest, abdominal sounds are often
heard. They consist chiefly in gurgling or in a noise like that
caused by the air rushing into a bottle which has been turned
upon its side when full of water. Such sounds are easily dis-
tinguishable from those occurring in a di.sea.sed chest as they bear
no relation to the rythmical action of breathing.

Right Side. In the tipper ajid middle thirds the sounds do not
differ from tho.se of the left side. In the lower third the respira-
tory sound is clear from the 4th to the 7th ribs ; from this it de-
creases and is lost at the loth.

Ausadtation. 167

Ox. In very lean cattle the respiratory murmur heard in front
of the shoulder and over the scapula is more distinct than in the
same region of the horse.

Leftside. In the upper third di c\e2Lr respiratory murmur is
heard over the 8th, 9th and loth ribs but is lost about the nth.
In the middle third the vesicular sound is feeble at the lower
margin of the region and immediately behind the shoulder because
of the proximity of the base of the heart. Towards the upper
margin it is loud and harsh being complicated by the tubal soux\di.
It is full and clear over the yth rib whence it decreases in force to
be lost at the i ith above and the loth below. In the lower third
the double heart beat is alone heard over the lower part of the
4th rib, the respiratory murmur reappears over the 5th and 6th
whence it becomes weaker and is lost at the lower and upper
margin of the region respectively over the 8th and 9th ribs.

Right Side. The sounds of the upper //«z>^ simply repeat those
of the left side. In the middle third the chief difference is the
greater clearness and strength of the respiratory and tubal sounds
immediately behind the shoulder. In the lower third a moder-
ately strong respiratory murmur is rendered harsh by a tubal
.sound due to the proximity of the large bronchus going to the
anterior lobe of the right lung. The respiratory murmur con-
tinues with diminishing force to be lost over the 8th and 9th ribs.

Accidental but healthy Sounds. These are more loud and
frequent in the ox than in the horse. There is the same irregular
rumbling and gurgling especially on the posterior parts of the
chest. Gurgling as from a full bottle inverted is often clearly
heard over the last six ribs on the left side, and appears due to
the passage of liquids between the paunch and honey comb bag.
An occasional sound as of water falling into an empty barrel is
heard in the same region in cases of slight tympany and after
saliva has been swallowed. Rumbling sounds are chiefly heard
over the last ribs on the right .side where the large and small
intestines are situated. The superadded sounds in the ox are
those of crepitation ^.wA friction. The crepitatioti or fine crackling
due to a dryness of the areolar tissue under the .skin is frequently
present in oxen in average health. A fine crepitation is also heard
on the left side from the bursting of myriads of minute bubbles
of air generated among the contents of the paunch during the

1 68 Veterinary Medicine.

process of digestion. This is especially marked after the animal
has fed on green food or potatoes. A loud friction or rubbi^ig
sound, which may be imitated by placing the back of one hand
upon the ear and rubbing the palm of the opposite hand upon it,
is likewise heard over the left side after eating. It is produced by
the movements of the paunch during contraction and not being
synchronous with the respiratory acts cannot be confounded with
the friction sounds of pleurisy to be hereafter noticed.

Sheep. The diaphragm being attached to the last rib as in the
horse the respiratory murmur may be heard to the second last.
The shoulders being more movable than in the ox the anterior
part of the chest can be more satisfactorily examined. The vesi-
cular murmur is heard along the whole lower third on the left side
though the heart sounds are superadded over the 4th, 5th and
6th ribs. Crepitation from the subcutaneous areolar tis.sue is
rarely heard. Otherwise the sounds of the chest and abdomen
correspond to those of the ox.

Goat. This animal differs from the sheep mainly in the greater
force and clearness of the respiratory murmur.

Pig. It seems ridiculous to speak of auscultating the pig, yet
he is sometimes thin enough and quiet enough to permit of one
obtaining satisfactory results. Gentle treatment and scratching
the back and abdomen will often persuade him to be temporarily
quiet and docile. The vesicular murmur is very clear in the
middle third of the chest on either side, but diminishes gradually
on the la.st six ribs, and disappears on the second last. It is much
less intense in the upper and lower thirds. In the posterior part
of the chest rumbling and gurgling abdominal .sounds are frequent.

Dog. The respiratory murmur is very clear over the whole
chest. It is most intense along the middle third and becomes less
clear on the 4 or 5 last intercostal spaces. The mobility of the
shoulder permits an examination of nearly the entire chest. The
respiratory murmur may be heard over the entire length of the
lower third on the left side though the heart's sounds are equally
heard over the 4tli, 5th and 6th ribs. Rumbling and gurgling
abdominal sounds are much less frequent than in herbivora and
omnivora.

Birds. The respiratory murmur is loud, clear and almost harsh
on the sides of the thorax, beneath the wings, and considerably
softer as heard on the back.

Aziscidtation. 169

MORBID CHEST vSOUNDvS.

The close study of the healthy chest sounds upon the living
animal is an essential prerequisite to the appreciation of the
morbid. The abnormal noises are so varied, merge into each
other by such imperceptible degrees, and so coexist and complicate
each other that they often prove extremely puzzling to the un-
practised ear. It is no more necessary that the musician should
educate his ear to appreciate the most delicate gradations of
musical notes, than that the auscultator should educate his in the
sounds of the healthy and diseased chest. Written instructions
are of about equal value in the two cases, they prove auxiliaries
in the acquisition of knowledge but they can never supersede the
practical study of the chest. A mere theoretical knowledge is too
often useless in the presence of the patient.

The abnormal chest sounds are either modifications of those
existing in health, or superadded sounds which have no counter-
part in the healthy chest.

Modifications of healthy sounds. The vesicular or respiratory
murmur may be increased or diminished in force or it may be
entirely absent.

Increase of the respiratory murmur, is merely an increase
in force without any modification in character and resembles
juvenile respiration. If increased equally over the entire chest it
is general, if only in a part it is partial. General increase of
the vesicular murmur is heard after an animal has been sub-
mitted to moderate exertion for ten or fifteen minutes. In ani-
mals at rest it is heard in active fevers and in the symptomatic
fever which attends acute inflammations.

Partial increase as for example in one lung only, or in cir-
cumscribed parts of both lungs, and especially along their superior
borders, is indicative of disease of the lungs or the pleurae. It
testifies to the impermeability to air of some other portion of lung,
from congestion, splenisation , hepatisation, plugging of a bron-
chial tube with tenacious mucous, tubercular deposits, tumors,
emphysema, or hydrothorax. (See under these names.) The
healthy portion of lung in such cases takes on the function of the
whole, and the loud breathing is called supplementary.

Diminution of the respiratory murmur, like its increase,

lyo Veterinary Medicine.

xvi'^Y hz partial or general. General diminution is seen in
anaemia, in low fevers, in all very prostrate conditions from the
mere want of power to dilate the chest ; in general emphysema
(broken wind, heaves), in general miliary tubercular deposit in
the lungs, or in that form in cattle in which the tubercle has been
replaced by cretaceous deposits, from the animal's inability to
fully dilate the air cells ; in enteritis, peritonitis and metritis
the chest is more fully dilated because of the pain attendant on
that act, and the breathing being short and quick the murmur is
correspondingly low. Jn certain brain diseases with sluggish
respiration the sound is equally feeble.

Partial diminution of murmur is more surely indicative of
lung disease. It may arise from partial congestion when a sup-
plementary murmur will be observable over other parts of the lungs,
and a crepitant rale soon appears in the congested part ; from
local emphysema in which there is increased resonance in per-
cussing the part ; from tubercular or cretaceous deposit, wdien
there will be exaggerated murmur elsewhere, or from bronchitis
with blocking up of one or more small bronchial tubes and with
louder respiratory sound in other parts.

Absence of respiratory murmur may be due to various
causes, all of a diseased nature. Hepatisation of lung may be
recognized when this condition is found associated with a crepi-
tating rale around the margin of the silent part, and when per-
cussion .shows its solidity and want of resonance. Splenisation
is a.ssociated with absence of respiratory sound and dullness on
percus.sion, but no surrounding crepitation. Absence of .sound
in water in the chest is confined to the lower part of the chest,
keeps the .same level and ratio of increase in front and behind,
and in the horse on the two sides, and has been preceded by the
characteristic catching breathing and the friction .sounds of
pleurisy. Large tumors and exten.sive and circumscribed tuber-
cular deposit will give rise to absence of .sound over a limited area
and plugging up of one or more bronchial tubes will lead to a
similar result. Hepatisation of lung and water in the chest are,
however, the common causes of loss of respiratory murnuir.

The bronchial or tubal sound may be increased in pitch and
in harshness in two conditions, ist. In the early .stages of bron-
chitis when the lining mucous membrane of the air passages is

Aiisailtation. 171

dry, thickened and inelastic. 2d. When that portion of lung in-
tervening between one of the larger tubes and the surface of the
chest is solid (hepatised) and thus proves a better conductor of
sound than in the normal condition.

Superadded abnormal sounds. The bronchial sounds may
be altered in their character so as to become cavernous, am-
phoric or mucous (ratthng). The cavernous sound is usually
caused by the presence in the lung of the cavity left after the
discharge of an abscess or softened tubercle into a bronchial
tube. It is thus preceded by cough and white, creamy discharge
from the nose. If the discharge is fetid and grumous there has
probably been circumscribed gangrene of the lung. An approxi-
mation to the sound may be produced by blowing into a wide-
mouthed glass or porcelain vessel. The sound of amphoric
respiration on the contrary is like that made.by blowing into a
narrow-necked bottle. It is due to a similar cavity with a small
orifice or to the existence of pneumo-thorax communicating by a
narrow canal with a bronchial tube. It is rare in the lower ani-
mals, but Delafond mentions one case in the horse and two in
dogs.

Rales. The remaining morbid sounds are known as rciIes, or
rattles. They may either be referable to the bronchial tubes or
the lung tissue. They are called dry or humid, according as
they convey the idea of air drawn through a dry tube or one
containing liquid.

The dry rales are due to narrowing of the bronchial tubes
from the pressure of adjacent tumors, the thickening of the
mucous membrane or the deposition on the surface of layers
of tenacious mucus. The greater the narrowing the shriller the
sound, and hence the distinction of bronchial rales into sonorous
and sibilant (whistling).

The sonorous rale has been variously exemplified by the hum-
ming of a gnat, the cooing of a wood pigeon or the bass notes of
a violin. It commonly bespeaks the onset of bronchitis and tes-
tifies to the thickened, dry and rigid character of the tubes, but
may give place in as short a time as three hours to a mucous rale
from the occurrence of a free secretion. It rarely extends over
two or three days. Sometimes when caused by a piece of tena-
cious mucus obstructing a tube, it is very transient disappearing

172 Veterinary Medichie.

at once when the mucus is expelled by coughing. Sometimes it
is modified by an occasional clicking sound from the flapping of
a shred of semi-solid mucus attached to the walls of a bronchial
tube. This disappears when breathing becomes more hurried.

The sibilant (whistling; rale often acknowledges the same
causes as the sonorous, but indicates a narrower closure of the
tubes. More frequently it is heard further back on the chest and
results from pulmonary emphysema and dilatation of the smaller
bronchial tubes (broken wind, heaves). It is then heard chiefly
in expiration and coincidently with the second quick lifting of the
flank. It is further associated with the double lifting of the
flank in expiration with the short, weak, paroxysmal cough and
the indigestion characteristic of broken wind. If the whistling
noise is so loud as to be heard without applying the ear to the
chest it is called wheezing.

A mucous rale is caused by air passing through any liquid
contained in the bronchial tubes, such as mucus, pus, or blood. It
may be imitated by blowing a large number of soap bubbles in a
thick lather and noticing them burst simultaneously or successive-
\y. It is chiefly observed in bronchitis after the preliminary dry
stage of the mucous membrane has passed off and an abundance of
mucus has been secreted. The nature of the sound will vary ac-
cording as it conies from the larger or the smaller tubes or in other
words as to whether the bubbles are large or small. That from
the smaller tubes is sometimes called a submucous rale. Either
of these rales may be temporarj^ or permanent as the mucus may-
be momentarily cleared away by coughing.

The crepitant rale is a sound of very fine crackling which has
been variously compared to the crackling of salt when put on red
hot coals, the noise of a sponge expanding in water and the rub-
bing of a small lock of hair between the finger and thumb close to
the ear. The existence of the crepitant rale usually denotes the
existence of the early stage of inflammation of the lungs, and the
progress of hepatization in such cases may be traced by the ad-
vance of the line of crepitation which precedes it. So the progres-
sive absorption of exuded matter in recovery may be equally fol-
lowed by a line of crepitation gradually decreasing in area until it
meets in a point. The observations will be coroborated by the
dull sound elicited on percussing the parts. The production of

Ausadtation. 173

the sound has been attributed to the passage of air through the
thick mucus in the smallest bronchial tubes or more plausibly to
the separation of the walls of the air sacs and cells during inspir-
ation, they having been previously adherent by reason of the se-
cretions.

Crepitation is not heard in all pulmonary inflammations. In
weak animals with a low type of inflammation tending to gangrene,
and in those cases of broncho-pneumonia in which a viscid mucus
blocks up the bronchial tubes passing to the affected lobes, it may
be altogether absent.

Crepitation may further occur without inflammation. Thus in
pulmonary oedema (dropsy of the lung) and capillary hemorrhage
in which liquids are effused in the smaller bronchial tubes and air
sacs a crepitation is sometimes heard.

A modified crepitation (dry crepitant rale of Delafond) is
usually heard over an emphysematous lung. The noise in this
case has been compared to that induced by handhng a sheet of
paper.

The subcrepitant rale is another modification holding a place
intermediate between the crepitant and the mucous rales. It has
been likened to the sound of a moderate effervesence in beer or other
liquid. It is referable to the presence of mucus in the smaller
bronchial tubes and indicates bronchitis or broncho-pneumonia.

Still other sounds are heard in diseased conditions of the pleurae.
These are friction sound, creaking, metallic tinkling, and
gurgling or splashing.

A friction sound is heard in the early stages of pleurisy and is
caused by the dryness of the pleural surfaces from the absence of
the halitus or vapor which normally moistens them and the depo-
.sition of layers of lymph by which the surfaces are rendered rough
and uneven. An approximate sound may be observed by placing
the palm of the left hand on the right ear and drawing a finger
of the right softly over its back. The sound is quick and jerking,
one or a few jerks only being heard with each inspiration as the
act is cut short on account of the pain attending the friction. It
is rarely heard in expiration. It is chiefly heard at the lowest
part of the chest where the lungs have the greatest freedom of
movement. The thinness of the walls of the chest above the breast
bone in cattle and dogs permits the friction sound to be heard more

174 Veterinary Medirme.

distinctly than in the horse. After the lapse of twelve, twenty-
four or forty-eight hours the friction sound disappears, the sur-
faces of the pleurae being separated by the liquid effusion, but it
may reappear when the fluid is absorbed in the process of recov-
ery. Sometimes the friction is further manifested by vibration
of the walls of the chest perceptible to the touch.

The creaking sound, as from the bending of a piece of strong
leather is caused by the movement of a thick and solid false mem-
brane binding the lungs to the side of the chest. This is often
confounded with crepitation.

Metallic tinkling is only heard when liquid and gas both exist
in the pleural sac and is due to the falling of a drop from the
shreds of false membrane above into the fluid contents below.
The sound is somewhat like the falling of drops in a closed cask
half full of water, or it may be fairly exemplified by placing the
palm of the left hand flat on the right ear and striking the back
of the hand smartly with the middle finger of the right. The
sound is chiefly heard after the patient has changed its position
and especially after rising. The explanation of this is that in the
recumbent position the liquid changes its place and bathes parts
which in standing are surrounded by gaseous products only.
Drops accordingly fall into the liquid for some time with dimin-
ishing rapidity until they cease altogether. Other explanations
of the sound but which less frequently exist are : the ascent of a
bubble through the liquid and its bursting on the surface ; and
the sudden recoil of air from one wall of the plueral cavity to the
other as the result of movement or sound generated in the deeper
seated solid structures.

A gurgling or splashing sound is equally indicative of the
presence of fluid and gas in the pleural sac. It is almost never
heard unless after a sudden movement on the part of the patient
causing considerable commotion in the contained liquid. Gur-
gling sounds transmitted from the abdomen are too often mistaken
for this. In small animals wath liydro-pneumo-thorax a quick
shaking of the patient will develop it.

Auscultation of the Cough is sometimes valuable, though
more difficult and less satisfactory in the lower animals than in
man, chiefly because of the extensive movement of the ribs in the
former. As conveyed through a healthy lung to the ear applied

Auscultation. 175

on the side of the chest, the sound is short, dull and indistinct.
When the lung is more solid from hepatisation, pleural exudation
or other cause, or when the bronchi are dilated the sound is loud
and strong. The extent over which it may be heard thus forcibl}-
agrees w^ith the area of lung in a state of consolidation. When a
considerable cavity or canal communicates with a bronchial tube
and extends to near the surface of the lung the sound is loud and
rmging. The note is specially clear and metallic when such a
cavity opens into the bronchus by a narrow orifice ; an apt illus-
tration of this noise may be obtained by coughing into a narrow
necked vessel.

The results obtained by auscultation should be confirmed by
percussion before arriving at any definite conclusion as to the state
of the chest. Consolidated lung tissue is a much better conductor
of sound than the healthy, and sounds conveyed through this may
be heard at a considerable distance from their point of origin.
Thus the heart sounds are frequently heard over any part of the
right side of the chest, and crepitation and other sounds may be
heard in the centre of a hepatized portion. On all such occasions
the dull sound elicited on percussion will not fail to correct the
fallacy.

PALPATION. TOUCH.

This is chiefly useful in cases of pleurisy. As already noticed
the vibration of the chest walls which accompanies the early fric-
tion sound is sometimes perceptible by the hand applied on the
side of the chest. Pressing firmly in the intercostal spaces at the
affected part invariably causes wincing and in cattle grunting.
Pinching the back in inflammatory chest diseases in cattle but
e.specially in pleurisy has a similar effect.

MENSURATION.

Measurement of the chest gives less reliable results in the lower
animals than in man. A cord four feet long should have one end
placed on a definite point on the withers and not removed until
both sides have been examined. It should be first carried down
to a point in the middle of the breast bone and the distance
marked by a knot ; a comparison may be made by carrying to the
same point over the opposite side. It should next be carried sue-

176 Vetcrbiary Medicine.

cessively to the lower end of the Sth rib on the two sides and the
difference marked, and lastly from the lower end of the third rib
to the lower end of the eighth. These measurements should be
made at one stage of the respiratory act, say when the chest is
fully dilated, and similar measurements when the chest is collapsed
to ascertain any difference in the expansion of the two sides of
the chest. In the smaller animals any difference in the expansion
of the two sides may be observed by inspection only, the practi-
tioner standing directly behind the animal and watching the
movements of the two sides from this standpoint.

A permanent dilatation of one side may be seen in water in the
chest confined to one side, and particularly if of some standing.
Complete hepatisation of one lung gives a similar result. The
intercostal spaces are observed to be wider than usual in such
cases, and the movements of the opposite side of the chest are
much more extensive than of the affected one.

A collapse with limited movement of one side is an accompani-
ment of chronic disease of the lung, with wasting of its substance
as in cases of tubercular deposit.

DISEASES OF THE I.UNGS.

Divisions of liitig diseases. Bronchitis, pneumonia, pleurisy, their re-
sults, nervous disorders, asthma, hiccough. CEdema. Emphysema. Mor-
bid growths, neoplasms. Infectious and parasitic diseases.

Inflammatory diseases of the respiratory organs situated within
the chest may be divided into : inflammation of the air tubes
within the substance of the lungs — bronchitis : — inflammation of
the spongy tissue of the lung — pneumo7iia . — inflammation of the
covering of the lungs and lining serous membrane of the chest —
pleurisy . — and complicated cases in which two or more of these
conditions coexist. Beside inflammatory diseases there are the
various permanent morbid results of these affections, such as con-
solidation of lung from exuded products becoming organized ;
collapse (compression) of lung from organization and contraction
of false membranes, thickening or dilatation of bronchial tubes
as a result of bronchitis ; also nervous affections, such as asthma
and hiccough ; morbid alterations in the lung tissue independently
of inflammation, as pulmonary or pleural oedema and emphy-
sema ; specific morbid deposits, as tubercles, glander nodes,
cancer, melanosis, etc., and morbid states, due to parasites, as
in the verminous affections of cattle, sheep, etc.

177

BRONCHITIS.

Relation to other maladies of the air-passages. Horse. Causes, suscepti-
bility, heat, cold, sudden changes, thick coat, rebreathed air, on shipboard,
in zoological gardens, in close stables, in navies, organic matter in expired
air, water vapor in expired air, effect on the air and bacteria. Ingesta in
bronchia. Medicinal liquids in bronchia in horses and cattle. Exposed
locations. Clipping. Smoke and gaseous irritants. vSymptoms, in mild
cases, in severe : fever, cough in dry stage, after secretion, auscultatory
sounds, percussion, discharge, vpatery, glairy, frothy, later milky, flocculent,
purulent. Convalescence. Capillary and pseudomembranous form. Intensity
of symptoms, labored breathing, dyspnoea, violent cough, pinched counte-
nance, dark mucosae, perspirations, palpitations, asphyxia. Course, du-
ration. Termination, difficult expectoration, blocking of bronchia, pneu-
monia, bowel susceptibility, skin congestion, laminitis. Chronic condition.
Lesions, congestion and contents of bronchia, soft, thick, friable mucosa,
absence of vascular ramification, tenacious mucus, false membranes. Col-
lapse, atelectasis, spleuisation, emphysema, bronchiectasis. Treatment,
in mild cases, in severe, hygienic, steaming, sulphur dioxide, derivatives,
guarded laxative, neutral salts, calmatives, expectorants, alkalies, stimu-
lant, oxygen, peroxide of hydrogen, iodide of potassium. Diet. In ad-
vanced stages tonics.

Defi7iition. Inflammation of the mucous membrane which lines
the bronchia. It is the counterpart of coryza and laryngitis, be-
ing but the inflammation of another portion of the same mucous
membrane which hues the whole respiratory track. That portion of
this mucous membrane which lines the trachea is rarely or never
the exclusive .seat of inflammation, so that in case of its being
implicated we do not speak of the case as one of tracheitis but as
lary7igitis or bronchitis, according as the throat or bronchia form
the seat of active inflammatory action.

The bronchial mucous membrane is often inflamed in influenza,
strangles, contagious pleuro-pneumonia of cattle, distemper in
dogs, and parasitic diseases of the lungs, but the following re-
marks will be confined to the .simple inflammatory affection. It
appears as an acute 2i\\^ a chronic affection.

HORSE. ACUTE BRONCHITIS.

This is more frequent in the horse than in other animals, and
178

Bronchitis.

179

especiall}^ so in young animals when newly stabled or put in
training.

Ca2cses. These are the same as thos2of catarrh and sore throat.
It is but the continuation of the same mucous membrane which
is affected in all alike, and the same atmospheric changes, hot
stables, noxious inhalations and exposures to cold and wet will in-
duce this disease rather than the others when the bronchial mucous
membrane is more predisposed. Bronchitis often supervenes
upon sore throat, by the extension of the inflammation down-
ward into the chest. Chilling of the surface by exposure to cold,
drenching rains, is a frequent cause, by reason of the intimate
.sympathy existing between the skin and the mucous membrane.
For the same reason certain conditions of the skin will predispose,
thus a long, thick coat which keeps the animal constantly
drenched with sweat and the skin relaxed and sensitive. Will-
iams draws attention to the frequency and severity of bronchitis
in both horses and cattle conveyed by sea during .stormy weather,
and especially when the hatches had to be fastened down. Such
an experience combines in one the evils of an overheated stall, a
sudden transition often to extreme cold, a lowering of the vitality
of the whole system by the circulation of non-aerated blood, a
systemic poisoning by the retention of the waste organic pro-
ducts that would otherwise have been eliminated, and the special
weakening of the lung tissue by congestion of the whole pulmonic
circulation.

But the development of bronchitis and broncho-pneumonia is
the least fatal result. The statistics of our European cattle traf-
fic are rich in the examples of absolute .suffocation of cargoes in
transit to Europe. The following from Report of U. S. Treasury
Cattle Commission is illustrative :

' ' Dr. Thayer reports the case of a steamer from Boston to Liv-
erpool, with 400 cattle on board, which encountered a storm and
came through it with only one animal surviving. Mr. Toffey, of
Jersey City, lost 30 head out of a cargo of 300 by suffocation in
1880. This happened, he informs us, on a calm sea on a south-
ern route with a temperature about 90° F. , and the wind astern
and light so as just to keep pace with the ship. The air on board
the ship became perfectly stagnant, and there was no means of es-
tablishing an artificial current. A still more disastrous experience

i8o Veterinary Medicine.

.befell the steamer Thanemore, Captain Sibthorp, of the William
Johnson & Co. line. This vessel left Baltimore with 565 cattle
on board, of which 228 perished by suffocation before she reached
Cape Henry. "

Among animals that survive such treatment the susceptibility
to lung disease including even the contagious forms like tubercu-
losis is enormously enhanced.

EFFECTS OF MODERATELY VITIATED AIR.

"When air only moderately vitiated is breathed continuously
for a greater length of time the results are still very injurious,
and in the front rank of diseases so caused stand pulmonary con-
sumption, and other destructive affections of the lungs. Perhaps
no better example of this can be given than that of the monkey
houses of the Zoological Gardens of London and Paris. While
these houses were small and ill-ventilated the monkeys died in large
numbers from pulmonary consumption, but after they had been
enlarged and better ventilated the mortality from this cause nearly
ceased. (Arnott.) "

" Town dairy cows which are packed in close ill-ventilated
buildings and never allowed to go out are very subject to consump-
tion, while horses kept in no better conditions, but spending nearly
half their time in the open air, rarely have phthisis. (With lung
plague it will be remembered that the out-door exercise and min-
gling of herds leads to an increase of the mortality.) Horses
newly stabled suffer severely from diseases of the lungs. The
same holds true of human beings. A long list of careful observ-
ers have noticed the essential connection of lack of ventilation and
pulmonary consumption. Baudelacque, Carmichael, Arnott, lyC-
pelletier, Allison, Sir James Clark, Toyubee, Guy, Greenhow,
Sir Alexander Armstrong, Parkes, and Aitken have especially in-
sisted upon consumption being a sequence of lack of ventilation.
Dr. Cormac indeed insists with great force that consumption is
originated by rebreathed air.

' ' The notorious prevalence of consumption in sailors has been
directly traced to the impure air in which they sleep, and an ex-
tensive outbreak of lung disease (not tubercular), leading to
destruction of lung tissue, in the English Mediteranean squadron

Bronchitis. i8i

in i860 was clearly traced by Dr. Bryson to the contamination of
the air. In a nursery hospital at Dublin with entire neglect of
ventilation, 2,944 children died in four years, whereas after the
ventilation had been improved only 279 died in the same length
of time. "

" Parkes (Practical Hygiene) says :

' ' ' But not only phthisis may be reasonably considered to have
one of its modes of origin in the breathing of an atmosphere con-
taminated by respiration, but other lung diseases, bronchitis and
pneumonia, appear also to be more common in such circumstances.
Both among seamen and civilians working in confined, close
rooms, who are otherwise so differently circumstanced, we find an
excess of the acute lung affections. '

In this connection, the statement of the air breathed by an ox
per hour and that supplied him on board a ship with insufficient
ventilation or none may be instructive. The ox takes in with
each breath about 5 liters of air. This is at the rate of 50 liters
per minute, or 3,000 per hour = 105.9 cubic feet. This amount
of air is therefore rendered all but irrespirable by each animal in
the course of an hour. And this, be it noted, is by breathing
alone, and makes no account of the contamination by perspira-
tion in the overheated hold, and by the emanations from the ac-
cumulating excrement. "

' ' On board the steamers we have found the space alloted to each
bullock to vary from 150 to 240 cubic feet. On the steamship
"Holland," loaded at New York, August 21, iSSr, we found the
stalls amidships allowed the full space of 240 cubic feet per head.
In the bow where there was less height between the decks the
space was considerably less. On the lower deck, where 129 cat-
tle were accommodated, the space allowed each was 217.4 cubic
feet. The portholes in the upper deck were nine inches in diam-
eter and there was one for each pair of stalls — central and lateral
— or for eight oxen. These being well above the water line would
be available for ventilation in ordinary weather. The port-holes
in the lower deek, similarly arranged, were about two feet above
the water line, and consequently not available for ventilation, save
in exceptionally calm weather. The temperature on the main
deck of this ship (between the outer and main deck), when only
half the cattle had been loaded, was in the neighborhood of 90°

1 82 Veterinary Medicine.

although she was lying in the center of the North River with port
holes and hatches open, and a fresh breeze blowing from the
north. "

' ' On the ' Assyriaan Monarch ' the space per head was only
192 cubic feet, but this ship was supplied with a ventilating fan
or blower capable of delivering over 50,000 cubic feet of fresh air
per hour, so that her ventilation was abundantly provided for.
In some smaller ships we found the space per head to exceed
little, if at all, 150 cubic feet. In these, accordingly, a single
hour without any change of air would threaten the life of every
animal on board, and two hours would endanger those for which
even the larger space is provided. It is true that such absolute
seclusion is rai'ely required, and that a certain amount of aerial
diffusion is always going on through imperfectly cloLsed hatches,
companion ways, and ventilators, yet that these are often insuffi-
cient has been amply shown by such losses as are reported above,
as well as by the bronchitis and tuberculosis which Drs. Whitney,
Lyman, and Williams have found in the lungs of American ani-
mals arriving in England."

" ORGANIC MATTER IN EXPIRED AIR."

' ' The decomposing organic matter given off by the lungs and
skin is probably the most injurious of the animal excreta, when
allowed to act on the system for a length of time. This exhaled
organic matter is easily recognized in the air by chemical tests, or
by the putrid odor evolved when cotton wool, that has been
breathed through, is left to soak in otherwise pure water at a
temperature of 70° to 80° Fahrenheit. The experiments of
Gavarret and Hammond, in which expired air had its carbonic
acid and water vapor removed, leaving only the organic matter,
showed that the latter was highly deleterious. Hammond found
that a mouse died in forty-five minutes in such an atmosphere.
It has also been again and again demonstrated that air containing
a given amount of carbonic acid as the result of respiration is far
more poisonous than air which contains the same amount of car-
bonic acid as a product of combustion."

" WATER VAPOR IN EXPIRED AIR."

" The amount of water vapor given off by the lungs varies

Bronchitis. 183

greatly according as the air is already more or less saturated with
water. As the air in the stalls between decks is always saturated
with water vapor, we may take the very lowest estimate for each
animal, namely, 60 ounces in 24 hours, which for a cargo of 200
head would amount to over 93 gallons. And this is in addition
to the exhalations from the skin and the bowel and kidney excre-
tions. The air between decks is therefore constantly saturated
with moisture which condenses and runs down in streams on
every solid object. Among the ill effects of this saturation may
be noted : ' '

' ' First. The saturation of the air with water vapor increases
the exhalation of carbon dioxide from the lungs. This effect on
the excretion of carbonic acid is usually so great as to counter-
balance the tendency of warm air to reduce the production of this
acid. This saturation, therefore, with water increases the danger
of suffocation by the accumulation of the irrespirable carbon di-
oxide in the ship, unless the air is being constantly removed. "

"Second. The excess of moisture in the warm atmosphere
hastens the decomposition of the organic matter derived from the
lungs, skin, and manure. Sir Alexander Armstrong, head of the
medical department of the British Navy, says : " There can be no
more fertile source of disease among seamen, or, indeed, other
persons, than the constant inhalation of a moist atmosphere,
whether sleeping or waking ; but particularly is this influence in-
jurious wlien the moisture exists between a ship's decks, where it
may be at the same time more or less impure, and hot or cold,
according to circumstances." It has become an aphorism with
sanitarians that " a damp ship is an unhealthy ship," and many
instances are adduced in which a sufficient renewal of the air be-
tween decks, with or without stoves to dry it, has transformed a
naval pest-house into a salubrious vessel."

" All such considerations must emphasize the demand for such
a constant renewal of air between decks on steamers carrying
cattle as shall serve to obviate all those conditions of ill-health,
with congestion and inflammation of the lungs, as have proved in
the past a serious drawback to our foreign cattle-trade. To ac-
complish this and at once remove from between decks the excess
of carbon dioxide, of decomposing organic matter, and of humidity,
and to furnish air approaching in purity and dryness that of the

184 Veterinary Medichic.

atmosphere outside, we can conceive of nothing more simple and
effective than thorough ventilation by fan or heat extraction, as
referred to below. " Report of the U. S. Treasury Cattle Com-
mission, 1882.

The above quotations were written with special reference to
cattle but the author reproduces them here as in principle applic-
able to horses as well.

In both horses and cattle treated as above it is common to find
ingesta in the bronchia drawn in during the violent paroxy.sms of
coughing. Here we have a direct mechanical irritant and a
means of septic infection, highly calculated to induce unhealthy
broncho-pneumonia. Williams quotes the case of a horse in
which vomition was caused by an over dose of aconite, and a por-
tion of the food entered the bronchi. ,

In this connection must be named the introduction into the
bronchia of liquids forcibly administered to horses and cattle. In
the horse the length of the soft palate enables him to hold liquids
in the mouth during his pleasure, and among the expedients
adopted to coerce him are the very dangerous ones of holding the
nostrils and of pouring the liquid through the nose. When the
nostrils are held the urgent demand for air leads to attempts to
breathe through ihe mouth, and, whether he succeeds in this or
not, the usual result is the drawing of a portion of the liquid into
the lungs. When it is poured through the nose the animal cannot
protect himself except by rapid gulping, and as he must breathe, a
portion of the liquid is usually drawn into the lungs. Any irritant
taken in this way will develop bronchitis, and some bland agents
like melted lard are almost equally injurious. Cattle having a short
palate can scarcely resist swallowing liquids that are poured into
the mouth, but a cough with the succeeding quick inspiration will
almost certainly draw a portion into the bronchia. To return to
the influence of cold, exposed situations which receive the full
force of cold winds, those from the north and west on the Atlantic
slope are specially conducive to bronchitis. Exposure of newly
clipped animals to stand without protection in winter or early
spring, has the same tendency. Finally the inhalation of smoke
or of heated and irritant gases and vapors, as in a burning build-
ing, is an effective factor.

Symptoms. In its mildest form bronchitis is a transient illness

Bronchitis. 185

with some dullness, impaired appetite, hot, dry mouth, redness
of the visible mucous membranes, a moderately strong, resonant
cough, attended with slight pain, slight rise of temperature,
accelerated breathing and pulse, and mucous discharge from the
nose. Such an attack passes over in a few days and without any
medicinal treatment if ordinary precautions are taken to avoid a
repetition of its causes.

In severe cases the symptoms are more intense from the first.
Besides the dullness and inappetence, hot, dry mouth, generally
increased temperature of the body (102° to 104° F. ), accelerated
and labored breathing, and other manifestations of fever, there
are more specific symptoms. The cough is dry, hard, pain-
ful, often paroxysmal, and appears as if it came from the very
depth of the chest. A strong, harsh, bronchial sound is heard
over the lower end of the trachea and the upper border of the
middle third of the chest just behind the shoulder. Percussion
detects no change from the natural resonance of the chest, nor
auscultation any crepitating sound. Pressure in the intercostal
spaces causes no suffering. The expired air feels hot. The
pulse though accelerated is moderately soft and sometimes even
weak, a condition which marks inflammations of mucous mem-
branes as contrasted with those of the serous. The mucous
membrane of the nose has a dark red hue, especially when the
inflammation extends to the smaller ramifications of the bronchial
tubes so as to impair the aeration of the blood. In the same state
there is excessive dullness and prostration because of the supply
of partially venous blood to the brain. The head is held low,
the nose often supported upon the manger, and the eyelids are
semi-closed and injected.

From the second to the fourth day a free exudation takes place
from the surface of the mucous membrane, and the symptoms are
materially changed. The cough becomes more frequent but
softer, looser, and attended with a rattle from the air passing
through the abundant mucous secretion. The cooing or tubal
sound heard at the lower end of the windpipe and behind the
shoulder has now given place to a miicoiis rale. A nasal dis-
charge appears at first watery, thin, of a whitish, glairy froth,
but .soon becoming more opaque, white, milky and flocculent and
having little tendency to stick to the nostrils. This is often ex-

1 86 Veterijtary Mediciyie.

pslled with sneezing and accompanied by movement of the jaws.
With the access of free secretion there is a great mitigation of the
fever and the other distressing symptoms, and, if no relapse nor
compHcation supervenes, recovery may be complete in a fortnight
or three weeks from the onset.

From this time all the febrile symptoms decline and disappear,
appetite and liveliness return, the discharge rapidly diminishes
and finally disappears, when the patient may be said to have com-
pletely recovered.

Capillary and pseudo-membranous bronchitis are described
by Reynal as occurring in young horses recently brought into the
army and subjected to the hot and close stables in some of the
French barracks. It began as ordinary bronchitis, which in place
of tending to recovery, propagated itself to the most minute
bronchial ramifications, and was frequently complicated by the
formation of false membranes. The signs of its accession are an
extreme intensity of the general symptoms, the rapid, labored,
difficult breathing, accompanied by convulsive action of the
pectoral and abdominal muscles ; the frequent, painful, suffocating
and abortive cough, which violently shakes the whole body ; the
extended head, open mouth, distorted nostrils, reddish brown
protruding eyes ; the pinched, haggard features, and the frothy
mucous, nasal discharge striated with blood, and later interspersed
with shreds of false membrane similar to those existing in croup.
In connection with these are the symptoms of extreme oppression ,
partial sweats, tumultuous action of the heart and small, weak,
rapid pulse. Death resulted from suffocation during a paroxysm
of coughing.

Course. Duration. Termination. Bronchitis is not usually
fatal, except in very young or old or worn out animals, or unless
it assumes the capillary form or is complicated by pneumonia,
pulmonary abscess or by metastasis to the bowels or feet. In the
mildest cases health is re-established in three or four days, and in
the severe, about the twelfth, fifteenth or twentieth da3^ In old
and debilitated animals in which pure bronchitis proves fatal, the
abundant effusion into the bronchial tubes, the influence of gravi-
tation retaining this in the smaller tubes, the palsy of the
cilia which normally carry it outward, and the want of power to
expectorate by coughing, usually bring about suffocation. This

Bronchitis. 187

is favored by the nonserated state of the blood, which rapidly
prostrates the already weakened nervous centres. The superven-
tion of pneumonia will be marked by a new class of symptoms,
especiall}' labored breathing, dullness on percussion and crepita-
tion on auscultation. The susceptibility of the bowels is so great
in some cases of bronchitis, particularly in those associated with
a low fever, that superpurgation, enteritis and death may result
from the smallest dose of laxative medicine, — the author has seen
a fatal result from the administration of two drachms of aloes in
a case of this kind. In such circumstances the skin usually par-
ticipates in an equal degree, and though the superpurgation be
checked an extension of the disease to the feet may still prove
fatal or induce such changes of structure as to leave the animal
practically worthless. In old animals or after repeated severe
attacks of bronchitis it may merge into the chronic form. Thick
wind is a frequent sequel of severe cases from thickening or dila-
tation of the bronchial tubes, from collapse of the lung or from
emphysema.

Post-mortem appearances. In the bodies of animals that have
died of bronchitis the air-passages within the lungs are filled
with a white or greenish yellow mucus. If this is washed from
the tubes by a stream of water, the mucous membrane is often
found to be injected, studded more or less profusely with red
points or with branching red lines, and with petechia, and the
mucous membrane is softened, sometimes thickened and friable.
When, however, the bronchitis has been attended by a free puru-
lent expectoration the mucous membrane may, when washed,
show no perceptible alteration from the healthy standard as ex-
amined by the naked eye.

In the capillary form the blocking up of the smaller tubes by a
tenacious frothy mucus, and by the false membranes which form
complete casts of many of the tubes and the partial consolidation
(collapse) of circumscribed pyriform masses of lung tissue with
which such tubes communicate form the chief features on exami-
tion after death.

This state of consolidation or collapse of lung is frequently seen
in simple bronchitis as well. It is then due to the blocking up of
one or more bronchia by plugs of tenacious mucus which act as
valves, preventing the entrance of air, though it may permit of

1 88 Veterinary Mediciiie.

its eas)' passage outward. This state of lung differs materially
from the consolidation due to inflamed lung tissue (hepatisation).
When cut it does not present the granular appearance of the lat-
ter, caused by the exudation into the minute air cells, but the cut
surface has an uniform homogeneous aspect aptly likened by
Lsennec to vnisciUar fiesh (splenisation;. Mendelson, Traube
and Gairdner have induced artificial collapse of the lung by in-
troducing foreign bodies into the bronchia of animals.

Emphysema of the margins of the lung is a frequent concomi-
tant of collapse. The cause is plain. The portion of lung, the
subject of collapse, emptied of its air, does not occupy a tithe of
the space it would normally fill. The rest of the lung tissue ex-
pands unduly to fill out the vacated portion of chest and the cells
become over-distended and ruptured. The emphysematous lung
is known by its lighter color, by its irregular bulging surface, by
the subsidence of these elevations when pricked with a needle,
and by a more marked crepitation when pressed. When the cells
have burst and the air escaped into the areolar tissue between the
lobes, it appears as dark lines circumscribing small portions of
pulmonary tissue and collapsing when pricked.

Treatment. The mildest cases will recover of themselves,
especially if care is taken to protect the patients against cold, wet,
draughts of cold air, over-exertion, and other injurious causes,
and to give a part of the food warm and sloppy. In severe cases
treatment must be more active, but it will be borne in mind that
severe depletive measures are badly endured. Bleeding danger-
ously increases the already existing weakness and prostration
without affording any corresponding advantage. ' It is only ad-
missible when from the severity of the symptoms in the early
stages suffocation is threatened or when the brain becomes in-
volved in disease.

Causing the patient to inhale water vapor from scalded bran or
hay is to be assiduously carried on for half an hour to an hour
twice or thrice daily until expectoration has been freely e.stabli.shed
and the cough and fever alike moderated. The density of the
vapor must of course be apportioned to the particular case so as
to avoid any approach to suffocation. The addition of the fumes
of burning sulphur will often by their astringent and antiphlogistic
action on the mucous membrane, rander the vaporous application

Bronchitis. 189

more effective. A pinch put into a small piece of paper twisted
at one end to prevent burning of the fingers may be set fire to
and the fumes allowed to pervade the appartment so that they can
be breathed freely without inducing cough. A mustard poultice
to the neck and sides of the chest should also be applied and kept
on an hour or until effusion into the skin is well marked \iy thick-
ening of its substance. Injections of warm water should be given
alike to check or obviate shivering and to equalize the general
temperature and to solicit the action of the bowels. In sporadic
casss with active fever and full strong pulse a laxative dose of
aloes (3 to 4 drachms) may be given, but if with a low fever and
during the prevalence of influenza not more than half the dose
should be given or enemata alone ma\' be relied upon. As soon
as the medicine has .set or at once if it is withheld, neutral salts
may be given (Liquor Ammonise Acetatis 2 oz. or Sweet Spirits
of Nitre i oz. or nitrate of potass ^ oz. combined with 10 drops
tincture of aconite repeated twice or thrice daily). If the cough
is troublesome and secretion long in being established, expector-
ants ma}' bs used (oxymel of squill 3 oz., powdered squill J,^ oz.
or liquorice i drachm) with half the doses of the neutral salts.

In the early stages to hasten expectoration such preparations as
the following may be given :

Recipe: Potas. Bicarb. 2 ounces; Ammon. Carb. 2 ounces;
Digitalis Pulv. 2 drams. Mix. Divide into eight powders : give
one every four hours.

Recipe : Ammon. Murias. 2 ounces ; Choral. Hydrat. i ounce ;
Tinct. Hyoscam. 2 fluid ounces; Aqua 8 fluid ounces. Mix.
Give two tablespoonfuls ever}- four hours.

Apomorphia, tartar emetic, turpentine or benzoin may be em-
ployed or even pilocarpin, care being taken not to increase pros-
tration unduly. Compre.ssed air, oxygen and peroxide of
hydrogen will sometimes relieve.

With the advent of expectoration, or earlier, iodide of potassium
in one drachm dose, thrice a daj- will do much to obviate gland-
ular and other enlargement which would tend to develop 7-oaring.

The diet should be laxative, non-stimulating and somewhat
spare. Mashes of wheat bran, boiled linseed or boiled barley ;
roots such as turnips, carrots, beets ; in summer a limited supply
of fresh grass, with little hay at any time and that scalded, may

I go Veterinary Medicine.

indicate the nature of the ahments to be used. As a beverage
chilled fresh water or linseed tea may be supplied ad libitum.

Should the nasal discharge manifest no disposition to cease at
the end of 15 or 20 days, as will sometimes happen in young
horses, stimulants and tonics must be employed. Gentian (4
drachms). Sulphate of iron (2 drachms), Arsenious acid (5 to 10
grains J or nux vomica (i scruple) may be given daily as ball,
electuary or powder. A full and nutritive diet should at the same
time be allowed, and open air exercise enjoined.

CHRONIC BRONCHITIS IN THE HORvSE.
BRONCHIAL CATAARH.

As Sequel of Acute : as result of unhygienic environment, diet and usage.
Symptoms, breathing accelerated, double expiratory act, short breath, cough
husky, or paroxysmal, excited b}' cold air, water, discharge white floccu-
lent. Percussion, drumlike patches ; Auscultation mucous and sibilant rales.
Lesions, thick mucus, pale membranes, bronchiectasis, emphysema, ulcera-
tion. Thick wind. Treatment, stimulating, tonic, derivative, medicated
vapors, careful diet. Tar water.

This may be a sequel of the acute form, or it may appear at
once as a catarrhal discharge from the bronchial tubes and with-
out any very marked febrile affection, in animals debilitated by
damp stables, overwork and a faulty regimen and diet.

Symptoms. Respiration accelerated, and expiration effected
with a double lifting of the flank ; the lior.se is easily blown when
moderately exercised ; the cough is frequent, soft or rattling and
paroxysmal — sometimes hard and deep - is excited when brought
from the warm stable into the cold air, and is followed by a
whiti.sli, flocculent, purulent discharge from the nostrils, con-
sistent but not sticky (like buttermilk). The pulse is rapid and
small in volume.

Percussion manifests a healthy resonance over the greater part
or all of the chest, a drumlike sound over given areas, and auscul-
tation over its median part detects a bronchial rattle and in most
cases a dry sibilant rale.

After death the bronchial tubes are found to contain an abund-
ance of thick mucus, though abnormal redness of the mucous
membrane is by no means a necessary condition. There is always
more or less dilatation of the bronchial tubes especially at their
points of s-ubdi vision where they are often twice their healthy
calibre, and an emphysematous state of the lungs is equally con-
stant. Delafond and Rodet have noted minute ulcers on the
bronchial mucous membrane and Reynal miliary abscesses and
grayish and white indurations of the lung tissue and bronchial
glands which may have been glanderous.

It will be observed that the symptoms and lesions closely re-
semble those of broken wind (heaves), and unless early and suc-

191

192 Veterinary Medicine.

cessfuUy treated, into this it gradually merges. The chief dis-
tinguishing symptoms are the abundance and nature of the dis-
charge, the fetor of the breath, and the presence of the mucous
rale in the chest. It is one of the conditions known by the horse-
man's expression " thick tvind.'''

Treatment. Like its type (dilatation of the bronchia, bron-
chiectasis) in man this disease obstinately resists treatment. In
our efforts to cure it the same general principles must be followed
as in acute bronchitis, with this grand qualification that the gen-
eral aim must be to stimulate and support. Stimulating liniments
may be repeatedly applied along the course of the trachea and on
the sides of the chest. An equable temperature is desirable and
a dry building. Water vapor medicated with various astringents
and antiseptics (creosote, carbolic acid, turpentine, tar, or tar
vapor) is to be commended. A course of tonic and expectorant
medicine is desirable and a highly nutritious and laxative diet is
imperatively demanded.

As tonics Gentian may be given daily in 4 drachm doses com-
bined with quaiacum in do.ses of 2 scruples. In mcst ca.ses it will
be advisable to add to the above or employ separately arsenious
acid in doses of 5 to 10 grains combined with three times the
amount of bicarbonate of soda, and given daily for a month or
longer.

The diet should be as for broken wind, nutritious, in small
bulk, of a laxative nature and given at least an hour before work.
A moderate supply of grass, roots, bran, oats or barley may be
given, but hay must be sparingly supplied and, if exclusively
clover hay, dry and dusty, is better withheld. In the north of
France horses with chronic bronchitis are maintained in a service-
able condition by a diet of cut straw and cut hay, well sifted to
remove all dust mixed with oats and molasses and set aside in a
large cask to ferment before being given to the animals. Tar
water may be the exclusive drink.

A pint of linseed, well boiled, and given daily for a length of
time in succession is often of great value.

BRONCHITIS IN THE OX.

Working oxen most susceptible. Causes, damp buildings, wet, cold, ex-
posed localities. Debility, overwork, poor feeding, close, foul stables, sud-
den changes of temperature. Previous attacks. Symptoms, mild form,
and severe, fever, sneezing, cough, dry, later soft, prostration, retraction of
nostrils, labored breathing, hot breath, discharge, watery, milky, purulent.
Duration, Complications and sequelae. Chronic form. Respiratory dis-
turbance, paroxysmal cough, purulent discharge, mucous and sibilant rales,
emaciation. Lesions. Treatment, laxative safer, expectorant, derivative
stimulant, etc., as in horse. Bronchitis in pigs and sheep.

This is less common than the same disease in the horse, though
in working oxen, in which many of the same causes operate, it is
frequentl}' seen. It is not infrequent in other cattle in damp
buildings or in wet cold exposed situations. Debility from over-
work and poor feeding, often brings on the chronic form of this
disease. Living out in damp nights after a hard day's work is
another frequent cau.se. The enervating influence of the hot foul
air of many cow houses conduces to it and is specially injurious
if alternated with a chilling atmosphere out of doors. Previous
attacks strongly predispose to future ones.

Symptoms. Some cases are so slight as to escape a cursory ob-
servation and subsiding in a few days leave the animal perfectly
well. Others are severe and may prove dangerous.

The earlier symptoms are dullness, staring coat or shivering,
and sneezing, followed by reaction with hot clammy mouth, gen-
eral increase of temperature, rapid pulse, reddened nose and eyes,
and suspended rumination. The more characteristic symptoms
are a hard, dry, hacking cough, not so resonant as in the horse,
and soon a mucous discharge from the nose usually cleared away
by the tongue almost as rapidly as formed.

If the case increases in severity, and in many cases almost from
the first there is great depression, hanging head, semi-closed wa-
tery eyes, extreme movement of the nostrils, hot expired air,
labored action of the flank, complete loss of appetite, constipa-
tion, faeces covered by mucus, cough very hard, painful, oc-
curring in paroxysms and easily excited by touching the larynx
or trachea. This is followed by a loose cough, a free discharge

13 193

194 Veterinary Mcdichie.

from the nose and a mucous rale on auscultation. Percussion
gives healthy resonance. The disease reaches its height on the
fifth day and recovery may be almost perfect on the eighth. Its
chief danger is from a complication with pneumonia or pleurisy,
or from its merging into the chronic form.

Chronic bronchitis in the ox is characterized by a persistent
disturbance of the respiration, paroxysms of coughing, a white
flocculent discharge from the nose, increasing emaciation, palor of
the mucous membranes, a mucous rale over the windpipe and
median part of the chest and a cooing sound over other points.
If left to itself emaciation becomes extreme, the skin is harsh,
inelastic, attached to the ribs and covered by vermin, and death
usually ensues from diarrhoea or consumption.

After death the lesions are like those seen in the horse, unless
there is the complication of tuberculous or other disease of the
substance of the lungs.

Treatment. Neither the general care nor the remedial treat-
ment differs materially from that for the horse. The principle
difference is in the lesser liability to superpurgation and in the
preference to be given to Epsom or glauber salts over aloes as a
laxative. Either saline may be given in dose of one pound com-
bined with an ounce of ginger or other stimulants, and followed
up by similar diuretics, expectorants and tonics, as in the horse.
The chrojiic form is to be treated as in the horse.

Pigs and sheep affected with bronchitis must be treated on
the same general principles as the ox, only giving one-fifth the
amount of the different medicaments, and in the case of the pig
oleaginous purgatives and emetics as advised for the dog.

BRONCHITIS IN THE DOG.

Causes, damp kennels, cold and damp aflei hunting, pampering and ex-
posure, distemper. Symptoms, fever, cough hard, later soft, discharge wa-
tery, glairy, purulent. In capillary bronchitis cough more paroxysmal,
painful and attended with vomiting. Disturbance of breathing, pulse, tem-
perature. Fatality in different breeds. Treatment, laxative, expectorants,
diuretics, heart tonic, calmative, water vapor, chest jacket, stimulant ex-
pectorants, stimulants, tonics. Diet.

This is conitnon and severe. Hotinds kept in damp kennels,
much exposed to cold and damp after being heated in hunt-
ing, or subjected to freqtient and sudden alternations of tem-
perature are specially liable. Pampered pets kept in warm
rooms, overfed and having little open air exercise, are equally-
subject to its attacks. It is an usual form in which distemper is
manifested.

Symptoms. There is roughness of the coat or shivering and a
small, hard cough often repeated. If confined to the bronchi the
cough soon becomes loose, a free discharge sets in, and with care
recovery may be secured in five or six days.

If the smaller bronchial tubes are involved the symptoms are
more intense and persistent. The temperature may reach 104°
or 105°. To the same early symptoms succeed, a painful cough
occurring in paroxysms and sometimes followed by vomiting of a
glairy mucus. There is running from the eyes and nose, and
reddening of thin membranes. The creature .stands with his
elbows turned out, his flanks heaving and his heart beating rap-
idly and tumultuously. In the worst cases when the inflamma-
tion has been propagated to the smallest bronchial tubes consti-
tuting capillary bronchitis, these symptoms are seen in their most
aggravated type and the subject often dies of suffocation, or by
implication of the lung tissue. Percussion and auscultation are
even more applicable than in the larger animals, showing the
clear resonance, of the lung tissue, the tubal murmur in the early
stages and the mucous rattle in the later ones. In the capillary
form a distinct crepitation is heard like that of pneumonia.
Bronchitis proves most fatal to the higher bred dogs, such as King
Charles spaniels, Italian greyhounds, and English terriers, and

195

196 Veterinary Medicine.

according to St. Cyr small dogs suffer more severely than large
ones.

Treatment. If the bowels are costive a tablespoonful of castor
oil should be given, followed up by nauseating expectorants and
diuretics (tartar emetic two grains, nitrate of potass one drachm,
and sugar one drachm, mix thoroughly, divide into twelve pow-
ders and shake one on the tongue thrice daily). If the cough is
very troublesome two grains of powdered digitalis may be added
to each dose, or after the nasal discharge has been freely estab-
lished two to four grains of opium among the tartar. The
opiates are of great value in controlling the paroxysms of cough-
ing and the propagation of the disease to the smallest ramifica-
tions of the air passages, but as they check secretion they must
be used with caution until a free discharge has been established.
In the early stages bromides, hyoscyannes or digitalis may be
preferred. Muriate or carbonate of ammonia, syrup of Tolu,
senega, or gnaiac may follow.

Inhalations of water vapor, the maintenance of an equable
temperature, and the moist chest jacket, followed by mustard
poultices to the throat and chest are not to be neglected. The
diet should be simple, oatmeal or Indian corn pudding with milk,
soups and the like may be allowed, but as a rule butcher meat is
to be withheld. If the patient has previously fed entirely on the
latter it should now be given in very limited amount only, and
qualified by an admixture of farinaceous diet.

In some cases the prostration becomes so great that the patient
must be supported by tonics and stimulants (a teaspoonful each
of sweet spirits of nitre and tincture of gentian, or a teaspoonful
of port wine repeated twice daily).

In case of persistent discharge, iron, liquor arsenicalis, the
same strength as Fowler's solution, or cod-liver oil may be used.

CROUPOUS BRONCHITIS IN CATTI.E AND SHEEP.

Causes, smoke, hot air or gas, irritant inhalations, concomitant of in-
fectious diseases. Lesions, intense congestion covered by fibrinous exu-
dates. Symptoms, slowly or suddenly developed, fever, loud, wheezing,
stertorous, panting breathing, dyspncea, dry rales and blowing. Course-
Treatment, moist jacket, soothing, expectorant, stimulant inhalations, ex-
pectorants, derivatives.

This affection has been found in cattle and sheep from exposure
to smoke, hot air or gas, and other irritants, and even from ex-
posure to cold, and without any suspicion of a contagious ele-
ment. Again it has been seen as a complication in Rinderpest,
lung plague and malignant catarrh. The lesions are those of
tumefaction and extreme arborescent redness of the mucosa, and
the formation of patches of a dense fibrinous exudate of a yel-
lowish color, in .some cases completely obstructing some of the
smaller tubes.

Symptoms. The attack may come on slowly as in ordinary
bronchitis, while in other cases it is sudden. The respiration be-
ing loud, wheezing, stertorous and panting and general dyspoena
supervening. Auscultation furnishes loud, blowing sounds, dry
rales and rouchi, while percussion may show no abnormal change.
A .strong tremor is felt by the hand on the trachea, and after a
paroxysm of coughing false membranes may be expelled. If
there is no improvement by the .second or third day death is liable
to supervene by asphyxia.

Treatment is usually unsatisfactory. The hot, moist jacket,
inhalations of vapors of warm water, of carbonate of ammonia,
and of ether may be tried, counter-irritants to the chest, and in-
ternally liquor ammonia acetatis and iodide of .sodium would be
indicated. When the membranes are somewhat loo.sened pilo-
carpin, or in weaker subjects apomorphine may a.ssist their ex-
pulsion.

197-

ACUTE CONGESTION OF THE EUNGS. PUEMONARY
HYPEREMIA.

Active and passive congestions. Congestion of incipient pneumonia.
Congestion of over-exertion. Causes, lack of condition, fat, plethora,
gorged stomach, hot weather, cold rains, cold baths, infectious diseases.
Symptoms, dilated nostrils, labored breathing, deep lifting of flanks, pant-
ing, pendent head, staring, fixed, bloodshot eyes, pale — later dark red nasal
mucosa, rapid julse, palpitating heart, fine crepitation, cold limbs, tremors,
perspiration, obstinate standing, till unable, blood from nose. Fulminant
cases. Exposure cases. Course. Termination. Resolution. Lesions,
lungs black, gorged, do not crepitate nor collapse, lessened buoyancy, cut
surface, compressed bronchioles and alveoli, right heart and veins gorged,
blood black, semi-liquid, petechise. Nature. Not yet inflammatory, blocd
engorgement, no cell proliferation, migration, non-exudation, pulmonary
vaso-motor paresis, effect of blood pressure, of peptones, etc, of exhaus-
tion. Treatment, relieve respiratory muscles, derivation to surface, stimu-
lants, hot pediluvia and packs, relief of vascular sj-stem, bleeding, heart
stimulants, digitalis.

Congestion of the kings occurs in all animals as the percursor
of inflammation, but as death may occur without the superven-
tion of actual inflammation a special notice appears to be de-
manded. The hypersemia of the lungs may be seen in two forms,
active and passive, the latter form being secondary to other
diseases, such as valvular diseases of the left heart, by reason of
which the blood is forced back on the lungs and creates mechani-
cal congestion. The active form is a pathological process devel-
oped in the lung itself, and which often proves fatal through
arrest of the circulation through this organ.

Causes. The pulmonary congestions preceding pneumonia are
due to the .same causes with that disease. The most typical,
acute and deadly form of pulmonary congestion is usually due to
over-exertion in an animal that is fat and out of condition. The
English hunting field presents the most typical specimens. A
horse that has just left the dealer's hands, or that is plethoric,
fat, soft and flabby, is ridden over a heavy country, and though
he may perform well for a few miles, he soon hangs heavily on
the bit, slackens his pace, and if not pulled up, staggers and falls
"all of a heap." A farm horse, taken from grass or other, soft
198

Acute Congestion of the Lnngs. Pubnonary Hyperccmia. 199

feeding, and entirely out of condition often suffers in the same
way, in going perhaps for the veterinarian in case of urgent
colic in one of its fellows. Cruzel draws attention to similar con-
gestions from over-exertion in fat cattle, and Trasbot in wild
stags and hogs when beechnuts and acorns were abundant, in
pampered family horses and in plethoric farm animals generally.
Excessive heat (heat apoplexy) is invoked as a cause, and the
arrest of hgematosis and consequent stagnation in the pulmonary
capillaries are undoubtedly accessory causes, yet the majority of
cases, and the most typical and fatal, occur in the winter season
(the hunting season). On the other hand, chills from rains or
cold draughts, especially when heated and exhausted, are com-
mon causes, and the disease often comes on more gradually,
attaining its acme after five or six hours. A horse perspiring
after a hard drive and left to face a cold blast unblanketed, or one
plunged by accident into ice cold water for ten minutes (Trasbot)
are examples of this kind. These cases are ushered in by violent
rigors, whereas in those due to over-exertion this is much less
marked and is usually only suggested by the coldness of surface
and extremities. Another condition which contributes to pul-
monary congestion is a full stomach. The plentitude of the ab-
dominal organs leads to compression of the lungs and hampered
circulation, and when to this is added over-exertion and exhaus-
tion acute congestion is speedily induced.

Acute congestions are noticed as an accompaniment of other
diseases, but these are mostly either the localization in the lung
of a specific morbid process (anthrax, influenza, distemper,
strangles), or it is due to auto-poisoning, as when the cutaneous
transpiration is suppressed by a coating of glue, or to embolism.

Symptoms. In the horse which fails under severe exertion
there are the dilated nostrils, the labored breathing, the deep,
almost convulsive action of the flanks, the hanging on the reins,
the slacking of the pace, the unsteadiness of gait, and lastly the
fall. There may now be noticed the protruded bloodshot e3^es,
the agonized expression of countenance, the extended head, the
pallor, and later the blueness of the nasal mucous membrane, the
short, panting breathing, accompanied by a roaring noise alike in
inspiration and expiration, and the small, weak, rapid pulse
often imperceptible at the jaw. If the animal has been stopped

200 Veterinary Medicine.

short of having fallen, or if he is able to get upon his feet, he
stands with his limbs apart to secure his stabilit3^ and with
the elbows turned out to facilitate the expansion of the chest.
As the breathing becomes panting the respirations are less deep,
the ribs are maintained permanently drawn outward, and the
flanks rise and fall to a limited extent only but with great rapidity
(eighty to one hundred per minute). Auscultation may detect
at first an increase in the pitch of the respiratory murmur, and
the presence of the finest possible crepitation soicnd. Soon the
murmur decreases uniformly. The extremities are cold, and in
this coldness the general surface to some extent participates even
though it may be covered by perspiration. Tremors or rigors
are present. The heart is felt behind the left elbow to beat
tumultuously. If blood is drawn it flows in a thin, black, tary
stream.

In some cases blood more or less frothy is discharged from the
nostrils as the result of rupture of pulmonary vessels.

In the fulminant cases in cattle respiration is rapid, even pant-
ing, wheezing, the expiration attended by a hoarse grunt, some-
times nasal hemorrhage, great prostration, profuse perspiration, a
.stupor sets in and the animal falls and dies, with more or less
struggling.

In the cases which develop more slowly, and as the result of
cold and chill whether in horses or cattle, there is dullness, anor-
exia, prostration, increasing rapidity and oppre.s.sion of the breath-
ing, a small, frequent, hoarse cough, and at first distinct pallor of
the conjunctiva and pituitary mucosa, with more or less trembling.
The head is extended on the neck, toward an open door or win-
dow, if available, until prostration and .stupor forbid. The pulse
is small, thready, often almost imperceptible and much accelerated,
while the heart beats are .strong, violent, tumultuous. For a time
the respiration may be not more than double the normal rythm,
but it tends to more or less rapid increase with wheezing or ster-
torous sounds and shaken by trembling of the respiratory muscles.
The nasal discharge is slight and grayish often with streaks of
blood. If it increases the cough becomes looser and .softer.
Quite early the respiratory murmur decreases over the whole lung
and a blowing sound from the bronchia or larnyx is heard on
the upper middle third of the chest. This may be complicated by

Acute Congestion of the Lungs. PulmoJiary Hypercemia. 201

a mucous rale, or when ligemorrhage has supervened by a loud
rattling. Percussion shows a lack of resonance over the whole
lung, not so flat and definitely circumscribed as in pneumonia but
a partial flatness of sound over the v^'hole chest. In pneumonia a
limited area of lung is absolutely solidified (hepatized) while the
remaining lung is practically normal, whereas in acute congestion
often the whole lung is gorged with blood but for some time no
part of it is entirely divested of air.

Another marked feature is the maintenance at first of the nor-
mal temperature with only a slight rise of about 1°. This serves
to distinguish congestion of the lungs from sunstroke (heat anhge-
matosis) in which the temperature usually rises to 108° or 110° F.
or higher. The temperature rises however as the disease advances
and merges into pneumonia. Another distinguishing feature
from sunstroke is the early pallor of the mucous membranes which
in heat apoplexy are strongly congested. In congestion they be-
come dark red only with the advance of the disease and the ad-
vent of asphyxia. These features serve also to distinguish acute
pulmonary congestion from contagious fevers, pneumonia and
other inflammations of internal organs.

Course. Termination. The more acute (fulminant) forms are
promptly fatal. In the exhausted system the lungs have become
uniformly gorged with blood, which can no longer be forced
through the capillaries by the right heart, the heart in turn is
overdistended with blood and ceases to beat and death ensues in a
few minutes.

In the less acute cases the patient survives twenty-four hours
and upward, the whole lung not being equally implicated but only
certain lobules, usually the lower, or the congestion, if uniform in
all the lung, being less extreme.

In favorable cases recovery takes place in one or two days.
There is a return of life and appetite, a gradual improvement in
pulse and breathing, the respirations becoming deeper and longer,
and in a few hours all the more violent symptoms may have dis-
appeared. With a more gradual improvement recovery may still
be complete in four or five days.

Lesions. When the subject has died suddenly the appearances
are essentially those of uniform engorgement of the pulmonary
capillaries with blood. The general aspect is a dark red, varying

202 Veterinary Medicine.

from reddish brown to black, the darkest shades corresponding to
circumscribed areas of actual haemorrhage. • In the worst cases
the whole mass may appear like black currant jelly. The lungs
do not collapse when the chest is opened, they are more or less
friable at various points, and different portions will sink or float
in (not on) water, according as it may be more or less airless. A
dark liquid blood exudes freely from the torn or cut surface.
Sections of the lung tissue hardened and examined under the mi-
croscope show the alveoli and bronchioles devoid of exudate, but
having their cavities compressed and obliterated by the pressure
of the swollen mucosa, and its investing blood clot. The heart
is overdistended with fluid blood. In asphyxiated cases the gen-
eral venous system is filled with black, liquid blood, and the se-
rosse spotted with petechise.

Nature. The nature of this disease is variously luiderstood.
It differs from inflammation in the absence of active cell prolifier-
ation, and migrations of inflammatory exudation, and of fever at
all proportionate to the extent of the lesions. All these may and
do supervene if the patient survives but they are practically ab-
sent for a length of time at the outset. Some attribute it to pare-
sis of the vaso-motor centres for the lungs, as the result of their
over .stimulation and of the retrocession of blood from the chilled
surface to the internal organs. But congestions caused by cut-
ting the cervical branch of the sympathetic nerve or the sciatic
plexas are not marked b}' a .similar blood extrava.sation and de-
.struction of tis.sue. The delicate structure of the lung tissue and
the comparative absence of mechanical support will account for
this in part, the great force of the circulation overloading the cap-
illaries, under the impulse of the heart so closely adjacent, has
doubtless a certain effect, and the venous nature of the blood thus
forced into the lungs and calculated to arre.st all normal function
has a potent influence. If we add to this, for the over-exertion
cases, the sudden advent into the circulatory stream of unchanged
peptones and other ingredients of the portal blood of highly fed
and plethoric animals we find a sufficiently pathogenic combina-
tion. In all acute cases however the adiposity, poor condition
and susceptibility to speedy exhau.stion must be given their full
share of responsibility.

Treatment. Girths, saddles and anything else that may hamper

Acute Congestion of the Lungs. Pulmonary Hyperccmia. 203

the movement of the chest must be at once removed and the
horse's head turned to the wind, an active stimulant given and the
legs well rubbed and loosely flannel bandaged. The nature of
the stimulant is of less consequence than its prompt administra-
tion. Two ounces of chloroform, of sulphuric ether, or of sweet
spirits of nitre ; half a pint of whisky, brandy or gin ; or a pint
of any of the more stimulating wines may be given, diluted in
warm water so as to remove tli2ir irritating qualities. A drink
of warm gruel will often go far to restore warmth to the surface
and to unload the overtaxed lungs. Frequent large injections of
warm water have a similar effect. Active hand rubbing of the
legs and the wrapping of them loossly in flannel bandages pre-
viously warmed at the fire is equally valuable. If a roomy, well
ventilated, loose box can be obtained the horse should be led to
it gently and a light but warm rug placed upon the body. Valu-
able derivation may be obtained from pediluvia, the feet and legs
up to the knees and hocks being put in buckets of water as hot
as the hands can bear, and at the same time actively rubbed. If
this is impossible the legs may be wrapped in bandages and wet
with hot water every few minutes. Or this soothing derivative
agent may be applied as well to the surface of the chest. A
blanket wrung out of hot (nearly boiling) water until it no
longer drops is wrapped round the body and covered up with two
or three dry rugs. A second smaller rug is wrung and placed on
the neck and covered by a sufficiency of hoods to keep in the
heat. The legs are meanwhile hand rubbed and bandaged and
the other measures above recommended carried out to restore the
circulation in the surface and extremities. The time-honored
practice of bleeding freely from the jugular vein is one of the
most effective means of relieving the over-charged heart and
lungs, and should be resorted to at the earliest possible moment.
The blood will at first flow in a small, dark stream, but as the
circulation obtains relief the jet will increase in volume and the
general symptoms will improve. From four to six quarts may
be taken wdth advantage from an ordinary horse. This is not a
pneumonia but an overloaded heart and lungs, threatening speedy
death and which the abstraction of blood. promptly relieves.

The longer the bleeding is delayed the less effective it is. It
should not supersede the other measures already recommended.

204 Veterinary Medicine.

There is no real paradox in both bleeding and giving stimulants
in such a case, as the essential condition is one of weakness, and
if the abstraction of blood has been of use in relieving the
clogged heart and lungs, the depression under which these have
labored may be still further overcome by agents calculated to
rouse their suspended vitality.

Trasbot strongly recommends large doses of tartar emetic and
iodide of potassium to reduce the blood pressue in the lungs, an
advice which will be received with hesitation by those who dread
the already paretic condition of the heart. His combination of
iodide of potassium with digitalis will be more confidently re-
sorted to. One drachm of the former may be given with a half
drachm of the latter twice daily.

With the advent of marked fever and other signs of pneumo-
nia, the treatment for that disease should be resorted to.

PUIvMONARY CEDEMA.

Causes, pneumonia, extra force of right heart or weakness of left, insuffi-
ciency of mitral valves, deflection of blood by obstruction in one portion of
hing, pressure of tumor on pulmonary veins. Malignant oedema. Malig-
nant catarrh. Bright's disease. Anaemia. Parasitism. Symptoms, ab-
normal heart sound, or urinary secretion. Parasitism. Percussion shows
flat sound auscultation lowered, respiratory murmur, heightened blowing.
No crepitation. Expectoration serous. Prognosis grave. Treatment, at-
tacks primary disease. Posture. Elimination. Dry capping. Heart
tonic.

A dropsy of the lung tissue may supervene in weak conditions,
in the course of inflammatory disease of the lungs ; it may also
depend on an imperfect balance in the forces of the right and left
heart respectively, which leads to the habitual throwing of blood
pres.sure back upon the lungs. Still more frequently the conges-
tion and dropsy depends on insufficiency of the mitral valves by
reason of which a reflux of blood toward the lungs takes place
at each heart-beat. The pressure of tumors on the pulmonary
veins may have a similar action. Obstruction of circulation in
one portion of lung may cause an extra blood pressure on an ad-

Piibnonary QZdevia. 205

jacent one, and oe:lenia so caused may be found especially in cattle
and pigs in which the interlobular connective tissue is specially
abundant. This may be seen in miliary tuberculosis in cattle, and
it probably contributes to produce the extraordinary liquid col-
lections that characterize lung plague. In cattle also malignant
oedema may affect the lung, and an oedematous condition is some-
times met with in malignant catarrh. Bright's disease is another
cause, the ursemic dropsy finding a favorite seat of election in
the loose lung tissue unsupported by solid tissues. The anaemia
resulting from parasitism like distomato.sis may similarly affect
the lung.

The symptoms of pulmonary oedema will usually be compli-
cated by those of the affection causing it. Thus modification of
the first heart sound or of the urinary secretion, or the existence
of parasitism, would furnish valuable indications.

The physical signs of lung disease vary. If pneumonia is
present it is betrayed by its characteristic symptoms. In the ab-
sence of inflammation there is dullness on percussion over the
affected area, and on auscultation an absence of the respiratory
murmur, and perhaps abnormal clearness of bronchial, cardiac
and other sounds from deeper parts. It differs from pneumonia
in the absence of fever and of any crepitation surrounding the
consolidated portion. The expectoration is serous or watery,
rather than rusty or purulent.

The prognosis is always grave in proportion to the incurable
nature of the primary disease. Chronic valvular or Bright's
disease, miliary tuberculosis or malignant tumors would render
the case hopeless, while in acute pneumonia, or nephritis or para-
sitism there may be some hope. The treatment will largely con-
sist in the therapeutics of the primary disease, yet we may also
seek to relieve the dangerous symptoms of oedema. The fre-
quent change of position may serve to limit hypostatic accumula-
tion. Diuretics or purgatives in strong patients will favor ab-
sorption. Pilocarpin more than any other agent secures tem-
porary absorption but cannot be continued owing to its depressing
effects. Digitalis is often valuable in improving the heart's
action, and acting freely on the kidneys. Dry capping on the
chest acts as a derivative.

ATELKCTASIS. COLLAPSE OF LUNG.

Atelectasis iu bronchitis, congenital, etc. Airless condition in the ab-
sence of exudation. Causes, congenital persistence in butcher animals.
Blocking of air tubes by exudate — ball valve. Desquamation of ciliated
epithelium. Compression by hydrothorax, pneumothorax, and false mem-
brane. Symptoms. Percussion flatness, juvenile respiration elsewhere,
blowing sounds loud. Drum like sounds on emphysema and pneumothorax.
Cyanosis. Lesions, depressed, flesh-like, non-crepitating lobules or lobu-
letes, sink in water, dilatable. Treatment, rouse respiratory centres, douches,
cold and warm, slapping, electricity, forced inspiration, diet, massage.
Treat attendant disease.

This has been already referred to as a result of bronchitis, but
it deserves special mention as a sequel of that affection, and in va-
rious domestic animals, as an independent condition. The condi-
tion is one of consolidation of lung by the complete exclusion of
air, but without any infiltration of its sub.stance by inflammatory
exudate or dropsical effusion. The tissue remains in its normal
state apart from the fact that its bronchioles and air sacs are undi-
lated. The affected portion has a solid dark fleshy appearance.
The collap.sed portion often represents one lobule or group of lo-
bules which communicate with a single bronchium.

Causes. In some instances the conditions remain from birth,
the lobule never having been called into use. This is seen espec-
ially in cattle and other meat producing animals, in which active
breathing is .systematically suppressed in the interests of rapid
growth and the deposition of fat. In the improved breeds the
lungs remain larger than the exigencies of the life demand, and
large portions remain out of use. In bronchitis the condition is
acquired, and is mainly dependent on the blocking of a bronchial
tube with tenacious mucus or a dcssicated mass. The pathologi-
cal lesions of bronchitis favor this since one of the earliest changes
in the inflamed mucosa is the desquamation of the columnar
epithelium. This removal of much of the cilia and the paralysis
of much of what is left annihilates for a time the normal method
of clearing away the secretion, and this being now produced in
excess blocks the tubes. This secretion virtually acts like a ball
valve in favoring the exit of the air during the convulsive expira-
206

Atelectasis. Collapse of Liuig. 207

tion of coughing, and hindering its entrance during the succeed-
ing inspiration. The bronchia and bronchioles decrease in size to
near their termination, so that, as forced out in coughing, the se-
cretion enters the larger tube and allows the exit of air, which as
drawn back in inspiration it enters the smaller tube and closes it
against any possible serial entrance. Mendelssohn and Traube
demonstrated this action by introducing a shot into a dog's lung,
and in two days the left lung was found collapsed and the right
one the seat of complementary emphysema. The violence and
frequency of the cough therefore bears a ratio to the occurrence
and extent of atelectasis. Other causes are the compression of
the lower lobes of the lung by hydrothorax, b)^ pneumothorax
(developed by lacerated lung or perforated chest wall) or by a
false membrane contracting in process of organization.

Symptoms. As a congenital condition in the improved meat
producing animals the condition is rarely recognized in life and
cannot be said to be a defect. The collapsed lobule being farther
removed from the air may be a more favorable field for the growth
of pathogenic bacteria, but on the other hand these do not so
readily penetrate it as if the tubes were open. When the collapse
is more extensive, the contrast in the flatness on percussion and
indistinctness of the respiratory murmur on the affected side, and
the marked resonance and loud murmur on the other, may serve
to identify the affection. In extensive, traumatic cases this con-
trast is much more prominently marked, as the expanded portions
have to take on extra compensatory work and are not infrequently
rendered emphysematous. The drum-like .sound in percussion of
such parts, and in the upper part of the chest in pneumothorax
are pathognomomic of these conditions. Again in hydrothorax
the horizontal upper level of the area of dulness betrays a liquid
cause. Severe cases are marked by cyamosis.

The lesio7is seen in atelectasis consist in depressed areas of a
dark fleshy color on the surface of the lung, usually sharply lim-
ited by the borders of the lobules, and in strong contrast with the
bulging, light colored lobules adjacent, which are often emphy-
sematous. The collapsed lobule may usually be dilated when air
is forced into the bronchium, but if it has been of some standing
this is often difficult or impo.ssible. If it has resulted from bron-
chitis or compression of a previously inflated lung it will often

2o8 Veterinary Medicine.

float ill (not on) water, from a little retained air, but in congen-
ital atelectasis it is airless and sinks to the bottom.

When /rm/;;/^'w/ is demanded it will vary according to the cause.
In congenital atelectasis the respiratory centres mu.st be roused.
The new born animal may be sprinkled alternately with ice cold
and hot water, or the chest ma}' be slapped with the palm of the
hand or a wet towel. The nostrils must be cleared of mucus, and
the lungs inflated by blowing or bellows, the larynx being pressed
back against the gullet to prevent inflation of the stomach. If
available electricity may be applied to the chest walls. These
measures may be repeated at intervals and the .systemic weakness
overcome by nourishing food, stimulants and friction of the skin.

In acquired atelectasis we should seek to correct the disease to
which it owes its existence. In bronchitis the measures already
indicated for the liquefaction and removal of the expectoration
will be in order ; in hydrothorax a judicious paracentesis and in
pneumothorax the aspiration of the gas, and the closure of any
traumatic opening through which that gas has gained access.

HEMOPTYSIS.

Causes, over-exertion in plethoric, glanders, pulmonary tubercle,
petechial fever, embolism, aneurism, ulcerated new formations, anthrax,
septicEeinia, hseniorrhagic diathesis. Symptoms. Inappetence, cough,
cold limbs, rigor, hard pulse, jugular pulse, violent heart beats, unsteady
gait. Discharge, bloody, crimson, frothy, with cough, without acid, ex-
cited breathing, debility. Indications from pre-existing disease. Treat-
ment, quiet, elevated head, cold irrigation, ice bags, acetate of lead, opium,
ergot, matico, tannin, iron, oil of turpentine, laxatives, cool stable.

The term hcEmoptysis (al/jia, blood, Trruw, I spit,) is now entirely-
restricted to bleeding from the lungs and lower air-passages. It
is a very rare complaint in the lower animals, but is sometimes
seen in both horse and ox. In very plethoric subjects the over-
loaded circulatory organs give way in the delicate membrane,
lining the ultimate bronchial tubes and the air cells. The ex-
citing cause in such cases is usually some severe effort of draught,
a violent gallop, or other unwonted exertion. It occurs in gland-
ers from rupture of caseated pulmonary nodules. It does not
appear to be so common in phthisis in the lower animals as in
man, but one case occurred under the eye of the writer in which
the bursting of a large tubercle in the lung of a cow involved the
rupture of a considerable vessel with a fatal result. Pulmonary
embolism and infarction, petechial fever, aneurism, ulcerated
neoplasms, anthrax, and septicaemia are additional causes.
Lastly haemoptysis sometimes takes place in hsemorrhagic sub-
jects without any appreciable rupture of vessels, the blood sweat-
ing from the surface of the bronchial mucous membrane.

Premonitory symptoms are sometimes noticed, such as dul-
ness, and lassitude, loss of appetite, a frequent short cough,
coldness of the limbs and surface, shivering, full, hard pulse,
pulsation in the jugulars, tumultuous action of the heart, and un-
steadiness of gait.

More commonly it comes on suddenly as the result of severe
muscular strain or excitement. The blood flows from the nose,
and rarely from the mouth in solipedes, but indiscriminately from
both in other animals. It is bright red, clear, frothy, or mixed
with mucus, and variable in amount. It is easily distinguished
14 209

2IO Veterinary Medicine.

from nasal haemorrhage, which is not frothy, and from bleeding
from the stomach, which is clotted and blackened, with an acid
odor from the presence of the gastric juice. The cough of haem-
optysis contrasts with the sneezing of epistaxis and the retching of
haematemsis. The rattling cough increases the discharge, as does
also a dependent position of the head. Besides the cough there
is usually an anxious countenance, accelerated breathing and con-
siderable lifting of the flank. When the loss is excessive there
is weakness, giddiness, rolling of the eyes, and pallor of the visi-
ble mucous membranes.

The previous ill-health of the patient, the presence of tubercle
as ascertained by auscultation and- percussion, and the haemor-
rhagic constitution as shown by occurrence of bleeding from
other parts of the system will lessen the chances of a favorable
termination. Sometimes, too, the flow is so profuse that the
blood cannot be coughed up, and filling the bronchial tubes it
destroys life suddenly by suffocation.

Treattnent. When brought on by severe exertion absolute
quiescence will usually check haemoptysis. Keeping the head
in an elevated position favors its arrest. The application of cold
water to the head, neck and thorax, and the giving of iced water,
strongly acidulated by vinegar or one of the mineral acids may
sometimes be required. In threatening or obstinate cases one
drachm of acetate of lead may be given thrice daily to check by
its astringent effect on the vessels, and the addition of a drachm
of opium is of great value in suppressing the cough. Ergot,
tannin, matico, and oil of turpentine have each been employed
with advantage, and when costiveness exists a saline laxative
(one pound sulphate of soda) may be usefully resorted to. The
patient should be kept in a cool, airy dwelling, and should rest
for fifteen or twenty days after an attack.

PULMONARY APOPLEXY. HEMORRHAGIC INFARC-
TION.

Different forms. Embolism with infarction. Embolism from arteritis.
Rupture of blood-vessel. Changes in color. Symptoms. Repair.

Hgemorrhage into the lungs may be : ist. Petechial in infec-
tious diseases. 2d. interlobidar as from ruptured vessels. 3d.
Infarctio7i or apoplexy. hifarctio7i results from embolism of a
branch of the pulmonary artery, which may in its turn be due to
clots formed in a diseased heart or in the systemic veins and car-
ried to the lungs in the blood stream. It may also result from
inflammation of the inner coat of the pulmonary artery. A vir-
tual stasis occurs beyond the embolism, and the blood filtering in
through the anastomosing capillaries fills and blackens the affected
lobule. With rupture of a considerable vessel the blood escapes
en masse and appears like black currant jelly. As it ages it be-
comes granular and changes to a yellow color, or it may form a
necrotic mass enclosed in a cyst as in lung plague. The symp-
toms, apart from the absence of respiratory murmur and resonance,
are not diagnostic. It may take months to undergo liquefaction
and absorption. Iodide of potassium, bitters and stimulating
diuretics may be given.

2IZ

PNEUMONITIS; PNEUMONIA; INFLAMMATION
OF THE LUNGS.

Definition. Inflammation of the spongy tissue of the lungs un-
complicated by that of the bronchia or pleura.

Divisions. This affection has been variously divided according
to seat, 7iat2cre, and complications : thus :

Single Pneumonia : Affecting one lung : 7'ig-lit or left.

Double Pneumoiiia : Affecting both lungs.

Lobar Pneumonia : Affecting one lobe or by lobes.

Lobular Pneumonia : Affecting by lobules.

Acute Pneumonia : Subacute Pneumonia. Chronic Pneumonia.

Croupous or Fibrinous : With fibrinous exudate.

Catarrhal : With exudate rich in cells and granules.

HcE7norrhagic : With extravasation of blood.

Purulent : Tending to pus : abscess.

Necrotic: Tending to gangrene : sequestra.

Desquamative : With great proliferation of alveolar epithelium.

Literstitial. Interlobular : Affecting mainly the interlobular
connective tissue.

Hypostatic : Dependent on gravitation of the blood.

Metastatic: Due to embolism.

Parasitic: Caused by parasites. Due to wounds or foreign
bodies.

Contagious and Traumatic Pjiezimonia.

Many of these are, however, but localizations of the same affec-
tion and others are manifestly microbian diseases which in the
present .state of pathology it is not always easy to early distinguish
.sufficiently 'for clinical and therapeutic purposes. For the sake of
convenience therefore pneumonia will here be treated of generally,
and under the headings devoted to etiology, pathology, thera-
peutics, etc., attention will be given to distinctions. Those pneu-
monias that are but pulmonary manifestations of other diseases —
influenza, glanders, tuberculosis, strangles, contagious pneumo-
enteritis, lung plague, septicgemia, pyaemia, swine plague, hog
cholera, petechial fever, actinomycoses, and neoplasms will be con-
sidered under these respective headings.

212

ACUTE CROUPOUS PNEUMONIA. PNEUMONITIS IN
THE HORSE.

Definition. Differentiation from acute vascular congestion. Predisposing
causes, age, sex, stabling, training, diet, impure air, low health, previous
limg disease, plethora, climate, season, exciting causes, chill, fatigue, leuco"
maines, sudor, draughts, plunging iu or spraying with cold water, clipping,
inhalation of irritant smoke, gas, dust, drawing of food, irritating or insolu-
ble drugs into the lungs, neoplasms, parasites, contusions, fractured ribs,
punctures, contagion, plurality of germs, bacillus of Friedlauder, micro-
coccus of Talaraon and Fraukel, diplococcus pneumonise equina of
Scbiitz, diplococcus pneumoniae equina of Cadeac. Symptoms, chill,
hyperthermia, dullness on percussion and crepitation in the lower part
of the lung, reaction, congested mucosa, accelerated labored breathing,
excited circulation, pulse oppressed, cough deep, patient statant, elbows
everted, nose protruded, nostrils dilated, approaching door or window,
pinched countenance, skin dry, harsh, adherent, partial sweats, loins iusensi"
ble, nasal discharge rusty, dependent part of lung largely non-resonant, with
peripheral crepitation. Blowing in abnormal situation over hepatized lung.
Decubitus, its significance. Course. Results. Favorable indications in
pulse, breathing, face, temperature, appetite, decubitus, clearing of lung.
Unfavorable indications in breathing, pulse, fever, face, uneasy movements,
pawing, cold limbs, prostration, nervousness, weakness. Sabacuto Pneu-
monia. Terminations of pneumonia, death, resolution, splenization, abscess,
gangrene, red hepatisation, gray hepatisation, fibrinous consolidation.
Lesions. Congestion, exudation and cell growth, hepatization — red and
gray, deliquescence, abscess. Blood, loss of red globules, increase of white,
excess of fibrine, glandular swelling, pleurisy, degenerations in other organs,
laminitis, rheumatism. Treatment, adapted to strength of subject and type
of disease, hygienic, anti-rigor, antiphlogistic, expectant, stimulant, anti-
pyretic, febrifuge, sedative, moist compresses, derivatives, laxatives. In
subacute form tonics, heart stimulants, febrifuge. In chronic cases add rich
digestible diet, and easy open air life.

This consists in inflammation of the spongy tisstie of the lung
involving mainly and primarily the walls of the alveoli and inter-
lobular connective tissue with their respective trophic centres
(nuclei). The acute congestion of excessive heart action and de-
bilitated pulmonary capillaries described above, is primarily a
disease of the bloodvessels which become over distended and ma}--
or may not lead to the inflammatory processes in their walls and
the tissues adjacent. Pneumonia on the other hand is essentially

213

214 Vetej'inary Medicine.

inflammation of these tissues and nuclei, with exudatiou usually
of a fibrinous material into their substance.

Predisposing Causes. ^. Age. A very early age is nearly
exempt, and from 6 j^ears upward there are fewer cases relative to
the equine population, variations that may be bstter accounted for
by stabling, training and acquired immunity than by the mere
fact of age. Of 237 cases, 2 were 3)^ years ; 32 were 4 years ;
19 were 5 years ; 131 were 6 to 11 years ; 46 were over 11 years ;
and 7 of uncertain age (Trasbot). 2. Sex. No visible effect.
3. Stabling, training, change of food. While the young colt
at pasture is practically immune, the period of stabling, transi-
tion to a dry and grain diet, and to the nervous excitement at-
tendant on training and unwonted work as shown in the statistics
of Percivall and Trasbot determine an enormous increase of cases.
In a cavalry regiment Percivall found that 56.6 per cent, of all
lung diseases occurred before the 5th year, and Trasbot found
that at the Alfert Veterinary College 13.5 per cent, of all equine
pneumonias occurred in the 4th year. 4 Hot Stables. Impure
Air. These two conditions usually coexist and prove potent
causes especially in young horses brought from the fields. We
cannot, however, separate this cause as usually observed from the
action of pathogenic germs which are preserved and concentrated
in such places. 5. Poor Health. Debilitating diseases, insuf-
ficient and poor diet, overwork, exposure to cold draughts or
darkness and any other cause which lowers the vitality predis-
poses. 6. A Previous Attack. This usually leaves some struc-
tural or functional change which renders the lung more sus-
ceptible to a subsequent invasion. Against this must be placed
the immunity which follows the contagious forms, but as this is
usually exhausted in the course of six months it does not invali-
date the position that the permanent impairment of pulmonary in-
tegrity is a predisposing cause. 7. Plethora Tending as this
does to congestion it must be accepted also for the next patho-
logical step — pneumonia. 8. Climate and Season. This is
notoriously an important factor. At Paris, Trasbot met with 237
cases in the nine months from October to June inclusive and but
8 ca.ses in the summer months — July, August and September. In
Great Britian, where the vicissitudes are le.ss .severe Percivall had
in the cavalry horses in the seven months from October to April

Acute Croupous Pneumonia. Pyieiunonitis in ihe Horse. 215

inclusive 146 cases = 20.85 per month, and in the 5 months from
May to September inckisive 62 cases = 12.4 per month.

Exciting Caicses. Nearly all the above causes when acting with
unusual force may become direct factors in causation. The ef-
fect of a sudden and extreme chill is especially to be feared.
Even in cases that are unquestionably due to a microbe as the es-
sential cause, the nervous disorder manifested in the chill, and the
clogging of the pulmonary circulation in connection with the re-
trocession of blood from the surface of the body furnishes the op-
portunity for the colonization of the germ. The average horse
at pasture will stand with impunity cold storms of rain, snow, and
sleet, and transitions from a warm noonday sun to a cold night
wind and dew and even frost, but under other conditions of the
system, with the fatigue and fret and sudden changes of food and
regimen attendant on domestication, or with any derangement of
an important bodily function the chill is often the manifest occa-
sion of disturbance of the balance of health, and the supervention
of pneumonia. Fatigue, a system charged with leucomanies,
and a free perspiration, which is suddenly checked by exposure,
at rest, to a cold ram , or snow, to a draught between door
and window, to immersion in the cold waters of a river, or
to sponging with cold water is quite liable to cause pneumonia.
An unduly heavy winter coat, an individual peculiarity or deter-
mined by a cold environment in autumn often predisposes strongl}^
to such dangerous chills, by the frequency and profuseness of the
perspirations and general relaxation of the system. Clipping of
such subjects is a true hygienic measure though it entails the
need of extra care in blanketing. Again in the animal that has
already suffered from disease of the respiratory organs these
chills are more dangerous factors.

Direct irritation by inhalation of smoke and other products of
combustion ; or acrid or irritant gases or dust ; by the drawing of
food by aspiration into the lungs (as in paralysis of the larnyx or
pharnyx, choking, apoplexy, vomiting, etc.) ; b}^ pouring irri-
tant or insoluble drugs (oil, lard) through the nose ; by the pres-
sure of neoplasms Tactinomycosis, tubercle, glanders, cancer) ; or
by the presence of parasites (strongyles, distomata, echinococci,
linquatulas.

Pncujnonia from Contusion of the chest, fracture of a rib, or
puncture or laceration of the lung is recognized.

2i6 Veterinary Medicine.

Contagion. The presence of a contagiiim in pneumonia is to-
day well established. Clinical observation had indicated this
even before the discovery of a specific germ, but recent bacterio-
logical investigations and the transmission of the disease by inoc-
ulation of artificial cultures have definitely settled the question.
It does not follow that all cases are contagious, nor equally so, but
the recognition of the contagious form satisfactorily explains the
prevalence of the disease in one stable while an adjoining one es-
capes, and the eruption of new cases in a stable after an animal
affected with the disease or convalescent from it has been intro-
duced. It has been objected that many horses stand in the stable
with pneumonia cases and escape, but so is it with glanders, cow-
pox, and many other affections. It merely argues an immunity
in the case of some, and for the disease germ a very limited
transmissibility through the air. The further objection that the
existence of lesions in the lung before the onset of fever, excludes
this from the list of infectious diseases, is untenable since many
undeniably contagious diseases, like cutaneous anthrax, glanders,
lung plague, cowpox, appear locall}' before any constitutional dis-
turbance occurs, which later as the result of extensive local dis-
ease and the circulation of toxins in the blood. It places conta-
gious pneumonia however in that long list of infectious diseases
which develop first locally in the seat of infection and later become
more or less generalized.

It must be admitted however that the germ of pneumonia is
not the same for all cases of the disease and for all genera of ani-
mals. It must also be allowed that the same germ does not al-
ways maintain the same degree of virulence, and that it may even
live for a time on the buccal mucosa of an animal belonging to a
susceptible genus without any morbid result. In short we must
recognize that different germs of pneumonia may become tem-
porarily non-virulent or only slightly virulent, and remain patho-
logically quiescent, as for example during the summer months,
to reassert itself later when the conditions become more favorable
to its pathogenesis.

BACTERIOIvOGY.

a. Bacillus of Frikdla.nder. This is a short rod with
rounded ends, often merely oval, occurring in pairs, or chains of

Acute Croupous Pneumonia. Pneumonitis in the Horse. 217

four, and under given circumstances surrounded by a transparent
gelatinous capsule. It is serobic, noumotile, does not liquefy
gelatine, nor sporulate, and in gelatine stick cultures has a nail-
like growth. This was found by Friendlander, Frobenius,
Weichselbaum and Wolf in the pulmonary alveoli in a small pro-
portion of cases of croupous pneumonia in man. The cultures,
injected into the lungs of animals, killed one dog (out of five), six
Guinea pigs (out of eleven), and thirty-two mice (all the in-
jected). Ivesions were intense congestion of the lungs, seropuru-
lent pleural effusion, and enlarged spleen, while the bacillus
swarmed in the blood and exudate.

Micrococcus Pneumonias Croupos^. First found by Stern-
berg in his own saliva in health, and by Pasteur in the saliva of a
rabid child. Afterward found in the great majority of lungs
affected with croupous pneumonia in man, by Talamon, Salvioli,
Sternberg, Frankel, Weichselbaum, Netter, Gamalei, etc. I^ater
it was found in meningitis, in ulcerative endocarditis, in ar-
thritis, in otitis media, and in acute abscess in man.

It is a spherical or oval coccus, arranged in pairs, in fours, or ex-
ceptionally in eights or tens. Lanceolate forms are the rule in
the blood of animals, and circular in artificial cultures. It stains
readily in aniline colors and by Gram's method, grows inordinary
culture media, at 37° C. in the absence of free acid, and in
gelatine stick cultures as small, white colonies along the line of
culture, without liquefying the gelatine. It dies in ten minutes
at 52° C. (Sternberg). Its virulence lessens in artificial cul-
tures, but is restored by passing through the body of a suscepti-
ble animal.

Injection into the lungs or trachea of rabbits, mice, sheep and,
less certainly, Guinea pigs, produced distinct fibrinous pneumonia
filled with the microbe. In dogs, subcutaneously, it caused ab-
scess, but in the lungs an acute fibrinous pneumonia which only
exceptionally proved fatal, recovery usually taking place in ten to
fifteen days.

Klemperer induced immunity, sometimes lasting six months,
by intravenous injection of filtered cultures.

DiPLOCOCCus Pneumonia Equina. First found by Schiitz in
the lungs of pneumonic horses in 1887. It is an oval coccus ar-
ranged usually in pairs or in threes or fours, and surrounded by

2i8 Veterinary Medicine.

a transparent envelope. It stains in aniline colors but not by
Gram's method. It is aerobic and ^rows in gelatine at ordinary
temperature without liquefying it, and in stick cultures forms a
line of small, white, separate colonies which do not coalesce by
growth. Does not grow on the surface of the gelatine around
the puncture. Line cultures on agar are in colonies like minute
transparent droplets. In bouillon it develops long chains.

Inoculated on the rabbit, Guinea pig and mouse, it produced
death with pneumonic affections (hsemorrhagic congestion or in-
flammation), but it failed to take in some of the rabbits and Guinea
pigs. Chickens and pigs proved immune. Injected into the
horse's lung or as .spray into the trachea it produced true croup-
ous pneumonia. Fiedaler and others obtained similar results.
Peter has found the faeces of pneinuonic horses virulent, an im-
portant point in connection with disinfection.

Schiitz found that 20 grammes of the culture, in an equal
quantity of boiled water, injected into the horse's trachea, pro-
duced a rise of temperature by two or three degrees, with rigors,
cough, accelerated pulse, elevated temperature, dyspncEa and
prostration, but that this subsided in a few hours. By repeating
this every thirty-six hours, the fourth or fifth would fail to pro-
duce a reaction and the subject proved immune.

Cadeac's Diplococcus Pneumonia Equina. In the lungs
of cases of contagious pleuro-pneumonia of the horse Cadeac found
a round noncapsulated coccus appearing in pairs, or rarely in
chains, and staining by Gram's method. It grew slowly in
bouillon and agar at 37° C, forming on the latter in twenty-four
hours, a thick, whitish, oily drop, which, as it grew larger, as-
sumed a ."^ilvery whiteness, and dried in the centre. In bouillon
it precipitated a powdery sediment. The reaction of the culture
medium was unchanged. It lost virulence rapidly in artificial
cultures or by a heat of 50° C. , and it died in ten minutes at a
temperature of 60° C. Virulence vfz.9, long retained whtn dried,
or even in putrid material.

This proved infecting to the ass, rabbit and Guinea-pig, while
the cat and white rat proved immune. Intratracheal injection
of the dog produced a transient pneumonia. The ass inoculated
with the blood of the infected rabbit died in three days, with a
hepartzed lung, pleurisy, and swarms of the microbes in the lungs,

Acute Croupojis Pncumoyiia. Pneumonitis in the Horse. 219

blood and internal organs. Rabbits injected intravenously had
enlarged spleen, reddish exudate in the serous cavities, urine
stained with haemoglobin, and lungs and kidneys congested.
With intratracheal injections the lesions were exclusively pul-
monary. The pulmonary lesions were less constant in the Guinea-
pig. Weakened virus caused pulmonary lesions only without
.septicaemia.

It has been suggested that this coccus is at least closely related
to that of pneumo-enteritis of the horse.

Sympto7ns. The onset of pneumonia is not often seen by the
veterinarian, who is called in only after the cough, loss of appe-
tite, hurried breathing and rigor has revealed illness to the at-
tendants. Hence perhaps chill and rise of temperature have been
placed among the earliest symptoms. The symptoms are more
violent in the racer, trotter and other nervous animals. Trasbot
positively claims, that considerable pulmonary inflammation and
even exudation have taken place before there is any chill or rise
of temperature. This is especially the case in the heavy lym-
phatic races of draught horses, which often according to this
author perform their usual work for days after inflammatory
exudation has set in. A fair counterpart of this is found in lung
plague of cattle and it would indicate that both start from a local
infection, which gradually extends until the systemic derang-
ment is induced. As usually seen, and especially when it follows
exposure to severe cold, a staring coat or a shivering fit usher
in the disease, the degree of the chill bearing some ratio to the
coldness of the air and to the future severity of the malady. This
may be accompanied by a small, dry cough, but without any other
marked sign of lung disease. With the access of the hot stage
the characteristic symptoms of lung disease are manifested, at first
resembling those of congested Imigs, but less severe than those given
under that head. There is a distinct increase of the body tem-
perature ; the visible mucous membranes are suffused with a blush ;
the expired air feels hot upon the hand ; the breathing, 30 to 40
per minute, is short and accompanied by much lifting of the
flanks — {labored^ ; the cough is deep as if coming from the depth
of the chest, but not so hard nor .so painful as in bronchitis ; the
legs are placed apart, the elbows turned out and the head pro-
truded to facilitate breathing ; the nose is turned to an open door

220 Vctermajy Medicine.

or window if any snch is available ; the contraction of the muscles
of the face, the dilated nostrils and the retracted angle of the
mouth give an anxious expression to the countenance ; the eyes
are semiclosed ; the pulse full but ^oi'i— {oppressed)— , beats from
48 to 70 per minute ; the bowels are slightly costive, the urine
scanty and high colored ; the skin \\\^\2i<i'i\Q— hidebound— \\^xs\\
and dry, though sweats may bedew it in parts ; the loins insensi-
ble to pinching ; and if there is any discharge from the nose it
consists only in a reddish — rusty — colored mucus.

Auscultation and percussion complete the diagnosis. At the
outset the inflamed portion of lung, usually near its lower part,
conveys a crepitating sound to the ear, but as consolidation ex-
tends the healthy murmur and the crepitating rale are alike sup-
pressed over the whole extent of the hepatised portion around the
margin of which a line of crepitation betrays the limit of the ad-
vancing inflammation. A similar Hne of crepitation encircles th
hepatised mass even when the exuded products are being absorbed
and when the lung is being cleared up and restored to its healthy
state. Thus the advance of the inflammation, and the progress
of recovery can be equally followed by the crepitation which, in
the different circumstances, betokens active inflammation or active
absorption. When both lungs are involved the posterior parts
are chiefly implicated, while if the pneumonia is single it may
attack the anterior, median or posterior part, or the entire lung may
become consolidated. If hepatisation exists in the anterior part
of the lung the thick fleshy shoulder will forbid any satisfactory
examination, but if in the middle portion only, while the respira-
tory murmur is lost it will be replaced by a strong blowing sound
(bronchial respiration) because the noise of the air rushing
through the larger bronchial tubes to the posterior healthy part
of the lung is conveyed with greater force to the ear through the
consolidated lung tissue. This is audible from the lower third of
the chest to the upper limit of hepatization. The respiratory
murmur in the healthy lung is always louder than is natural.

Percussion confirms these results. Over the hepatised lung
where no respiratory sound remains, a dull, dead sound only is
brought out by the impulse of the fingers or closed fist, compar-
able to that obtained by percussion over the muscular masses of
the shoulder or haunch, and forming a marked contrast to that

Acute Croupous Pneumonia. Pneumonitis in the Horse. 221

obtained over the surrounding healthy lung. There is not that
tenderness on pressure in the intercostal spaces which characterises
pleuris}^ but a sharp blow with the closed fist leads to wincing
and usually grunting because of the concussion to which the
diseased part is subjected. By increasing the force of such blows
the deepest parts of the lungs may be tested, since in this way
dullness due to consolidation of the deeper portions of the lungs
may be detected even though the superficial investing parts are
healthy.

The nature of the symptoms will vary according to the extent
and character of the inflammation, from mild febrile reaction, with
excited breathing and slight crepitation, to the more severe
varieties in which the intensity of the symptoms are such as to
threaten suffocation.

A marked feature of pneumonia in solipedes is that the patient
obstinately stands in one position and never lies down so long as
the severity of the inflammation lasts. The sharp crest on the
lower border of his breast bone compels the horse to lie on his
side, and since in this postion the whole weight of the body has
to be overcome in any full dilatation of the chest, he cannot retain
the recumbent posture when any serious impediment to breathing
exists. Hence it is that the fact of a horse suffering from pneumo-
nia having lain down and remained so for some time is justly
accepted as an indication of improvement.

Progress and 7'estilts of the disease. The general symptoms
above noted, remain with more or less intensity throughout. After
the first flush of heat, on the occurrence of febrile reaction, the
limbs become alternately hot and cold, and in this the general sur-
face partakes to a less extent.

The tendency of pneumonia is to a crisis and recovery. Cer-
tain days have been supposed to be critical and on the whole the
third, seventh, eleventh and fourteenth are those on which a
favorable change is most probable.

Among the more favorable iiidications are the manifest abate-
ment of the high bodily temperature and febrile symptoms gen-
erally, the increasing ease and regularity of the breathing, the
greater force, distinctness and slowness of the pulse, the perma-
nent return of warmth to the limbs, the softer and more elastic
feeling of the skin, the recovery of appetite, and above all, the

222 Veterinary Medicine.

turning of the nos2 from the open window or the retention of the
recumbent position for a length of time. These symptoms will
become more patent day by day, and the absorption of the effused
products and the clearing up of the lung may be traced by the
gradually decreasing area of dullness and of the circular line of
crepitation as ascertained by percussion and auscultation.

If on the contrary the disease takes an unfavorable turn, some
such signs as the following will manifest it : Increasing rapidity
and embarrasment of the breathing ; smallness and indis-
tinctness of the pulse, which is increased to perhaps lOo beats
per minute ; tumultuous heart's action, the impulse of which is
strongly felt behind the left elbow ; a more laborious working of
the flanks ; frequent despondent looking toward the flanks ; paw-
ing wath the fore feet, lying down, and as suddenly rising again ;
permanent coldness of the extremities ; hanging head with great
dullness and despondency of expression ; dull, .sunken, lusterless
eye ; hanging lower lip ; leaden hue of the nasal mucous mem-
brane ; convulsive twitching of the muscles of the .surface ;
reeling in gait, and extension of the crepitation over all the still
pervious lung.

SuBACUTK Pneumonia. This term is employed to designate
that subdued or milder form of the disease which sometimes
arises spontaneously and at others follows the acute.

In this variety the characteristic symptoms may be much less
marked and the disease is less ea.sily recognized. There is some
acceleration and quickness of pulse, lifting of the flanks and heat
of the mouth and body generally. There are alternations of heat
and cold of the surface and extremities, a rough, unthrifty coat,
hidebound, a dull, listless moping manner and the same symp-
toms on auscultation and percussion as in the acute form.

The changes take place slowly but the disease may prove ob-
stinate and is often followed by permanent alterations in the lungs.
Rheumatic affections of the limbs, inflammation of the feet, and
other diseases frequently supervene during the course of this form
of the affection.

The terminations of pneumonia are : — by death ; resolution
with absorption of exuded products : — splenisation ; abscess ;
gangrene ; permanent consolidation with organization of ex-
uded products. The disea.se will sometimes lapse into the chronic
form.

Acute Croupous Pneumonia. Pneumonitis in the Horse. 223

Death is fortunately the least frequent issue. It may follow on
rapidly advancing and general congestion of the lung, — asphyxia ;
from heart failure, the overworked organ becoming exhausted
under the strain of forcing the blood through the virtually imper-
vious lungs; from hyperthermia, the limit of bodily temperature
io8°F. having been reached or exceeded ; or from collapse and
exhaustion.

In resolution which is the most favorable termination the fe-
brile and other symptoms subside and the exudations in the effused
lung undergo a process of liquefaction and absorption until neither
auscultation, nor percussion nor even the examination of the lung
after death will show the slightest trace of the pre-existent
disease. This is the most common termination in single pneu-
monia in the horse.

Splenisation is that condition of lung already described under
the head of pul^nonary congestio7i, and if affecting both lungs
throughout, necessarily destroys life by arresting the aeration of
the blood.

Abscess. Diffuse suppuration is very common in the stage of
gray hepatization. In this the affected lung becomes more or less
extensively infiltrated with pus limited by no distinct membrane
like the pus of an abscess, but exuding freely from the cut sur-
face of the lung or escaping from its interstices when it is pressed.
It is preceded and in its early stages associated with the formation
of granular masses and corpuscles. Its existence cannot be cer-
tainly ascertained though it may be surmised when after hepatiza-
tion of a portion of hxngo. in ueous rale, a sort of gurgling, is heard
in the adjacent bronchium and an abundant muco-purulent dis-
charge takes place from the nose. It threatens extensive destruc-
tion of lung tissue.

Circurnscribed suppuration or abscess is infrequent though occa-
sionally met with in the horse and ox. In this case the excessive
exudation at one point liquefies and the surrounding lymph becom-
ing organized into a vascular membrane an abscess is formed.
This may burst into the bronchial tubes and be discharged by the
nose. In less favorable cases it makes its way toward the pleural
surface and opens into the cavity of the chest. It is impo.ssible
to detect the existence of a pulmonary abscess though after it has
burst into a bronchial tube the existence of the cavity may be as-
certained by the amphoric sound heard on auscultation.

224 Veterinary Medicine.

Animals may recover from such pulmonary suppurations or if
they are too extensive the consequent depletion may induce hec-
tic and death.

Gangrene of the lung is happily rare and has appeared to be
connected with close, foul stables, previous ill health, and work
after the onset of pneumonia. It is characterized by high temper-
ature (io5° to ioS° F. ) by great dulnessand prostration due to the
poisoning of the nerve centres, by weakness and unsteadiness, by
complete loss of appetite, and at length an intolerable foetor of the
breath as if from putrefying animal matter. In rare cases re-
covery may take place, the dead portion having become detached
and expectorated.

Consolidation from hepatization is the condition in which
the inflamed lung is always found, in the second stage of the dis-
ease. The lung has then the density and brownish red appear-
ance naturally belonging to the liver {red hepatization), which
changes on the occurrence of softening of the exuded products to
a grayish hue {gray hepatization) . But after the subsidence of
the acute symptoms, the process of liquefaction and absorption is
not always complete, a portion of the exuded product becomes
vascular, is developed into fibrous tissue and remains permanently
impervious to air. Such is the state of the lung in many cases of
thick or short wind in horses when these have occurred as a sequel
of pneumonia. A horse suffering in this way has the breathing
habitually accelerated and is thrown into a state of great distress
by any attempt to make him perform hard work such as gallop-
ing, dragging a load up hill and the like. A chronic cough may
equally accompany this condition.

Pathological Lesions. These differ according to the stage of
the disease. In \\\& first stage, that of congestion the lung tissue
is engorged with blood as described under the head of congested
lungs. As early as 6 or 7 hours after artificial irritation, the
alveoli of the affected part are already filled by exudation and cell
proliferation. Until this has taken place the alveoli can still be
distended by blowing into the bronchial tube.

In the second stage the condition of the lung is that of red
hepatisation, .so called from its resemblance in color and con-
•sistency to the liver. There are gradations between congestion
and red hepatisation. In the earlier stages of the latter, the lung

Acute Croupous Pnciunonia. Pneumonitis in the Horse. 225

retains a measure of its softness, elasticity and permeability to air,
though it is considerably firmer and less permeable than that
which is in a state of congestion and differs further from it in
exuding from its cut surface not a grumous, dark bloody pulp,
but a clear straw colored fluid. In the advanced red hepatisatioji
the lung is of a firm consistency and granular liver like appear-
ance. In color it varies from a bright red to a dark liver hue,
the darker shades being chiefly met with in old animals or when
the inflammation and fever have been intense and prostrating.
Varying shades are seen in different lobules of the same lung.
Its air cells are no longer pervious, it no longer crepitates under
the pressure of the finger, nor floats in water, and its friability is
such that it breaks down readily when the finger is thrust into its
substance. Its surface is distinctly granular from the fibrinous
plugging of the alveoli. Such a lung does not collapse when the
chest is opened but retains its bulk and shape and in some cases
the diseased portion may, by reason of the abundance of the ex-
udation, be really larger than the same portion of lung in a normal
state of dilatation. Its surface may thus retain the imprint of the
ribs. Owing to the stasis of the blood in the vessels a hepatised
portion of lung cannot be injected. The exudation which infil-
trates the lung tissue and obliterates the air cells contains in the
vicinity of the bloodvessels numerous granular masses and cor-
puscles and in the darker colored portions blood globules, owing
to the action of diapedesisofthe red cells and the rupture of minute
vessels. The smaller bronchial tubes stand out white and empty
showing that the}'- have escaped the inflammator}' action. He-
patization usually extends from the anterior lobe or lower border
upward.

Gray hepatization is a sequel of the r^^and presents the same
firmness, friability and usually the same granular aspect ; the
lack of crepitation on pressure, and the higher density than water.
From the cut surface a fatty or purulent fluid exudes spon-
taneously, or in other cases only when pressure is applied. The
granular masses and corpuscles have disappeared, and if supura-
tion is not so abundant as to prove extensively destructive to
lung tissue, that is gradually deared up and restored to health.
This state is always a very perilous one.

Abscess of the lung sometimes met with in animals dying of
15

226 Veterinary Medicine.

pneumonia shows a circumscribed area of inflammation and indu-
ration with the Hquid pus in the centre immediately surrounded
by a vascular (limiting) membrane. Abscess may be single or
multiple though in the latter case it is commonly a symptom of
pyaemia.

In gangrene of the lung the part may be in the dried condition
of an eschar ; it may indicate gangrene only by its altered color,
its flaccidity, its fetid smell and the altered appearance of all its
microscopic elements ; it may be denoted by a putrid softening,
the tissue easily breaking down into a stinking pulp of mixed fi-
brous and granular materials ; or lastly there may be merely a
cavity with traces of putrid contents, the dead mass having been
detached, disintegrated and expectorated.

Modifications of the Blood aiid Distant Organs.

A marked feature of pneumonia is the destruction of red blood
globules. This is early indicated in the staining of the visible
mucosae by the liberated haemaglobin and by actual count they may
be reduced in the horse from 7,500,000 to 6,000,000 per cubic
millimeter (Trashot). There is an increase of white globules, an
absolute increase, not only in ratio to the red. The haematoblasts
are enormously increased especially during defervescence. The
fibrine (fibrine formers) is materially increased ; in the horse from
3.5 to 6.7 or 7.5 per 1,000 (Grehaut). Albumen is diminished.
Soda salts are increased. The bronchial lymphatic glands are al-
ways congested, swollen and reddened with some serous effusion.
They may become the seat of inflammatory cell growth (embry-
onic tissue) or even of suppuration. The abscess may open into
the bronchia or pleura. These are especially to be dreaded from
their tendency to implicate the inferior laryngeal nerve and induce
roaring.

Pleurisy is inevitable when the inflammation reaches the sur-
face of the lung, hence hydrothorax is often present. Pericardi-
tis and hydropericardium are similarly met with. Endocarditis is
occasionally present and may be traced to strain of the valves of
the laboring heart, or to direct infection with the pneumonia mi-
crobe. Dilatation of the right ventricle is common as a result of
the obstructed pulmonary circulation.

Acute Croupous PncutnoJiia. Pncicmonitis in the Horse. 227

Fatty degeneration of the heart and congestions of the intes-
tinal mucosa, liver, kidneys, and spleen are further complications.

Finally larainitis and rheumatoid affections occur as complica-
tions.

Treatment. This must be adapted to the nature and condition
of the subject and to the character of the disease. A horse in
vigorous condition or with an acute type of inflammation may be
greatly benefitted by an actively d2pleting treatment, whereas to
the same animal in a low state of health, or during the prevalence
of an epidemic form of the malady depletion may be destruction.
It is not 'Sought here, as is so often done in the consideration of
this disease, to ring the changes, as to the probability of a change
of type in disease, or a change of theory on the part of physicians,
having affected the practice of bloodletting. True to our primary
purpose of rendering the work eminently practical, we shall first
notice the general management applicable to all ca.ses, then the
treatment of the two great types of the disease, acute (sthenic),
and subacute (asthenic), leaving to the enlightened judgment of
the reader to apply an appropriately modified system to that large
class of cases which occupy an intermediate position.

A pure airy box is first demanded, with the windows or doors
toward the south, or at least not turned in the direction of the
prevailing cold winds. The craving for pure air, so strikingly
shown by the position which the animal assumes, ought never to
be ignored nor neglected. We do not advocate the system of the
late Professor Coleman who kept pneumonia patients in open
sheds exposed to all vicissitudes of temperature winter or summer,
and yet the fact that many recovered under such treatment as well
as under a more rigorous system, having been turned out into the
open fields amidst frost and snow, ought to open the eyes of all
to the incomparable value of fresh air in this disease. The box
then must be dry, cool and airy but without a cold exposure and
without draughts of cold air.

Next in importance to pure, cool air is the comfort of the pa-
tient. Any tendency to chill, shivering, staring coat, or coldness
of the surface and extremities is to be counteracted as far as pos-
sible. One or more blankets according to the condition of the pa-
tient and the temperature of the atmosphere are valuable and for
the same reason a hood may be put on. Coldness of the limbs is

228 Veterinary Medicine.

to be met by active rubbing with the hand or with wisps of drj'
hay and then wrapping up loosely in flannel bandages. Some ap-
ply to the limbs ammonia and oil, spirits of turpentine, and other
stinmlants and thus by a powerful derivative action obtain an al-
leviation of the lung symptoms. For the same reason a mustard
poultice on the chest, or the hot wet rugs recommended for con-
gested lungs, often prove valuable in the earlier stages. Large
injections of warm water and the supply of warm gruels are not
to be neglected when they can be employed. Measures such as
these directed to check any chill aud render the circulation free
and uniform in the skin and extremities, if adopted during the
cold stages of the fever, will sometimes succeed in bringing about
a resolution of the pulmonary congestion and warding off a threat-
ened attack of pneumonia.

The diet should be of a non-stimulating and laxative kind.
Bran mashes, linseed, oatmeal, or other gruels, carrots, turnips,
scalded hay, or green food, if at the proper season, should be
given in small quantities so as not to satiate.

Antiphlogistic Treatment. Half a century ago bloodletting was
considered the remedy /ar excellence for pneumonia and it seemed
justified by the marked relief to breathing and pulse which
usually at once followed a free bleeding. In a short time, how-
ever, the fever would rise anew and the distressing symptoms re-
appear, which led the school of Broussais to repeat the bleeding,
coup sur coup, as often as the exacerbation appeared. There was
no respite for either age or condition, the debilitated city toiler,
the babe at the breast, and man of eighty tottering into the grave
had alike to submit to the lancet, and when the oppressive symp-
toms returned, the blood had to flow anew. Broussais himself,
however, recognized his error in his later life, and remarkably
enough, his conversion was effected through veterinary practice.
His two carriage horses were successively attacked by pneumonia :
the first was treated by bleeding coup sur coup and recovered : the
second was put under a more conservative treatment and also got
well, but while the first remained soft, flabby, debilitated and sus-
ceptible for a length of time, the second was on convalescence at
once able to go into active work. The enormous abuse of bleed-
ing, led to its more complete abandonment than would otherwise
have been probable, and the contrast between the high mortality

Acute Croupous Pneumonia. Pneumonitis in the Horse. 229

of cases treated by excessive bleeding, and the lower fatality in
pneumonias treated without phlebotomy on the expectant (let
alone) plan of Dietl or the stimulating method of Todd, Bennett
and others, served to hasten its abandonment. Yet in bloodletting
we have an instrument for good or evil which is not to be judged
on slight evidence. The mere lessening of the blood pressure is
to be little considered, as it requires the abstraction of nearly one-
third of the entire mass of blood to visibly affect this. The vas-
cular walls at once adapt themselves to the lessened amount. Nor
is the mere lessening of the volume a vital point. After moderate
bleeding this is made up in a few hours : after severe bleeding in
24 to /l8 hours. The loss of adult red globules is more lasting.
Bleeding to the extent of one per cent, of the body weight may
have the number restored in seven days. The young red globules
though rapidly produced have individually less haemoglobin, and
they can convey less oxygen to the tissues. This should mean
less oxidation, less heat, less waste, less urea, uric acid, hippuric
acid and other poisonous products in the tissues. Yet Baur says
that in anaemia there is a greater metabolism of proteids and more
excretion of urea. How easy it is to blunder in looking from one
single point of view. Again after bleeding there is a great relative
increase of the various forms of white blood globules, most of
them young and therefore with somewhat altered functions. The
paucity of red globules and excess of white are brought about by
the pneumonia and independently of bleeding, so that it is difficult
to say whether the phlebotomist is enhancing an evil, or helping
a natural therapeusis. It seems hopeless to estimate the effects
of these and other changes in the blood after bleeding, upon th©
metabolic processes of nutrition, secretion and sanguification,
This digression has not been made to ellucidate the results or the-
modus operandi of bleeding, but rather to illustrate the complexity-
of the problem involved and to warn against broad ^nd unwar-
ranted generalizations from insufficient premises.

Even to-day practitioners of the soundest judgment meet with a
limited number of cases in which they resort to bleeding with ad-
vantage. These occur mainly in strong, robus^ constitutions, in
individuals accustomed to an invigorating, open air life, liberal^
diet and abundant exercise. Ev^en in these this measure is chiefly -
resorted to, to relieve an acute pulmouar-y cppgestipn with ^,

230 Veterinary Medicine.

dangerous distension and over charging of a fatigued and over-
worked heart. In short the condition is one closely allied to acute
congestion in which the value of bleeding is all but universally
admitted. It is especially warranted early in the disease, though
it may still be adopted with caution in a similar condition which
has supervened at a later stage. A strong pulse and bright red
mucous membranes, are not as has been supposed, essential pre-
requisites to its employment. The mucosae may be pale, or more
likel}' cyanotic, and the pulse small and weak, from the over
charging of the heart and its tendency to failure, and it is to re-
lieve these conditions that we adopt this most potent of all meas-
ures for. securing a temporary lessening of the blood pressure in
the right heart and pulmonary circulation. Even the transient
relief may allow this to right itself and then less radical or danger-
ous measures may be relied on. Bleeding should very rarely be
resorted to save at the outset of the disease ; extensive exudation
into the lung tissue strongly contra-indicates it ; it cannot be safely
employed in the very young or old, in weak or debilitated sub-
jects, when the pneumonia has relapsed or supervened on another
serious malady, or when occurring in an unhealthy district. Dela-
fond met with a very high death-rate from bleeding in a damp
undrained locality. Where bleeding is permissible, the blood
should be drawn from the jugular in a full stream, from a large
orifice, the finger being placed upon the pulse, and the flow
arrested as soon as the blood is felt to pass along the vessel in a
fuller, freer current, and the breathing is seen to be relieved. It
can rarely be repeated with profit or safety, and in the vast ma-
jority of cases can be well dispensed with altogether.

Antipyretic Treatment. When the temperature runs danger-
ously high, a temporary use of antipyrin, acetanilid, phenacetin,
or other potent antithermic remedy may be resorted to. But
agents that so profoundly affect the heat centres are not devoid of
danger and should not as a rule be continued after the dangerous
excess of temperature has been overcome. They may be looked
on as valuable to temporarily obviate an extreme danger rather
than as a form of regular treatment.

The modern resort of applying ice bags to the chest may be sim-
ilarly disposed of. In very high fever they have been apparently
beneficial, but the danger of chill or injurious reaction is so great

Acute Croupous Pneumonia. Pneumonitis in the Horse. 231

that they must bs employed with the greatest possible considera-
tion and care.

Refrigerant Febrifuge. Neutral salts such as saltpeter in 2
drachm doses every six hours may be given in the drinking water.
Th2S2 are valuable for their cooling and eliminating action, and
possibl}' in counteracting the viscidit}^ of the blood and exuda-
tions. Acetate of potash, bicarbonate of soda, iodide of potas-
sium or muriate of ammonia may be substituted.

Stimjilants. In debilitated subjects or with low fever or op-
pressed heart the stimulating diuretics like sweet spirits of nitre
or liquor of the acetate of ammonia are to be preferred, and this is
especially the case during convalescence. They at once sustain
the flagging heart and aid in the excretion of morbid products.
Digitalis is often of great value in the same sen.se, and as a heart
stimulant nux vomica.

Some follow Todd and Bennett in seeking stimulation from al-
cohol, ammonia and its salts, ether, etc. When the circulation is
weak or flagging these are often of value and they may even act
directly on the pathogenic microbe. The inhalation of oxygen,
or the solution of proxide of hydrogen given by the mouth has
often an excellent effect.

Sedatives. Aconite has become too much of a domestic remedy,
nevertheless it may be used with advantage in high fever with ex-
cited heart action, to moderate the circulation and relieve the
breathing. Veratrum, hydrobromic acid, bromide of sodium or
ammonium, or chloral hydrate may be used as alternates or sub-
stitutes.

Compresses. Fomentations. Poultices. No measure is safer
nor more promising, especially in the early stages, than the poul-
tice jacket or compress. A blanket wrung out of hot water is
wrapped around the chest, covered with a thick dry one, and held
firmly attached by elastic circingles. Or soaked cotton wool is
applied and covered with a dry blanket or a rubber sheet. The
more acute the inflammation the more valuable is this measure.

Derivatives. As a derivative the mustard pulp rubbed in and
covered with thick paper or rubber is especially valuable. In one
hour it may secure a free exudation and material relief to the
breathing. It may be replaced b}^ ammonia and oil, with or with-
out a covering, by hot water or b}- cantharides. This must how-

232 Vderhiary Medicine.

ever ba used with judgment. In the early stage with a high
tj'pe of inflammation and fever the surface irritation ma}^ aggra-
vate this through sympathy ; in such cases therefore the severity of
the inflammation should first be moderated before using an active
counterirritant. In debilitated conditions, too with an altered or
depraved state of the blood and during the prevalence of a low
type of the disease, sloughing may ensue from incautious blister-
ing;

The repetition of the blister is often useful, the healing process
going on simultaneously in the blistered surface and the dis-
eased lung by virtue of nervous sympathy.

To complete recovery a course of vegetable tonics, such as gen-
tian, nux vomica, calumba, may be given with iodide of potass-
ium for a week or more. Constipation occurring during conva-
lescence must always be corrected by food, (bran mashes, linseed
gruel), injections, or oleaginous, saline, or aloetic laxatives. The
greatest care should be exercised to secure pure air, comfort, sun-
shine, good grooming and general hygiene, and to prevent over-
exertion during convalescence.

In the subacute types of pneumonia the fundamental difference
in the treatment consists in the avoidance of all depressing reme-
dies and the employment of stimulants and a supporting diet from
the beginning. Sweet spirits of nitre and liquor of the acetate of
ammonia, carbonate of ammonia or salammoniac with digitalis
and strychnia may be used from the first. Vegetable tonics may
be resorted to at an early stage, peroxide of hydrogen, and when
expectoration is established and the fever moderated even mineral
tonics may be employed. Nourishing gruels, mashes, roots,
green food, and scalded oats may be used in turn to coax the ap-
petite and not to satiate. In other respects the treatment is the
same as for the acute. This form of the disease is liable to prove
obstinate and persistent, and there appears to be a greater tenden-
cy to complications and so called metastasis, as enteritis, laminitis
or rheumatoid affections of the back or limbs. These when they
occur must be treated as if they had arisen in ordinary circum-
stances, having regard meanwhile to the remaining inflammation
in the lungs, for that has not necessarily been quite superseded but
only alleviated.

Chronic Pneumonia. This has been described but if uncom-

Croupous Pncicmonia in the Ox. 233

plicated by consumption it appears to be usually only that consolida-
tion of lung, due to the organization of exuded products into fibrous
tissue, which occasionally forms a sequel of acute inflammation of
the lungs. In such cases an access of circumscribed local conges-
tion is liable to result from overexertion, or a chronic state of ir-
ritation is maintained attended with more or less fever, inappetence,
mal-assimilation, and often in the long run hectic, under which the
animal is worn out. In such cases the chief indications are to
avoid overwork or any undue strain upon the breathing organs, to
support the patient by nourishing and easily digested food, and to
control and remove any local irritation by measures indicated under
the head of acute pneumonia.

CROUPOUS PNEUMONIA IN THE OX.

Subacute in many cases. Effect of temperament, and work. Acute form.
Symptoms. Decubitus. Unfavorable symptoms. Prognosis. Suppura-
tion frequent : indications. Gangrene. Coliquative Diarrhoea. Lesions,
Comparison with those of lung plague. Tubercle. Treatment, bleeding,
laxatives, refrigerant salts, derivatives, stimulants, tonics. Chronic form.
Symptoms. Treatment.

In the large ruminants this disease tends more towards a sub-
acute type than in the horse, and coming on insidiously from or-
dinary causes is liable to be confounded with the contagioics pleii-
ro-p7ieumoiiia of the bovine race. As in the horse the nervous
animals show more violent symptoms. It is rare in milch cows
and young cattle and more frequent in w^ork oxen.

In the acute form the symptoms mainly agree with those of the
horse. There is the same shivering, followed by a hot stage, hy-
perthermia, the accelerated pulse, the short quick labored breath-
ing, heaving flanks, cough frequent, deep, hacking, and easily ex-
cited, dilating nostrils, redness of the mucous membrane, and
the same indications on auscultation and percussion, care be-
ing taken to obviate misconception of natural conditions in the
chest of the ox. There is in addition a dry muzzle, tenderness of
the back and breast bones and wincing when they are pinched be-
tween the fingers and thumb ; suspension of the appetite and rum-
ination and in cows suppression of the secretion of milk ; the mouth
is often opened and the tongue protruded to facilitate breathing,

234 Veterinary Mediciyie.

and in bad cases each expiration is accompanied by a moan or
grunt. In many cases the ox can He on his flattened breast-bone
and maintain the breathing process, but when the disease is severe
he stands no less obstinately than the horse, his elbows turned out,
his nose protruded and directed towards a window or other open-
ing.

Among the unfavorable symptoms may be mentioned increas-
ing anxiet}' and distress, a more oppressed breathing, the animal
standing constantly in one position with legs apart, elbows turned
out, his nose extremely raised, nostrils widely dilating, mouth
open, tongue protruded, the expiratory grunt deep and prolonged,
the cough infrequent and so weak as to be almost inaudible, be-
ing rather like a forced expiration, and the pulse rapid, feeble or
imperceptible. The prognosis is favorable in moderate cases sub-
jected to early treatment.

The termination b}^ suppziratioii is more frequent than in the
horse. The general symptoms are ameliorated, appetite and rum-
ination return though they remain capricious and irregular, there
remains the double action of the flanks, the dry, rough muzzle,
the tense, inelastic skin, frequently varying in temperature, the
beast shivers at intervals, the cough is weak and often repeated, a
yellowish thick discharge takes place from the nose, weakness and
emaciation increa.ses and the animal dies in from twenty to thirty
days.

Gangrene of the lung sometimes supervenes and is indicated by
similar symptoms as in the horse. In severe and prolonged cases
a violent fetid diarrhoea often supervenes and hastens a fatal re-
sult.

The post mortem lesions are similar to those of the horse.
The cut surface of the hepatized lung, however, is divided
into irregular red spaces by intersecting yellow lines — hence
the name of marbled lung, from a supposed resemblance to
that stone. The red spaces represent the pulmonary lobules and
the whitish lines the surrounding areolar tissue which b^ing
especially abundant in ruminants and pigs stands out prominently
when infiltrated with the yellowish exudation. There is then
nothing specific in this appearance as has been erroneously sup-
posed, it is merely the result of the different conformation of the
lung in these animals and is always seen in the hepatized lung
unless when from extravasation of blood into its substance the

Crottpojis Pneumonia in the Ox. 235

redness is rendered uniform. The amount of exudate into the
interlobular tissue is, however, never so great as in lung plague.

The greater frequency of suppuration in the lung of the ox, as
well as the greater tendenc}^ to tubercular deposit in prolonged
cases are additional features in the diseased lungs.

Treatment. Blood-letting should be employed only with pre-
cautions, as in the horse. A saline laxative (i lb. Epsom salts
and Yz lb. molasses) may be used with advantage and safety early
in the disease though in advanced stages it may sometimes prove
dangerous from the tendency to diarrhoea. If constipation appears
at a late stage injections of warm water and a mild laxative (6
ounces sulphate of soda) only, should be given. The purgative
may be followed by the same neutral salts and in the same doses
as for the horse. Counterirritants are of equal value. A mustard
poultice may be kept on for several hours, or a mixture in equal
parts of oil of turpentine, ammonia, and olive oil may be actively
rubbed over both sides of the chest and repeated daily until
tender. In Denmark a prompt and efficient blister is made with
I part of Croton oil and 10 parts each of sulphuric ether and
spirits of wine. This is rubbed actively over the chest and
washed off as soon as a sufficient effect has been produced. It
must be carefully watched to prevent blemishing.

In the low types of the disease and during convalescence stimu-
lants and tonics are to be employed as recommended for the horse.

Chronic Pneumonia. Gelle describes a chronic form of this
disease in cows. For about a month the patient became increas-
ingly emaciated, there was a frequent, dry, weak cough, lifting of
the flanks, and expiration double and accompanied by a moan.
All these symptoms w^ere aggravated by gentle exercise. Percus-
sion detected dullness at the lower part of the lung and ausculta-
tion a distinct crepitating rale. The pulse was weak and rapid,
the mucous membranes red and tumid, skin dry, ears and horns
cold, appetite small and capricious, rumination rare, excrements
soft, and milk almost dried up.

The treatment is by diuretics with vegetable tonics and stimu-
lants and active counterirritation over the chest. Gelle considers
the malady as all but incurable unless active blistering is promptly
employed so soon as the malady has assumed the chronic form
and before extensive structural changes have taken place in the
lungs.

CROUPOUS PNEUMONIA IN SHEEP.

Causes, damp, cold soils, inclement weather, cold rains, hard driving,
shearing or washing in cold weather, change to a cold climate, or from a
warm barn, hot barns, heavy fleeces, sudden plethora. Symptoms, in con-
gestive cases, in inflammatory. Treatment, preventive, hygienic, anti-
phlogistic, laxative, febrifuge, derivative.

This disease is not uiifrequent in these animals, occurring en-
zootically in low, wet pastures ; or from cold storms of wind, sleet
or drenching rains, particularly after hard driving, or shearing ;
or from washing during inclement weather. Dressing with mer-
curial ointment in cases of scab is a frequent cause of pneumonia
and death in Lincolnshire and various other English counties.
Lastly M. Seron in Hurtrel d' Arboval's " Didionaire'" describes
its prevalence in Seine- Infer iezire among low conditioned sheep
subjected abruptly to a very nutritious diet. The hot buildings,
heavy fleeces, and sudden plethora, appear to conduce to danger-
ous pulmonary congestions. The symptoms do not differ materi-
ally from those seen in the ox except so far as they are modified
by the fact that the disease often terminates fatally before hepa-
tization has been established and the symptoms and post mortem
appearances are those of congestion and sanguineous engorgment
of the lung rather than of hepatization.

This engorged state of the lungs it is which has led Youatt and
others to describe them erroneously as ' ' gangrenous ' ' and
shepherds to name the disease ' ' rot of the lights. ' ' The condi-
tion is that of acute congestion and analogous to that seen in con-
gested lungs in the horse.

The treatment ought to be chiefly preventive and will consist in
the avoidance of the causes above indicated.

When the disease has set in, fresh air, and general comfort,
bleeding if in the very earliest stages and in a strong patient,
purging (3 ounces sulphate of soda and yi^ lb. treacle in warm
gruel) and a free supply of nitre (about ^ an ounce daily to
each) in the water or gruel supplied are the leading indications. As
a counterirritant aqua ammonia acts well being sufficiently con-
confined by the fleece.

236

PIG. PNEUMONIA.

Symptoms, chill, burrowing, hot skin, congh, disturbed breathing, indica-
tions of exudation. Treatment, laxative, sedative, nauseant, febrifuge, wet
jacket, blister.

Hogs are not exempt from this disease. They show the same
symptoms of chill with hiding under the litter, followed by a hot
stage, cough, hurried breathing, and (if the clothing of fat is not
too thick) conclusive results on auscultation and percussion.

As treatment bleeding from the ears and tail is .sometimes re-
sorted to with questionable benefit, A laxative of three ounces of
castor oil or three or fourcroton beans given in the food is of value.
Tartar emetic in doses of }{ grain and nitrate of potash in lo
grain doses .should be shaken on the tongue at least four times
daily to keep up a continued nausea and action on the urinary or-
gans. The tartar emetic so worthless in the larger animals is of
value in the pig and dog. A damp compress or bli.ster may be
used. The skin of the animal is difficult to blister, but by the use
of the Danish croton liniment, mentioned for the ox, of hot wa-
ter, or of a mixture of oil of turpentine and croton, 8 parts of the
former and i part of the latter, a sufficient effect can usually be
obtained.

DOG. PNEUMONIA.

Breeds most liable. Causes, overexertion, cold baths, clipping, exposure
in cold, distemper. Symptoms, chill, fever, disturbed breathing, cold ex-
tremities, cough. Treatment, dietary, nursing, laxative, nauseant, febrifuge,
moist jacket, mustard, stimulants, tonics, heart tonics and careful nutriti-
tion during convalescence.

Pneumonia in birds. Causes, exposure, neglect, foul coops, hot, close
houses, etc. Symptoms, erect plumage, drooping head, wings, and tail,
dark comb, gaping, panting, cough, crepitation. Treatment, hygienic, lax-
ative, febrifuge.

This is a frequent affection in hounds. In hunting or cours-
ing dogs the causes are like those operating in the horse. The

237

238 Veterinary Medicine.

clipping of long haired dogs in inclement weather, swimming
dogs in winter without afterwards drying or heating them by ex-
ercise, and shutting them out of doors at night, when accustomed
to a warm dwelling are occasional causes. It sometimes occurs
epizootically and frequently supervenes during distemper.

The chief symptoms of chill, fever, and difficulty in breathing
are like as in other animals, while the results of auscultation and
percussion are more satisfactory than in any other domestic ani-
mal. The dog sits on its haunches to facilitate breathing ; his el-
bows turned out, his mouth .open and his tongue protruded.
Coldness of the ears and a short quick cough are usually marked
.symptoms.

Treatment. The general care applicable to other animals is
equally demanded here. The diet should consist of mild broths,
or farinaceous foods with a little gravy if necessary to render it
palatable.

Bleeding from the jugular has been recommended and may be
admissible at the outset of the disease in a very few appropriate
cases. If costiveness exists a tablespoonful of castor oil may be
given (more or less according to the size of the animal), following
this up by the tartar emetic, nitre and .sugar recommended for
bronchitis. The poultice jacket is of great value. Mustard poul-
tices may later be applied to the sides of the chest. Stimulants,
tonics and nourishing diet may be required during convalescence,
or when the disease assumes a low type.

CROUPOUS PNEUMONIA IN FOWLS.

In chickens exposure and neglect are alleged causes. Foul
coops and the contrast between the warm building and cold outer
air are justly blamed. Ruffled feathers, drooping head, dark col-
ored comb and wattles, trailing wings, a disposition to gape, pant-
ing and cough are noticed. Under the wings and over the back
crepitations and dulness may be detected. The patient may take
a teaspoonful of castor oil, and saltpetre or iodide of potassium
may be given in the drinking water. In careful doses the other
remedial measures may be attempted.

ACUTE PLEURISY IN THE HORSE. PLEURITIS.

Causes, cold, damp, soils and exposures, as with rheumatism, youth, vigor,
heavy diet, digestion, or hepatic disorder, overexertion, perspiration and
succeeding chill, wading or swimming rivers, standing in snow, salted snow,
rain, sleet, snow, draughts between open doors and windows, clipping, cold
sponging of legs, tuberculosis, a common cause in man and cattle is rare in
horses, surface pneumonias, cancers, actinomycosis, tumors. Traumas from
broken rib, penetrating intercostal wound, blows, contusions, ruptured pul-
monary or intercostal abscess. Irritant ( infectious ) exudate suggests mi-
crobes. Symptoms, chill, reaction, partial sweats, pawing, pointing one
foot, hyperthermia, hard, jarring pulse, hurried breathing, inspiration catch-
ing, pleuritic ridge, uneasy movements, hacking cough, tumors and twitch-
ing of chest muscles, tender intercostals, grunting, friction sound, subsiding
with appearance of dull area below, signs of effusion, relief, dyspnoea, lift-
ing flanks and loins, perspirations, stocking limbs, pasty swelling on ster-
num, effusion of same level on both sieles, creaking sounds,- splashing, gur-
gling, metallic tinkling, weakness, sinking. Signs of adhesions, compres-
sion of lung, abscess. Duration. Lesions, early formation of false mem-
branes, pleuritic effusion, its composition, its color at different stages, dry
pleurisy, serofibrinous, sero-fibro-purulent. hydro-pneumothorax, tubercle.
Prognosis. Treatment, during the chill, warm air, clothing, drinks, injec-
tions, compresses, pilocarpin during early inflammatory stage, derivatives,
dry cupping, mustard, cantharides, hot water, or air, cold applications, lax-
atives, calmatives, anti-rheumatics, alkaline agents, with bitters, diuretics,
heart tonic, iodine, mercury, thoracentesis.

Causes. Pleurisy is common in all domestic animals and es-
pecially so in cold, damp, exposed localities which suffer equally
from rheumatism. It occa.sionally extends to the fascia of the
limbs, the joints, or the navicular or other trochlea as a rheu-
matic affection. The disea.se is prevalent among young and vig-
orous horses, four or five years old, on stimulating feeding.
Here hepatic derangements and poisons, over-exertion, perspira-
tion and succeeding chills are especially to be .suspected. Plung-
ing the limbs in ice cold water as in wading a river (Fromage),
standing in snow and above all in salted snow, or facing a cold
rain, sleet, or snow when perspiring or fatigued, are recognized
causes. A full drink of ice cold water when freely perspiring,
and followed by .standing in the fro.sty air, or in a cold current in-
doors. Exposure unblanketed after clipping in winter (Field,

239

240 Veterinary Medicine.

Trasbot), and even sponging the bod 3^ or legs with cold water
when heated or fatigued or both. St. Cyr found that pneumonias
stood to pleuri.sies as 3 : i , Trashbot as 10 : i , yet the latter draws
attention to the fact that in cavalry horses habituated to the stable
and sent out into camps in the depth of winter, the pleurisies are
more numerous than pneumonias. This may suffice to show the
importance of the role filled by cold and chill in the production of
pleuris)'. Yet many physicians look upon the chill as a predispo-
sition only, while the true origin of disease is microbian. And in
man a large proportion of pleurisies appear to be distinctly tuber-
culous. Bowditch traced 90 cases of acute pleurisy and found that
32 had tuberculosis. The objection to generalizing too largely on
this for the lower animals is that the horse and dog, in which tu-
berculosis is rare, are by far the most common subjects of pleurisy,
whilst cows which are very prone to tuberculosis show few cases
of simple pleurisy. Again we find pleurisy in the horse as the re-
sult of other diseases localized in or adjacent to the pleura, and
where there is nothing to indicate tuberculosis. Thus it follows
pneumonia approaching the surface of the lung, cancers, actino-
mycosis and other tumors, and traumas— a pulmonary abscess
bursting into the pleura, a broken rib scratching and lacerating
the lung, a perforating wound of the intercostal space, or in cattle
a sharp pointed body advancing from the reticulum toward the
heart.

But the presumptive absence of the tubercle bacillus in the
great majority of pleurisies in the horse does not prove the absence
of all pathogenic microbes. Trasbot, who rejects the microbian
theory, found that the injection of a little of the exudate into the
pleural cavity of a sound horse, always determined a generalized
pleurisy. Injections of distilled water with the same antiseptic
precautions, made separately by himself and lyaborde, had no
pathogenic effect. Trasbot attributes the pleurisy vaguely, to the
irritant effect of the exudate, but if it should finally be shown that
this exudate contains microbes, though they may not be those of
tuberculosis, the irritant action will be much more clearly ex-
plained. There are forms of pleurisy which are unquestionably
the result of microbes, as in lung plague, influenza, canine dis-
temper, glanders, tuberculosis, pneumo-enteritis, actinomycosis,
and theoretically it might be supposed that in our ordinary acute

Acute Pleurisy in the Horse. Pleuritis. 241

pleurisies, other germs that have been lurking harmless in the
sj'stem may take occasion by reason of the lowered vitality in-
duced by a chill, or a trauma, to colonize the thoracic serosa and
develop pleurisy. Under such a theory, the predisposing and
microbian element would remain equally effectual, but only oper-
ative when conjoined, neither being pathogenic without the other.

Until the constancy of the microbian factor is demonstrated we
must recognize the time honored doctrine, that pleurisy may be
due to cold, exposure, over exertions, to traumatic injuries, blows,
concussions, fractures, penetrating wounds, and to extension by
contiguity from adjacent diseases.

Most commonly pleurisy is unilateral on the right side but is
often on the left or on both stdes.

Symptoms. There is the early symptom of shivering followed
by a hot .stage in which the limbs participate and partial .sweats
bedew the surface. There are first uneasy movements of the fore
limbs with some lifting of the flanks and this discomfort increases
until the patient is panting with pain and occasionally glancing
round at his heaving flanks and even pawing as in colic. If the
pleurisy is confined to one side the corresponding fore limb is
often advanced before the other. The temperature is 102° and
upward. The pulse is quick, hard and incompressible being
usually compared to a jarred wire and beats from 48 to over 60
per minute. The breathing is highly characteristic. It is hurried,
is carried on chiefly by the abdominal muscles to avoid the rubbing
of the inflamed pleurae on each other, and has the inspiration
short and suddenh^ checked by an audible closure of the glottis
while the expiration is .slow and prolonged. This character of
the breathing is well observed when the ear is placed against the
false nostril. The laboring abdominal muscles stand out as a
ridge from the outer angle of the ilium along the lower ends of
the last ribs (pleuritic ridge). A tremor on this line is often
noticeable in the early stages. It may also be felt by the hand
laid on the costal region. The horse does not stand obstinately
still as in pneumonia, but frequently moves as if seeking an easier
posture. The short, hacking cough contrasts with the deep, rare
cough of pneumonia. The expired air is not so hot, nor the
mucous membrane of the no.se so red as in the last named disease
and there is no nasal discharge. A twitching of the muscles of

242 Veterinary Medicine.

the chest is sometimes seen and if the intercostal muscles are
pressed upon, the animal winces and frequenth- grunts. This last
symptom is likewise seen in rheumatic disease of the intercostal
muscles (pleurodynia) but the absence of the fever, the cough,
and other chest symptoms sufficiently distinguish this. Ausculta-
tion detects in the early stages in addition to a healthy respiratory
murmur, a friction sound audible in inspiration only in short jerks
near the close of the act and comparable to the rubbing of the
palm of one hand over the other laid over the ear, but this is no
longer heard when effusion of liquid has taken place into the
pleurae. Percussion in the early stages detects no change from
the healthy chest resonance.

If not relieved in from twenty- four to thirty-six hours, a re-
markable modification of the symptoms takes place indicating the
occurrence of effusion. The violent symptoms are suddenly re-
lieved. The quick catching breathing which is in many cases ac-
companied by a grunt, becomes easy and though fuller than
natural is comparatively regular. In particular the inspiration is
free and full and comparatively painless, the sudden check and
the grunt by which it was arrested having alike disappeared.
The tension of the abdominal muscles and the tucked up appear-
ance of the flanks give way ; the pulse acquires a softer character,
the haggard pinched countenance is relaxed, and a general ap-
pearance of comfort and even liveliness prevades the animal. This
temporary improvement is often so great that the horse will take
to feeding as if he had all at once recovered.

The apparent recover}^ is, however, only transient. Soon the
pulse becomes more frequent and loses its fulness, the breathing
is more laborious and attended with a characteristic lifting of the
flanks and loins, the nostrils are widely dilated, the limbs out-
stretched and the elbows outturned, the eyes stare and project
and the countenance has a haggard appearance indicating threat-
ened suffocation. Partial sweats ma}^ break out on the surface,
due to the state of nervous excitement and general relaxation and
supplementing in some degree the impaired exhalation from the
lungs. Auscultation over the lower region of the chest shows a
complete absence of the respiratory murmur, rising to the same
level precisely at all points. Percussion elicits no resonance on
the same region. If the effusion has taken place slowly or existed

Acute PleJirisy in the Horse. Pleuritis. 743

for soni2 tiin2, thi dulness and absence of sound will usually in-
dicate that th2 liquid ris2S to tha same level on both sides. So
thin and permeable is the posterior mediastinum in its lower part
that unless thickly coated by new solid exudations, the effusion
readily passes through it and rises to the same height on both
sides. If gas as well as liquid is produced in the pleural sac a
gurgling or splashing sound may be heard on auscultation, and
occasionally, after rising or other change of position, a metallic
tinkling, due to droppings from the shreds of false membranes
above into the fluid below.

As the disease proceeds dropsical effusions are observed beneath
the skin of the breast and abdomen, a mucous rattle is heard in
the trachea, the nose, ears and limbs become cold, the pulse in-
creases in rapidity and weakness, shows the distinct anaemic tremor
or thrill, and becomes rapidly imperceptible ; the horse moves un-
steadily and often falls suddenly dead.

This early fatality is, however, only seen in the worst cases.
In those about to terminate favorably improvement is shown
usually about the fourth day. The lifting of the flanks and loins
becomes moderated, the ribs move more freely, the grunt ceases,
the pulse is fuller, softer and less frequent, and auscultation and
percussion show a steady decrease in the effusion. Appetite
meanwhile returns, the horse moves more freely, lies down for a
length of time in succession, and convalescence lasts from two to
three weeks.

In the less fortunate cases structural changes more or less per-
manent, keep up symptoms of illness for a variable length of time.
Sometimes after the liquid effusion has been absorbed the lung
remains attached to the side of the chest by newly formed tissue
(false membrane) and while this is undergoing a drying and
organizing process, it gives rise to a leathery, creaking sound
heard on auscultation and easily mistaken for crepitation. Some-
times an abscess forms on the surface of the pleura or in the newly
organized false membrane, and either bursts into the pleural sac
(empyema) where it serves to increase and sustain the irritation,
or it makes its way through the intercostal spaces and is discharged
externally. In this last case its advance toward the surface is
heralded by an extensive inflammatory infiltration and pasty
swelling much more tender to the touch than the dropsical swell-

244 Veterinary Medicine.

ing already referred to. Another condition is that in which false
membranes of considerable thickness invest a lung and, following
the law of all fibrous structures in process of organization, they
contract and cause a compression and partial collapse of the con-
tained lung tissue. A flattening of the corresponding side of the
chest and a muffled and almost inaudible respiratory murmur is
the result of this condition. In some measure these symptoms
are present during convalescence in all cases of pleurisy since the
lung never expands to its full size till some time after apparent re-
covery, but it is only when the organ is invested with false mem-
brane that the symptoms are very apparent.

In all such cases of prolonged pleurisy from protracted structural
change there is continued illness without the violent symptoms by
which the acute form of the disease is manifested. The acute
suffering, the restlessness, the grunt, and even the catching
breathing may be absent ; the temperature may be almost reduced
to the healthy .standard, the pulse small and tolerably soft, the
appetite considerably improved and the different secretions toler-
ably normal ; yet the pinching of the intercostal spaces causes
sharp pain, and measurement, auscultation and percussion testify to
the persistence of disease. The animal is hidebound, unthrifty
and unequal to any exertion. The cough is weak and painful and
sometimes accompanied by a grunt.

Besides the changes connected with exudation and effusion,
and organization or suppuration in the exuded products, gangrene
sometimes results. A case of this kind is related by Percivall.

The duration of pleurisy may thus extend from two days in
very acute cases to several weeks, or even months if we estimate
it by the continuance of hydro-thorax in the chronic cases.

Post Mortem Appearances. These consist mainly in the pres-
ence of false membranes lining the pleura and hanging in cobweb
like shreds into the cavity of the chest, and of the liquid effusion
which fills up the chest at its most dependent part. The pericar-
dium also contains fluid in many cases. The periods at which
exudation takes place, and when the principal changes take place
in the exuded materials have been well investigated by Dupuy,
Hamont, Delafond and St.Cyr. They induced pleurisy by inject-
ing irritant liquids into the chest, and noted the regular sequence
of changes.

Acute Pleurisy in the Horse. Pleuritis. 245

Dupuy injected two drachms of oxalic acid dissolved in three
ounces of water. Symptoms of. pleurisy at once came on, with
the friction sound characteristic of its early stages. Next day
friction sound had ceased and evidence of effusion existed. The
same experiment repeated on several horses showed that if killed
at any period subsequently to this, considerable exudation had
already taken place. In one horse in which the disease was of
50 hours' standing the chest contained 43 pints of citrine-colored
fluid, and abundance of yellow, thick, false membrane enveloping
the costal and pulmonary pleurae.

Hamont injected seven ounces of a weak solution of tartaric
acid into the left pleural sac, repeated the injection next morning
and destroyed the horse twenty minutes afterward. The chest
opened immediately showed a small amount of liquid on the
affected side, and the pleura injected and reddened.

Delafond made twenty-tw^o experiments with the same general
result.

Percivall found recent adhesions between the lungs and side so
early as seventeen hours after the commencement of the pleurisy.

Andral injected rabbits with acetic acid and in nineteen hours
found in the injected pleura soft, thin, false membranes traversed
by red anastomosing lines, and in certain cases a serous or puri-
form fluid.

W. Williams found a false membrane formed twenty-fours after
the injection of the irritant.

St. Cyr in a series of 43 experimental and casual pleurisies in
horses, found that in a very few hours there was marked local
congestion and swelling of the pleura speedily followed by the
formation of soft, pulpy, friable false membranes, largely amor-
phous and granular but impregnated with many cells and nuclei.
These adhere feebly to the pleura but may accumulate with pro-
digious rapidity so as to cover in three or four days the whole
pleural surface on one or both sides. The attendant serous effu-
sion was bloody, turbid, or lactescent. The pleural surface under
the false membrane was highly vascular and studded with fragile,
red conical elevations projecting into the membrane. Exception-
ally the sub-serous connective tissue became the seat of exudation
as well.

From the sixth to the ninth day the false membranes began to

246 Veterinary Medicine.

become vascular and from the tenth to the fourteenth day com-
menced to organize into the connective tissue. With the advent
of this stage, the inflammatory action tended to subside, and the
reabsorption and repair to ensue.

Pleuritic effnsio7i. This varies greatly at the different stages of
the disease. As effused it has a composition resembling that of
the blood :—

Water, ---911 to 924

Albumen, - - - - - - - - - 63.33 to 82.50

Fibrine formers, ------ 2.16 to 12.50

Extractive matter.
Salts.
The progressive changes from the haemorrhagic effusion to the
limpid hydrothorax and their relation to the different stages of the
disease and the subsidence of the inflammation are of the greatest
importance in deciding questions of responsibility, when the
animal has recently changed hands. St. Cyr has classified his
cases in the following instructive table :

Effusions.

Duration of the
Disease.

Port Wine

Sero-san-
guineous.

Muddy

or
Grayish.

Limpid.

Total.

From 1st to 7th day.

" 8th to 15th day.

" i6thto3othday.
After 30th day . . .

9
2

6

3

I

3
4

6

5
3

18
15

7
3

II

10

8

14

43

Up to the 7th day 50 per cent were dark red ; after the 7th da)^
only 13.3 per cent ; and after the 15th day none. Up to the 7th
day 83.3 per cent were either dark red or sero-sanguineous and
not one had attained to translucency. After the 7th day only 8
percent were of port wine hue, and by the i5tli day 24 per cent,
of all cases of over seven days standing were already transparent.
Of all cases of over 15 days standing, 80 per cent, were perfectly
translucent and none showed the dark red hue. Finally after the
30th day all remaining cases were limpid. This of course must
not be applied with the same confidence in both directions. While
translucency of the effusion bespeaks seven days standing and

Acute Pleurisy in the Horse. Pleuritis. 247

probably fifteen or twenty, the dark red hue must not be held to
imply a recent date for the attack. A relapse in the course of con-
valescence may easily and quickly stain anew a liquid that was
already limpid, or had advanced far toward this condition.

The appearance of the lung tissue in a case of confirmed pleu-
risy is characteristic. The lung is of a dull red color, shrunken,
slightly collapsed, flabby, scarcely crepitant under pressure and
heavier than water or floating in water. It is tough, not friable
like hepatized lung, and its cut .surface is dry, smooth, and pre-
sents the interlobular septa very well marked. This is due to the
compres.sion by effused liquid, and by the organizing and contract-
ing false membranes covering the lung and implies nothing more
than simple condensation. The air cell may be collapsed, but
contains no new product and has not parted with its epithelium
and the lung can be inflated through the bronchia.

Differentiation according to the nature of the effusion. Pathol-
ogists have divided acute pleurisy into the djy, sero-fibrinotis, and
sero-fibro-purulent.

1. Dry or fibrinous pleurisy has usually a more acute type
and the exudate containing an excess of the fibrinogenous elements
forms a coagulum or false membrane on the affected surface tend-
ing to bind that to the part adjacent — the lungs to the costal
pleura. The serum, small in quantity, is in the main retained in
the exudate or if set free is actively reabsorbed by the healthy
pleura.

2. Sero-fibrinous pleurisy. This form is u.sually less acute
and more extended involving perhaps an entire pleural sac, or
even both sides of the chest. This is the common form of pleurisy
and is that referred to in the experiments of St. Cyr and others
above. The earliest lesions in experimental cases (with chloride
of zinc solution) in dogs are an uniform bright red congestion,
with a bright, shining .surface as yet perfectly dry. There is al-
ready shedding of patches of the endothelial cells, swelling and
proliferation of the superficial connective tissue cells and the for-
mation of a few pus globules. This is seen in from half an hour
to six hours after the application of the irritant.

Next follows the exudation of fibrine and serum, which respec-
tively coagulate as false membrane on the inflamed membrane, or
drop to the bottom of the sac as liquid. The fibrine appears as

248 Vcteri)iary Medicine.

granules, little knobs and threads between and on the endothelial
cells and entangling a few pus cells. The changes are now much
more marked in the connective tissue cells, which are more
numerous, larger, nucleated and often stellate or polygonal.
Changes are well advanced in twenty-four hours. The cells
go on increasing to the fourth or fifth da}^ when new blood vessels
are formed into the membrane and may be injected from the
pleura. From this time, in favorable cases absorption of the
liquid proceeds, and the fibrine is organized, and by the fourteenth
day is transformed into connective tissue, the superficial cells
forming endothelium and the deeper, branching connective tissue
cells. The result is the thickening of the pleura and the forma-
tion of adhesions. The case, however, may prove fatal, or it may
be protracted through the continued production of fibrine and
serum, or it may pass into empyema.

3. Sero-fibrino-purulent pleurisy. Empyema. This is
usuall}^ very dangerous as well as complicated. It may supervene
on the last described form. It may depend on rupture into the
pleura of abscess of the lung, bronchial glands, liver, diaphragm
or intercostal space and the infection of the chest cavity. It may
in the same way follow the laceration of a bronchium by a broken
rib, the perforation of the intercostal space by a foreign body, or
(in cattle) the penetration of the chest by a sharp-pointed body
from the recticulum. It may follow at once on pleurisy of a very
high grade. Probably in all such cases there is infection of the
pleura by pus microbes. When there is a communication with a
bronchium, the reticulum or the external air there are usually
septic germs in addition, and the contents of the chest become
foetid.

The purulent fluid may accumulate in the lower part of the
pleural sac, or it may be confined in abscess form in the false
membrane, and extend thence into surrounding tissues. The pus-
containing pleura, or cavity infected by the pus germs, assumes
the appearance of a granulating surface, or of the lining mem-
brane of an abscess, and continues to produce pus in greater or
less amount.

The formation of pus in the pleura is known as empyema.
When air enters the pleura through a wound perforating the chest
wall, or when gas is formed in the pleura, the condition is pneu-

Acute Pleurisy in the Horse. Pleuritis. 249

mothorax. As liquid is usually present as well it is hydro--
pneumothorax.

Tubercular and other forms of pleurisy have in certain cases
been superadded to the specific local lesions, by which such dis-
eases are individually characterized.

Prognosis. Occurring in an otherwise healthy system and
especially if coutined to one side of the chest, pleurisy is not fre-
quently fatal, and under appropriate treatment recovery is often-
times rapid and satisfactory. A certain number of cases merge
into chronic hydrothorax, the inflammation apparently subsiding,
but reabsorption failing to take place. The hydrothorax may
last for months or even a year.

Treatment, if seen during the chill and before inflammation
has been definitely established every effort must be directed to se-
cure its abortion, if possible. No time should be lost in placing
the patient in a warm comfortable stall or box, covering him with
woolen blankets and actively rubbing and loosely flannel bandag-
ing the legs. Warm drinks and warm injections must be given.
Half an ounce or an ounce of camomile or boneset in infusion
in two or three quarts of hot water, or in the absence of this
any of the carminatives, or etherial, alcoholic or ammoniacal
stimulants may be given. Pilocarpin in 7 grain dose hypodermi-
cally may promptly secure a revulsion of blood to the skin and at
once overcome the chill and prove a most effective derivative from
the pleura. Placing the legs in buckets of hot water, or the whole
animal in a hot air bath will often act equally well. Packing the
chest and even the abdomen in a blanket wrung out of very hot
water and covering it closely by one or two dry ones, or, better
still, by a rubber or other impermeable covering, will long retain
both heat and moisture, securing free cutaneous circulation, and
soothing in a most effective way the irritation in the chest. This
may be maintained as long as requisite to relieve the patient, and
then the body may be uncovered, apart at a time, rubbed dry and
covered with a dry woolen blanket. By using elastic circingles
over the compress they are adapted to the respiratory movements
and any restriction in the movement of the ribs is beneficial by
limitnigthe friction, pain and irritation in the pleura.

In the second stage, when inflammation has already set in, the
same general measures of derivation toward the skin and hot bath

250 Veterinary Medicine.

or soothing derivative compress are still demanded though they
may be substituted by more stimulating derivatives. The bleed-
ing of the patient into his own vessels is sought in various ways.
On the continent of Europe stimulating embrocations (essential
oils, ammonia and oil, nuistard, etc.) are applied to the limbs.
In America and England similar agents are more commonly ap-
plied to the walls of the chest and dry cupping in the .same region
has been resorted to. Metallic cups with small mouths and having
a capacity of about a pint each, have the air rarefied by plunging
into each a spirit lamp, and, on its withdrawal, suddenly applying
the mouth of the cup on the .skin of the co.stal region previously
well coated with lard. Another form of cup is made with a tube
and stopcock in its otherwise blind end by means of which it is
exhausted with a syringe after its mouth has been applied to the
skin. In the absence of both a narrow mouthed glass tumbler
may be employed, the air is rarified by inserting into it a burning
spill of paper or wood for a few seconds and on its withdrawal the
cup is instantly inverted on the skin. If the animal is very hairy
or very thin it may be necessary to shave the .part, and smear
with oil and even to select a very narrow mouthed cup. When
applied the cup is cooled with water or otherwise and owing to
the partial vacuum the skin is .strongly drawn up into it and. the
blood accumulates in and under the skin. It may be kept on for
half an hour at a time and witli ten or twelve cups on one side
the patient tends to profu.se perspiration establishing a strong re-
vulsion toward the skin, and great relief. In dangerous cases
three or four applications may be required in twenty-four hours.

Next to this the mustard application is perhaps the safest and
most valuable. The be,st ground mustard (black by preference)
is made into a very thin pulp with tepid or cold (never hot nor boil-
ing) water and rubbed in against the hair so as to soak the surface
of the skin ; it is then closely covered with paper and with a rub-
ber or other impervious covering or, in default of better, with a
close blanket and left on for two hours. By this time the skin
should be thickened to the extent of at least a quarter of an inch
and the derivation and relief will be very manifest.

Cantharides is sometimes used but like most other severe irri-
tants, is liable to induce sympathetic irritation in an already se-
verely inflamed pleura, and thus to obviate all benefit. Canthar-
ides is also liable through extensive absorption to irritate the kid-

Acute Pleurisy iu the Horse. Pleuritis. 251

neys. To counteract this Bouley gave ^4 drachm doses of cam-
phor with alleged good effect.

Some practitioners make local applications of hot water and of
aqua ammonia (confined) but unless very closely watched these
are liable to destroy the hair follicles and produce permanent
blemish.

The hot air, steam bath, and hot compress have the advantage
over the mere irritant derivatives that their action is from first to
last soothing and free from all risk of inducing sympathetic irrita-
tion and yet as derivatives they are eminently efficient. Next to
them in safety and efficacy comes dry cupping.

The irritant derivatives are often the most valuable, but must
be used with great judgment. They are always dangerous when
the pleural inflammation runs very high and when the local irri-
tation and suffering are specially acute. Under such circum-
stances it is usually desirable to adopt other measures to moderate
the severity of the inflammation, and to fall back on baths, com-
presses and cups until the irritation is alleviated before vegetable
or animal vesicants are resorted to. In acute and severe attacks
these latter are especially applicable to the early stages before the
inflammation has been fully formed, or after the .stage of free
effusion has set in.

With high fever and no benefit from hot local applications,
cold irrigation or refrigerant compresses to the walls of the chest,
have proved useful, but considering the role filled by cold in cau-
sation and the suggested relation between pleurisy and rheuma-
tism this is not to be followed as a general practice.

If the patient has been a hearty feeder and if there is evident
costiveness a purgative (aloes or sulphate of soda) is often desira-
ble at the outset, but if the disease is of a low type this is always
dangerous, owing to susceptibility of the intestinal mucosa and it
is safer to correct constipation by injections or at most by a pint
of olive oil.

When the suffering is very acute and is aggravating the fever,
a hypodermic injection of morphine will often greatl}^ relieve and
even favor a revulsion of blood toward the .skin, but as it tends to
suppress the action of both bowels and kidneys it should be
avoided unless it seems absolutely necessary, and above all it
slionld not be given by the stomach. Cocaine hypodermically
may be used to relieve pain.

252 Veterinary Medicine.

Both fever and suffering can sometimes be greatly relieved by
large doses (2 drachms 3 or 4 times daily) of salicylate of soda,
which again suggests a close relation of the disease to rheumatism.
Acetanilid or phenacetin may be used to fill the same indication.

Next come the questions of alkaline and diuretic treatment.
Some cases do well if given nitrate of potash freely in the drink-
ing water. Some prefer the alkaline diuretics, such as acetate of
potash or ammonia, bicarbonate of potash or soda, biborate of
soda, or the vegetable diuretics such as colchicum, squills, etc.
Fraenkel found that, while comparatively ineffective alone, these
proved most efficient (in man) when combined with cinchona or
other bitter. The hint should be useful to the veterinarian. Di-
uretics in the stage of effusion should be pushed as far as the
strength of the patient will warrant.

Friedberger and Frohner recommend pilocarpin, and no agent
produces an equal secretion from the natural emunctories and an
equal tendency to reabsorption. It is however so profoundly
exhausting that it must be used with the greatest judgment
and caution.

Digitalis has often an excellent effect. Though not primarily
a diuretic, it is a powerful tonic of the heart and circulation, and
by increasing the blood tension it usually produces a free flow
of urine. In combination with the diuretic salts it may be used
from the first but it is especially valuable, after effusion and when
attention must be given mainly to securing reabsorption. Care
is demanded that we avoid its cumulative action, and in place of
continous large doses, a strong infusion applied over the loins will
sometimes have a good effect. It may also be combined with
bitters and even with ferruginous tonics in the advanced stages.

In combination with neutral salts and digitalis, iodide of potas-
sium would seem to be indicated. Results however do not show
a great superiority to other diuretics in favoring absorption.

Tincture of iodine, painted upon the chest over the affected
parts, and repeated until tender, acts more or less as both a de-
rivative and deobstruent. A liniment of iodide of potassium and
soap is a convenient form of application.

The inunction of the chest walls with mercurial ointment has
strong advocates both among physicians and veterinarians, and
is combined in such cases with the exhibition of calomel in-

Pleurisy in Cattle. 253

ternally. Unless the good effects are shown in a day or two it
may well be abandoned.

When effusion becomes dangerous through excess, and in ad-
vanced cases when it fails to yield to medicinal measures thora-
centesis is called for. (See under hydrothorax.)

PLEURISY IN CATTLE,

Milch cows and work oxen most liable. Causes. Damp buildings and
locations, sudden transitions from heat to cold, exposure when fatigued, etc.
Symptoms, rigor, reaction, cold horns and limbs, later hot, excited pulse,
catchingbreathing, hyperthermia, 104° to 105°, tender chine and intercostals,
friction sound, later dulness, creaking, weaker murmur, subacute cases
often tuberculous, effusion unilateral, chronic cases. Lesions, as in horse
with superficial marbling of lung. Treatment, laxative, warm drink,
compresses, derivatives, sedatives, diuretics, heart tonics, diuretics,
thoracentesis.

This is not common in young growing cattle, but is more
frequent in milch cows and work oxen. It is due to the same
causes as in the horse, and especially to chills when heated,
damp buildings and locations, cold draughts between open windows
or doors, and cold storms. The greatest danger comes from
hot, close stables, like many distiller}^ stables, approximating to
the temperature of the animal body and from which the stock are
suddenly turned out of doors, or shipped by car or boat with a
temperature near zero, and above all if furnished ice water to
drink. Such animals taking no exercise to increase the circu-
lation and heat, are especially liable to shiver and contract illness.
Rigors too are easily induced in animals .standing in hot buildings,
when, in connection with the cleaning, an adjacent door is thrown
wide open or two on opposite sides of the house. Working oxen
heated with exerci.se and then exposed to extreme cold and com-
pulsory inaction are endangered.

Symptoms. The attack is manifested by the same general
symptoms as in the horse. The rigors are often very well marked,
especially over the shoulder ; the tenderness of the chine and
intercostal spaces is striking ; the breathing is catching but there

54 Veterinary Medicine.

is rarely the same restlessness as in the horse ; the bowels are
costive, appetite and rumination impaired or suspended, and the
paunch is often distended with gas. The tenderness of the
intercostal spaces, the friction sound of the pleura, and the main-
tenance of the respiratory murmur and the normal resonance of
the lung, become the ultimate diagnostic symptoms. The pulse
may be 70° and upward, the temperature above 104° to 105°.
In some insidious cases indeed the fever is very slight and besides
the general wasting of the animal, the indications obtained by
physical examination alone enabled us to recognize the malady.
Tuberculous pleurisy which is very common in cattle is to be
suspected in such cases.

Effusion is recognized by the dulness of the lower part of the
chest up to a certain line, and often unilateral, by the softer
pulse, by the dilated nostrils, or open mouth, the contracted
facial muscles, by the glazed eye, and anxious expression, by
oppressed breathing and often by engorgement under the chest
and in the limbs.

When the disease lasts over ten or twelve days it tends to pass
into the chronic form. Or a chronic pleurisy of a subacute type
may begin dc novo and pursue an insidious and latent course.

If the disease commences as a subacute affection there may
have been for a month, capricious appetite, general illhealth
and falling away b2fore any other symptom is noticed. Now
the breathing is manifestly excited, a small, short cough is heard
at intervals, the pulse is accelerated but weak, and pinching
auscultation and percussion detect unequivocal signs of pleurisy.
From this the symptoms become more decided though for a length
of time they are very slight, the animal meanwhile becomes
increasingly emaciated, and perishes ultimately in a state of great
weakness. Such insidious cases are always to be suspected of
tuberculosis.

The post morte77i appcaraiices resemble those of the horse.
The surface of the lung beneath the diseased portions of pleura,
however, often presents a marbled appearance from the infiltration
of the areolar tissue between the adjacent pulmonary lobules.
The organization of the false membranes begins on an average
about the tenth day.

Treatment. The same general principles must be followed as

Pleurisy in Cattle. 255

in the horse. Bleeding can rarely be employed, partly because
the disease so often assumes a subacute form, and partly because
when first seen considerable effusion' has often already taken place
and severe depletive measures are thereby contraindicated.

A laxative dose (i Hb.) of sulphate magnesia, may be given in
warm gruel, and the same means by compresses, hot fomentations
and counterirritation adopted, and the same sedative and diuretic
medicines given as in the horse. In the advanced stages and in
the low types of the di.sease the stimulating diuretics (sweet spirits
of nitre, and liquor of the acetate of ammonia) and vegetable and
mineral tonics are especially indicated. The diet in these last
types must be nutritive, laxative and easily digested.

Tapping of the chest is equally applicable as in the horse, (ySee
Hydrothorax. )

In the chronic forms everything is to be done to support the
general health whether by food stimulants or tonics, and counter-
irritants may be applied several times.

PLEURISY IN SHEEP.

Causes, exposure, after clipping, washing in cold weather, alternations
from hot buildings to cold fields, shedding of the wool. Symptoms, hyper-
thermia, troubled breathing and pulse with catching inspiration, tender in-
tercostals, friction sound, and signs of effusion. Treatment, preventive,
shelter, febrifuges in food or water, aqua ammonia to sides.

The causes of pleurisy in sheep may be largely included in the
general statement — expostire. Cold washing and exposure after
clipping is especially injurious. Devieusart saw 300 cases of
pleuri.sy and thirty deaths in a flock of sheep shorn in February.
If kept secluded in warm buildings sheep may be shorn in mid-
winter, but any reckless exposure, and any sudden reduction of
the temperature of the building is liable to be disastrous. Scab
and other skin affections which lead to a shedding of the wool in
inclement weather may also be the occasion of widespread attacks.
Otherwise the causes are es.sentially those of the same disease in
the larger animals.

The symptoms re.semble those of pneumonia, but with the pe-
culiar sharp, short arrest of the inspiration, and the marked ten-
derness of the intercostal spaces as above described. The cough
is short, dry, hacking and infrequent or suppressed as much as
pos.sible. Auscultation and percussion signs, corresponding to
those found in other animals, are easil}^ got in the newly shorn
.sheep. In the unshorn the wool must be parted and a stethescope
employed.

The treatment is mainly preventive, or when the disease is
present, of a general nature applicable to flocks. A warm barn,
with pure air, blanketing, wet compresses, to which may be added
extract of henbane, and nitrate of potash in the drinking water
give examples of general medication. As a derivative, aqua am-
monia and oil may be applied in lines on the chest exposed by
parting the wool or generally on the .shorn. Where the patient
can receive the requi.site attention further treatment .should be on
lines laid down for cattle.

256

DOG. PLEURISY.

Causes, exposure to cold, etc. Chill, reaction, disturbed breathing,
catching inspiration, rapid, hard pulse, hyperthermia, tender chest, friction
sound, later dullness at lower part of the chest in any position. Treatment,
as in pneumonia, with antirheumatics and diuretics freely. Thoracentesis.

This is occasionally seen in the dog as the result of exposure,
and like other diseases of the chest is easily recognized. It owns
the same causes with pneumonia.

Symptoms. There is first dulness, shivering and some excite-
ment of respiration. To this follow the more acute symptoms,
the hard pulse, the rapid, catching breathing, the animal standing
or sitting on his haunches, the open mouth, pendent tongue, the
injected mucous membrane, the costiveness, but above all the
tenderness of the intercostal spaces, the early friction sound on
auscultation, the pain and normal resonance on percussion, the
muscular twitchings and the short, suppressed, painful cough.
When effusion has occurred its amount may easily be estimated
by turning the animal alternately on its feet, back and haunches,
and observing how high the dullness extends in these various
positions.

The same treatment may be adopted as in pneumonia, with this
difference that salicin may be given freely, and when effusion has
taken place active diuretics are specially indicated, and hence
tincture of squils (a teaspoonful) may be made to replace the
nitre. In advanced and obstinate cases, or where danger exists
from rapid effusion, the liquid may be drawn off with a cannula
and trochar as in other animals.

17 257

PLKURO-PNEUMONIA. BRONCHO-PNEUMONIA.
BRONCHO-PIvEURO-PNEUMONIA.

Though we often meet with typical forms of bronchitis, pneumo-
nia ^ndi pleicrisy , it is much more common to find them combined
more or less with each other. Thus combined inflammation of
the bronchial tubes and pulmonary substance is frequent ; inflam-
mation affecting both the lung and its investing pleural membrane
is no less common ; and cases are seen in which all three struc-
tures are involved. These conditions are to be recognized by the
presence of the symptoms of both the coexisting maladies but
particularly by the indications furnished by touch, auscultation
and percussion. The predominance of one disease over another
will decide the nature of the treatment which must be adapted to
the peculiar character of each case whether tnainly bronchitic,
pneicmonic, or pletiritic. It is these mixed cases that test the
ability and judgment of the practitioner as he must carefully in-
dividualize each case, ascertain the different parts affected, the
grade of the inflammatory action, the nature of the attendant
fever, the presence or absence of epizootic influence, etc., and hav-
ing all these conditions in view must apply remedial measures ac-
cordingly.

It must be evident that particular directions cannot be supplied
for all of these cases. General principles only can be inculcated
and their adaptation to the varied phases of different cases left to
the judgment of the student.

258

HYDROTHORAX.

All animals liable. Causes, pleurisy, obstruction to pulmonary or inter-
costal veins, heart disease, Brigbt's disease, anaemia, parasitic or otherwise.
Effusion reddish gray or clear straw color, inflammatory and dropsical.
Symptoms, troubles of respiration, as a secondary disease complicated by
dropsies elsewhere, signs of hydrothorax without fever, shedding of hair.
Treatment, diuretic, tonic, derivative, thoracentesis, trochar and cannula or
aspiration, point of election for puncture, method, asepsis, drainage by as-
pirator, or into an aatisspti-c solution, eligible cases, dangers attending
thoracentesis, shock, rupture of false membranes and lung, infection of
pleura, injection of antiseptics.

HydrotJiorax or water in the chest is common to all domestic
animals. It is as we have seen one of the most ordinary results
of pleurisy, and may persist long after that disease has disappeared.
It likewise occurs independently of inflammation as a dropsical
effusion. Thus when the return of blood by the bronchial, pul-
monary or intercostal viens, is hindered by any cause such as
tumors in the bronchial glands or subvertebral region a passive
effusion may take place through the coats of the vessels. In im-
perfection of the mitral valves the regurgitation of blood in
the pulmonary veins during each cardiac systole equally causes
such transudation. Chronic disease of the kidneys (Bright's dis-
ease) with the retention of effete and injurious materials in the
blood leads to drops}^ of the chest as in other parts of the body.
Again in many debilitated conditions parasitic and otherwise, with
a tendency to general dropsy the chest participates and a collec-
tion of fluid takes place in the pleurae.

The nature of the contained fluid will varj^ according to the
conditions in which it has been effused. If the result of inflam-
mation there are the different stages already indicated : first, of a
yellow citrine color or red from contained blood ; second, grayish
and muddy either from contained pus or other changes taking
place in the fluid ; and third, clear limpid and translucent as seen
in the later stages. If merely a dropsical effusion the fluid is
watery clear and transluent or with a slight straw color. The in-
flammatory effusion contains fibrine or fibrinogenous elements, is
associated with the formation of false membranes, and though it

259

26o Veterhiary Medicine.

may remain fluid so long as it is retained in the chest, it coagu-
lates rapidly when withdrawn. The dropsical effusion rarely
contains fibrine, and then only in very small amount, and it does
not coagulate when drawn off from the chest. The inflammatory
effusion usually contains a greater proportion of common salt,
phosphates or albumen than exist in the blood, and floating
granules, particles and cell forms, none of which conditions charac-
terize the dropsical effusions. The most prominent feature of
the inflammatory effusions is thus seen to be their power of co-
agulation, by virtue of the contained fibrine, when exposed to
the air.

Symptoms. When a sequel of pleurisy it is manifested b}^ the
symptoms already mentioned under that head as indicating the oc-
currence of effusion.

The dropsical cases may come on rapidly and present all the
signs of troubled respiration together with the results of ausculta-
tion and percussion that characterize rapid inflammatory effusion
but without the fever and acute symptoms of pleurisy. More
usually it comes on insidiously, the lung accommodates itself to
the gradual increase of the fluid and it is only when the accumu-
lation has become excessive that the symptoms become promi-
inent. In heart or kidney disease the filling of the legs and infil-
trations of the eyelids and of the skin beneath the chest and ab-
domen are precursors or early concomitants of the disease, but in
all cases the accumulation in the chest is to be measured by the
height of the line of dulness on percussion and the extent of chest
surface giving forth no respiratory murmur on auscultation. As
the liquid rises on both sides of the chest, as it always does in such
cases in the horse, the breathing becomes short and labored, being
chiefly effected by the action of the diaphram and the flanks — the
ribs moving only slightly. The nostrils are widely dilated with
each breath. The previously existing want of vigor and energy,
the weak pulse, the poor appetite and the pallor of the mucous
membranes become aggravated ; the animal becomes very weak
and prostrate, the loins insensible, the permanently tucked up
flanks labor tumultuously, the loins rise in inspiration, the face
is pinched and haggard, the eyeballs glazed and protruding, and
death is preceded by the same general symptoms as in rapid effu-
sion after pleurisy. A prominent feature of this, as of all dropsi-

HydrotJwrax. 261

cal affections, and one usually seen in the hydrothorax of inflam-
mation as well, is the ease with which, even at an early stage of
the disease, the long hairs of the mane and tail may be pulled out.
In many cases they come out in handfulls when the comb or the
fingers are passed through them.

Treatment. The treatment must be of the actively diuretic
kind recommended for the effusion of pleurisy. It is modified
however in one respect. The inflammatory action having subsided
or nearly so and the condition being now essentially one of weak-
ness a free use of tonics is demanded. Many a patient dies in such
circumstances from the actively depletive treatment to which it
has been subjected and the want of attention to its need of
generous diet and other support. The agents prescribed for the
advanced stage of pleurisy may be given, or the digitalis or other
diuretics and bitters may be combined with iodide of potassium
in one or two drachm doses, the amount being apportioned to the
strength of the animal. Iron in the form of sulphate, perchloride
or iodide may be freely given combined with gentian, quassia, or
other vegetable tonic, and above all a liberal and easily digested
diet must be allowed. Good will sometimes result from repeated
applications of strong iodine ointment to the sides with active
friction.

When the condition is dependent on disease of the heart, kid-
ney or other organ, these must be attended to according to their
special requirements.

Disconnected from such complications hydrothorax will often
give way to an active treatment similar to that indicated above.
In .some cases however our only hope of even temporarily pro-
longing life lies in the operation for drawing off the fluid.

Tapping the chest or as it is technically called thoracentesis
or paracentesis thoracis has proved sufficiently successful in the
lower animals to warrant its continuance in cases that resist other
modes of treatment. It is highly probable that the larger pro-
portion of unsuccessful cases is due in great part to the hopelessly^
advanced stage at which it is often had resort to, to the-
insufficient precautions adopted in its performance, and. to the
want of appropriate dietetic and medicinal treatment. Dr. Bow-
ditch's treatment hy paracentesia saved in the human subject at the
rate of about two patients in five and we ought by availing of
similar precautions to reach the same .standard.

262 Veterinary Medicine.

The cannula employed in veterinary practice is a silver tube two
inches in length, a quarter of an inch in diameter and furnished
with a shield of the same metal at one end. The trochar by which
it is introduced is of steel or brass. To carry out Dr. Bowditch's
system the operator must supply himself with a syringe of a some-
what smaller bore and an intermediate brass piece of a size adapted
to fit accurately into the cannula and supplied with a stopcock. By
an instrument of this kind the fluid can be drawn off by means of
the syringe without any risk of the introduction of aerial germs
which always tend to induce suppuration and even a putrefactive
decomposition in the contained fluid.

The point selected to operate on is, in the horse, ox or dog, in
front of the anterior border of the ninth rib, at its lower end or
close to its union with the cartilage. The point of the trochar
should be directed slightly upward and forward to avoid the pos-
sibility of injuring the diaphragm. The skin is first rendered
aseptic by shaving, followed by a thorough soapy wash and a free
use of mercuric chloride solution (1:500). It is then pricked
with a lancet, then drawn aside that the wounds in the skin and
muscles may not correspond after the cannula has been withdrawn.
The trochar is then pushed steadily through the intercostal space
till all obstruction has been overcome, when it may be concluded
that the pleural sac has been reached. The trochar is now with-
drawn and the fluid allowed to flow from the cannula until there is
presumably some risk of the introduction of air, \Yhen the brass
piece is to be applied and the remainder drawn off with the
syringe or aspirator. As a substitute for the aspirator a caout-
chouc tube, eighteen inches long, put on the cannula or needle
and having its lower end plunged in a solution of boric acid
will prevent the entrance of germs. A prob has often to be
introduced to prevent plugging of the cannula by floating
false membranes, and a new puncture in a different place
may be necessary. In the case of excessive accumulation
it is often advisable to draw it off at two operations, as recom-
mended in large abscess of the pleura and for the same reasons.
The need for such a precaution will be understood when it is
stated that in bad cases the chest contains as much as six or seven
ordinary .stable bucketfuls of the liquid. If, however, it is lim-
ited in amount it ma^' be all withdrawn at once.

Hydrothorax. 263

The most successful cases in the horse have been upon young,
vigorous animals, from four to eight years old, during the first
month of illness, and where the pleurisy has been confined to one
side.

Dr. Bowditch lays down the following rules for the adoption of
paracentesis in man {Clinical Medicine, by Prof. W. T. Gaird-
ner) : —

' ' I now never operate unless I find some distension or rounding
out of the chest, and filling up of some of the intercostal spaces,
so that the chest presents a uniform curve, and not alternate de-
pressions and elevations as in the healthy chest. I operate under
the following circumstances when I feel certain there is fluid :

" I. When there is severe permanent dyspiicea — orthopnoea —
however acute the disease if I find fluid filling the pleural cavity,
or nearly filling it.

"2. When there are occasional attacks of orthopnoea threaten-
ing death, even if there be not sufficient to fill more than half of
the cavity. If the fluid seems to be the cause of the dyspnoea I
operate, because occasionally I have lost -a patient while waiting
for more extensive physical signs. This rule I apply to acute and
chronic cases.

" 3. I use the trochar after three or four weeks of ineffectual
treatment, without any absorption being produced.

" 4. In chronic idiopathic hydrothorax, a latent pleurisy with
simply physical signs to indicate extensive effusion, but when the
rational signs are either very slight or none at all save a general
malaise and weakness."

The use of iodide of potassium and vegetable and mineral
tonics must be perseveringly employed and the strength further
supported by a generous diet, to secure the animal against the
dangers of extreme prostration, of suppuration, or other undesira-
ble conditions of the exuded product.

Among the dangers attending thoracentesis are fainting as a
result of shock on the sudden withdrawal of so much liquid,
rupture of the false membranes, and even of the enclosed lung
tissue or of blood vessels, under the sudden expansion of the par-
tially collapsed lung confined by the investing false membrane,
and the introduction of pus or septic germs into the pleural cavit3^
To obviate the first named dangers tight bands (circingles) around

264 Veteri7iary Medicine.

the chest will give support and limit sudden expansion. In case
of excess of liquid the withdrawal of one-half or two-thirds at
a time will allow opportunity for accommodation. Haemorrhage
may be met by the internal use of chloride, sulphate or nitrate of
iron, matico, hamamelis or tannic acid, and a weak solution of
boric acid or other antiseptic agent may even be injected in small
amount into the pleural cavity.

In obstinate and chronic cases the injection of a weak solution
of iodine and iodide of potassium is often of service. In other
cases a normal chloride of sodium solution (previously sterilized)
may be introduced as soon as a partial evacuation causes uneasi-
ness, and by a succession of such evacuations and injections the
residuum liquid may be rendered clear and largely aseptic on a
single occasion.

In the smaller animals the selection of the most dependent part
for insertion of the trochar is not so essential, as the body may be
turned to facilitate the drainage.

On completion of the operation the wound may be again treated
antiseptically and coated with aristol or collodion.

PNEUMOTHORAX. AIR OR GAS IN THE PLEURA.

Causes, decomposition of liquid effusion, perforation from a bronchium,
the stomach, a thoracic wound. Symptoms, metallic tinkling, splashing,
succussion, drum-like resonance, suppressed respiratory murmur, distance
of cough sound, distress, anxiety, dyspnoea, bulging intercostal spaces,
sometimes a wound. Treatment, closure of wound, calmatives, aspiration
of gas. Treatment for pleurisy.

The collection of air or gas in the cavity of the pleura has al-
ready been noticed as co-existing with liquid effusion in some
cases of advanced pleurisy. It may arise from other causes,
among which may be noted : i. When a mass of pulmonary
tubercle connected with a bronchial tube has opened into the
pleural sac. 2. When a communication has been established be-
tween the pleural cavity and the alimentary canal, as in combined
rupture of the stomach and diaphragm, or of the double colon and
diaphragm. 3. When a rib is fractured and the broken end pen-
etrates the lung tissue and opens into one or more small bronchial
tubes. 4. When a wound has been inflicted penetrating the walls
of the chest and forming a valvular orifice through which air is
drawn inward during each inspiratory act, but out of which it
cannot pass when the thorax collapses.

The amount of gas present may be extremely slight, or in a
case such as that from a valvular wound it may cause complete
collapse of the lung, falling up the entire half of the thorax and
bulging into the opposite half.

The symptoms are often very obscure. If with liquid the me-
tallic tinkling after rising, in small animals the splashing when
shaken and the other sounds of auscultation and percussion will
point it out as described under pleurisy. In the case of a broken
rib the distortion, swelling and tenderness, will lead to suspicion.
A penetrating sound will be sufficiently evident, and in the case
of tubercle previous cough and ill-health will have been manifest.

The specific signs of uncomplicated pneumothorax are : ist, A
drum-like resonance on percussion over the seat of the gas,
usually at the upper part of the chest ; 2d, A partially suppressed
or distant respiratory murmur over the same area ; 3d, A muffled
or suppressed sound of thecough ; 4th, Sometimes, especially if the

265

266 Vetermary Medicine.

gas is abundant, prominence of the chest on that side ; 5th, There
are also more or less distress and anxiety, difficult breathing, quick,
weak, rapid pulse, and other signs of illness.

Some cases of this kind recover spontaneously or with the
liquid effusion with which they are associated ; in traumatic cases
the wound is sometimes sealed up by a pleuritic exudation which
here becomes a curative process ; while in some examples of val-
vular wound of the lung or walls of the chest death may ensue
in a period varying from a few minutes and upwards to weeks.

Treatment is limited to the prevention of the ingress of air
through an external wound where that exists ; the employment of
opiates and other agents to moderate attendant suffering ; to
measures calculated to moderate the intensity of resulting pleu-
risy, and, in cases where there is imminent danger from accumu-
lation of gas, to the puncture of the chest and the careful withdrawal
of the gas by aspiration. If necessary sterilized air may be
made to replace the aspirated gas.

PYO-PNEUMOTHORAX, EMPYEMA.

Causes, septic cocci entering through wound or blood. Symptoms, those
of hydrothorax, with prostration, fcetor, and it may be issue of pus.
Treatment by antiseptic injections.

A purulent fluid in the pleural cavity may be found in ordinary
pleurisy, but is much more likely to supervene in traumatic forms,
in which the pus cocci reach the cavity through the wound of the
bronchia, alimentary canal, or chest walls.

The symptoms are essentially those of pneumothorax, with
greater prostration, and in certain cases a distinct feverish smell
or fcetor of the breath, or the escape of pus through a wound.
In treatment the difference from pneumothorax is mainly in the
antiseptic character of the injections and the freer emploj^ment
of stimulants and tonics. Salt, salicylic acid, borax, peroxide
of hydrogen, aluminium acetate, or potassium permanganate so-
lutions may be used. Tonics (quinia) and antiseptics (sulphites,
salicylates, iron) may be given.

CHRONIC PLEURISY.

Animals liable. Causes, irritation through effusion and exudate acting on
susceptible pleura, or by other disease products in lung or pleura. Unhy-
gienic surroundings and management predisposes. Frequent chills in cold
water. Symptoms, unthriftiness, easily blown, fatigued, or sweated, cough,
paroxysmal under exertion, pallor of mucous membranes becoming congest-
ed on slight exertion, difficult breathing when recumbent, percussion and
auscultation signs of pleurisy and hydrothorax. Lesions, great liquid effu-
sion, clotting on exposure, with much albumen and cell-forms. False
membranes partially organized. Treatment, tonic, diuretic, derivative,
diet nourishing, counterirritants, paracentesis.

In all domestic animals acute pleurisy may merge into the
chronic form, the irritation being maintained by the presence of
the residuum liquid and the false membranes and adhesions which
interfere with the free dilatation of the chest. The pleura too,
having been once inflamed, retains an increased susceptibility to
such disturbing conditions. In other cases the affection is sympto-
matic of other chronic affections, as tuberculosis, glanders, and
neoplasms of various kinds. It has been seen especially in old,
weak and debilitated subjects, kept in confined, impure stables or
habitually exposed to undue cold and damp. Hence dairy cows
in unhygienic conditions, and hunting dogs, which plunge in wa-
ter when heated, are among the mo.st frequent victims.

Symptoms are often obscure. The affected horse may be bright
and lively, .showing little respiratory disturbance unless under
exertion. Yet there is a general appearance of unthriftiness, with
erect, dry hair, hidebound, and a small, dry cough. Under work
there is hurried breathing, early exhaustion, ready perspiration,
and aggravation of the cough which then occurs in paroxysms.
Auscultation and percussion give characteristic signs according as
there may or may not be false membranes or effusion at particu-
lar points. It is usually bilateral in horses, unilateral in other
animals.

In cows in addition to the corresponding symptoms, there is
pallor of the mucous membranes when at rest, quickly transform-
ed into congestion under exercise, suppre.ssion of the milk, and
weak heart beats unless when excited. In the advanced condi-

267

268 Veterinary Medicine.

tion the animal has difficulty of breathing when recumbent on the
sound side and subcutaneous infiltration is felt or seen beneath the
sternum or in 'the limbs. The affected side shows an increased
dimension, vertical and longitudinal, of the chest, and the inter-
costal spaces in their lower part bulge out and fluctuate.

In cows and indolent animals there may be a quiescent condi-
tion or very slow progress, but any violent exertion is likely to
give a sudden stimulus to the morbid process.

Lesions. The liquid effusion, usually unilateral, except in the
horse may amount to 40 quarts in the latter animal, 30 quarts in
the ox (Rigot), and 5 to 6 quarts in the dog. Unless there has
been a recent sudden accession of inflammation it is of a pale
straw color, with, in the dog, a slight rosj- tinge. It clots loosely
on exposure to the air and contains a large amount of albumen
and few cell-forms. The false membranes are thick and white at
some points and red and vascular at others. In the main they
are completely organized. The lung is more or less collapsed and
the right heart dilated and attenuated.

Treatmejit must be in the main tonic, diuretic and derivative.
Food must be nourishing, digestible and in liberal amount ; diur-
etics and bitter tonics with digitalis and, (if there is little fever)
preparations of iron are to be pushed as far as the strength will
allow ; and the counterirritants applied to the sides of the chest a
number of times in succession. Iodides may be used internally
and externally, and paracentesis must be employed unless early
improvement is manifested.

PLEURODYNIA.

Definition. Sj'mptoms, stiffness, pointing of fore limb, catching inspira-
tion, tender intercostals, less fever, cough, and hardness of pulse than in
pleurisy, no friction sound nor signs of pleuritic effusion. Treatment, anti-
rheumatic, derivatives, colchicum, alkalies, salicj-late, salol, phenacetin,
warm (steam) bath, warm building and clothing.

Defijiitlo7i. Rheumatism of the intercostal muscles. This has
been occasional!}' observed in the horse, and is IJable to be mis-
taken for pleuris}', which it closely resembles in its symptoms.
There are the same stiffness of the fore limb on the affected .side,
the same short breathing, the same fixed and inactive appearance
of the ribs, and the same extreme tenderness on pressure as in
pleurisy ; but the high type of fever, the cough and the full hard
and accelerated pulse are usually absent ; the tenderness tends to
.shift from one point to another, there is no shivering nor friction
sound in the early .stages, and no subsequent absence of sound and
deadness on percussion over the lower part of the chest as result
from effusion. When associated with fever it is ver}^ difficult to
distinguish from pleurisy, and its recognition can only be made
by these physical signs just mentioned.

Treatment. This must be the same as in rheumatic attacks in
general. Rub the chest actively and repeatedly with a mixture
of equal parts of spirits of turpentine, laudanum and olive oil,
give Yz drachm doses of powdered colchicum daily and bicarbon-
ate of potass freel)^ in the water drank. Or give four times a day
2 drachms of salicylate of soda, or i drachm of salol, or phena-
cetin. K warm building and warm clothing are essential ele-
ments in treatment.

269

BRONCHIAL ASTHMx\ IN THE DOG.

Definition. Pathology, neurotic origin, bronchial spasms, swelling of
mucosa, fibrinous inflammation of bronchioles, Berkart's streptococcus, irri-
tants formed in indigestion, overfeeding, inactivity, plethora, constipation.
Symptoms, obesity, sluggishness, recurrent paroxysms of dyspnoea, hard
cough, tense abdomen, constipation, piles, depilation of skin, tartar covered
teeth, foetid breath. Retching, vomiting, a glairy mucus, emaciation may
follow. Lesions, emphysema, fatty deposits in mediastinum, old standing
diseases of the heart, lungs and digestive organs. Treatment, antispas-
modics by lungs or rectum, stramomium, nitre fumes, emetic, purgatives,
vegetable diet, exercise, sedatives, blisters. Asthma in the horse.

Definitio7i. — A neurotic affection mainly affecting the pneumo-
gastric nerve, and leading to paroxysms of stenosis or constric-
tion of the bronchioles and attacks of dyspnoea. In its initial
.stages it is associated with corpulence and disordered digestion,
and later with congestion and swelling of the mucosa of the
bronchioles, emphysema, and dilatation of the right side of the
heart.

Pathology: Asthma is generally attributed to spasm of the
bronchial mu.scles (Williams), and though recent observations
have failed to sustain this it must be admitted that in the majori-
ty of cases it is of decided neurotic origin. Again it is attributed
to erythematous swelling in patches of the bronchial miicosa,
(Clark). Another theory is that it is a fibrinous inflammation of
the mucosa of the bronchioles, the tenacious exudate blocking the
tubes more or less completely and relief coming with a more
diffluent secretion. Berkart found a streptococcus in the sputa
which he supposed to be the final cause. Again it has been held
to depend on the circulation in the blood of deleterious matters
introduced during digestion. Again it has been attributed to a
neurosis roused by constipation and the accumulation of irritant
matters in the intestine. Whatever local conditions ma}^ be
operative, there can be no doubt that in dogs it is almost exclu-
sively confined to those kept indoors, overfed, without exercise,
plethoric and con.stipated. The disease seems to originate in and
persist by nervous disorder propagated from the digestive organs.
270

Bronchial Asthma in the Dog. 27 r

A change of diet or any disturbing cause may bring on a par-
oxysm.

Symptoms. The disease is one of pet dogs, kept in towns, de-
prived of exercise, fresh air, and of the opportunity to relieve the
bowels at will, and gorged with highly spiced meats, and sweets
at least three times a day. Sluggishness and obesity are marked
characteristics of the dog when first attacked though in the ad-
vanced stages the violence of the paroxj'sms and their frequent
recurrence may have induced extreme emaciation.

The affection is usually ushered in by a cough, at first slight,
but soon becoming frequent, hard and sonorous, as in the early
stages of bronchitis. The cough becomes very troublesome and
the breathing habitually labored, but at irregular intervals a
paroxysm comes on which threatens death by suffocation. The
dog stands or sits on his haunches with open mouth, pendent
tongue and staring eyeballs, panting for breath, and has his con-
dition aggravated by every change of position or other source of
excitement. By the frequency and severity of the attacks may
be estimated the danger of the patient.

An examination in the intervals of the attacks detects some
disturbance of the digestive organs. The tense and distended
condition of the abdomen usually manifests the existence of over-
loaded stomach and bowels, of indigestion, tympany and consti-
pation. Piles are often present as a result of long continued
costiveness. The skin is dry and unthrifty, and often in patches
denuded of hair. The teeth are covered with tartar and the
breath foetid.

Retching is occasionally seen to occur during a violent access
of coughing, but only a little glairy mucus is brought up.

The cough, hurried breathing, and paroxysms of dyspnoea be-
come aggravated, the general health suffers largely, and death
often ensues in a state of great weakness and emaciation.

On dissection of such cases the lesions of various old standing
diseases of the heart, lungs, or abdominal organs have been met
with at times, and such disorders have doubtless a.ssisted in main-
taining and aggravating the asthma. The mo.st constant lesions,
however, are emphysema of the lung, and accumulations of fat
in the mediastinum.

Treatment, ist. During a paroxysm. This is confined to

272 Veterinary Medicine.

the administration of antispasmodics either by inhalation or as
an injection to avoid the additional suffering of swallowing.
Ether or chloroform may be inhaled from a sponge, but the em-
ployment of these should be guarded especially in advanced cases
when besides the prevailing weakness there is reason to suspect
structural changes in the heart. The same agents in doses of
one, two or three teaspoonfuls, or laudanum in double that
quantity may be thrown up as an enema, and may be combined
with a couple of ounces of castor oil when costiveness exists.
The fumes from burning stramonium or from burning brown pa-
per which has been previously soaked in a strong solution of nitrate
of potass, will in many cases suddenly cut short the paroxysm. If
on the other hand there is reason to believe that the stomach is
overloaded the attacks will often be suddenly cut short by giving
an emetic. For this purpose a grain of tartar emetic may be
shaken upon the tongue, or a dessert spoonful of wine of ipeca-
cuan, or of antimony, poured over the throat. 2d. In the in-
tervals between the paroxysms. Attention must be given to
counteract any inflammatory action in the chest by which the
disease may be maintained. Our chief object, however, must be
to divest the animal of its superfluous fat and bring the digestive
organs into a healthy condition. Unfortunately the propensity to
fatten in some dogs seems to be a morbid condition. The food
appears to be stored up as fat at the expense of muscular and
other tissues even when the animal is kept on the borders of star-
vation. All flesh must be withheld and coarse vegetable fare
alone allowed. A well boiled pudding (porridge) made with oat-
meal or Indian corn meal, water and a little salt, with a small
quantity of skimmed milk or buttermilk, is an excellent diet in
such cases. The amount must be small, though the hitherto
pampered favorite will rarely seek to fully replenish his stomach
until he has forgotten his former extravagant habits.

A good deal of open air exercise must be given, not violent,
but gentle and long continued, and this though the patient may
appear physically unfit for it. Exercise should be given three
hours or more after a full meal. Purgatives (one ounce castor
oil) should be administered twice a week. A clean bed, not too
soft nor luxurious, should be allowed in a dry, airy place. The
skin should be well brushed daily and occasionally washed thor-

Bronchial Asthma in the Dog. 273

oughly with soap, care being taken to dry the coat completely
afterwards. Sedatives should be giv^en daily, such as a half grain
each of stramonium and tartar emetic, and in advanced stages
with weakness and emaciation vegetable tonics will be demanded.

Blaine strongly advocates a course of emetics, given every
alternate day, and Mayhew lauds frequently repeated ammoniacal
blisters to the sides. Such measures will be especially applicable
when there is irritation and discharge from the bronchial mucous
membrane. Strong subjects can alone, however, bear such treat-
ment.

All cases of asthma in the dog are obstinate and critical and
require much judgment in treatment.

ASTHMA IN THE HORSE.

Hering records a case of spasmodic asthma, in a strong cart
horse. Besides the oppressed and difficult respiration, the animal
was excessively dull and had no appetite, but the pulse was al-
most of the natural standard. The animal was not benefited by
opening medicine but improved under active doses of extract of
hyoscyamus. Quillaume reports two asses attacked apparently
in the same way, and Del wart and Robertson refer to other
cases. They recovered under antispasmodics. These are at
least closely related to heaves, which is largely a neurosis at first.

ASTHMA. BROKEN WIND. HEAVES. DYSPNCEA.

Definition, nenrotic affectiou with digestive and respiratory disorders.
Causes, no racial exemption, disease largely coextensive with leafy hay
from clover, alfalfa and other leguminous plants, musty hay, cryptogams,
overloading the stomach, active work on a full stomach, overdriving, bron-
chitis, chronic bronchitis, emphysema. Nature, a neurotic affection, start-
ing with derangement of some part of the vagus, dilatation of the right
heart, congestion of the bronchioles. Symptoms, double expiratory action,
flatulence, weak, husky cough, wheezing, glairy, grayish nasal discharge,
wheezing, increased resonance along the margins of the lungs, sibilant
rale, heart's impulse strong, even felt on right side, aggravation with over-
loaded stomach, costiveness or muggy atmosphere, improvement on laxa-
tive (green) food. Treatment, succulent green food, natural pastures, re-
lieve any abnormal state of lungs or bowels, pure air, heart tonic, diet,
arsenic, special diagnosis, guard against masking of symptoms by narcotics,
privation of water, shot, lard, recto-vaginal fistula, diagnostic signs, dilated
nostrils, auscultation and percussion signs of emphysema, relapse under
hay and water.

Definitioyi. A chronic affection of the equine species, mani-
fested by a hurried, wheezy breathing, greatly aggravated by
close, muggy weather, a full stomach, certain kinds of diet, or
by exercise ; by a double lifting of the flank with each expira-
tion ; by a small, weak, dry cough, often occurring in paroxysms
and easily excited by a drink of cold water, exposure to cold air
or a fibrous quality of food ; and lastly, by a marked dii:order of
the digestive organs.

Causes. This disease is essentially the result of faulty feeding
and working, though preexisting diseases of the air passages and
sudden violent muscular efforts no doubt occasionally contribute to
its development.

It has been alleged that some races of honses are exempt from
this disease. Among these the Arabian, Persian, Barb, Spanish
and Portugese are especially named but their immunity in all prob-
ability depends on the feeding and management rather than on any
peculiarity of breed. The countries where these horses are met
with are not subject to a prolonged winter but yield green food
throughout the greater part of the year, and it is a notorious fact
■that no horse becomes brokenwinded at pasture. The Arabians
274

Asthma. Broken Wind. Heaves. Dyspnea. 275

moreover ' ' feed their horses 011 the scanty plants which the bor-
ders of the deserts supply and. when these are wanting they
are fed on a little barley with chopped straw, withered
herbs, roots dragged from the sands, dates when these can
be obtained, and in cases of need the milk of the camel. They
drink at long intervals and in moderate quantities, " (I,ow).
Since an habitually overloaded stomach is the most common cause
of heaves the absence of the affection in the Arab is not surprising.
But the Arab unfortunately enjoys no such security in England or
America. Concerning the Barb, Delwart remarks that after a
day's hard work, fasting, he is fed on six or seven pounds only
of barley, and without the cut straw that the Arab is allowed in
similar circumstances.

In Spain and Portugal horses at work are fed on broken wheat
and barley straw, from twelve to twenty-five pounds, and barley
from six to twelve pounds daily, according to the size of the ani-
mal and the demands upon his strength. The mares are constant-
ly'- at pasture and according to the rainfall they are starved or in
abundance. Green food and a limited straw and grain diet are
precisely the conditions in which broken wind does not appear.
Rodriguez, veterinarian to the queen says that the disease was
unknown to Spain until the cultivation of red clover, lucerne, and
sainfoin. At Aranjuez, horses fed on the hay of these plants,
lost vigor and wind and several became decidedly broken winded.
All were, however, restored to health and vigor by a return to
their former diet. Count Cardenas found that his horses gained
in flesh on the new fodder, but that symptoms of broken wind
developed themselves rapidly.

In France, M. Demoussy records similar facts. In Segala,
where the aliment is substantially haj-, broken winded horses
abound, whilst in the adjacent district of Causse where horses are
fed through the winter on straw and barley broken by the mules
feet in the act of threshing or treading out, the disease is virtually
unknown.

lyucerne and sweet trefoil are indigenous and grow abundantly
in Causse and Caussergne but eaten green or after their seed has
been shaken off and the stems have acquired a dry ligneous char-
acter these are innocuous. When however condemned to stand
in the stable through a severe winter, with their racks constantly

276 Veterinary Medicine.

filled with hay, the)^ will eat from thirty to thirty-five pounds of
this daily and many become brokenwinded. The breeding mares
which get little hay, seldom become affected though the plenitude
of their abdomen and the impaired respiratory function might be
thought to conduce to the affection.

In England broken wind is much less prevalent than on the
European Continent and it is deserving of notice that lucerne and
sainfoin hold no place among the British green crops, that red
clover hay is only exceptionally met with owing to the amount of
land that is clover-sick, that natural hay is largely used, and that
when horses are largely fed on hay it is qualified by such laxative
agents as turnips, carrots, beet, etc.

All this throws light on the innnunity of horses on our western
prairies and plains. Feeding on the indigenous grasses fresh or
made into hay, they are saved from the noxious influence of those
artificial products which are found in all countries to determine
the development of broken wind. It needs not that we adopt
the popular notion that any special plant growing in these pas-
tures ensures the safety of the equine races. It is merely a repe-
tition in the Western Hemisphere of the experience so long before
obtained in the case of Spain. Parallel with the progress of cul-
tivation in our western lands, we see this malady advancing.
Fifty years ago it was virtually unknown in Michigan and adja-
cent states whereas now these states can almost emulate New
York in the relative number of their victims. It must not how-
ever be supposed that this cultivated fodder is the sole cause of
the westward march of this malady. With improved agriculture
have come better roads, spring wagons and driving at a pace
which was comparatively unknown to the early settlers.

In California the condition of Spain was for long pretty accur-
ately repeated. With no winter worthy of the name, troops of
horses were left at pasture throughout the whole year and those
that were stabled subsisted chiefly on natural hay in which the
indigenous grasses were commingled with white — but no red —
clover. California long retained the reputation of having no
broken-winded horses.

In our Eastern states where the disease was thirty years ago so
notoriously prevalent, the fields of luxuriant red clover might well
have excited the envy of the English farmer. The hay made

Asthma. Broken Wind. Heaves. Dyspnoea. 277

from this, full of seed and dust was given without stint to the
farm horses, which during the rigor of the winter were often shut
up in stable for a length of time continously and dangerously
gorged themselves with this provender. In the Eastern States
with a steady falling off in the red clover, there is also a corres-
ponding reduction in the number of cases of heaves. The grain
allowed them, a mixture, supposed to consist of Indian corn, oats
and buckwheat, given as a dry coarse flour, was little calculated
to counteract the effects of the clover haj^ and the entire absence
of turnips and other succulent roots as a farm crop precluded their
use as a preventive of the nlalad3^ We need not forget the
prevalent ambition to possess a fast trotter, nor the effect of the
climate on the air-passages (See chronic bronchitis) in estimating
the causes of this malady in the Eastern states.

The mere overloading of the stomach is a potent cause of the
development of heaves. The horse is above all other animals
compelled to undergo hard work on a full stomach. Coleman
cites the experience of the coaching days when each horse had
20 lbs. of oats daily and not more than 5 lbs. of hay with no water
before work. These horses were driven fast for long stages yet
they never contracted broken wind under this treatment. Farm-
ers' and millers' horses on the other hand were most subject to
the disease because gorged continually with hay chaff and mealy
food, and worked in this condition. " Nimrod" who confirms
Coleman's statement says " I have taken some pains to ascertain
this fact by my own personal inquiries. One proprietor who has
nearly fifty horses at work — many of which are in as fast coaches
as any that travel on the road — assured me lately that he had
not a broken-winded horse in his yard ; whereas before he stinted
them in their hay he generally had one to five in that state."
Percivall testifies to its comparative infrequency in the English
cavalry horses, which have their diet carefully regulated. Hay
musty from bad harvesting or other cause and such as is rank
from growing in low wet localities are caeteris paribus more in-
jurious than good hay.

Every day observation shows that driving a horse upon a full
stomach often causes broken-wind and nothing will more surely
aggravate it, when it does exist. The same remark may be made
of the drinking of large quantities of water after feeding and just

278 Veterinary Medicine.

before going to work. Gross feeders are above all others the sub-
jects of the complaint.

The question arises how a disturbing cause operating directly
upon the digestive organs should affect the respiratory, in such a
marked and permanent manner. It cannot be because of the
gastric and abdominal distension since pregnant mares though in
a state of much greater plentitude, are not thereby rendered
liable to broken wind, and if they have previously suffered from
this infirmity, the symptoms are usually less marked when breed-
ing. The explanation first advanced by Dupuy appears to be the
correct one. The lungs, the stomach, and certain other organs
derive innervation from the vagus nerve, and certain disturbances
of the stomach and intestines so impair the function of this nerve
that the lungs are affected, at first functionally and afterwards
structurally. In support of this view is the fact that broken
wind is usually associated quite as much with digestive as respira-
tory derangement. The horse though a heavy feeder becomes
unthrifty, hidebound and emaciated ; his dung is passed in an
undigested state like so much chopped straw, and flatus is con-
tinually passed from the bowels. Indeed the almost incessant
passage of wind and faeces, during the first mile or two of a jour-
ney, is a disgusting evidence of the malady. The power of
doses of shot, fat and other agents to temporarily allay the symp-
toms may be held to point in the same direction.

Beside causes operating on the side of the digestive organs
others undoubtedly superinduce the disease, and among these se-
vere exertions and chronic bronchitis ought to hold prominent
positions.

Overexertion induces overdistension and rupture of the air cells
by the forced retention of air within the lungs, bj^ the closure of
the glottis, while the chest is strongly compressed by the respira-
tory muscles. It is an essential condition to all severe exertion
in man that the breath should be held, and though the horse ap-
pears equal to the same efforts of draught after the operation of
tracheotomy has deprived him of the power of holding the breath,
yet he would seem to be sooner exhausted (Goubaux, Colin,
Bouley), from which it may be inferred that this power is fre-
quently exercised, and it probably always is in any sudden severe
effort as in starting a heavy load, or jumping a five-bar gate.

Asthma. Broken Wind. Heaves. Dyspnoea. 279

This retention of air in the hings during violent compression of
the chest walls is precisely the condition met with during an
access of coughing, and in both cases alike there is the tendency
to overdistension of the minute tubes and air cells until they have
lost their power of contraction, or they may even give way and
allow the air to pass out and lodge in the lung tissue.

Another mode in which violent effort injures the lungs is by
the rapid and continued inhalation of great quantities of air dur-
ing rapid breathing, so as to dilate the lungs suddenly to their
fullest extent. Sometimes from irregular distribution of the
serial current or from the want of tone in a particular part of the
lung that gives way under the pressure and the air cells become
overdistended or ruptured. This condition is especially met in
the more rapid paces. It is well exemplified in the results of the
deep breathing after cutting the vagi nerves.

In either case the result will be more certain if the effort is
made upon a full stomach or with the functions of the vagus
nerve impaired by a previous faulty diet.

That broken wind is a frequent concomitant or sequel of
ehronic bronchitis is undeniable, and theoretically nothing is more
likely to cause dilatation and rupture of the air cells and conse-
quent impairment of the innervation and contractility of the lung
than violent fits of coughing, while the bronchial tubes have
thickened and friable walls, or are partially plugged by tenacious
mucus.

Broken wind is mainly a disease of old horses, though I have
seen several cases in five-j^ear-old animals, and Bouley records a
case in a two-year-old colt out of a badly broken-winded mare.
This would seem to indicate an hereditary proclivity, and there
is no doubt that the shallow, narrow, weak che.st predisposing to
this as to many other pulmonary complaints is transmitted from
parent to offspring.

Nature of the Disease. Emphysema of the lungs is the most
constant structural change met with in the bodies of animals
which have suffered from broken wind. This condition of the
horse's lung appears to have been noticed by the early Greek,
writers. It was advanced as the cause of broken wind by Riding
in 1704 (Pathologic Veterinaire), by Floyer in England in 1761
(Treatise on Asthma in Man), by Vitet in France in 1783 (Medi-

28o Vetermary Medicine.

cine Veterinaire, IvVon), by Freutzel in Germany, and Bracy
Clark in England in 1795. It was only, however, after the ad-
mirable discoveries of Laennec that the question was systematical-
ly investigated by Delafond, who has furnished the most compre-
hensive data on the subject. Out of fifty-four broken-winded
horses dissected by him no less than forty-five had the lungs
extensively emphysematous. This emphysematous lung differs
according to whether the emphysema is vesicular or interlobular .

In vesicular emphysema the smallest bronchial tubes and
the air cells have become distended beyond the natural standard
and remain permanently so, the lung tissue having lost its power
of contraction. If such a lung is inflated and dried, and a thin
slice taken from the surface of the emphysematous part the size
of the minute orifices on the cut surface will show its condition.
These fine openings are only the air cells cut across, and in their
healthy state the}' will admit no larger object than the point of a
needle or a fine bristle. They are slightly larger in adult and
especially in old horses than they are in the young. If affected
by emphysema they will often admit a hempseed or even a small
pea. On opening a healthy chest the lung collapses, contracting
on itself and expelling the contained air ; if the lung is emphy-
sematous the diseased portion does not collapse and if the entire
lung is affected it continues to fill the chest and may even bulge
outward after it has been opened. The color of the emphysema-
tous lung is of a brighter red than are the healthy portions. If
a diseased lung has been left exposed to the air for twenty-four
to thirty-six hours and then cut across in all directions, the dis-
eased lobules may be distinguished at a glance by this lighter
shade, and such light portions if near the surface will be found to
correspond to elevations above the general level of the lung. If
the diseased lung is placed in water it floats on the surface like
an inflated bladder scarcely at all sinking into the fluid. If the
lung is blown full of air the emphysematous part is first filled
causing the bulging on the surface to bs still more marked than
before. Vesicular emphysema rarely affects an entire lung ; it
is usually confined to the anterior lobas and to the thin lower
and posterior borders of the organ.

Interlobular emphysema is the extravasation of air into the
connection tissue between the lobules owing to rupture of the air

Asthma. Broken Wind. Heaves. Dyspna^a. 281

cells, and smaller bronchial tubes. It may occur independently
of the vesicular emphysema but niore frequently, it is preceded
by that form and results from it. It is manifested on the surface
of the lung by irregularly formed tran.sparent elevations movable
from one place to another under the pressure of the finger con-
trary to what is the case in vesicular emphysema. These vary
from the size of a pea to that of a hen's Q^'g. When the air
exists in the cellular ti.ssne between the lobules it appears as in-
tersecting lines circuuLscribing irregular spans, and seemingly
dark colored to a superficial glance but seem to be transparent
on a closer examination. I^ike the elevations on the surface these
collapse on being pricked.

When a lung in this state has been inflated and dried it presents
on the diseased parts the union of several air .sacs into one by the
rupture of their intervening walls so that a pea may be lodged in
the cavit}^ ; it further shows wide and prolonged canals on the
surface and in the intervals between the lobules — the dilated
areolae of the connective tissue. These abnormal conditions like
the vesicular emphysema are chieflj^ met within the anterior lobes
of the lungs along their free borders and on their inner surface
near the entrance of the bronchi.

One or both of these two forms of emphysema may be con-
sidered as essential conditions in all forms of broken wind. It
does not follow that this is the primary disease ; we have already
seen that the cause of the malady is usually to be sought on the
side of the digestive organs, and that impaired innervation, on
the part of the vagus nerve or of the ganglia in the brain presid-
ing over it, leads to these functional and structural changes in
the lungs. If these changes are results and not causes, their ex-
tent will not necessarily bear a constant proportion to the intensity
of the disease, though in reality they are generally found to do so.

From a series of injections of lungs from broken-winded horses
M. Demoussy arrived at the conclu.sion that the essential lesion
of broken-wind was an aneurismal dilatation of the capillary ves-
sels of the lung. This is like the condition of the mucosa found
in asthma in man and is explainable in both cases by the impaired
innervation, as dilatation of these minute vessels is a natural con-
sequence of the loss of vaso-motor nervous power, and contact
with air saturated with carbonic acid.

282 Veterinary Medicine.

Dilatation of the smaller bronchial tubes is frequentlj^ present
and especiall}^ characterises such cases as supervene on chronic
bronchitis. These dilated tubes contain a plastic, whitish, inodor-
ous mucus.

Another frequent concomitant of the emphysematous lung is
a dilatation of the right cavities of the heart, especially the auricle,
and an attenuation of their walls. The same condition is noticed
in pulmonary emphysema in man and like this is probably due to
the slow and imperfect circulation in the diseased lung.

Collating these structural changes with the different causes of
the disease we find that they harmonize with the theory of im-
paired function on the part of the vagus nerve or its presiding gan-
glia, whether this functional disturbance has its origin in disorder
of the digestive organs, as in the great majority of cases, in severe
muscular efforts, or in chronic bronchitis.

Section of the vagi nerves affords an exaggerated instance of
their paralysis and its results. These are mainly emphysema,
capillary dilatation, blood extravasation, inflammation arid pul-
monary collapse. Emphysema is the first result and due to the
slow, deep respiration (Boddaert) and loss of contractibility
(lyonget) ; capillar}^ dilatation results from the extreme distension
of the air cells and the retention in them of air highly charged
with carbonic acid (Bonders) ; the other lesions occur later and
own very different causes.

That this is the true nature of the disease would further appear
from the occurrence of emphysema without broken wind, two
cases of which are recorded by Percivall ; and from the existence
of broken wind without emphysema. Cases of this last variety
have been recorded by Godine, Volpi, Rodet, D'Arboval, and
Delafond in France ; and by Sewali, Dick, Smith, Hallen and
Gloag in Britain. In connection with this last class of cases it
must be noted that dilatation of the right cavities of the heart
sometimes gives rise to very similar symptoms, and that the signs
of chronic bronchitis are often scarcely distinguishable from those
of broken wind. In catarrhal bronchitis too, after the air tubes
have been washed, it is sometimes impossible to decide whether
the lining membrane has been the subject of inflammation or not.

Syynptoms. The most prominent are the double lift of the flank
with each expiratory act, in the absence of fever, the short, weak.

Asthma. Broken Wind. Heaves. Dyspnoea. 283

dry and almost inaudible cough, the wheezing noise in breathing
when that is accelerated b)' exertion, and the intestinal flatulence
with the frequent passage of gas.

The cough usually heralds the advent of other symptoms. Often
the character of the cough draws forth the remark that an animal
is becoming broken winded and though no other symptom is seen
at this time they thereafter rapidly develop themselves. At this
early stage of the disease the cough is paroxysmal, coming on in
fits during work or after a drink of cold water. Once the disease
is established the horse rarely coughs more than once at a time.
The cough is extremely short, weak and low and followed by a
sort of wheeze. So specific is it that if once heard it can readily
be recognized. The sudden effort made in coughing usually leads
to the expulsion of gas from the flatulent bowels.

The double lifting of the flank in expiration is not peculiar to
broken wind. It is seen as well in most diseases of the lungs and
even of other organs (enteritis, peritonitis) which interfere with
the freedom of the respiratory act. If however it is not attended
by fever but associated with the broken winded cough, the wheez-
ing respiration, the disordered and flatulent state of the bowels,
the tumultuous beating of the heart against the left side after ex-
ertion, and the slight flow of clear, watery matter from the nose,
it is pathognomonic. The act of inspiration is quick and free, that
of expiration is not uniform and continuous as in health, but con-
sists of two stages interrupted by a momentar}' arrest. In the
first stage the posterior part of the abdomen is slightly raised and
and it falls in laterally ; then comes an almost imperceptible pe-
riod of inaction, followed at once by the further lifting of the
flanks to complete the expulsion of air from the lungs. The first
stage seems the natural collapse of the walls of the chest and for-
ward movement of the diaphragm, the second a contraction of the
abdominal muscles partly due to an exercise of will to over-
come the obstacle to the expulsion of air.

In ver}' bad or advanced cases these sj'mptoms are more marked.
The inspiration is sudden and manifested by a rapid expansion of
the chest, and dropping of the belly previously supported by ac-
tive contraction of the abdominal muscles. The two stages of the
expiratory act are quite distinct. The first is manifested by a
sudden falling in of the walls of the chest so that the ribs no longer

284 Veterinary Medicine.

stand out prominently beyond their interspaces ; the abdomen
equally rises inferiorly and falls in laterally so that a projecting
ridge is formed from the lower end of the last rib to the point of
the hip. This is specially marked during the period of inaction,
and this is succeeded by the second effort quick and almost con-
vulsive. These movements are so extensive that they are con-
veyed in a striking degree to any vehicle to which the animal is
attached, especiall)^ if it has only two wheels, and a rider on
horseback feels the movement still more disagreeably. When a
horse is in this state the alternate rising and falling of the abdom-
inal organs imparts a synchronous movement of protrusion and
and contraction to the anus and in thin subjects a rising and fall-
ing of the muscles on each side of the root of the tail. The nos-
trils too are kept constantly dilated.

There is a nasal discharge, but this is very inconsiderable in the
early stages of the malady. It is a clear watery or slightly gray-
ish albuminous material without any visible admixture of pus
globules, and on drying it leaves a scarcely perceptible crust. At
first it appears intermittently and in minute quantities, but in bad
cases it becomes almost constant, and is especially profuse after
exercise.

Abnormal respiratory sounds are marked symptoms in the
advanced stages. The wheezing nois2 of the breathing, especial-
ly when that is excited by exertion, may be heard at a short
distance from the animal. The increased resonance on percussion
along the lower border of the lung is only heard when the em-
physema is extensive. The dry sibilant or whistling rale heard
over the same parts is equally a symptom of the advanced stages.
When there is much discharge a moist rattle is often heard over
the lower end of the windpipe or immediately behind the middle
of the shoulder. The overlaying of the anterior lobe by the
thick, muscular shoulder, and the complication of results ob-
tained at the free border of the lung by the abdominal noises and
resonance render these results less conclusive in the earlier stages
and slighter cases.

The application of the hand to the side of the chest behind the
left elbow may detect a strong impulse of the heart with each
beat. If the patient is actively exercised for some time this may
be felt on the right side as well. This symptom indicates the
existence of dilatation of the right cavities of the heart.

Asthma. Broken Wind. Heaves. Dyspnoea. 285

The symptoms of indigestion are also very manifest. The
dung passed is Hke so much chopped hay and oats, and does not
at all resemble the faeces of a healthy horse. The abdomen is
tumid, tjnse and filled with flatus, which is frequently passed
per-ano, and has no doubt given rise to the name of broken wind.
This expulsion of gas from the rectum usually takes place when-
ever the animal is excited to cough. When first started on a
journey, the frequent passage of wind and dung for the first mile
or two is one of the most disagreeable features of the disease.
When the animal has thus emptied himself \\^ usually goes much
better for the remainder of the journey.

Broken-winded horses are always greedy feeders, and if they
get little work they manage to maintain their flesh. But they
are soft and flabby, and if put to active work they fall off rapidly,
becoming emaciated and hidebound, a true indication of their
impaired digestion.

The symptoms are liable to occasional aggravation. If the
stomach and bowels are overloaded they are invariably so. If
the patient is kept in a hot, close stable, the same result follows.
Thick, muggy w:ather has the same effect. After a more than
usually severe day's work all the symptoms may be intensified,
and this may continue for several days or a week. Boule}- at-
tributes this to an extensive rupture of air cells and a sudden
increase of emphysema, and the gradual subsidence of the symp-
toms to the partial absorption of the displaced air and the accom-
modation of the lung to its new condition.

Light and laxative diet on the other hand alleviates the S3'mp-
toms and a broken-winded horse usually improves at grass.

Cow'se. The general tendency of broken wind is to persistent
aggravation, but by a judicious regimen many cases may be
checked in their progress and greatly relieved, or even cured.

T^'eatment. We have already seen that broken wind is vir-
tually unknown on natural pastures where the grass is short,
green and succulent. Turning out on such pastures will improve
or even temporarily cure mild cases. The same may be said
of the lexative systems of diet. (See that recommended for
chronic bronchitis') . Feeding on dry grain only, wnth a very lim-
ited .supply of water, will enable many broken-winded horses to
do ordinary work with comparative ease and comfort. In such

286 Veterinary Medicine.

cases, however, improvement is only due to the empty and un-
clogged condition of the digestive organs and the symptoms
return with all their former intensity when the original diet is
restored. By way of palliation much may be secured by avoiding
accidental causes of aggravation. If catarrh or bronchitis has
supervened it should be treated in the ordinary way. If the
stomach and bowels are overloaded and costive, a small dose of
aloes and enemata will relieve. If the stable is close a free ad-
mission of air will be beneficial. The temporary excitement in
these cases may be further alleviated by sedatives, of which
opium and digitalis have been mostly employed. The last agent
will sometimes control the breathing to such an extent that the
horse may be thought to have completely recovered. Professor
Dick believed that he had effected a cure in one case by the ad-
ministration at a single dose of a drachm each of camphor, opium,
calomel and digitalis. Temporarj^ results only can, however, be
expected from such agents, except in the case of an aggravation
due to a cause acting for a limited time only, in which case the
partial improvement may be lasting.

By adopting such measures to check accidental complications
and confining the animal to a rigid system of diet a broken winded
horse may be worked with comfort to himself and his master.
The aliment should be principally or exclusively of oats, bran or
barley, though good succulent grass, turnips, carrots, beet, and
potatoes ma}' be allowed, as may also wheat or oat straw in
limited quantity, but no hay and above all none prepared from
red clover, alfalfa, sainfoin, or allied foreign plants and none that
is musty or otherwise injured by keeping. No food nor water
must be allowed for one or two hours before going to work, and
the pace must be slow at first and gradually increased as the horse
empties himself, and the breathing gets less embrrassed. If
meadow hay, straw or other bulky food is allowed in small quan-
tity this must be after the horse has returned from his day's work.

If the food above recommended is boiled or pulped, and mixed
with some saccharine agent as molasses its restorative action is
enhanced.

If, however, we add to these hygienic and dietetic measures a
prolonged course of arsenic, the symptoms generally disappear.
From five to fifteen grains of arsenic made into a powder with a

Asthma. Broken Wind. Heaves. Dyspncca. 287

draclim of bicarbonate of soda ina}^ be given daily in the food
until improvement is noticed or sj'mptoms of the poisonous action
of the agent appear. When these are manifested in loss of appe-
tite, colicy pains or red and watery eyes the medicine must be
suspended and begun again some days later in smaller doses.

The therapeutic value of arsenic in this case is probably largely
due to its action on the nervous system, which has long been
recognized. As early as the first century of the Christian Era,
Dioscorides, recommended its use in asthma and in recent times
it has acquired a considerable reputation for the treatment of
neuralgia. Another— though perhaps an allied— physiological
action of arsenic no doubt adds to its value in this equine disorder.
This is its power of retarding the waste of tissues. This property
it possesses in common with tea, coffee and some other agents,
but to a greater degree. This has led to its extensive employ-
ment by the peasants in L,ower Austria, Styria, and the mountains
separating Austria from Hungary, who found that it improved
their personal appearance, increased their weight and enabled
them to sustain greater exertions in climbing without fatigue. It
was the revelations of Dr. Tschudi concerning the Styrian arsenic
eaters that first led Professor Bouley to try this agent in broken
wind.

Examination of Broken-winded Horses. Though the
symptoms enumerated above are sufficient to detect broken-wind
in all ordinary cases, yet it may not be time thrown away to cau-
tion the reader against pronouncing it absent when the more
prominent symptoms are not seen. Unscrupulous dealers do not
hesitate to avail of a variety of devices to conceal the symptoms
and make the animal pass for a sound horse. Digitalis and other
sedatives are so employed, but are mostly rejected because the)'
render the horse dull and sluggish. By some the bowels are un-
loaded by a dose of physic, the horse is kept on a spare diet of
oats, beans and other grain, water is withheld, and on the morn-
ing of sale one or two pounds of leaden shot or of bacon fat are
administered. The inconvenience attendant on the presence of
these agents in the stomach makes the animal desist as much as
possible from moving the abdominal organs, and the double lift-
ing of the flank is thus more or less completely hidden. With
the veterinarian however this measure like the last defeats its own

288 Ve/erinary Medicine.

purpose, for such horses are always intolerably thirsty and if al-
lowed to regale themselves at the nearest watering trough, the
charm is broken, the double lift returns and with it all the
symptoms of the malady.

A brutal practice existed among ancient farriers, of making an
artificial opening into the rectum to allow the exit of the flatus
upon which they conceived the disease to depend. This was
effected either by cutting through the .sphinctor ani with a knife
or by making a new opening to one side of it with a red hot iron.
According to Ferguson this has been improved upon by the
modern Irish jockey, in the case of broken-winded mares. With
the knife an artificial communication is made between the rectum
and the vagina, of sufficient size to insure that it will remain open
and large enough to allow pellets of dung to pass into the vagina.
The double lifting of the flank forces the fseces through this arti-
ficial opening, and to avoid the inconvenience of their presence in
the vagina the animal carefully refrains from this action. This
orifice further allows the free escape of anj' gases generated
in the rectum and thus materially relieves the flatulence. Fer-
guson says he has seen broken-winded mares that have been
operated on in this manner, that breathed so freely that even pro-
fessional men have failed to detect the affection.

In all cases of broken wind, no matter how masked there will
be manifest, on slight exertion, a permanent dilatation of the no.s-
trils — i.e., alike in inspiration and expiration, — and when any
such suspicious symptom is seen the horse .should be carefully
examined, especially the state of his lungs as ascertained by aus-
cultation and percussion, his breathing after he has freely partaken
of water and hay, and, if there is suspicion of drugging, after he
has stood over night in a hot stable plentifully supplied with both
hay and water.

It should be borne in mind that mares advanced in pregnancy
often show no double action of the flank though decidedly broken
winded.

POLYPUS OF THE BRONCHIAL TUBES.

Like other mucous membranes, that covering the bronchial
tubes, is hable to diseased growths, which may each remain attached
by a broad base, and form a morbid elevation of the surface, or
it may become loosened and retain its connection with the mucous
membrane only by a neck or pedicle. An interesting case of the
latter variety is recorded in the Edinburgh Veterinary Revieiv for
January, 1864, by Mr. Parker of Birmingham. It was attached
to the wall of the right bronchus about an inch below the bifur-
cation of the trachea, and had an ovoid form measuring 8^ inches
in its longest circumference by 4}^ in its shorter. The pedicle was
lYi inch long and allowed the tumor to pass freely upward into
the lower part of the wdndpipe, threatening instant suffocation. It
had a fibrous structure and was continous with the interlacing
bundles of yellow- elastic tissues which cover the cartilaginous
rings of the bronchus.

From its frequent displacement upward the tumor gave rise to
paroxysms of hurried and difficult breathing apparently threaten-
ing suffocation, but when these passed off, respiration was tolera-
bly tranquil and easy. The fits of dyspnoea came on after any
unwonted excitement, but above all after a cough. In such cases
the tumor had been coughed up into the lower end of the wind-
pipe and until it slid back into its former position, the animal
seemed on the verj' verge of death. The paroxysms had appeared
very frequently during a period of five months that had elapsed
since her purchase, increasing steadily in severity and finally
causing death. The lungs contained many small abscesses the
result doubtless of the frequent paroxysms of dyspnoea.

Cases of this kind are not usually amenable to treatment, nev-
ertheless as they are pretty certain to end fatally if neglected, it
would be quite permissible to perform tracheotomy in the lower
part of the neck and attempt to snare the tumor with an elastic
wire passed through a single or double tube. The tumor might
even be seized by a vulsella and twisted off, provided it could be
reached.

19 289

DISEASES OF THE BRONCHIAI. AND MESENTERIC
GEANDS.

These are the seat of congestions, neoplasms, and parasites, in-
cluding pentastoma, actinomycosis, tubercle, glanders, etc., which
will be treated under their respective headings.

PARASITES OF THE AIR PASSAGES, LUNGS, AND
PLEURA.

Nearly all the domestic animals are subject to parasites of the
lower air passages. These give rise to verminous bronchitis in
cattle, sheep, horses, swine, goats and camels, to gapes in birds,
and to pulmonary acariasis in fowls. The lungs and pleura are
invaded by distomum, echinococcus, cysticercus, aspergillus, etc.
(See parasites).

290

DISEASES OF THE HEART AND ORGANS
OF CIRCULATION.

Susceptibility in different genera. Reasons for partial immunity of the
quadruped, special and general causes in quadrupeds, violent, forced work,
fatty degeneration, swallowing of pointed metallic bodies, difiBcult diagno-
sis in the animal. Position of the heart in the horse, ox, sheep, pig, car-
uivora, birds. Structure of the heart as a pump. Results of imperfect
structure or action. Heart-walls. Table of size of the heart. Capacity.
Weight. Pulse in each healthy genus, according to age, size, environment,
temperament, proximity to parturition. Morbid conditions of the pulse,
frequent, slow, quick, tardy, full, strong, weak, feeble, indistinct, small,
hard, wiry, thready, oppressed, leaping and receding, intermittent, unequal,
irregular, anaemic, venous. Percussion. Palpitation. Ausculation. Healthy
sounds. Morbid sounds, in unusual place, force, intensity, rythm, repeti-
tion of 1st sound, of 2nd sound. Murmurs, synchronance with given stages
of heart movement, their significance, pericardial murmur. General symp-
toms of heart disease, cold extremities, passive congestions, dropsies of
limbs, etc., shortness of breath, venous pulse, vertigo, dulness, sluggish-
ness, corpulence.

The lower animals are perhaps less subject to heart disease than
mankind, but the comparative immunity generally assumed for
them is far from being a real one. The horizontal position of the
quadruped largely obviates that special tax upon the heait de-
manded by the erect position of man, and especially by the elevated
place given to his more ample and vascular brain. Animals too
are comparatively free from those mental and moral influences
which so largely affect the regularity of the circulation in the
human subject. But on the other hand many physical causes of
heart disea.se affect the lower creation equally with their lord,
while some undoubtedly operate with special force on the brute.
All animals are subject to diseases of the heart as of other internal
organs, from exposure ; this organ is occasionally involved from
its contiguity with other diseased structures or from interdepend-
ence of function as we have already seen in certain diseases of
the lungs (congestion, brokenwind, etc.); the tendency to heart
disease frequently runs in a particular family of animals, espe-
cially with the rheumatic constitution, which is transmitted from
parent to offspring as surely as the color of the skin the turn of

291

292 Veterinary Medicine.

the horn or the depth and spring of the rib. The lower animals
are further subject to congenital malformations and imperfections
and to deposits of morbid material around the heart or in its sub-
stance so as to impair its healthy action.

Horses and dogs have special predisposing causes in the violent
and prolonged exertion to which they are habitually exposed.
The quiet sluggish and nonexcitable ox and pig meet with dan-
gers no less real though of a different kind in the overfeeding
which induces fatty degeneration of the heart as of other muscu-
lar tissues. The larger ruminants are further endangered by
their propensity to swallow needles and other sharp pointed bodies
which ultimately reach and penetrate the heart.

The prevalence of heart disease in animals may be deduced
from the fact that out of 150 horses, oxen and dogs dissected at
Montfaugon by lycblanc in 1840, not less than one twentieth pre-
sented cardiac lesions. The supposition of an immunity of the
lower animals has been largely due to the heavy muscular shoul-
der of quadrupeds which covers the upper and anterior regions of
the heart shutting them out from physical exploration. In man
the entire heart and connecting blood vessels are so open to exam-
ination that the physician can pronounce with the greatest accu-
racy not only concerning the existence of disease, but also its pre-
cise locality and nature. In the quadruped no such facility is
open to us, and veterinarians have too generally refused to face the
difficulty, preferring to ignore heart diseases, or still worse seek-
ing to cover their ignorance by the assertion that such affections
rarely exist. Now however we not only know that heart diseases
are much more frequent in the lower animals than heretofore be-
lieved, but that as a general rule they are sufficiently manifested
and recognizable by their distinctive symptoms.

Position and exposure of the heart. In the horse the heart
has only its apex and a small portion of its left ventricle approach-
ed to the surface of the chest, at a point where it is felt to beat
behind the left elbow. The apex approaches the surface in the
interval between the fifth and sixth ribs and close above the
breast bone. The posterior border of the ventricle follows a nearly
vertical line upwards from this point, while the anterior border
has a direction upward and forward crossing diagonally over the
fifth rib. The part of the ventricle exposed extends about three

Diseases of the Heart and Organs of Circnlation. 293

inches upwards from the apex, and is about two inches in its
transverse diameter. The great mass of the organ is covered by
lung substance.

In the ox about the same extent of heart tissue is exposed. In
sheep a portion about an inch in height and one and a half inches
in breadth is left uncovered by lung. In the pig the heart is ex-
posed only in a triangular space of about an inch across.

In the carnivora the heart lies more directly in the median line
of the chest. It appears as if tilted forv^ard so that its apex is di-
rected backward and its base forward , while the body of the organ
lies directly over the breast bone. The lungs invest it on both
sides preventing any approximation to the walls of the chest later-
ally, and it can best be auscultated by applying the ear over the
sternum.

In birds the heart is situated in the centre of the chest and en-
veloped by lung tissue so that its exploration is about equally dif-
ficult at all points.

The larger blood vessels at their origin from the heart are not
open to examination in the lower animals except to a limited ex-
tent in the dog.

Internal arrangement and structure of the heart.. In all
warm blooded animals the heart is composed of two portions, the
internal cavities of which are perfectly distinct from each other
and contain blood in different conditions ; the right portion hold-
ing the impure, purple or venous blood which has just circulated
through the body, and the left portion being filled with the bright
crimson or arterial blood, which has been aerated by circulating
through the lungs. Each of these portions is divided into two
distinct cavities, an ?<!/>/^r (auricle) which receives the blood from
the veins, and a lozver (ventricle) which receives the blood from
the auricle and transmits it into the arteries. The auricle is sep-
arated from the ventricle by a transverse musculo-membranous
partition having a large central orifice furnished with valves (au-
riculo-ventricular), the free borders of which are turned down-
ward so that they allow the blood to flow freely downward from
the auricle but completely close the orifice and prevent any reflex
when the ventricle contracts. The great artery which originates
from the base of each ventricle is likewise furnished with a sys-
tem of valves (semilunar) having their free borders turned

294 Veterinary Medicine.

into the artery, so that they allow blood to flow freely into
that vessel during the contraction of the ventricle, but prevent
any reflux into the heart when the ventricle again dilates.
The apparatus may be likened to a force pump with two systems
of valves, one to prevent the return of any water from the pump
into the fountain ; the other to hinder any reflux from the deliv-
ery pipe into the pump. Any interference with either of these
valves entails a very serious and usually a fatal disorder of func-
tion.

These orifices differ considerably in size. Those between the
auricles and ventricles are considerably larger than those at the
commencements of the great arteries. Those on the right side of
the heart too are greater than those on the left. They vary with
the form of the heart. Thus in dilatation of an auricle and ven-
tricle on one .side of the heart, the auriculo-ventricular opening
becomes equally widened and the valves remaining disproportion-
ately small the blood is allowed to rush back into the auricle dur-
ing ventricular contraction. The left auriculo-ventricular open-
ing has been known to become contracted in some very flat and
shallow chests ; the blood failing to circulate freely through the
lungs and to reach the left side of the heart in a full supply this
orifice accommodates its size to the amount, and may become so
narrowed that it forms a serious obstacle to the blood flow and a
series of morbid changes result following the backward course of
the circulation. The auricle first becomes overdistended and its
muscular walls increase in thickness and consistency ; the lungs
tend next to suffer from a passive congestion, and lastlv the right
side of the heart becomes engorged and enlarged.

Any obstruction in the aorta which conveys the blood from the
left side of the heart equally leads to dilatation of its internal cav-
ity and abnormal thickness of its walls.

The imperfection of the valves is one of the most serious results
of such changes in heart structure. The sounds by which such
imperfection may be recognized will be presently noticed, mean-
while the mode of testing this in the heart of the dead animal will
be referred to. If due to structural changes in the valves them-
selves, the new deposits, the cicatrices, the lacerations, etc. , will
be visible to the eye. Though no such disease changes are seen
the valves may still manifest imperfection by failing to fulfill

Diseases of the Heart and Organs of Circidation.

295

their normal function when put to the test. Water is poured in-
to one or other of the great arteries which arise from the ventri-
cles, the vessel being held vertically, and if it fails to descend into
the heart the valvular action is perfect. The auriculo-ventricular
valves may be equally tested by filling the ventricle and observing
whether there is a reflux into the auricle.

The thickness of the walls of the heart varies in disease.
The auricular walls are invariably thin and flaccid except as above
noted with diminution of the auriculo-ventricular orifice. The
walls of the right and left ventricles differ in thickness in accord-
ance with the distance to which they have respectively to propel
the blood and the propulsive effort demanded. Thus the walls of
the right ve^itricle which is only called upon to propel the blood
through the lungs are only about yi an inch in thickness and are
thinnest at their lower part. Those of the left ventricle which
have to send the blood to the most distant parts of the, body are
from I to I ^ inches except at the lower part where they form
the apex of the heart, and are reduced to a tenuity resembling the
walls of the auricles. They are thickest at the median part, and
diminish slightly in an upward or downward direction. The bulk
of these walls is excessively muscular, the fibres arranged as an
elaborate double spiral and connected with a layer of white fi-
brous tissue placed in the interval between the auricles and ven-
tricles and surrounding the auriculo-ventricular openings and the
orifices by which the great arteries take their origin. It is at this
point, where the muscular fibres of the ventricles are connected
with the white fibrous rings, where rupture of the heart usually
takes place.

The following measurements may be held to refer to medium
sized animals of the different kinds mentioned.

Longitudinal

Transverse Diameter at the
Base of the Ventricles.

Circumfer-

Inches.

Antero-Posterior
Inches.

Transverse
Inches.

Inches.

Horse

Ox

Sheep

Pig

Dog

10

4

^\

3*

1\

6|

3

3f

3f

5i

2

2

19I

7i

95

8^

296 Veterinary Medicine.

The internal capacity of the ventricles is so modified by
the amount oi post mortem contraction that it differs widely from
the actual capacity during life. The left ventricle of the larger
domestic quadrupeds usually admits from 3^ oz. to over 5 oz.,
while the right ventricle whose walls are so much thinner and
more lax will contain double that amount. In the smaller ani-
mals about a tenth of these quantities will be admitted.

The weight of the heart too can only be stated as an average
or for medium sized animals. In the horse it may be from 4)^ lbs.
to 9 lbs. ; in the ox from 3 lbs. 5 oz. to 4^ lbs. ; in the sheep
from 5^ oz. to 7 oz. ; in the pig- from 9)^ oz. to 14 oz. ; and in
the dog- from 5 oz. to 7 oz. This statement must be understood
to apply to dogs approximating in size to the .shepherd's.

Taking into account the size of the particular animal an^^ con-
siderable deviation from these measurements and weights may be
accepted as abnormal. The ratio to the body weight is about : —
horse and dog i : 100, ox, sheep and pig i : 220. This neces-
sarily varies with condition— fat or lean.

The pulse offers valuable indications in disease of the heart.

The number of the pulse in healthy full-grown animals may be
set down as follows per minute : — horse, 36 to 46 ; ox, 38 to 42
(with loaded paunch or in a hot stable up to 70) ; sheep, goat
and pig 70 to 80; dog 80 to 100; cat 120 to 140; goose no;
pigeon 136 ; chicken 140. In old age the pulse is less frequent.
This dnninution may extend to 5 beats per minute in the larger
quadrupeds and to 20 or even 30 in the .smaller. Youth and
.small size again are associated with a greater rapidity of the pulse.
The pulse of the foal, at birth, is about three times that of the
horse ; in the colt of six months it is double ; at a year old about
one and a half times ; and at two years old one and a quarter.

The smaller the animal, caeteris paribus , the more rapid is the
pulse. Hot buildings, exertion, fear or any other exciting cause
likewise accelerates it. It is more frequent with the nervous
temperament, as for for example in the English race horse, or the
greyhound, than in the dull lymphatic cart-horse or mastiff. In
advanced pregnancy it is increased in number. In the cow and
mare it undergoes a monthly increase of four or five beats per
minute after the sixth month. (Delafond)

Independently of the.se conditions a rapid pulse indicates febrile

Diseases of the Heart and Organs of Circulation. 297

excitement attendant on active inflammatory or other disease, or
a state of weakness and debility. In this last condition the heart
beats more frequently to secure a more rapid circulation in the
capillary blood vessels, and thus make up to the craving tissues
by frequency of contact, what is wanting in the quantity and
quality of the nutritive fluid. This point cannot be too much
insisted upon, as the fatal doctrine that a rapid pulse indicates
force of the circulation is very misleading as to treatment.

The force and character of the pulse differ in the various
species. In the horse it is full, moderately tense and elastic.
In the ass and mule it is smaller and harder, with an inequality
of force in successive beats, and sometimes even a beat is sup-
pressed or imperceptible. In the ox the pulse is full, soft and
regular, appearing to roll forward beneath the fingers. In the
sheep and goat the pulse is small but with a peculiar quick or
sharp beat. The pig's pulse is said to be firm and hard. That
of the dog and cat is firm and hard coming with a sharp impulse
against the finger. In the dog, however, successive beats are not
always of the same force and an intermission or complete absence
of a beat is by no means an indication of disease of the heart or
other serious malady. It often attends the slightest excitement
in a perfectly healthy animal.

In disease thQ pulsations may become : — frequent or increased
in number ; slow or decreased in number ; quick or striking with
a sharp impulse against the finger ; tardy or without sharpness
of stroke and as if they rolled slowly past under the finger ; full
and strong when the impulse is forcible and not easily compressed
b}'- the finger ; weak, feeble or indistinct in the opposite con-
ditions ; small when though perfectly distinct and forcible they
are wanting in fulness ; hard, when forcible and jarring (this
is sometimes called wiry or, if smaller, thready) ; soft when
though the artery may be full the beat is devoid of hardness and
easily compressible so as to be unfelt ; oppressed when with a
full rounded artery, the impulse is jerking though not hard and
as if the distended vessels opposed the transmission of the im-
pulse ; jerking and receding — leaping, when with empty and
flaccid arteries the pulse seems to leap forward with each beat of
the heart — (this pulsation may be visible to the eye in the caro-
tids) ; intermittent when after a number of beats at regular in-

298 Veterinary Medicine.

tervals there is a complete pause extending over that period of
time which would have been occupied by a full beat ; unequal
when some beats are strotig and others weak ; irregular when
without any distinct intermission for a period equal to that of a
single beat, the intervals between successive beats are of varying
length. The pulse further has a peculiar thrill or tremor in
states of great debility with deficiency of blood and imperfect
filling of the vessels.

Of these the leaping, the intermittent, the unequal and the
irregular pulses are of special importance in their bearing on
heart diseases.

The jerking and receding pulse is felt in cases of imperfection
of the semilunar valves at the commencement of the great aorta,
and which allows blood propelled into the arteries by the contrac-
tion of the ventricle to flow back into the ventricle during its state
of relaxation. This pulse is met with in other conditions as in
aneurism of the aorta, but if from heart disease it is distinguished
by the presence of a blozving miirvuir with the second sound of
the heart.

The intermittent pulse indicates functional derangement of the
heart but it does not as is generally believed betoken structural
disease. It is frequently observed in healthy asses and mules,
and in dogs however slightly excited whether by fear or J03', or
by the mere fact of their being handled, it is so common as to be
almost the rule rather than the exception. It may be seen in a
healthy horse as the result of excitement. During the early
stages of convalesence from inflammatory affections of the lungs
in the horse the pulse is often intermittent. The pulsations are
at the same time unequal. There is a regular cycle of beats grad-
ually decreasing in force and extending over a complete respira-
tory act. The cycle commences with the strongest beat during or
immediately after the act of expiration, and the succeeding four
or five beats are less and less forcible until the chest is fully ex-
panded when there is a quiescent interval corresponding to the
period of one beat. In many such cases there is no other indica-
tion of heart disease and the phenomenon appears due to the in-
terference with the circulation by the hepatized lung, to the im-
paired nervous energy of the heart and to its compression between
the distended lungs. A pulse simply intermittent and not asso-

Diseases of the Heart and Organs of Cirenlation. 299

dated with any further sign of heart disease does not then possess
the significance generally attributed to it, but a careful examina-
tion of the heart should invaribly be made when this functional
disorder is observed. It exists or ma}^ be brought about by slight
excitement in the great majority of heart diseases.

In case of intermittent pulse it is useful to ascertain whether
there is also an intermission of the heart's beat, since in softening
of the heart, that organ may beat without being able to transmit
the impulse along the artery.

A pulse at once unequal and irregular is a much more serious
indication than a merely intermittent pulse. It is observed espec-
ially in fatty degeneration of the muscular substance, and with
imperfection of the valves on the left side of the organ, though it
may be present in other cardiac diseases independent of the exist-
tence of those lesions.

In hypertrophy of the left ventricle, the pulse is full and strong
and the impulse appears prolonged, because of the greater length
of time taken up by the ventricle in the act of contraction. When
dilatation coexists with hypertrophy the impulse is still full and
strong, more blood being transmitted through the vessel ; but when
dilatation is combined with attennation of the ventricular walls
the impulse is soft and weak by reason of the feebleness of the
contractions.

The pulse at the radial artery should be about synchronous with
the beat of the heart. If retarded it may be held to indicate the
existence on the anterior aorta or its primary divisions of an aneu-
rism with elastic walls or more probably an imperfection of the
aortic valves, which allows a regurgitation of the blood into the
heart.

Venous pulse. A venous pulse seen in the lower end of the
jugular veins is common in the domestic animals. In the ox it is
quite compatible with health and is only to be judged by its am-
plitude and force. In other animals it often coexists with conges-
tion of the lungs which impedes the circulation through the right
side of the heart and leads to engorgement of the venous system.
In the absence of this condition it frequently indicates an imper-
fection of the auriculo-ventricular valves in the right heart and a
reflux of blood from the contracting ventricle which checks the
descending current in the veins.

300 Vete7'hiary Medicine.

Percussion. In the horse a dull, dead sound is emitted when
percussion is made over the left side for about four inches above
the breast bone and in the space corresponding to the lower ends
and the cartilages of prolongation of the fourth, fifth and sixth
ribs. In the ox this dulness is less marked on the level of the sixth
rib. The same results can be obtained on the right side b}^ im-
parting heavier blows to the chest walls so as to derive the sound
from the deeper parts.

The area of dulness is increased in cases of hypertrophy or in di-
latation of the heart when the enlarged organ presses aside the
lung tissue and exposes a greater amount of its substance to the
chest walls. The same result takes place in hydropericardium.

The area of dullness is diminished in cases of ruptured air cells
(as in " heaves ") when the inflated and expanded lung tissue en-
velopes the heart more completely and gives out its own clear
resonance where the dull sound of the heart is usually obtained.

Application of the hand. Palpation. In conditions of
health and in quietude the hand applied on the side of the chest,
close behind the left elbow only just perceives the beat of the heart
with each contraction. If the animal is excited whether from
fear, j 05^ or physical suffering the heart's impulse becomes more
powerful and by this alone the state of its function may be very
satisfactorily ascertained. The impulse is strong in all active fe-
vers and extensive inflammations of important organs, but it is
especially marked in diseases of the heart and lungs. Irregularity
in the force of successive beats is seen in various heart diseases
and debilitated conditions are recognized in the same way.

Any want of harmony between the heart's action and the pulse
may be observed by laying the right hand over the region of the
heart and applying the fingers of the left on the radial artery. In
debility and especially if from a deficiency of blood the violent or
tumultuous action of the heart contrasts strangely with the weak
jerking and compressible pulse. The same symptoms are noticed
when the valves of the heart close their orifices imperfectly. In
convalescence from lung diseases and in certain diseases of the
heart a beat may be felt by the right hand for which no corres-
ponding pulsation is felt in the radial artery by the left.

When the heart is hypertrophied the impulse is stronger and is
associated with a full, strong, and rolling pulse. When it is atro-

Discrscs of the Heart and Organs of Circnlation. 301

phied the impulse on the chest and pulse beat are equally weak.
When water exists in the pericardium the heart strikes the ribs
with less force.

Sounds of the Heart. Synchronous with each beat of the
heart two distinct sounds are heard, separated by a short interval,
inappreciable to most ears, and followed by a period of silence.
These sounds are distinct alike in character and duration. The
first sozind is dull and prolonged ; the second is short and quick.
Some idea of these sounds w\z.y be formed by the pronunciation of
the two syllables, lub — tip, but an acquaintance with the sounds
themselves is essential to a correct conception of them. The pe-
riod of time occupied by the first sound is double that taken up by
the second and in man and the smaller quadrupeds the subsequent
period of silence is of equal duration with the second sound. Di-
viding the time belonging to one revolution of the heart into four
equal periods the first two are taken up by the first sound, the
third by the second sound and the fourth by the interval of silence.
In the horse the silence is more prolonged, and occupies the entire
latter half of the period of a revolution. The relations stand
thus : — the first sound extends over two-sixths of the time, the
second sound over one-sixth, and the silence over three-sixths.

The_/?r^/ sound, sychronous with the beat of the heart against
the ribs corresponds also in point of time with the contraction of
the ventricles, the closure and tension of the auriculo-ventricular
valves and the rush of the blood into the great arteries. The sec-
ond sound corresponds to the reflux of blood in the arteries and
the closure of the valves between them and the heart. The period
of silence represents the period of rest during which the heart is
being filled from the veins.

In the horse, at rest, the first is the only sound that can be
distinctly heard in many cases, but during the exci.emeut of ex-
ercise, or in febrile conditions the second is sufficiently apparent
and any deviation from the natural character is easily noted.

These sounds are most distinct over the lower end of the fifth
and sixth ribs on the left side, but they may be heard distinctly
behind the middle of the shoulder on either side when the cor-
responding limb is advanced. In birds the\' may be heard be-
neath the wings but above all and most clearly over the breast-
bone.

302 Veterinary Medicine.

In disease these sounds may be heard in unusual situations,
they may be aUered in force duration or rythm, or they may be
associated with other sounds or superseded by them.

The sounds may be heard in new situations, in displacements
of the heart from tumors or effusions in the chest, structural
changes in the lungs, pleurae, or pericardium, aneurism of the
aorta, etc., etc.

The heart sounds are clearly heard over any part of the chest
when the lung tissue intervening between that part of the surface
and the heart is solid (hepatized). They are heard distinctly be-
hind the median part of the right shoulder, when liquid effusion
into the left pleural sac has displaced the heart to the right ; and
when the right cavities of the heart are extensively dilated as ex-
ists so commonly in the advanced stages of ' ' heaves. ' '

The extent over which the sounds may be heard is increased
when the lung surrounding the heart is solidified (hepatisation,
splenisation, etc.), or when liquid effusion exists in the chest.
A liquid but more especially a solid is a better conductor of
sound than the spongy lung. Enlargement (hypertrophy) of
the heart equally increa.ses the area of sound. The area of sound
is lessened by atrophy of the heart, and by an emphysematous
condition of the lungs by which the heart is more extensively
covered and further separated from the walls of the chest.

The force or intensity of the heart sounds is increased in high
fever, in acute inflammation, in increase of the muscular walls of
the heart with enlargement of the internal cavities, in functional
disturbance from fear or other exciting cause, and in palpitation.
Often in a weak and bloodless patient the heart sounds can be
clearly heard at several yards distance from the animal. The zVz-
tensity of the sounds is diminished in debility when not associated
with palpitation, in atrophy of the muscular substance of the
heart, in hypertrophy of the muscular tissue of the heart
with diminution of its internal cavities, in broken wi?id when
the the emphysematous lung more completely envelopes the
heart, and in cases of extensive liquid effusion into the pericar-
dium which prevents the apex of the heart from striking against
the side of the chest.

The regular rythm, normally manifested by the two sounds
and the silence, may be modified in the unequal irregular or in-

Diseases of the Heart and Organs of CirculatioJi. 303

termittent contractions of the heart. Kussmaul's paradoxical
pulse is one in which the pulse is more frequent but less full dur-
ing inspiration than expiration. Seen in weak heart, during re-
covery from chest diseases, in chronic pericarditis, and when fi-
brous bands encircle the root of the aorta. Bigeminal and tri-
geminal when two or three beats follow each other rapidl}^ and
are separated from the preceding and succeeding beats by longer
intervals. This occurs in disease of the mitral valve, and in
other weak states of the heart. Foetal heart rythm in which the
pause is shortened and the two sounds of the heart are almost
identical, is seen in the later stages of fevers, and in extreme
dilation. A curious aberration of rythm is the repetition of either
the first or second sound. If of the first sound (anapestic bruit)
each beat will be accompanied by three sounds the first two of which
resemble the first sound of health. If the second sound is repeated
(dactylic bruit, bruit de galop) the first sound only will be pro-
longed and the last two sharp and quick. The repetition of the
la.st sound is probably due to impaired nervous supply which allows
the completion of the contraction of the ventricle and the closure
of the arterial (semilunar) valves sooner on one side than the
other. If due to diminution of the arterial orifice which re-
tarded the emptying of one of the ventricles, the first sound would
probably be accompanied by a blowing murmur. If the auriculo-
ventricular valves on one side were imperfect, allowing a reflux
into the auricle and a more rapid emptj'ing of the ventricle a
blowing murmur would equally accompany the first sound. In
either of these two last mentioned cases the murmur would mask
or hide the first of two doubled sounds.

The repetition of the ist sound is often due to dilitatiou of one
ventricle, which in consequence is longer in reaching the same
sensation of plenitude, and in receiving the stimulus to contraction.

Morbid Sounds. Murmurs. The distinct and superadded
sounds heard in disease are usually designated murmurs. They
originate in the interior of the heart (endocardial) or externally
to the heart (pericardial). The endocardial sounds mostly arise
from some abnormal conditions of the valves or orifices and con-
sist in a blowing or rushing noise which usualiy accompanies or
displaces one of the heart sounds, though it ma)^ precede or suc-
ceed these. The following table modified from that of Bartle

304 Veterinary Medici 71 e.

and Roger presents at a glance the relations of these different
sounds and their significance.

Blowing or Hissing Murmurs.

Blowing murmur ~| f Narrowing of the auriculo-ventricular

before the first \ \ orifice. Vegetations or coagula on

sound. J ( the valves.

f Strongest toward the base of ) Narrowing of the
I the heart. Propagated j aortic opening.
! along the great arteries.
Blowing murmixr with ! ] Narrowing of the

the first sound. \ Strongest toward the apex of | pulmonary artery

I the heart. Not propaga- } or insufficiency of
i ted in the great arteries. | the auriculo-ven-
[ J tricular valves.

„, . „ .,, ■) Double rushing sound heard f Insufficiency of the

Blowmg murmur with I over the grett arteries, at arterial ^ (semi-
the second sound. | each beat of the heart. \ lunar) valves.

„, . r.. 1 Double rushing sound \n\ Aneurism (dilata-

Blowmg murmur after I ,, ^^.-^^ Jf.r, ^,^ . , [ ,■ . ,,,^ „^^^,

.ww...g xxx^.^^. C...V.. , ^jj^ arteries with each beat y tion of the great
the second sound. J of the heart. J aorta. ^

From the table it will be seen that each orifice in the heart may
become the seat of two perfectly distinct and independent mur-
murs ; one due to constriction of the orifice in which case the
sound is produced with the onward progress of the blood wave ;
and one due to dilatation of the orifice or insufficient closure of it
by the valves, when the sound is due to a recoil or regurgitation
of the blood. There is a further sound due to mere roughness of
the valves in cases of disease when the sound will be with the nor-
mal current of blood, though a second or regurgitant hiss is often
heard from the valves being at the same time insufficient to close
the orifice. Another blowing murmur is usually heard over the
heart and coincident with its first sound in the bloodless state
(anaemia). This is not necessarily connected with any diseased
condition of the heart itself.

The nature of these murmurs differs in special instances.
They may resemble the soft whisper of the words zuho or azue, of
the double letter ss, or the single letter r, according as they are
soft or hard and purring.

The pericardial murmur, caused by the rubbing of the dry
roughened surface of the serous membrane covering the heart on
the correspondingly dry rough surface of the same membrane, re-

Diseases of the Heart a7id Organs of Circulati07i. 305

fleeted on the investing sac, resembles that caused by passing the
pahn of the one hand over the other which lies on the ear. It is
distinguished from the friction sound of pleurisy by its coinciding
with the movements of the heart and not with those of respiration.
It is usually heard alike during the sounds of the heart and dur-
ing the period of silence or in other words during the movements
of contraction and dilatation in that organ.

General Symptoms of Heart disease. In the acute inflam-
matory affections there are the signs of general constitutional dis-
turbance attending similar affections in other organs. The decis-
ion as to the true nature of the disease must be arrived at from the
special character of the pulse, heart sounds, etc. as already noticed.

In the chronic forms of the disease however a particular class of
symptoms usually point towards the organ affected. In cattle,
sheep and pigs raised only for slaughter, and as far as possible
protected against active exertion, serious heart diseases may exist
for a length of time without making themselves manifest by any
prominent symptoms. Thus in cows, pins and other sharp pointed
bodies swallowed with the food frequently make their way to the
heart and lodge for a length of time in its vicinity without mate-
rial derangement and when at last the animal dies a sudden death
they are found transfixing the walls of that organ. In the horse
or other animal subjected to exertion the symptoms are usually
very patent.

When the heart is enlarged the pulse strong and the circula-
tion full and free, apoplexies or hemorrhages especially on the
brain or other soft organs where the resistance is least, are liable
to occur. When on the other hand the circulation is weak from
atrophy or fatty degeneration of the heart, or from insufficiency
of the valves there is a tendency to coldness of the extremities,
and to passive congestions with their consequences : — serous effu-
sions, dropsies, and difficult breathing. The imperfect supply of
blood to the muscles of the extremities sometimes brings about an
unsteadiness of gait in the hind limbs when the animal is trotted
for a short distance and sometimes cramps supervene.

Continued coldness of the limbs, and a filling or thickening first
of the hind limbs then of the fore and lastly of the chest and belly
and of the skin beneath their dependent parts are useful indica-
tions.

20

3o6 Veterinary Medicine.

Shortness of breath and inabihty to proceed when trotted or
galloped on hard ground or when walked up hill, the animal being
in fair condition, without fever or cough, but subject to cold ex-
tremities and a venous pulse in the jugulars, almost certainl}' in-
dicates insufficiency of the auriculo-ventricular valves on the right
side of the heart.

Vertigo megrims or giddiness may be caused by heart disease
The horse without having sustained any pressure on the veins of
the neck by the collar, and having had no previous symptom of
brain disease suddenly reels in harness and perhaps falls. There
are the cold and engorged limbs or a tendency to their engorge-
ment as in the former case. The attacks recur, when the horse
is put to the same exertion, and he proves utterly worthless. In
such cases a careful examination of the pulse and heart sounds
will complete the chain of evidence.

An almost constant feature of chronic heart disease is a condi-
tion of dulness, sluggishness, and in many cases, curiously enough,
a tendency to lay on fat, so that although the patient is unfit to
work, he appears to enjoy excellent general health to which a pe-
riod is only put by sudden death.

Affections of the heart are primarily divisible into functional
and strjtcticral disorders.

PALPITATIONS.

Convulsive contraction of the heart, functional or structural diagnostic
features of these. Significance of the functional disorder, genera most lia-
ble. Treatment, quiet, heart tonic, digitalis, correct other disorders.

These consist in a sudden violent and convulsive beating of the
heart, not connected with any appreciable structural disease. They
differ chiefly from the palpitations of organic disease of the heart
in the absence of any apparent local change to account for their
occurrence. The following table from Bellingham furnishes a
number of criteria equally valuable in the lower animals as in
man.

PALPITATION DEPENDENT ON OR- PALPITATION INDEPENDENT OF OR-
GANIC DISEASE OF THE HEART. ! GANIC DISEASE OF THE HEART.

1. Palpitation usually comes on i. Palpitation usually sets in sud-
slowly and gradually. denly.

2. Palpitation constant, though | 2. Palpitation not constant, hav-
more marked at one period than at ; ing perfect intermissions,
another. j

3. Impulse of the heart usually j 3. Impulse neither heaving nor
stronger than natural, sometimes re- prolonged ; often abrupt knocking
markably increased heaving and and circumscribed, and accompanied

prolonged ; at others irregular and
unequal.

4. Palpitation often accompanied
by the auscultatory signs of diseased
valves.

5. Rythm of the heart regular,
irregular, or intermittent; its action
not necessarily quickened.

by a fluttering sensation (visible
jerking or lifting) in the precordial
region or epigastrium (flank and abr
domen).

4. Auscultatory signs of diseased'
valves absent ; bellows sound often
present in the large arteries and ai
continuous murmur in the veins.

5. Rythm of heart usually regu-
lar, sometimes intermittent; its
action generally more rapid than,
natural.

6. Mucous membranes often red- ; 6. Mucous membranes generally
dened and congested ; dropsy of pale ; dropsy of hind limbs rare,
hind limbs common.

7. Palpitation increased by exer- 7. Palpitation increased by close
else, by stimulants and tonics, etc. ; confinement ; by local and general
relieved by rest and frequently also bleedings, etc.; relieved by moderate
by local and general bleeding and an : exercise and by stimulants and
antiphlogistic regimen. tonics, particularly the preparations

I of iron.

3o8 Veterinary Medicine.

Palpitations in the lower animals not dependent on any struc-
tural disease of the heart are usually due to some violent mental
emotion, such as fear or joy. The author once possessed a fast
and clever cob, having no sign of organic disease, and equal to
the severest work on the road without showing signs of exhaus-
tion, but which nevertheless was affected by palpitation when
threatened with a cane in his stall, or if he had been guilty of some
wilful misdemeanor for which he dreaded punishment. In such
cases the heart's action was accelerated and the beating could be
heard loudly for a distance of several yards. They are especially
common in dogs under strong mental emotion (joy, fear), and in
dogs and pigs suffering from digestive disorder (worms) or chest
diseases.

Percivall collects a series of cases from the I \'tcrinarian under
the head of Spasm of the Diaphragm, a diagnosis originating in
the jerking movement of the flank, a symptom which, as is shown
in the above table, is common to man as well. I^eblanc equally
collects cases from the French veterinary journals and acknowl-
edges their true character. One of these observed by Coulbeaux
is thus described : "The respiratory movements are interrupted
by a violent lifting of the flanks, confined to the upper part,
and so intense as to be appreciated by the hand as well as the
eye. The lifting of the flank which is limited to a few square
inches of surface precisely in the hollow of this region, is per-
fectly isochronous with the beats of the heart, which cannot be
appreciated but by the ear. ' '

A case reported by Levrat at greater length may also be given.
The subject a mare, fifteen years old, and kept for hire, was at-
tacked without any known cause. ' ' There was a jerking of the
whole body produced by the extraordinary force of the beats
of the heart which struck violently against the back towards
the upper ends of the first asternal ribs on the left side. The
shock is very distinct and does not appear to be due to any
tumor interposed between the heart and the ribs ; its force is
such that it causes a movement of the whole body, which can
be seen at a great distance. The beats of the heart very regu-
lar, numbering fifty per minute, were heterochronous with the
pulsations of the submaxillary artery, which are of the same
number." (The pulsation was evidently retarded). "The

Palpitations. 309

pulse was soft and regular. The breathing was peculiar. On
approaching the ear to the nostrils the animal is heard to make
three successiv'e inspirations which coincide with the beats of
the heart ; each of these inspirations is followed by an expira-
tion so short and feeble that the expired air can not be felt ; the
fourth is followed by full expiration sustained during three
beats of the heart." This form of respiration was continued
without intermission for an entire day.

In three ca.ses observed at the Lyons Veterinary School the
disease continued for eight days. In all these and twenty more
observed by Leblanc, the patients invariably recovered. The
steady persistence of the disease for .several days and the subse-
quent complete recovery under the unaided action of digitalis
would .seem to warrant the conclusion that such cases were really
accompaniments of structural diseases of the heart and not mere
functional disorders. Even inflammation of the lining membrane
of the heart often exists without any obvious fever or other
manifest symptom of illness, and in the dissecting rooms of
medical schools nothing is more common than to find traces of
pre-exi.sting heart di.sease in patients whose whole life had been
pas.sed without the suspicion of such a malady.

A number of such cases observed in England and on the Euro-
pean Continent are adduced to prove .spasm of the diaphragm or
of the abdominal muscles, (Delafond), and great importance is
attached to the fact that the convulsive movements of the abdo-
men and loins are heterochronous with the beats of the heart.
This lack of exact coincidence however does not seem to amount
to more than a perceptible delay after the heart beat, ju.st as the
maxillary pulsation is delayed in case of aneurism of the aorta.
This has been my own experience with such cases. The flank
movements have been equal in number to the heart beats or have
corresponded to certain beats in the heart C3xle, and have been
perceptibly retarded in accordance with the necessity for time for
the transmission of the blood wave along the po.sterior aorta and
the development of the reflex action which set the phrenic and ab-
dominal muscles in motion. We must of course accept the con-
vulsive action of the phrenic and abdominal muscles, only it would
seem that each such movement has its starting point in the con-
traction of the heart. In cases that show no relation in number

3IO Veteri7iary Medicine.

nor succession with the heart beats, we can freely acknowledge a
neurosis starting at a point different from the heart, but in all ex-
amples which are manifestly connected with heart movements, and
readily curable by the heart-tonic digitalis, the recognition of the
cardiac derangement as an initial factor is sound alike in pathol-
ogy and practice.

Nervous and purely functional palpitations are probably con-
fined to cases in which they are manifested at intervals appearing
under the influence of some transient excitement, and continuing
only for a few minutes at a time.

In the ansemic or bloodless condition the palpitation of weak-
ness is often observed under the slightest exciting cause. It is
then associated with a pallid state of the visible mucous mem-
branes, a weak, trickling pulse and a blowing murmur in the
larger veins.

Palpitations are much more frequent in pigs and dogs than in
horses.

Treat7nent. Quietness and avoidance of all excitement are first
to be secured, then the action of the heart is to be calmed and reg-
ulated by the use of digitalis. To the horse 15 to 30 grains of
the powered leaves may be given thrice daily, and to the dog from
two to four grains at equal intervals. When the disease is associ-
ated with anaemia this agent may still be used in combination with
the various tonic remedies recommended, but in the smallest
doses only as the heart is usually morbidly sensitive to external
influences. Chloral hydrate has been used with success. Brom-
ides, valerian, and belladonna may be tried in obstinate cases.
Any other deviation from a healthy condition must be noted and
corrected, especially any disordered condition of the stomach or
bowels.

ANGINA PECTORIS. BREAST PANG.

W. Williams describes a case of illness in the horse to which he
gives this name. When standing idle he had twitchings of the
pectoral muscles, and when exercised these and adjacent muscles
became violently convulsed, the left fore limb being alternately
fixed by spasm, and paralyzed so that it was useless and the ani-
mal fell if compelled to move. There was " venous pulse, great
irregularity of the heart's action, a loud cooing or blowing sound
and strong impulse indicative of hypertrophy and a want of cor-
respondence between the cardiac energy and feeble pulse. " It
was unfortunate that the murmur was not associated by the ob-
server with a particular heart sound, and with the right or left
side of the heart, and that hypertrophy was not diagnosed by
percussion, since the case can be of little value as it stands.

Breast pang is usually associated with some disease of the heart :
obstruction (usually calcification) of the coronary arteries, insuf-
ficiency of the aortic valves, calcareous degeneration of the aorta,
aortic aneurism, or fatty degeneration of the heart. Eoomis,
basing his view on dissections made by himself and others, re-
solves all of these into concurrent ischsemia of the heart, the cir-
culation in the coronary arteries being seriously interfered with.
' ' That the sudden withdrawal of a supply of blood to a part may
occasion neuralgia is shown by the intense pain in the limb which
directly follows embolism of the femoral artery. Moreover gen-
eral anaemia, as is well known, favors the recurrence of neuralgia
in various situations. " Inability of the heart to propel the blood
is to be explained in the same way.

The difficulty of endorsing Williams' diagnosis lies in the fact
that the disease, so far as it is a distinct disease, is functional and
manifested by pain, the nature of which can only be inferred in
the case of the lower animals (not by spasms of the pectoral mus-
cles), and that hypertrophy of the heart is not likely to be present
in case of insufficiency of blood supply to its walls.

In true angina pectoris of the horse, treatment is useless. Ab-
solute rest is a prime requisite, and anodynes, stimulants, heart
tonics, and nerve tonics are indicated. But the horse at rest
with no prospect of final recovery is simply a source of expense.

311

FUNCTIONAL IRREGUI.ARITY IN THE RYTHM OF
THE HEART.

Associated or not with palpitation, irregularity in the force or
frequency of the heart-beats is sometimes met with at intervals
or independently of any further indication of structural disease.
Particularly in the greyhound and certain other breeds of dogs
the temporary occurrence of intermitting action of the heart is a
frequent though a very transient condition. It may be excited by
some emotion or excitement such as the attentions of the owner,
or the straining anxiety in the immediate anticipation of the chase.
Here again digitalis is pronounced the great panacea though it
need not be resorted to unless the habit interferes with the use-
fulness of the animal. If in any degree dependent on weakness,
that must be counteracted by a systematic tonic treatment.

312

CONGENITAL MAI.FORMATIONS AND DISPLACE-
MENTS OF THE HEART.

Ectopia Cordis. Cyanosis, pervious foramen ovale. Symptoms, blue
mucosjE, coldness, staring coat, unlhriftiness. Unequal to exertion, palpi-
tations, murmur before the first heart sound. Obstructed circulation in the
lungs as a cause of cyanosis, cyanosis as a cause of lung disease.

These have been much le.ss frequently observed in the lower
animals than in man. The anomalies observed in mammals in-
clude the following : The displacement of the heart to the right
side of the chest ; di.splacenient entirely out of the chest (ectopia
cordis); permanent communication between the right and left
auricles (^cyanosis); entire ab.sence of heart; two hearts; one
common ventricle communicating with two auricles as in reptiles ;
three ventricles ; only one auricle ; absence of one or several
valves ; absence of the pericardium ; variations in the mode of
connection of the heart and large vessels, etc.

Displacements of the heart have been especially studied by
Hering on calves. The breast bone remained as originally devel-
oped in two lateral halves, and the heart remained outside con-
nected with the interior of the chest only by its large vessels.
The heart thus exposed and covered only by its investing mem-
brane (pericardium) afforded an excellent opportunity to study
its action, of which Hering freely availed himself. Animals
affected in this way survived their birth but a very short time.
An approach to this condition was thirty years ago made familiar
to the medical world in the person of M. Gouz, a German me-
chanic, the movements of whose heart could be easily watched
through a fissure in the breast bone.

Permanent communication between the two auricles.
Pervious foramen ovale. Cyanosis. Previous to birth there
is an opening between the right and left auricle, allowing the
blood to flow from the former into the latter in place of ,as in after
life, descending into the right ventricle and thence circulating
through the lungs. iVt birth this is contracted, and in a few days
is completely closed in accordance with the new life, which de-
mands that all blood must circulate through the lungs in order to

313

314 Veterinary Medicine.

its aeration. Sometimes this fails to be effected, and venous blood
from the right side of the heart continues to mix with arterial in
the left, deteriorating it in quality and unfitting it for nutrition,
secretion, calorification, and other essential processes. The semi-
venous blood circulating in the arteries gives a bluish hue to the
visible mucous membrane, hence the name of the blite disease.
This blood is unfit for sustaining the vital changes essential to the
production of animal heat, so that the animal suffers from cold-
ness of the surface and extremities, staring coat and general un-
thrifty appearance. Such subjects grow badlv, and refuse to lay
on flesh, but are said to arrive at maturity in some instances and
to have their imperfection recognized only because of the short
breathing, and irregular heart's action when subjected to exer-
tion. A heart murmur preceding the fir.st sound of health is
usually present, as in anaemia.

Drs. Abernethy and Wardrop draw attention to the frequency
of previous forame7i ovale in the human subject in connection
with pulmonary consumption, and opine that it is reopened as a
consequence of this disease. The coincidence has not been ob-
served in the lower animals, though if it were found to exist the
question would arise whether the deterioration of the blood and
general health in open foramen ovale did not also favor the de-
posit of tubercle in the lungs. When from deficient ventilation
the atmosphere and blood become impregnated with carbonic di-
oxide the production of tubercle in man or in animals is corre-
spondingly frequent.

The subjects of previous foramen ovale die 5'oung or prove
worthless when they arrive at maturity. Nothing can be done to
ameliorate the condition.

HYPERTROPHY OF THE HEART.

Simple, eccentric, concentric. Ventricles chiefly affected. Causes, in-
creased functional activity, from obstruction to the circulation, or con-
tinued extra exertion. Right ventricular hypertrophy-obstruction in the
pulmonary circulation ; left ventricular hypertrophy-obstruction in the
systemic. Auricular hypertrophy-insufficiency of the anriculo- ventricular
valves. Pericarditis as a cause. Abnormal weights. Symptoms, beats
more forcible and prolonged, ist sound low, prolonged, 2nd sound clear,
often doubled, increased dulness on percussion, diagnostic signs of hyper-
trophy, dilatation and a combination of the two. Simple hypertrophy
rarely dangerous, with dilatation grave, threatens congestions and apoplex-
ies. Treatment, rest, laxatives, sedatives, in irregular heart action digitalis,

An enlargement of the heart from increase of its muscular sub-
stance is by no means uncommon in the horse. It may exist
without any change in the capacity of the cavities of the heart
(simple hypertrophy) or it may be associated with dilatation of
one or more of these cavities (hypertrophy with dilatation ; — ex-
centric hypertrophy). A third variety has been described in
which the capacity of the cavities is decreased but Cruveilhier
and Budd have satisfactorily shown the nonexistence of this con-
dition except as a congenital deformity.

It is in the ventricles that the increase is chiefly observed, the
rea.son of which is to be found in the causes of the malady. These
usually consist in some obstruction to the circulation such as
chronic congestions in the lungs or elsewhere, rupture of air cells
in the lungs, tuberculous and other abnormal dcpo.sits in the chest
and elsewhere, tumors which by their position interfere with the
circulation through the larger vessels, and the like. Where by
some such cause the blood is impeded in its outward course, one
or both ventricles are called upon to contract more vigorously to
force a sufficient amount of blood onward and in accordance with
the inherent adaptability of the animal economy, there takes place
an increase of the muscular walls of the ventricle proportionate
to the required energy of the contractions. The condition then
is e.s.sentially due to a more active nutrition and growth of the
muscular substance and finds its exact parallels in the well-de-

315

3i6 Veterinary Medicine.

veloped legs of the ballet dancer or the brawny arm of the
blacksmith. All alike occur in accordance with a general law
that whenever there is habitually demanded of any organ an un-
usual activity of function, which stimulates without exhausting
its power, nature adds to the active element of such organ till the
required labor can be accomplished without the overwork of any
particular part.

Keeping this in view we can easily explain the increase of one
part of the heart without immediate implication of another. The
ventricles are more commonly enlarged than the auricles because
upon them devolves the work of overcoming the obstruction,
whether this exists in the lungs or the system at large. The
auricles fulfill little more than a passive function in receiving the
blood from the veins during the contraction of the ventricles and
allowing it to pass down into these when their relaxation takes
place. The closure of the auriculo-ventricular valves during the
ventricular contraction protects the auricles from the internal ten-
sion to which the lower part of the heart is subjected and thus
all tendency to increase is obviated.

The hypertrophied part corresponds to the locality of the ob-
struction. If it exists in the lungs (heaves, consumption, hepa-
tisation, chronic bronchitis), pulmonary artery, its valves at its
origin from the heart, or if it consists in contraction of that ori-
fice, the enlargement takes place primarily in the right ventricle,
the right auricle remaining unchanged so long as the auriculo-
ventricular valves act perfectly. The ventricle, however, tends
to dilate as well as enlarge in thickness of walls, and as soon as
this dilatation has proceeded so far as to widen the orifice between
the auricle and ventricle and render its valves insufficient, the
auricle also begins to dilate and its walls often increase in thick-
ness. But the vicious chain does not end here. Should the
animal survive and the original obstruction persist, the veins
throughout the system become habitually congested because of
the reflux of blood from the right auricle and ventricle, dropsies
appear in different parts, the congestion of the veins is continued
through the capillary blood-vessels to the arteries, the difficulty
of propelling the blood comes to be experienced by the left ven-
tricle and a corresponding series of morbid changes taking place
on that side, as have already ensued on the right, the vicious

Hypertrophy of the Heart. 317

circle is soon completed, and the entire organ becomes diseased,
each constituent part of the organ operating injuriously on that
which preceded it in the track of the circulation, and ever}^ new
change forming but a stepping stone to a more dangerous modifi-
cation.

On the other hand the obstruction may exist in the general cir-
culation, on the course of the aorta, or its branches, in its valves
at its origin from the heart, or in the narrowing of its orifice.
Then the increase takes place first in the left ventricle, is propa-
gated to the left auricle, leads to congestion of the veins, capil-
laries and arteries of the lungs, and lastly to disease of the right
side of the heart. Here there is a different starting point, but
the progress of the disease-changes in a direction opposed to the
course of the circulation is the same. *

The disease may, however, begin with the auricles, owing to
disease of the auriculo-ventricular valves impeding the flow of
blood into the ventricle, or to simple narrowing of the auriculo-ven-
tricular opening. The auricle is then primarily enlarged, the
corresponding veins congested, this is propagated to the capillaries
and arteries, and lastly the ventricle on the opposite side of the
heart is involved. This is chiefly seen with fibrinous deposits on
the valves or in the ca.se of polypus hanging into the auriculo-
ventricular opening. Aneurisms, embolisms, neoplasms, athero-
ma and calcic degeneration of the arterial walls may be effective
factors.

In addition to these cau.ses Bouilaud and Leblanc attach a high
importance to chronic inflammations of the .serous membranes,
which by reason of the contiguity of the latter to the muscular
.structure bring about a more abundant circulation in this and an
increased nutrition. Another cause is unintermitting hard work
which necessitates excessive exertion of the heart, to supply
blood more freely to the muscular system and the lungs. Many
hunters .suffer from this affection it is believed because of their
extraordinary exertions. The stallion Helenus had a heart of
14 lbs.

Weight of the heart. The heart in the lior.se which rarely
weighs over 9 lbs. is increa.sed from 10 lbs. to 14 lbs. in this dis-
ease and in one case in a cart hor.se, recorded by Stephen.son in
the Veterinarian for iS6r, it is said to have reached 32 lbs.

31 8 Veterinary Medicine.

Stephenson probably weighed the heart while filled with blood.
A diseased heart weighed in this way by Thomson amounted to
34 lbs., one by Gerlach, 19 lbs., an ox's heart by Herran 36 lbs.
In Stephenson's case there was further an extraordinary dilatation
of the anterior vena cara. Haycock (Veterinarian, 1850), records
a case in which though the heart only weighed 10 lbs. 8oz.. yet
the walls of the ventricles were double the normal thickness, those
of the left being 2^ inches while those of the right were i inch.
An estimate from the thickness of the walls, it must be borne in
mind, is not so satisfactory as the absolute weight taken after the
removal of the large vessels, the superfluous fat and the contained
blood.

The usual coincidence of other complaints supports the state-
ment that it is mostly due to obstruction to the circulation. A
few cases will illustrate. Dyer reports the case of a hunter in
which with general hypertrophy and dilatation of the right auri-
cle, the pulmonary artery was so large as to admit the fist. (Vet-
erinarian, 1861). Halloway relates a case in which there were ex-
tensive internal deposits of melanotic material, especially in the
mesenteric glands, liver, spleen, and kidneys (Veterinarian, 1850).
Haycock records a case with thickening of the auriculo ventricu-
lar valves on the right side, and of several of their tendinous
cords, also a diseased liver which had ruptured before death (Vet-
enarian, 1850). Percivall publishes a case associated with pleu-
risy and rheumatism (Veterinarian, 1858). Henderson furnishes
a case associated with diseased right auriculo-ventricular valves
and enlarged liver weighing 55 fts. (Veterinarian, 1847.)

Symptoms. In simple hypertrophy the heart beats are more
forcible and prolonged so that the period of silence or rest is
shortened. This is due to the greater length of time taken up in
the contraction of the ventricles. For the same reason the pulse
which mayor may not be accelerated, irregular or intermittent, is
full and rolling or as it were prolonged. The first sound of the
heart is prolonged and low or muffled, sometimes almost inaudible
while the second is unnaturally loud. Sometimes when one ven-
tricle only is enlarged that may complete its contraction later than
the other and the second sound is repeated as in the syllables
hib — tip tip. A duplication of the first sound only is less com-
mon. If the sounds are heard over a greater extent of the chest's

Hypertrophy of the Heart. 319

surface than is natural, the kings being healthy, it is probably due
to hypertrophy of the heart. If very clear on the right side they
indicate increase of the right ventricle. The heart's impulse is
usually strong and may be felt on both sides, and it may be over
the whole chest.

Percussion usually shows a more extended dulness in the re-
gion of the heart but the blows must be pretty forcible to bring
out the deeper resonance, otherwise it will come only from the thin
layer of lung. These results are of the greatest value in the
dog.

The pulse is usually regular and if excited to irregularity and
intermission quickly returns to its natural state when the patient is
left at rest.

As hypertrophy is usually associated with dilatation of the heart
the following table abridged and modified from Dr. Walshe will
prove valuable by presenting side by side the signs indicating hy-
pertrophy with and without dilatation, and simple dilatation.

TABIvE CONTRASTING THE MAIN SYMPTOMS OF HYPERTROPHY
, AND DILATATION.

A. General Physical Signs.

SIMPLE HYPERTROPHY. HYPERTROPHY WITH DI- SIMPL,E DIIvATATION.
NATATION.

Heart's impulse slow Force increased, sharp- Impulse conve3S a
and heaving as if press- er, more knocking, may feeble undulatory sensa-
ing steadily against an impart a shake to the tion ; force of successive
obstacle — in rythm reg- body. May be felt on beats unequal ; rythm
ular, in force unequal. the right side. irregular.

First sound is- dull. Sounds gain greatly in First sound short,
muffled, prolonged and loudness and extent of abrupt and clear. Second
weakened almost to ex- transmission, especially sound not specially af-
tinction. Second sound if the valves are not fected.
full and clanging ; per- thickened,
iod of silence shortened.

Murmur with the first Murmur with the first Murmur with the first
sound present at one sound may be present, sound from insufficiency
time and absent at an- from altered direction of of the auriculo-ventricu-
other. the orifice of the aorta, lar valves.

320 J^etcrinary Medicine.

B. General Functional Symptoms.

SIMPLE HYPERTROPHY. HYPERTROPHY' WITH DI- SIMPLE DILATATION.
LATATION.

Strength unimpaired. Strength tends to be- Strength fails.
Power of continued exer- come impaired,
tion (especially uphill)
limited by shortness of
breath.

Visible mucous mem- Purplenessand lividity Lividity of the mucous

branes healthy or of a of the mucous mem- membranes. Dropsical

l)rightred. branes proportionate to effusions of the limbs and

the valvular or pulmon- other dependent parts

ary obstruction. which pit on pressure.

Difficulty of breathing Difficulty of breathing Difficulty of breathing

occasional. occurs in paroxysms. great and constant, with

occasional aggravations.

Pulse full, strong, firm, Fullness of pulse con- Pulse small and feeble,

tense, resisting and pro- tinues but strength and much later than the heart

longed without jerk or power of resistance lost. beat. Regular or feeble,

thrill. fluttering and irregular.

Venous pulse in the

jugulars.

Rarely and never rap- Indirectly and more or Palpitation frequent.

idly the direct cause of less rapidly fatal. Faintness occurs from

death. time to time, and may

lapse into fainting and
sudden death.

Pure hypertrophy rarely implies imminent danger unless de-
pendent on some pre-existing structural disease which impedes
the freedom of the circulation. If excessive, however, or if as-
.sociated with dilatation the animal is short-winded and unfit for all
but the slowest work. It predispo.ses to congestion or apoplexy
of the lungs when its seat is the right ventricle, and to conges-
tions and hemorrhage in other parts of the system, brain, kidney,
lungs, liver, bowels, if in the left.

Asthma (dogs), heaves (horses), emphysema and tuberculosis
in cattle are occasional complications attended by grave symptoms.

Treatment. In advanced cases and .such as are dependent on
irremovable structural changes in the lungs or elsewhere no treat-
ment is of any avail. In recent and uncomplicated cases in the horse
and cow and in some more advanced conditions in other animals,

Hypertrophy of the Heaj^t. 321

not used for work, a palliative treatment may be profitably adopted.
This consists in a nitrogenous restricted and gently laxative diet,
perfect rest in fattening oxen and other animals, or in the horse
moderate and carefully regulated work, and as a medicament the
use of digitalis or aconite. No known remedy has any power to
directly check the growth of the heart and the utmost that can be
expected of these agents is to lessen the activity of the heart's
action and retard its growth. Digitalis may be given as recom-
mended for palpitation, or aconite in the form of tincture 20 drops
for horses and cattle and i to 2 drops for dogs, repeated four times
daily. Strophanthus may replace digitalis. When depletion
seems advisable purgatives or diuretics should be given as appears
most applicable to the particular case. Iodide of potassium has
been strongly recommended,

When extreme dilatation exists with the hypertrophy^ sedatives
should be given cautiously and their effects carefully watched as
the heart is often dangerously susceptible to depressing influences.
When the disease has advanced so far as to cause abundant drop-
sical effusions it is futile to resort to treatment as amelioration can
rarely be looked for, not even to the extent of allowing an animal
to be fattened.

The value of arsenic in most cases of broken wind (heaves)
has suggested the inquiry whether it does not operate directly on
the heart. L,eblanc who advances this query might have quoted
in explanation the known power of arsenic to retard and arrest
tissue change, with its natural consequences, the diminished
amount of effete matter thrown into the blood in any given time,
and the lessened necessity for an active circulation to supply any
great waste of structure. It may benefit such cases in this way
but does so probably to a far greater extent by an influence on
the nervous function analogous to its action in neuralgia and
other purely nervous disorders. Dilatation of the heart which
usualb'^ exists in heaves is usually benefited by tonics which like
arsenic are destitute of stimulating properties.

ATROPHY.

Simple, eccentric, concentric. Usually eccentric. Causes, effusion in
pericardium, obstruction of coronary arteries, by false membranes, etc.,
general inanition. Symptoms, beats weak, sounds loud, clear, decreased
area of dulness on percussion, pulse slow, weak, under excitement unequal,
irregular, intermittent with palpitation, dropsy of limbs, etc., murmur with
1st sound. Treatment only in early stages by removal of the cause.

The loss of substance in the muscular walls of the heart is
either swiple when there is no change in the capacity of its
different cavities : — eccentric when the chambers of the heart
are enlarged ; or concentric when these chambers are reduced
in size. Like hypertrophy it may affect the walls of one chamber
to the exclusion of the others.

Atrophy is much less frequent in the lower animals than hyper-
trophy and in nearly all cases on record it was associated with
dilatation.

The causes are not always very evident. Effusion into the per-
cardium is one of the most frequent, the compression of the heart
impairing its nutrition and decreasing its size. Especially is it
hurtful when several layers of false membranes deposited on the
surface of the heart become organized, preventing its sufficient
dilatation and compres.sing its nutrient blood-vessels. A case of
this kind in a dog occurred to Eeblanc ; the right auriculo- ven-
tricular opening was surrounded by thick organized layers of
fal.se membranes which by their contraction had largely di-
minished the opening and even pressed on the coronary artery
cutting off to a great extent the supply of blood to the walls of
the ventricle. Another alleged cause is a prolonged insufficient
nourishment to the entire body. Eeblanc has also observed this
in dogs the subjects of long continued wasting maladies.

Symptovis. In pure atrophy these are the opposite of those
seen in hypertrophy. The beats of the heart are weak or inap-
preciable to the hand placed on the side of the chest behind the
left elbow. The sounds of the heart are loud and clear, their in-
tensity being proportionate to the thinning of the walls and the
dilatation of the chambers. Percussion so far as it can be made
effectual, which is chiefly in dogs, shows a diminished area of dul-
322

Dilation of the Heart. 323

ness. The pulse is slow, weak, or indistinct, compressible, be-
coming accelerated, unequal, irregular, and intermittent when the
patient is excited. Palpitation is frequent, breathing is difficult
or easil}^ embarrassed and there is a tendency to dropsy of the
limbs and dependent parts. These symptoms are usually associa-
ted with considerable prostration and depression.

These are often complicated by symptoms of valvular disease
or dilatation.

Atrophy progresses slowly and rarely causes death in the earlier
stages. In its advanced stages when dropsy has supervened little
can be dene even in its mitigation. In the earliest stages only
can good be done by employing measures calculated to remove
its causes and thus put a stop to its progress.

DILATATION OF THE HEART.

Result of obstruction to circulation. In right ventricle usually. In au-
ricle from narrow auriculo-ventricular opening. Pure dilatation from sud-
den extreme blood pressure as in inflammations of the lungs. In fat cattle
from fatty obstructions around the heart and great vessels. Weakness of
cardiac muscles in fatty degeneration, fevers, debility, etc. Symptoms,
dyspnoea under slight exertion, unsteady walk, cold, dropsical limbs, venous
pulse, pulse small, weak, irregular, intermittent, with palpitations. Treat-
ment, in early stages arrest the causes, arsenic, digitalis, fatten for butcher.

Dilatation of the right cavities of the heart is one of the most
common heart diseases of the horse. It is an almost constant
condition in advanced broken wind, and is a frequent concomitant
of hypertrophy and an occasional one of atrophy of the heart.
Its usual direct cause is some obstacle to the free escape of blood
from the cavity affected. Thus in broken wind the difficulty of
the circulation through the lungs causes accumulation in the pul-
monary artery and right ventricle of the heart, the walls of which
are distended because of the unwonted internal pressure. When
the dilatation of this ventricle reaches a certain stage the auri-
culo-ventricular opening is equally widened, the valves become
insufficient to close it and the right auricle and venae cavae par-

324 Veterinary Medicine.

ticipate in turn in the internal pressure and dilatation. The right
ventricle is more often affected than the left, because of the
greater frequenc}- of obstruction in the circulation through the
lungs than in that through the general system, and because of the
thinness of its walls which more readily give way under internal
pressure. Dilatation may result from disease of the great arteries,
from diminution of their calibre by the pressure of tumours, or by
narrowing of their openings at the heart, whether as the result of
diseased valves or other morbid condition. As affecting the
auricles primarily its usual cause is narrowing of the auriculo-
ventricular opening from some abnormal deposit. The extreme
thinness of the walls of the auricles allows these to give way un-
der internal pressure even much more readily than the right
ventricle.

The causes it will be seen are similar to those inducing hyper-
trophy, and hence the frequent coexistence of the two. Pure
dilatation occurs especially when internal pressure takes place
suddenly and to excess, and while the nutritive functions are to a
great extent in abeyance. Such conditions are found in acute
inflammations of the respiratory organs, or of the inner or outer
membranes of the heart, and the rapid deposit in the lungs of
tubercles or other abnormal material.

Dilatation of the right side of the heart is a common complaint
in overfed cattle, and is apparently due to the diminished power
of resistance in the walls of the heart, the muscular substance of
which is partly replaced by fatty granules, and to the obstruction
offered to the circulation by the extraordinary accumulation of fat
around the base of the heart and the commencement of the large
blood vessels. Though a diseased condition this rarely shortens
life or interferes with the uses to which cattle are put.

The heart walls are similarly weakened and yield more readily
to the internal blood pressure in endocarditis, myocarditis, peri-
carditis, high fever, infectious diseases, poisonings, anaemia, and
debilitating diseases generally. Debility and incapacity to resist
the blood pressure is the essential prerequisite to dilatation.

The sympto7ns which have been already enumerated in the
table given under the head of hypertrophy are mainly these : Loss
of appetite, spirit and endurance ; faintness and difficulty of
breathing on the slightest exertion ; habitual coldness with a

hiflammations in the Heart. 325

tendency to dropsy of the extremities ; loss of control over the
extremities when walked or trotted far ; venous pulsation in the
jugulars ; heart's impulse weak and undulatory or tremulous, or
under exertion tumultuous or palpitating ; murmur often present
with the first sound ; the first or more commonly the second sound
may be doubled ; pulse small, weak, irregular, and often inter-
mittent, and frequently livid spots in the nasal mucous membrane.
Paroxysms of unsteady gait from irregular circulation in the
brain is frequent, and Dyer asserts that he has repeatedly seen
blindness as a result of this condition.

In treatment the main purpose should be to put a stop to the
cause of the disease before it has been developed to a dan-
gerous extent. When the malady is manifested by the symptoms
above enumerated the subject is rendered permanently unfit for
service and will probably die suddenly under some slight exer-
tion. Fattening animals in a condition of quietude will often lay
on flesh for an indefinite length of time notwithstanding that the
heart is considerably dilated. (See note on digitalis, strophanthus
and arsenious acid in dilated heart, under the head of hypertrophy') ,
To relieve the asthmatic attacks attending on an overtaxed heart
Zuill strongly recommends the combination of iodide of potassium,
digitalis, nux vomica and coca. But heart tonics are often much
more affective after the bowels and portal system have been un-
loaded by a laxative.

INFI.AMMATIONS IN THE HEART.

These are among the most common diseases of this organ and
moreover lead to many of the changes in structure to be hereafter
noticed so that it is convenient to treat of them here. According
to their relative frequency they may be ranged : — ist. Inflamma-
tion of the external covering of the heart — pericarditis ; 2d. In-
flammation of the internal lining membrane of the heart — endo-
carditis ; and 3d. Inflammation of the muscular substance of the-
heart — carditis.

PERICARDITIS.

Definition. Frequency in different genera. Causes, rheumatic, trauma-
tism, extension from pleurisy. Unwholesome buildings and localities, de-
bility. Symptoms, chill, reaction, pleuritic symptoms, hyperthermia, ten-
derness behind left elbow only, friction sound synchronous with heartbeat,
later it is lost and heart sounds are muffled, increased area of dulness on
percussion, oppressed breathing, venous pulse, patient statant, little fever
in chronic cases. Traumatism from the stomach, digestive disgrder, grunt-
ing, dropsy under the sternum with little fever at first. Lesions, as in pleu-
risy, obliteration of pericardial sac. In traumatism from stomach the for-
eign body is formed in the cardiac end of a band of lymph extending to the
reticulum. Treatment, in chill, after reaction, medicinal measures as in
pleurisy, local applications to the region of the heart. Paracentesis, inser-
tion of needle, antiseptic precautions. Chronic pericarditis in oxen.

Definition. Inflammation of the .strong fibro-serous sac in which
the heart is contained and which is reflected on the muscular sub-
stance of that organ .so as to form it.s external covering.

This is the most common inflammatory disease of the heart and
has been met with more frequently in horses and cattle than in the
smaller quadrupeds.

Causes.. It frequently coincides with or follows other diseases
sucli as influenza, pleiiro-pneuinonia and above all rheui7iatism.
In cattle and goats wounds from sharp pointed bodies, (needles,
pins, nails, etc.), which have been swallowed with the food and
have passed through the walls of the second .stomach, the dia-
phragm and pleura to the heart constitute a frequent cause in cat-
tle. The pericardium has been punctured by a fractured rib and
has been implicated in inflammation attendant on an abscess or
other lesion in the walls of the chest. Besides these the general
influences which cau.se uncomplicated attacks of the disease are
the same as those producing pleurisy, peritonitis, rheumatism and
inflammation of serous membranes generally. These are sudden
changes from heat to cold, cold winds, cold draughts, drenching,
chilling rains in animals already overheated and exhausted, or
prolonged exposure in severe weather, in low states of the sys-
tem. Leblanc ju.stly remarks that " with the morbid influences
which appear specific, there often coincide intemperate seasons,
326

Perica 7'ditas. 327

badl}^ arranged buildings, a want of sufficient attention to the
conditions of health, and in the case of herbivora, wet, cold, and
badly exposed pastures. " In other words whatever deteriorates
the health and vitality predisposes.

Symptoms. These are less characteristic than in man owing to the
smaller portion of the heart exposed, but they are usually marked
enough to permit a recognition of the disease. Acute form. The
affection is ushered in by chill, general fever, hyperthermia, (103°
to 104°), staring coat, hot, dry mouth, dilated nostrils, excited,
difficult breathing, double lifting of the flank with each expira-
tion, the existence of a prominent ridge from the lower end of the
last ribs along the flank to the outer angle of the hip bone, as in
pleurisy, pinched, anxious expression of countenance, fixed eyes,
accelerated, full, hard and often wiry pulse, and tenderness when
the ribs behind the left elbow are pinched or struck. The same
tenderness is noticed particularly in the ox and smaller quadru-
peds when pressure or compression is made beneath the breast
bone. Auscultation over the lower ends of the fifth and sixth
ribs and their cartilages detects a friction or rubbing sound in the
early stages and until liquid has been thrown out into the pericar-
dial sac. This sound may be at first the finest possible creaking,
afterward increasing to a distinct rubbing, is synchronous with the
b^at of the heart, and usually with the first sound. It is distin-
guished from the friction sound of pleurisy in occurring rythmi-
cally with the sounds of the heart and not with thoss of breath-
ing, and from sounds produced in the interior of the heart by its
absence when auscultation is made over the carotid or other large
artery. This friction sound is lost when serous effusion takes
place into the pericardium, but reappears when the liquid is ab-
sorbed in the process of recovery. Until effusion takes place the
impulse of the heart is strong, often irregular, in force, and some-
times accompanied by a purring tremor or, according to L,eblanc,
a metallic tinkle.

When effusion has taken place the pulse is weaker and softer,
irregular or intermittent, the impulse of the heart is weaker, the
friction sound is lost, and the area of dulness corresponding to the
heart is increased. Percussion shows it to extend higher than
three inches above the breast bone in the horse and more than
two or two and a half inches transversely. It is distinguished from

328 Veterinary Medicine.

the effusion of pleurisy in this, that the duhiess is confined to the
anterior part of the chest, having the outHne of an inverted cone,
and does not extend backward along a horizontal line, and, in soli-
pedes, in not showing equally on both sides. In the smaller ani-
mals it may be distinguished by not always occupying the de-
pendent part of the chest when the animal is placed in different
positions. As the effusion increases, the heart's sounds, previ-
ously strong, become first muffled, then more and more distant
until they may become altogether imperceptible. The difficulty
and oppression of the breathing increases, the nose is protruded,
the eyes more rigidly fixed, and the face more haggard ; a venous
pulse, apparently due to the compression of the heart and large
veins by the fluid, is ssen in the lower ends of the jugulars, and
the animal obstinately stands as indeed the solipeds do all through
the disease. At this advanced stage dropsies of the limbs, sheath,
and other dependent parts of the body are frequent.

A painful cough is sometimes though by no means invariably
present throughout the disease. Emaciation takes place rapidly
and in the more acute cases death ensues in five to eight days. A
fatal issue may be delayed until after three weeks or the affection
may merge into a chronic Jorm.

Chronic Pericarditis is sometimes seen in the ox without any
preceding acute attack. This is manifested by the local symptoms
without the accompanying acute fever. Along with a slight fever,
there is the oppressed breathing aggravated by exertion, the weak
irregular or intermittent pulse, the weak or distant heart sounds,
the absence of respiratory sounds and the dullness on percussion
over a space represented by an inverted cone at the anterior part
of the chest on each side, the venous pulse in the neck and the
general tendency to dropsy.

If the pericarditis has been the result of sharp pointed metallic
bodies swallowed and afterwards making their way to the heart, it
is sometimes preceded by eructations, tympan}^, difficulty in
swallowing or in rumination, and by dropsy under the sternum, but
more frequently the heart symptoms are the first to be noticed.
It is not attended by the high fever of other pericarditis.

Post Mortem Appearances. These do not differ materially from
those of pleurisy, to which accordingly the reader is referred.
The effusions and false membranes are of course localized in the

Pericarditas. 329

sac of the pericardium. A frequent termination is a permanent
adhesion of the pericardium througJiout more or less of its extent
to the surface of the heart. In cases of death the serous effusion
is commonly colored with blood though mostly from a. post mortem
infiltration of blood from the congested lungs. The effusion has
been known to measure fifteen litres in the horse. It may be
purulent or combined with foetid gases, particularly in traumatic
cases. After mild attacks white patches (milk spots) are often
left extending, it may be only through the pericardium and in
other cases reaching into the muscular substance. At a less ad-
vanced stage the false membranes are yellow, with a rough or
villous surface, they may be softened from fatty degeneration or
they may be more or less completely calcified.

When the cause has been perforation by a metallic body, it wall
be found surrounded by exudate enveloping a canal or band ex-
tending to the diaphragm or stomach.

Treatment. Pericarditis often proves fatal but it is by no
means invariably so in uncomplicated cases. There is especial
danger when serous effusion is excessive, when it occurs in a
weak and debilitated subject, or when it is complicated by pleurisy,
influenza or rheumatism. The preliminary chill may be met by
the measures advised for the rigor of pleurisy, but if the malady
is developed other treatment is required. The medication is still
essentially as for pleuris)^ only the primary disease (rheumatism,
influenza, pneumonia) must be specially attended to when such is
present. Acute pain may be met by carefully graduated doses of
opium or a-onite and by the moist jacket or fomentations. Some
employ icebags to soothe at once inflammation and pain and in the
absence of rheumatism these may be resorted to. In the small
animals leeches may be applied over the cardiac region. Dry
cupping is a good alternative applicable to all.

An active purgative is demanded unless the affection is attended
by a low type of fever or has occurred during the course of an
epizootic disease (Horse 5 to 7 drachms aloes, cow i to 2 lbs.
Kpsom Salts, dog i oz. castor oil). After the walls of the chest
have been well fomented they may be enveloped in a large mustard
poultice which must be continued until a considerable effusion
has taken place beneath the skin. To moderate and control the
heart's action give digitalis (horse and ox ^ drachm, dog 2 to 4

330 Veterinary Medicine.

grains) four times a day. After the purgative has acted an ounce
of nitrate or acetate of potass may be given daily to the larger
quadrupeds (i^ drachms to sheep and pigs, and 20 grains to
dogs) in the drinking water. These agents together with the
digitalis must be pushed to the largest doses when the effusion has
taken place abundantly and when it threatens to dangerously in-
terfere with the heart's action. Pilocarpin is a dernier resort, to
be used with caution. In similar circumstances, ointment or
tincture of iodine should be freely applied over the chest in the
region of the heart. Mu.stard and other vesicants repeatedly
applied often greatly hasten the reabsorption of the liquids.

From the first the animal must be warmly clothed and every
means employed to obtain free circulation and warmth on the sur-
face. The legs must be well rubbed and wound in warm flannel
bandages, or this failing, may have mustard freely applied to them.
Warm injections must be at the same time thrown into the rectum
and will benefit by soliciting the action of the bowels as well as in
raising the temperature of the surface generally. The food al-
lowed should be warm mashes of wheat bran, boiled linseed and
similar agents in small quantities.

If the amount of effusion threatens a fatal result, it may be
drawn off by a cannula and trochar introduced between the carti-
lages of the fifth and sixth ribs, by a valvular wound and with
antiseptic precaution (see hydrothorax), care being taken to avoid
puncturing the heart itself.

The trochar or aspirator needle should be pushed in a direction
upward and inward until resistance ceases or it is felt that the
heart has been touched. A caoutchouc tube may now be attached
to it and allowed to depend twelve or eighteen inches, and its
lower end should be plunged in a weak solution of boric acid or
other antiseptic. This avoids the entrance of air and insures
against the introduction of serial bacteria.

When the vital powers are being exhau.sted stimulants mu.st be
given to support the animal, combined with iodide of potassium.
(See advice concerning the allied condition in Hydrothorax) .

In the chronic pericarditis of oxen the fatality is greater. Treat-
ment consists mainly in counterirritants and powerful diuretics
employed in doses determined by the strength of the animal, and
combined with stimulants and tonics as in the advanced stages of
the acute disease.

Endocarditis. 331

In complicated forms of percarditis attention must be given
mainly to the constitutional affection; thus in infljienza a stimula-
ting and supporting treatment is demanded, and in rheumatism
colchicum, acetate of potass, salicylate of soda, salol and similar
agents must be freely administered, though not to the exclusion
of counterirritants to the region of the heart, and other measures
demanded bv the heart diseases.

ENDOCARDITIS.

Definition. Psthology and lesions, congestion of the endocardium cover-
ing the valves, valves liable through friction and strain, exudation in or on
the serosa rendering it opaque, coagula of fibrine on the surface,
secondary endocarditis mycotic, microbes, changes in serosa, distortions and
degenerations of valves. Symptoms, as in pericarditis, with violent heart
impulse of varying force, clear metallic sound, blowing murmurs, weak
pulse decreasing in force, irregular, intermittent, absence of local tenderness,
no friction sound, no increase in area of dulness, if lesions are in right
heart — venous pulse, venous congestion, dropsies. Valve lesions, in mitral
valve — general heart symptoms and murmur with ist heart sound, 2d sound
may be repeated and exceptionally a venous pulse — in tricuspid valve —
same with constant venous pulse, venous congestion and dropsy ; narrow-
ing of the mitral orifice — general heart symptoms and blowing murmur
before the ist sound ; narrowing of the tricuspid orifice — same with mur-
mur sometimes audible on the right side ; insufiiciency of aortic valves —
general heart symptoms and murmur with 2d heart sound, double rushing
sound in arteries and delay of pulse beat at jaw ; lesions in pulmonary
valves — same but without double rush in arteries, or delay of pulse beat at
jaw. Loose coagula. Embolism. Causes, as in pericarditis and strain on
valves, and poisons and microbes in the blood. Prognosis grave. Treat-
ment, as in the early stages of pericarditis, antirheumatics and germicides
more, and diuretics less desirable. For clots iodides, alkalies.

Definition. Inflammation of the serous membrane lining the
chambers and covering the valves of the heart.

Pathology and Morbid Anatomy. The causes and symptoms
will be better understood after the diseased conditions have been
comprehended. The earliest changes are the reddening and thick-
ening of the lining membrane of the heart but above all of that
covering the valves. The valves are particularly exposed to in-

332 Veterinary Medicine.

flanimation by reason of the friction of the blood when violently
forced through the narrow opening in excited conditions of the
heart, by the strain thrown upon them from the violent contrac-
tions of the heart or the recoil of blood in the arteries, and by
their susceptibility in common with all other fibrous structures to
rheumatic inflammation. The redness is of the ramified or
branching kind characteristic of inflammation, and is neither re-
movable by washing the surface nor does it correspond in position
with the colored portion only of a clot which the cavity in ques-
tion m2iy contain, as seen in bloodstaining occurring after death.
There is further exudation of plastic lymph into and beneath
the serous membrane, rendering it opaque, white and thick, or on
its surface forming granular elevations, and in the case of the
valves becoming moulded into ridges or festoons by the mutual
pressure of the different flaps on each other. The inflamed sur-
faces are further liable to be covered by masses of blood clot in
successive layers, deposited by the action of the fibrinogenous
matter developed in the inflamed part. These clots sometimes
accumulate in considerable masses, firmly adherent to the heart's
walls or valves by their attached surface, but soft and filamen-
tous on their free aspect. These clots or polypi, as they have
been called, are soft and loose on their free surface, and become
firmer toward their points of attachment. In other words their
consistency is in direct ratio to their age. If of old standing they
are usually pale yellow or white and streaked with red, while if
recent they are mostly red throughout. They vary in size from
a thin film to a mass filling up nearly the entire cavity in which
they are lodged, and as they frequently extend through the auri-
culo-ventricular openings or become applied against this or the
opening of the great artery, they seriously and sometimes fatally
interfere with the circulation. Leblanc asserts that large masses
of this kind may be deposited in a few days or even hours, caus-
ing sudden deaths, and especially in dogs. He has found other
circumstances than endocarditis to cause these fibrinous deposits,
and especially the absorption of pus, or the sudden suppression
of a long standing discharge, as in catarrh of the air-passages.
If death does not immediately ensue, these fibrinous deposits may
become vascular, as is the case with false membranes in the
the pleurae, becoming organized into fibrous tissue, or even de-

Endocarditis. 333

generating into calcareous matter, necrotic debris, or pus, several
instances of which as occurring in horse and cow are on record.

These cases illustrate endocarditis by irifection {mycotic, via-
lignant, or idcerative endocarditis^ , which occurs independently,
or as an extension of a bacteridian disease, primarily localized
elsewhere in the system. Thus it is a secondary lesion in infec-
tious omphalitis, pneumonia, pleurisy, arthritis, abscess, pyaemia,
etc. Beside the general lesions of endocarditis and a great ten-
dency to molecular death of the new formations and the under-
lying tissues, there is the presence of specific germs which have
been the occasion of the disease. Among these the staphylococ-
cus pyogenes aureus, the streptococcus pyogenes, and the diplo-
coccus pneumoniae, have been particularly noted. In case the
valves were already diseased, they become especially liable to be
colonized b}' any such bacteria that may be circulating in the
blood.

In the early stage there may be a mere swelling of the valves,
with as yet a smooth, unbroken surface, but with enlargement
and increase of the connective tissue cells, later fungous vegeta-
tions start out from the surface, and on these the fibrine of the
blood is deposited in layers.

Besides the formation of clots on their surfaces other changes
occur on the cardiac valves as the result of inflammation. The
organization of the exuded lymph within and upon them leads to
rigidity, loss of elasticity, unevenness of their surface, contrac-
tion and puckering so that the}^ can no longer approximate to
each other, but leave the orifice imperfectly closed. They may,
moreover, have gristle or bone deposited in their substance. The
osseous degeneration of such new products appears to be the most
common cause of those ossifications of the heart, of which speci-
mens are to be found in nearly all veterinary museums.

Chronic valve disease is thus found to be a common result of
endocarditis, and from the obstacle presented to the flow of blood
through the different cardiac orifices by the rigid, inelastic and
distorted valves, hypertrophy of the heart frequently supervenes.

In our domestic quadrupeds ante-mortem clots and fibrinous
polypi have been chiefly formed in the right side of the heart,
and di.seased valves in the left.

Symptojns. The general symptoms agree in many respects

334 Veterinary Medicine.

with those of pericarditis. There are the same general symptoms
of fever (temperature 102° to 106°), the same pinched, anxious
countenance, the same shortness of breath and oppression when
moved, the same violent heart's action, and the same rapid, ex-
citable pulse tending to be irregular and intermittent. Among
the more specific symptoms are a very violent impulse of the
heart against the left side, varying in force, however, in succes.
sive beats ; a metallic tinkling accompanying the impulse and
sometimes heard at some little distance from the body, a blowing
murmur as soon as the changes in the valves render them insuffi-
cient to close the orifices, and, if the obstruction exists on the
right side, venous pulse, general venous congestion, and dropsical
swellings.

The pulse may at first have considerable force but, as insuffi-
ciency of the valves ensues, it becomes small and weak, its weak-
ness forming a most marked contrast to the violence of the heart's
impulse against the side. The irregularity and intermission of
the pulse is to be ascribed at first to the impaired nervous energy
of the heart though later it is often due to the obstacle presented
by clots to the flow of blood from the heart, so that a beat some-
times takes place without a corresponding pulsation. It may
reach 80 or 160 per minute in horse or ox.

The blowing murmur when heard is one of the most character-
istic symptoms but must be carefully distinguished from other
allied heart sounds. If very loud it may be confounded with the
friction sound of pericarditis, but may be differentiated by its in-
variable coincidence with some particular portion of the heart's
beat. The absence of local tenderness is another distinctive
symptom. Again in pericarditis effusion takes place early annul-
ing friction sound, and diminishing alike the impulse and the
sounds of the heart.

It is of less practical value to be able to distinguish the precise
seat of the murmur, yet the following data will guide to such a
conclusion.

Simple induration or insufficiency of the Left Auriculo
ventricular (Mitral) valve. Paroxysms of palpitation, op-
pression, and difficulty of breathing; vertigo with loss of control
over the limbs and vacilating gait ; stupor, coma ; slight tremor
and blowing lioise with the first sound of the heart ; heart's im-

Eiidocardiiis. ' 335

pulse, violent, but irregular in force, sometimes double ; pulse
feeble, irregular, unequal, or intermittent ; sometimes though not
at all constantly a venous pulse in the lower end of the jugulars.
In chronic induration of this valve, or in osseous, or cartilagino-
ous degeneration the same symptoms are shown. The more gen-
eral symptoms may, hovvever, require exercise to develop them.

Induration, etc., of the Right Auriculo- Ventricular (tri-
cuspid) valve. The symptoms are almost identical with the last.
Venous pulse is constant, and, particularly after exertion, the
veins generally are distended. Dropsies are more common.

Narrowing of the Mitral orifice. In addition to the same
general symptoms as the last named lesions, there is a sighing,
blowing, purring or rasping sound, according to the degree of
narrowing, heard before the fir.st sound of the heart. It is the
noise of the blood rushing through the narrowed orifice between
auricle and ventricle. It is usually loudest behind the middle of
the shoulder on the left side. Feeble pulse, frequent imminence
of suffocation and filling of the limbs, etc., are nearly constant.

Narrowing of the Tricuspid orifice Symptoms nearly
identical with, the last. Venous pulse more con.stant. Blowing
murmur sometimes loudest on the rig Jit side of the chest.

Induration or insufficiency of the aortic valves. Blowing
murmur with the second sound of the heart. Double ru.shing
sound in the carotid with each heart's beat. There is an apprecia-
ble interval between the beat of the heart and corresponding pul-
sation at the jaw.

Induration or insufficiency of the pulmonary valves. Blow-
ing murmur with the second heart sound, but no corresponding
double sound in the carotid, nor any marked retarding of the
pulse.

Loose coagula in the heart or adherent ones {polypi) produce
one or other of the above class of symptoms, according to the
particular orifice they tend to block or the valves whose function
they impair.

Anaemia and leukaemia may have blowing murnuirs with the
finst or second heart sound.

Embolism. Plugging of arteries. Another class of symp-
toms sometimes supervenes becau.se of loose clots being washed
on into the arteries, and blocking them when they reach those

336 Veterinary Medicine.

that are too small to transmit them. These sj-mptoms will be as
varied as the organs whose arteries are plugged. If in the brain
there ^may be dulness, stupor, vertigo, somnolence, delirium ; if
in the liver, biliary and digestive derangement ; if in the lungs,
cough with the other signs of pneumonia and abscess ; and if in
the limbs lameness and paralysis, (brought on or aggravated by
exercise, and often removed by a few minutes' rest), wasting of
the muscles, etc. (^See Embolism) .

Causes. These are in the main the same as those of pericarditis.
Weak health, exposure to extremes of weather, punctures with
foreign bodies, but above all, the rheumatic constitution are com-
mon causes. Indeed rheumatism appears more prone to attack
the serous membrane lining the heart cavities than that envelop-
ing it externally. One reason for this is to be found in the great
and incesssantly recurring strain on the fibrous structure of the
valves, and particularly in hard worked horses and hunting dogs
in which the strain is often extreme. It has been argued that
the increased blood pressure caused by digitalis is an appreciable
cause. Its frequent coiniection with rheumatism is shown in the
rheumatic lesions of joints and fibrous structures seen in carcasses
dead of endocarditis.

Diseases in the muscular substance of the heart as cysts, ab-
scess, etc., frequently extend to the endocardium.

Among other causes must be mentioned disease-changes in
the blood. These may act on the valves directly as in the case of
lactic acid injected by Dr. Richardson, into the peritoneum with
the view of producing rheumatism and successfull}' as regards
the lesions of the cardiac valves ; or indirectly by determining
coagulation and irritation of the lining membrane coming into
contact with the clot. The very fibrinous and plastic state of the
blood in extensive inflammations is a probable cause of the occur-
rence of clots in the heart, and the frequency of such clots in the
dog has been ascribed to the plasticity of his blood (Leblanc).
The injection of pus into the blood or the absorption of microbes
from diseased surfaces will sometimes produce ulcerative disease
of the valves. The same is true as regards the germs of ompha-
litis, pneumonia, arthritis and other infectious diseases.

lyafosse records certain cases of endocarditis due to extension
of the disease from inflamed veins.

Endocarditis. 337

Prognosis. Endocarditis is always attended with great danger
to life, but it is more likely to terminate in chronic valvular dis-
ease which quite unfits the animal for useful work. Mild cases
may terminate in complete recovery.

Treatment. This is in the main the same as that adopted in
the early stages of pericarditis. Absolute rest is of prime impor-
tance. I^axatives, sedatives and counterirritants are to be mainly
relied upon. Belladonna and chloroform on the chest behind the
left elbow may be used. As there is not the same danger from
effusion, diuretics need not be pushed to the same extent. Digi-
talis must be avoided if possible until the high fever subsides.
In infective cases quinia, salicylate of soda, salol, or hyposulphite
of soda may be given. L,ater give tincture of muriate of iron.

In rhemuatic cases, treat as for an acute attack of rheumatism.
Frequent large doses of salicylate of soda or salol, large doses of
acetate of potass and colchicum, warm clothing and counter-
irritants to the region of the heart are especially demanded.
(See Rheumatism.)

When clots are suspected, and when endocarditis threatens to
lapse into the chronic form, it is recomended to give iodide of
potassium (horse and ox i drachm, dog 5 grains, twice daily)
with carbonate of ammonia or of potass and bitter tonics. A
lengthened rest after apparent recovery is essential to avoid per-
manent valve lesions.

CARDITIS. MYOCARDITIS.

Definition. Rare. Complicates pericarditis and endocarditis, wounds of
tha heart, and tubercular and other deposits. Symptoms. Treatment.

Definition. Inflammation of the nniscnlar substance of the
heart.

This is a rare affection and is necessarily limited to a small por-
tion of the heart's stibstance, otherwi.se, the cardiac contractions
must cease in obedience to the general law that the normal func-
tion of an inflamed organ is for the time abolished. It is mainly
seen as a concomitant of endocarditis or pericarditis, and extends
only to the superficial muscular layers ; or it results from a wound
as in the penetration of the heart by a needle or other sharp-
pointed body and is then equally circumscribed. It has been
seen as a complication in infectious di.seases — aphthous fever,
pyseinia, septicaemia, pneumonia and tuberculosis.

The evidences of the existence of carditis are chiefly the lesions
met with after death, ist, The existence of abscesses in the
heart's substance associated with polypus (Gowing, Leblanc,
etc.,) or otherwise (Reynal). Also diffu.se .suppuration in the
heart's substance (Puze, etc.) 2nd, Softening of the muscular
substance a state occasionally met with when an animal has died
of ruptured heart. 3d, Ulceration, of the walls of the heart as
reported by Mercier in a case of endocarditis. 4th, Transforma-
tion, and induration of the heart's substance whether into
fibrous tissue, cartilage or bone. This last condition of the walls
of the right auricle and ventricle has been repeatedly seen in old
horses, the change being in certain cases so extensive that one is
left in wonder as to how circulation could have been carried on.
Three specimens of this kind were preserved in the museum of
the Alfort Veterinary College, Paris, and the Royal Veterinary
College, London. I^afosse records two cases of gangrene of the
internal layers of muscle in endocarditis.

The symptoms are those of acute heart disease generally modi-
fied somewhat by the precise location of the inflamed spot, and
treatmeiit need not differ materially from that applied for inflam-
mation of the investing membranes, inner and outer, and for the
infectious disease which it complicates.
338 •

CHRONIC VALVULAR DISEAvSE OF THE HEART.

This, as already noticed, is a common result of endocarditis,
the valves being most obnoxious to disease in such cases. The
symptoms are those mentioned under endocarditis as character-
izing disease of the different valves, such as incapacity for exer-
tion, difficult breathing, palpitation, irregularity or intermission
of pulse, venous pulse, abnormal heart sounds, unsteadiness of
the limbs when driven, and dropsical swellings in the limbs and
elsewhere. The reader is referred to endocarditis for particulars,
it being borne in mind that these symptoms are not in this case
associated with fever.

Horses affected in this way are useless. Cattle may sometimes
be partially fattened by preserving them from all sources of ex-
citement, by keeping the bowels regular and by combating any
paroxysms with sedatives, such as aconite, veratrum, hydrocyanic
acid, or opium, and with digitalis.

339

FATTY DEGENERATION OF THE HEART.

Causes, improvemeut in the direction of easy fattening, inactive life, best
breeds of butcher cattle and pigs sufTer. Symptoms, weak, irregular, inter-
mittent pulse, palpitation, unfitness for exertion, general heart symptoms.

In addition to the fibrotis and bony transformations to which
the substance of the heart's walls is subject, a fatty metamorphosis
is frequently met with. In most cases the fat accumulates in
great masses externally, but in others the muscular tissue has to
a greater or less extent lost its natural structure and fatty granules
have taken the place of the sarcous elements. In overfed oxen
the right cavities of the heart rarely escape dilatation, and this
condition is very often accompanied by the fatty change.
Virchow has shown that highbred English pigs imported into
Germany are subject to a similar affection of the heart and of the
entire muscular system. It may occur during wa.sting diseases
and from phosphorous poisoning.

The symptoms are weak, irregtilar and intermitting puke, pal-
pitation on excitement, weakness of the heart's impulse in the
intervals, incapacity for exertion, sighing, Cheyne-Stokes respira-
tion, loss of control over the limbs when hurriedly driven and
tendency to dropsy. It is often associated with dilatation, is rarely
distinguishable from it in life, and is equally beyond remedial
measures. The feeding animals most commonly affected can
usually be fattened if removed from all sources of excitement.
In case of phosphorous poisoning improvement takes place when
the poison is stopped.

340

NEW FORMATIONS IN THE HEART. TUMORS.
PARASITES.

Glanders, abscess, melanosis, tubercle, polypus, nsevus, parasites— echino-
coccus, cysticercus tenuicollis, cysticercus cellulosa, trichina, sarcocyst,
filaria immitis, strongylus subulatus, strongylus vasorum.

I St. Deposits of Glanders. In many cases of glanders and
farcy in horses the specific product is deposited in the heart as
well as in other internal organs. Such deposits are small but
numerous, infiltrating the muscular tissue ; their cut surface is
dry, finely granular and of a yellowish white color.

2d. Abscesses are sometimes formed in the heart from the
colonization of microbes from suppurating surfaces.

3d. Cancer of the heart has been noticed chiefly in dogs by
Leblanc. It occurs only consecutively to cancer in other parts of
the body, yet it has sometimes acquired considerable dimensions
and interfered materially with the movements of the heart.

4th. Melanosis of the heart has been repeatedly noticed in the
horse. Some if not all such cases .should be classed with cancers,
as these internal deposits of black coloring matter in solipedes,
have, in our experience, mostly possessed malignant characters,
though they are usually simple tumors as developed in the skin of
the horse. These black masses usually project beneath the pericar-
dium or endocardium.

5tli. Tuberculous deposits have been met with in the sub-
stance of the heart in cases in which the lungs or other organ were
the seat of this disease.

6th. T\i^ fibrous growths ox polypi due to the deposition and or-
ganization of fibrinous material from the blood have been referred
to under endocarditis .

7th. Ganigee reports the existence of a vascular tumour of the
right ventricle of a horse in the museum of the Turin Veterinary
School. It consisted of varicose veins ramifying beneath the en-
docardium which in its turn was healthy.

8th. The parasites found in the heart are various, a. One,
the Echinococcus Veterinorum, has been repeatedly found in
the substance of the heart or projecting from its inner or outer sur-

341

342 Veterinary Medicine.

face. b. Another, the cysticercus tenuicollis, has been met
with in the pericardial sac of a calf (Reed), c. A third, the
cysticercus cellulosa infests the muscular structure of the heart
of measly pigs. d. The heart like other voluntary muscles of
hogs occasionally contains trichina spiralis, e. Rainey's cysts
(sarcocysts) are microscopic ovoid bodies usually found in the
hearts of oxen and other animals. /. A round worm , filaria immi-
tis. first described as filaria papillosa haematica by Delafond and
Gruby, lives in the blood of the dog, is one millimeter thick by fif-
teen to 30 centimeters long. It may obstruct the pulmonary artery
(Serres) or the mitral orifice (Silvestre). It may cause various
nervous disorders and even sudden death. Its mode of entrance
is unknown, g. Strongylus Subulatus, i to 2 mm. long by
70 to 90 //. in thickness was found in numbers in a nodule of a
dog's lung, and the dorsal vein of the penis of a dog (Leisering).
h. Strongylus Vasorum in the right auricle and ventricle of a
dog, in pea-hke blood clots. It is 14 to 21 mm. long by i m. in
thickness (Serres).

RUPTURE OF THE HEART.

In the lower animals ruptures of the heart have been observed
as the result of (a) extraordinary exertion, (b) violent concussion,
and (c) ulceration and degeneration. The rupture of the fatty
heart in the lower animals is not common.

Rupture during severe exertion occurs in the perfectly
healthy heart. The ruptures take place in the weakest point, and
most commonly in the fibrous ring which encircles the base of the
heart and attaches the great aorta. This is occasionally seen to
happen in very spirited horses during a severely contested race or
when a heavy load is being dragged up hill. Percivall mentions
the case of a horse at a Woolich racing meeting, which had just
lost a heat by half a head and which died just after passing the
winning post, with ruptured right auricle.

Cases occur during coitus (Hering), tympany (Anacker,
Mayer, Perdan) and operations (Stockfleth).

Rupture from Concussion more frequently implicates the
muscular walls which have not the same power of resistance when
they receive the blow in a relaxed condition. Parker met with a
case of rupture of the right auricle at its base or at the line of its
union with the ventricle. The subject was a pony which ran
away down hill and struck his right shoulder violentlj^ against a
cart wheel. In other instances the rupture takes place in the
posterior vena cava, and particularly if its walls have been the
seat of disease. Gamgee found rupture of the commencement of
the azygos vein in oxen killed by pithing in the slaughter houses
of Ferrara, and Professor Maffei subsequently found that out of
3095 oxen killed in these abattoirs 57 had this vein ruptured.
Gamgee' s explanation of the occurrence is that "the instant the
animals are pithed the wal's and contents of the chest become
paralyzed, the heart becomes an inert bag filled with fluid, the
jerk of which as the animal falls, causes rupture of the contain-
ing vessel at its weakest part and this is in truth the vena azygos
whose walls are thin and only protected externally by the pleura."
Hertwig gives other cases resulting from falls.

Perforation of the heart from ulceration is sometimes seen

343

344 Veterinary Medicine.

in cows when sharp-pointed metallic bodies from the stomach
make their way into its substance. An alleged case of rupture
following ulceration of the walls of the right ventricle is recorded
by Gaullet.

Inflammation, softening, fatty and calcareous degeneration,
dilatation, atheroma, and the presence of parasitis in its substance
render the heart more friable and predispose to rupture.

Lesion. The rupture is often at the fibrous ring encircling the
aorta or pulmonary artery ; in other cases in the muscular wall of
ventricle or auricle.

Symptoms. Death may be practically instantaneous. If de-
layed there is hurried breathing, anxiety, weakness, pallor of the
mucous membranes, staggering, trembling, vertigo, .stupor, and
convulsions.

DISEASES OF ARTERIES.

The chief morbid conditions seen in arteries are : Wounds, in-
flammation, thrombosis, emboHsm, degeneration, and aneurisms.
Wounds belong essentially to surger3^

ARTERITIS. EMBOLISM.

Internal and external arteritis. Thrombosis, from inflammation. Em-
bolism. Bruising. Stretching. Ligature. Lesions. Extension of clot,
color, consistency, adhesion, lamination. Composition of clot. Condition
of vessel. Changes in muscles. Causes : muscular tension, embolism.
Heart clots, venous clots. Infecting debris. Symptoms : paresis or par-
alysis on exertion. Local suffering, tenderness, firm swollen artery, de-
rangement of nutrition and function, atrophy. Chronic arteritis : A.ther-
oma. Changes in serosa. Fibrous thickening, atrophy, dilatation.
Strongylus. Treatment : rest, anodynes, alkalies, massage.

hiflanimatio7i of arteries has been divided into exte^'nal and
internal arteritis, according as it affects the fibrous sheath of the
artery or its inner lining membrane.

In external arteritis the exudation of lymph often forms a
protecting layer around the vessel, while the inner coats continu-
ing sound the current of blood remains unimpaired. Even when
suppuration takes place in the vicinity of a large artery, that
vessel may pass through the center of the abscess and convey the
blood as freely as before. The nutrition of the vessel thus de-
tached from the surrounding tissues is maintained by its accom-
panying nutrient artery, though if the akscess is large there is
danger of a deficient supply. The frequent presence of .such
arteries traversing an abscess should make the surgeon careful
how he breaks down the bright pink bands occasionally seen to
stretch across such cavities.

Internal arteritis, or inflammation of the internal coat of an
artery is incomparably more serious and mainly because it deter-
mines the coagulation of the contained blood and consequent
plugging of the vessel. This is but one manifestation of the gen-
eral law that in inflamed tissues the fibrine forming elements are
produced in excess, and when blood comes in contact with these
it tends to coagulate (thrombosis). On the other hand the in-
flammation in the arterial coats may ensue from the pressure of a

345

346 Veterinary Medicine.

blood clot formed in the veins or heart and carried on with the
current until it reaches an artery too small to admit it (embolism).

The inflammation may be confined to a limited space as when
an artery is bruised, stretched so as to tear through its inner
coats, or interrupted by a ligature. It may on the other hand be
diffused over a greater extent of the vessel, and in some cases
two inflamed portions are separated by intervals of sound artery.

Anatomical features of the inflamed artery. In active in-
flammation of the internal coats of an artery, it contains blood
clots, and if the inflamed surface is not very limited in extent the
vessel is completely plugged and the clot forms up to its nearest
transverse branch on the cardiac side, precisely as if the artery
had b2en tied. The resulting clot is sometimes tubular, so that
an impaired circulation is still carried on. The clot varies in
length according to the extent of vessel inflamed, or the distance
from the inflamed spot to the nearest diverging branch. The clot
is usually fusiform in outline and is firmly attached throughout
more or less of its diameter, and occasionally so firmly that it is
all but inseparable from the serous membrane. The narro^yed
ends of the clot mostly float free in the liquid blood and portions
from the end most distant from the heart will sometimes get de-
tached, and by blocking up smaller arteries give rise to new
centres of disease. This is a true instance of embolism or
plugging.

The clot has nearly always a grayish or yellowish white color
in the larger vessels, such as the posterior aorta, and an uniform
pink or red streaked with yellow in the small. It is possei^sed of
great firmness and elasticity. That portion of the surface which
was not attached to the arterial walls, during life, is clear, smooth
and glistening, while the portion which adhered to these walls is
rough, irregular, and broken into shreds. It is usually composed
of concentric layers .showing its mode of formation.

Clots of this kind analyzed by M. M. Lassaigne and Clement
were composed of water 74 .parts ; fibrine and albumen 25 parts ;
and alkaline .salts i part.

The vessels filled by these clots are very irregular in their out-
line being thick and bulging at one point and thin and constricted
at another. The outer coat is rarely the seat of morbid change,
though it sometimes shows branching redness and thickening
from exuded lymph. The internal coat where the clot was

Diseases of Arteries. 347

attached is intensely and unnaturally red, and a rough granular
surface has given place to the healthy, smooth glistening appear-
ance. In old standing cases the clots can only be separated from
such surfaces by dissection with the knife. Other portions of the
surface than those to which the clot adheres are usually smooth
and polished, though rough granular and injected patches are
sometimes met with independently of clots.

The mu.scles formerly supplied with blood by the obstructed
arteries are pale, discolored, unnaturally firm, and if some time
has elapsed since the plugging their fibrillated structure is made
out with difficulty.

Causes. The causes of arteritis are often obscure. Goubaux
conceived that it was frequently determined by extreme mu.scular
tension. In support of this view he adduced the facts that it has
been mainly observed in the horse, in which such stretching of
the muscles is greatest, and that its most common .seats have been
where the muscles and vessels are most liable to stretching.
Thus it is frequent in the posterior aorta towards its termination
or in other words where the adjacent muscles (psose) are very
liable to laceration from slipping backward or from efforts to dis-
engage the limbs when fixed in soft ground ; the femoral and
auxiliary arteries are likewise frequent seats of inflammation and
are likely to be overstretched when the limbs slip outwards.

Embolism or Plugging of the arteries must be accepted as
another cause. This is referred to under endoca7-ditis, as an oc-
casional consequence of the detachment of clots and fibrinous
substances from the internal membrane of the heart. The de-
tached mass in this case passes from the heart into the aorta and
thence through its divisions until it reaches a vessel too small
to receive it, when it is at once arrested and determines inflam-
matorv action in the plugged vessel. When arrested in some
soft organ such as the lungs, liver or brain the resulting inflam-
mation often gives ri.se to extensive suppuration and abscess. In
other situations its effects may be confined to inflammation, the
shutting off, of blood from particular parts, the impairment or
loss of their function and nutrition, and finally atrophy and de-
generation.

But the heart is not always the primary .source of such clots.
Virchow and others have demon.strated by post mortem examina-

348 Veterinary Medicine.

tions in cases of plugging and hy a number of experiments on the
lower animals, not only that such clots may have their place of
nativity in some distant and diseased part of the body and pro-
ceed in the veins to the heart, and thence through the arteries to
other distant parts of the body where they plug the vessels and
induce a train of mobid changes ; but that such embolism arteri-
tis and abscesses can be produced at will by the introduction into
the circulation of solid and insoluble (infecting) bodies. Frag-
ments of decaying and suppurating tissue and the elements of
tubercle and cancer may bs thus equally carried onward in the
current of the circulation, and reproduce themselves at those
points where their course is arrested. This is a mode in which
secondary deposits of these morbid matters are determined. Em-
bolism and arteritis in the body and limbs occuring in this way
necessarily have their point of departure in pre-existing disease
of the lungs. The clots loosened from the capillaries or veins
of the lungs are carried through the left side of the heart into the
arteries of the body at large to be arrested in some of the smaller
vessels. I have seen plugging of the digital arteries of the hind
limbs, to occur in this way in a horse that had been suffering
from inflamed lungs.

Microbes and toxins may pass harmlessly through healthy
parts, including the pulmonic circulation, to establish colonies
and embolism beyond where the tissues have become debilitated.
Thus Gamgee records a case of embolism of the anterior mesen-
tric, right external iliac and right femoral arteries, supervening
on an attack of strangles.

Syinptoms of acute arteritis. These consist largely in impaired
muscular power in the part, indications of acute local suffering,
such as trembling and tenderness to the touch, if the obstructed
vessel lies within reach it can be felt as an exquisitely tender cord-
like mass, and the limb on the distal side of the embolism and
dependent on the diseased vessel for its blood supply is anaemic
and cold. In the distal portion of the embolic artery and its
branches pulsation has ceased. If the lesion is extensive there
may be more or less fever, but a limited arteritis in a small vessel
may escape this complication. If the disease is of long standing
there is atrophy of the tissues formerly supplied by the embolic
vessels. The secondary derangement of nutrition and function

Diseases of Arteries. 349

are as varied as the organs affected and will be noted below in the
special article on thrombosis and embolism.

Chronic arteritis. Atheroma. This is an indolent inflam-
mation supposed to result mainly from strain and overwork, and
manifested by thickening and clouding of the serosa, with cell
proliferation, softening and fatty degeneration. The diseased
substance becomes soft, pultaceous, slightly greasy, and under
molecular degeneration it breaks up and is even in part washed
on in the blood stream. Other degenerations may occur in the
inflamed walls of the artery. The exudate may become organ-
ized, constituting fibrous thickening. It may become the seat of
calcareous degeneration. It may yield to the blood pressure, be-
coming slowly attenuated (atrophy), and even dilated (aneurism
by dilatation). As a cause of chronic internal arteritis in the
horse should be named the presence in the vessels of the larva of
the strongylus armatus. The posterior aorta and anterior mesen-
teric artery which are the most commonly infested by these para-
sites are frequently attenuated, dilated and calcified in this con-
nection.

Treatment. Acute arteritis should be treated like any other
local inflammation, by rest, soothing applications (fomentations,
astringents, icebags), and alkaline salts. It has been proposed
to manipulate the affected artery and contained thrombus, but
this can onl}^ tend to block the smaller arteries farther on, and
perhaps with even more injurious results. The liberal use of
alkalies on the other hand, if effective in dissolving any portion
of the clot, returns this to the blood stream in a condition that
will not endanger further embolism. The agents usually em-
ployed are carbonates of ammonia, potash or soda, and iodide of
potassium.

THROMBOSIS AND EMBOLISM.

Definition. Thrombosis — clotting in. the vessel. Embolism, blocking of
the vessel. Thrombus may form in any bloodvessel. Embolism occurs in
arteries. Clot follows the blood current. Causes of clotting — fibrinogen,
paraglobulin, fibrine ferment ; foreign bodies ; parasites ; air ; blood that has
been exposed, (transfusion; aerial germs ; disease germs ; chemical coagu-
lants; high and low temperatures ; I>reaches of endothelium ; congestion or
inflammation of the serosa ; stasis of blood and extensiou of clot ; ligature
near a branch vessel : deoxidation and carbonization of blood , marasmus ;
neoplasms ; traumas of the vascular coats. Infarction, causes of blocking ;
disintegration of clots, softening, liquefaction, ulceration, action of microbes ;
excess of white globules ; air; fat; parasites. Pathogenesis; complete oc-
clusion of vessel; infarction ; sequestrum; colateral circulation; embolism
of external iliac or femoral artery ; effects on pulse ; during rest ; atrophy ;
lameness comes on with exertion ; disappears underrest ; circulation inade-
quate to sustain active function. Embolism of internal iliac artery; efi'ect
on pulse ; on tail and pelvic organs. Embolism of axillary artery ; effect
on pulse, action, nutrition. Embolism of mesenteric artery ; verminous ;
effects on innervation and circulation ; spasms, congestions, paresis ; invo-
lution. Treatment : expectant ; alkalies ; gentle exercise, time.

Definitio)i. Thrombosis i.s the blocking of a blood vessel by
a clot formed in its interior by the deposition of layer above layer
on its inner coat.

Embolism is the blocking of a bloodvessel by a clot or other
solid body formed at a distant point of the circulation floated on
in the blood stream, and arrested when it reaches a vessel too
small to transmit it.

A thrombus may be formed at any point of the circulatory ap-
paratus (heart, arteries, veins) whenever the conditions are such
as to determine coagulation of the blood. An embolism on the
contrary is a disea.se of the arteries since in the.se the blood cur-
rent, proceeding centrifugally from the greater to the lesser, inev-
itably carries the moving solid to a point too narrow to allow of its
further progress. Thus clots originating in the .systemic veins
or right heart pass to the lungs atid produce embolism of the pul-
monary arteries whereas those formed in the pulmonary vein or
left heart are arrested in some part of the systemic arteries. Clots
formed in the portal vein however are arrested in the hepatic ves-
sels into which that trunk breaks up.
350

Thrombosis and Embolism. 351

Causes of Thrombus. The production of a thrombus may be
due to the condition of the blood or of the vessels. The researches
of Buchanan, Schmidt, Hammersten and others show that two
albuminoid elements, fibrinogen and paraglobulin, present in the
living blood, and a fibrine ferment mainly derived from the white
corpuscles iu process of change or destruction, determine power-
fully the formation of fibrine and clot. Hewson, Briicke and Lis-
ter have shown that blood may hz maintained fluid for many
hours iu an unimpaired vein, or turtle's heart tlicguh it may have
been removed from the body, the important condition bc;ing that
the vein shall retain its vitality and suffer no derangement of its
endothelium. Lister has even shown that blood may remain
fluid for many hours in a sterilized glass tube which has been
filled by passing the tube carefully inlo such a vein without dis-
turbing its lining membrane, or imparting motion to the liquid. In
such a case a thin film of coagulum only, forms on the interior of the
glass tube. In healthy blood, without addition of any extraneous
matter, and kept perfectly still, the plasma and globules retain
their integrity, and the former its fluidity for a length of time.
But if shed into a basin it coagulates at once.

a. Changes in the blood. Contact with foreign bodies generally
determines this change and prompt coagulation. Transfixing the
artery with a needle, even a silver one, the entrance of parasites
(actinomycosis, strongyli, filaria), the presence of pus, and of
certain infectious microbes and their products, the introduction of
solid particles i^aid even of air into the vessels, the transfusion of
blood which has been exposed to receive aerial germs, or which
contains microscopic clots, or the globules of which have become
modified by contact with a basin or other vessel, even the trans-
fusion of defibrinated blood may cause coagulation. The danger
is always greater if the blood is drawn from a different genus and
unfitted to live in the blood of the recipient. Disease germs are
especially dangerous if adapted to colonize the serosa of the ves-
sel and destroy its epithelium. A decrease of the density of the
blood favors coagulation, a lowering of one thousandth rendering
it syrupy, and various chemical agents induce or favor coagulation,
thus acetic acid, valerianic acid, alcohol, the salts of iron, and
above all the salts of lime act in this way. Very high and low
temperatures throw down the fibrine as a grumous precipitate, but
the clot remains soft.

352 Veterinary Medicine.

b. Changes i7i the vessels. Any disturbance or alteration of the
endothelium sets free the so-called fibrine ferment, and precipi-
tates coagulation. Lister found that contact of ammonia with
the interior of an otherwise living vein caused a thrombus. So in
all endarteritis and phlebitis coagulation takes place on the serosa
and quickly blocks the vessel. Even in the capillary vessels the
same principle holds, and in inflammation minute coagula
(thrombi) form in the capillary network throughout the whole
inflamed area. This explains not only the capillary blood stasis
but the thrombosis of inflamed arteries and veins. In these two
latter the clot increases and extends in the direction of blood
stasis : — in the artery toward the heart as far as the next colateral
branch, and in the veins away from the heart as far as to the next
colateral trunk. On the distal side of the arterial thrombus the
blood flows off freely toward the capillaries, but on the proximal
or cardiac side it is absolutely stagnant up to the next branch
through which it can freely flow into the capillary plexus. Into
this stagnant blood the fibrine ferment, produced by the altered
white globules in the clot already formed, slowly extends until
the whole has formed a firm coagulum. Beyond this the actively
moving blood carries off and dilutes this ferment so rapidly that
it can exert no appreciable effect on the fibrine-forming elements.
The principle is an important one in surgery, as the clot formed
entad of the ligature will be extensive in proportion to the dis-
tance from the first colateral trunk, and in inverse proportion to
this clot will be the danger of secondary haemorrhage. In veins
the same rule holds, with this difference that as the blood is flow-
ing toward the heart it empties the vessel on the cardiac side, and
stagnates on the distal side up to the next colateral branch.
Hence it is that a thrombus in a vein always extends away from
the heart, while that of the artery extends toward it.

Another cause of coagulation is the deoxidation of the blood
and the excess of carbon dioxide. This occurs in the .stagnant
blood in the vessels and above all in the capillaries. The normal
trophic changes in the serosa, fail to take place in contact with
blood in this .state, and the resulting changes in the white and
endothelial cells set free fibrine ferment and determine coagula-
tion. Stasis of the blood from any cause (ligature, pressure, em-
bolism), tends to this condition and the extension of the coagulum.

Thrombosis and Embolism. 353

A thrombosis of marasmus has been observed in anaemic and
debilitating diseases, and apart from the microbian invasions in a
certain number of those affections, this may be looked on as due
in part to the lessened density and other changes in the blood and
to the debility of the serosa of the vessels.

The compression of the vascular walls or their penetration by
neoplasms, tumors and ulcers, is another cause of coagulation and
thrombus, also a varicose or aneurismal dilatation, with weaken-
ing of the vascular walls, or dilatation of the heart with structural
changes in the endocardium as stated under that heading, or
compression of the smaller vessels and capillaries by an exudate
in process of organization, or a similar obliteration under the ac-
tion of extreme cold. Injury to the serosa of the vessel by
stretching, bruising, laceration or section determines a thrombus
starting from the injured endothelium. In the smaller vessels
the thrombus is usuall}^ deep red from the entangling of a large
quantity of red globules, whilst in the larger arteries the greater
part of the globules pass on and the coagulum is largely buff or
straw colored.

Again in obstruction in the smaller arteries, the inactive capil-
lary plexus and the tissue beyond are liable to become gorged with
blood with excess of red globules, from the adjacent capillary net-
work, constituting infarction, and ending in gangrene. In cases
in which this is prevented by the action of intense cold the part
may remain pale, as white infaj'dion.

Causes of Embolism. As already stated embolism results from
a detached portion of a thrombus passing to a smaller vessel and
obstructing it. Such detachment is favored b}^ molecular softening,
liquefaction or suppuration in the clot or beneath it, by the de-
structive action of microbes, or by friction or manipulation of the
ob.structed vessel. Excess of white globules (leukaemia) favors
the formation of minute coagula and embolism. Bubbles of air,
globules of fat, or cholesterine crystals block the fine pulmonary
capillaries, and the debris from atheromatous patches, ulcers, and
tumors opening on the inner wall of the artery form emboli in
various parts. Finally parasites, especially the larval strongydi
in solipedes and filaria and spiroptera in dogs, themselves obstruct
the vessels and determine coagulation.

Pathogenesis. In the larger arteries (aorta, radical stump of
23

354 Veterinary Medicine.

the mesenteric artery) clots (as from strongles) rarely produce
dangerous obstruction. In the smaller vessels stenosis is com-
plete and anaemia and gangrene are liable to occur unless the blood
supply is partially maintained by anastomotic vessels. When the
embolism affects a number of smaller arteries or capillaries in a
va.scular organ like the lungs, the blood filters in from the adja-
cent capillaries, in which circulation is still carried on, and this
passes through the softened and ruptured capillary walls so that
the tissue is charged with globules and constitutes a black infarc-
tio?t. In the lung this usually affects one or several lobulettes,
forming a pear shaped mass corresponding to the distribution of
the obstructed vessel. The cut surface is black, compact and
granular. The lymph thrown out around it forms an organized
fibrous sac, and the unclosed sequestrum undergoes a slow necro-
biosis, blanching and liquefaction into a pus-like fluid which is
removed by absorption. Such results are met with in the paren-
chymatous organs (lungs, liver, spleen, kidneys, etc.) and less
frequently in the limbs. The symptoms will correspond to the
particular organ invaded.

In the fore or hind limbs the result is usually less radical. The
vessels below the obstructed trunk are connected more or less
freely by anastomosing branches, so that the circulation in the
tissues below, though somewhat restricted, remains active enough
to sustain a fair measure of nutrition. Apart from the suffering,
attendant on the preliminary inflammation, the morbid phenomena
are largely confined to the absence of pulsation in the lower part
of the limb and the inability of the muscles to sustain active con-
traction.

Chronic Embolism of the External Iliac or Femoral Ar-
tery. In this condition the pulsations in the digital arteries are
imperceptible, if it has been of long standing there may be obvious
atrophy of the muscles of the thigh, but when standing quietly or
walking there is usually no lameness. In continuous rapid walk-
ing and above all in the trot, however, he soon begins to halt on
the affected limb, and this rapidly increases, the joints bending
under his weight, the toe dragging and the animal threatening to
drop altogether. If stopped and allowed to rest for ten or fifteen
minutes he gradually recovers and may be led quietly back to his
stable without a .sign of lameness. But if again trotted fifty or
one hundred paces the lameness develops anew and disapppears in

Thrombosis and Embolism. 355

the same way when left at rest. The circulation in the muscles
is enough for a moderate nutrition but altogether inadequate to
sustain active work.

Chronic Embolism of the Internal Iliac Artery. Inthisca,se
the control of the muscles of the limb may be perfect but there is
some indication of paresis of tail, bladder, rectum and anus. Im-
paction of the rectum is liable to occur. By examination through
the rectum the pulsations are felt to be strong in the aorta and ex-
ternal iliac, but imperceptible in the internal iliac blocked by the
embolus.

Chronic Embolism of the Axillary Artery. Here there are
the same general symptoms, the absence of the radial and digital
pulsations, the wasting of the muscles of the forearm, and the
intermittent lameness, developed rapidly by exercise and recover-
ing promptly under rest.

Acute Embolism of the Mesenteric Arteries. This will be
fully treated under the title of verminous colic in solipedes. The
blocking of the branches, usually of the anterior mesenteric
artery, leads to derangement of the innervation, congestions,
spasms, involutions and other disorders. The presence of the
strongyli in the fgeces, the general symptoms of intestinal worms,
and the recurrence of the indigestions and spasms would .serve to
indicate the nature of the complaint.

Treah7ient of Chronic Embolism . As affecting the arteries of the
limbs the repair must be largely left to nature, and we must place
the patient in condition, favorable to such repair. Except in the
early stages absolute rest is not necessary. Gentle exercise stim-
ulating to a freer circulatoin solicits a slow enlargement o£ the
anastomosing vessels (arterial or capillar)^), and when this has
reached a given stage, weak pulsations may again be felt in the
vessels beyond and the muscles will once more stand moderate,
work without lameness. Alkalies and iodide of potassium may
be given to solicit solution of the clot, but this can rarely be
counted on to the extent of rendering the vessel once more per-
vious. A small paddock in which the patient can move around
quietly is desirable, and in a few months a tolerable recovery may
have taken place.

Embolism in other organs must be treated on the same general
expectant method, and a considerable time is usually necessary to
secure a fair recovery.

ANEURISM.

Definition. Divisions, true, false, dissecting, arterio-venous, mixed,
traumatic, spontaneous. Causes, violence, rupture, debilitated vascular
walls, strains, stretching, force of blood current, overloaded intestine, strou-
gyli, contiguous inflammation, embolism, microbian invasion of the walls,
arteritis, concussion. Symptoms, soft tumor pulsating with the heart, a
double rushing sound, diagnosis from abscess, nervous disorders through
pressure, cramps, palpitations. Treatment, when desirable, rest, moderate,
laxative diet, iodides, bromides, icebags, compression, ligature, galvano-
puncture, wire coils, injections.

Definition. A pulsating swelling on an artery, consisting of a
sac filled with arterial blood.

Divisions. A true aneurism (aneurism by dilatation, ar-
teriectasis) is a simple dilatation of the artery, the tumor being
surrounded on all sides by the distended arterial walls. It is
usually fusiform or cylindroid, but may have the form of a more
or less rounded sac.

A false aneurism is where the wall of the artery has been
lacerated and the blood is enclosed in an adjacent sac of con-
densed connective tissue and communicates • with the interior of
the vessel. The same name has been given to cases in which the
inner coat only has given way, and the middle and outer coats
constitute the walls of the sac. From its liability to extend and
separate the tissues this is further known as a dissecting aneur-
ism. Arterio-venous aneurism in which an intervening sac
communicates with both artery and vein, has been found in the
human subject.

Mixed aneurisms are those in which a dilatation of the artery
is complicated by the presence of an outside pouch.

A distinction has also been made according to origin into
traumatic and spontaneous. The former is of necessity false,
whereas the latter may be false or trjie.

Causes. Apart from rupture of the arterial coat by direct vio-
lence, the common cause is a debility and loss of resistance in the
walls. In horses a far larger proportion of aneurisms are deep-
seated than in man, in whom forced muscular effort is less com-
mon. Yet even in horses the most common seat — the posterior
aorta — is liable to overstretching and to inflammation and soften-
ing by reason of contiguity to dorsal sprains. The posterior
356

Aneurism. 357

aorta too, from its size and direction on leaving the heart, is in
the direct Hne of the strongest blood current, and under long con-
tinued, forced and violent efforts (as in racing, hunting, and
heavy uphill draughts), has to sustain an extraordinary blood
pressure. Bouley claims as an additional cause the pressure of a
loaded colon. This is also the point of all others where the ves-
sels suffer from the presence of the larval strongyli. From what-
ever cause originating, congestion of the arterial coats leads to
more or less attenuation, softening or lack of cohesion, and they
tend to yield under the blood pressure. Similar conditions op-
erate on the smaller vessels in different parts of the body, and
thus overstretching, contiguous inflammation, and excessive
blood pressure cause such lesions in the chest, trunk and limbs.

Another cause is embolism which by blocking an arterj^ at once
increases the tension in the vessel on the cardiac side of the ob-
struction, and develops inflammation in the arterial coats, robbing
them of their cohesion and resisting power.

Eppinger has shown the importance of infectious microbes in
weakening the arterial walls and predisposing to aneurism.

The larval strongylus armatus already referred to is the most
potent factor in solipedes. They accumulate in the anterior
mesenteric artery, leading to clotting of the blood, inflammation of
the serous coat, and dilatation, so that in some verminous locali-
ties nearly every old horse shows a lesion of this vessel.

All forms of arteritis, and disease of the vascular walls which
entail attenuation or weakening, predispose to aneurism.

Of direct traumatism may be mentioned an aneurism of the
arch of the aorta in a horse struck b}^ a wagon pole, during a sharp
descent (Jacob), and two with aortic aneurism after violent blows
on the back with shafts of wagons.

Symptoms. An aneurism within reach of the hand is to be
recognized primarily by the pulsation of tlie swelling synchron-
ously with the beats of the heart, and by a double rushing sound
with each beat of the heart, observed on auscultation. An ab-
scess over a large artery lying on a bone may puLsate but it is to
be distinguished b)^ the presence of a single in place of a double
rushing sound on au.scultation, by the possibility of causing more
or less complete collapse under pressure, and by the history of an
active phlegmonous inflammation followed by softening which
steadih^ extends from the centre of the previously dense mass.

358 Veterinary Medicine.

In a case of aneurism of the gluteal artery of the horse reported by
King and in one observed by the author the symptoms were unmis-
takable. Other similar examples on the popliteal artery and other
failed to be recognized during life though attended by lameness.

In internal aneurism the symptoms are mostly indefinite. Olli-
vier found tympany and vomiting in a goat which at the necropsy
showed an aneurism of the anterior aorta as large as the closed
fist and enclosing a sewing needle. A more careful diagnosis
should have detected a retarding of the maxillary pulse and a
double rush over the carotid with each beat of the heart. Pres-
sure on the vagus doubtless led to the symptoms noticed. In
aneurism of the posterior aorta there have been noticed a loss of
life and energy, dulness, lack of appetite and stiffness of the loins.
Torpor of the bowels, expulsion of faeces with effort and groaning,
intermittent colics, lameness in one or both hind limbs, and finally
cramps in the hind limbs, and palpitations. In one case Maillet
was able to reach the aneurismal tumor through the rectum.

Treatment. The treatment of internal aneurism will be seldom
called for in the lower animals, as the disease is seldom diagnosed,
is beyond reach of mechanical applications, and survival without
certain power of endurance would seldom be desirable. In some
valuable breeding animals it might be worth while to seek pro-
longation of life. The most promising measures are absolute
rest, and low, non-stimulating diet of a laxative nature and in
small bulk. Iodide of potassium is often useful in man, and al-
though in the lower animals there is not the excuse of specific
disease, yet the rest to the circulation and reduction of blood ten-
sion are not to be undervalued. Bromides may be given with the
same object.

Other measures applicable only to aneurisms, within reach and
essentially of a surgical nature include : Ice bags and com-
pression. The compression should as a rule begin at the distal
end of the limb and be concentrated by suitably shaped pads on
the swellings. Ligature of the diseased artery above or below or
both above and below the tumor. Galvano-puncture of the aneu-
rism with the object of inducing coagulation. The introduc-
tion of coils of fine wire through a hypodermic needle with the
same object in view. In both horse and dog the persistent com-
pression with the finger seconded as it is by the plasticity of the
blood has succeeded in checking the flow from large arterial

A i'te7-io- Sclerosis. 359

orifices, and offers great encouragement in the application of
this measure to aneurisms. The injection into the sac of tincture
of chloride of iron with firm compression to prevent motion of the
blood is another available resort.

ARTERIO-SCI.EROSIS.

Fibrous thickening of the arterial coats and calcification are
well known lesions in the posterior aorta particularly of the horse.
Commencing in congestion or degeneration which lessens the re-
sistance of the vascular walls, the condition tends to dilatation, and
if this is checked by compensatory thickening, the condition of
.sclerosis is induced. The combination of a slight fusiform dilata-
tion and fibrous or calcareous sclerosis is well known in the pos-
terior aorta of the horse. Unless it advances to marked aneuris-
mal dilatation the condition is not often recognized. If diagnosed,
rest and quieting of the circulation are especiall}^ indicated.
Should it occur in other parts of the body the symptoms would cor-
respond to the organ invaded.

AXGEIOMA. CIRCOID ANEURISM. ANEURISM BY
ANASTOMOSIS. VENOUS TUMOR. NCEVUS.

These are forms of dilatation and elongation of the network of
small arteries, or veins, and even of the intervening capillaries.
In man these constitute the unsightly red patches and swellings
that appear on the face and hands. In animals with dark skins
a-id hairy covering they can only be recognized by the .swelling,
the feeling as of a bag of worms when the hand is pa.ssed over it,
and by the rushing sound when auscultated. The trouble is us-
ually .subcutaneous and is essentially a surgical one. The most
promising treatment is by persistent pressure, by electric current
supplementing the pres.sure, by electro-puncture, and by injec-
tions of muriate of iron. When the noevus is not too extensive
a double thread drawn by a needle through beneath the tumor at
.short intervals, then cut and each point tied separatelj^ so as to
completely stop circulation is most effective.

PHLEBITIS.

Divisions, traumatic and idiopathic. Causes, punctures, defective blood
supply in walls, debile coats, thrombus, infection, overstretching, injury or
disease of serosa, irritants in blood, microbic infection. Lesions, exuda-
tion, cell growth, breaches in serosa. Adhesive phlebitis, desquaniaiion,
granulation, occlusion. Suppurative phlebitis, infection, pyaemia, erysip-
elas, metritis, ulceration, neoplasms, phlebolites. Symptoms, local, firm,
corded, swollen vein, extends entad, venous congestion, dropsy, gangrene,
diagnosis from lymphangitis. Fever, venous congestion in vicinity.
Treatment, germicide, rest, cold, antiseptics, blisters.

Inflammation of veins as seen in the lower animals has usually
been a sequel of bleeding and is hence a purely surgical lesion.
Animals as well as man however are subject to idiopathic phlebi-
tis which as affecting the deeper seated veins may be held to be a
medical subject.

The causes of idiopathic phlebitis are varied. Injury to the
walls like the punctures made in bleeding; if they result in the ex-
posure of a raw, and above all an inflamed, surface to the blood,
tends to the formation of a thrombus, and of local inflammation.
Even the inflammation of the outer coat tends in the same way
to thrombosis and phlebitis, and the experiment of Nicas.se
showed that the dissection of its sheath from a vein, thus robbing
it of its vascular and nervous supply promptly induced coagula-
tion of the blood in the denuded part. The debilitated or devi-
talized walls evidently give off fibrinogen and fibrine ferment in
amount that is incompatible with the maintenance of fluidity. All
other forms of direct injury to the veins, leading to disturbance
of the endothelium or cell enlargement or exudation intheintima,
will operate in the same manner. Sometimes as in puerperal
phlebitis the inflammatiou extending from the adjacent tissue to
the walls of the veins, determines thrombosis, and the invasion by
pus microbes determines suppuration. Bruises, over-.stretching,
pressure with over-distension, and the circulation in the blood of
irritant matters may lead to changes in the wall, thrombus, and
inflammation. Such irritants may be septic or other bacterial
products, or they may arise from the colonization of bacteria on or
in the venous coats with the same final result.
360

Phlebitis. 361

The lesiojis in the vein are often primarily of the nature of exu-
dation and cell growth in the coat, without at first any change in
the serosa or endothelium. L,ater the changes implicate those,
thrombosis follows and one of various ulterior processes.

In adhesive phlebitis which is most frequent as the result of
purely mechanical injury, the endothelium is disquamated and
granulations from the denuded surface extend into the clot and fi-
nally occlude the vein. A recovery takes place by the organiza-
tion of this new product and the contraction of the vessel into a
simple fibrous cord.

In suppurative phlebitis, which occurs especially in connec-
tion with infection (erysipelas, metritis), the inflammation,
though starting in the same way in the vascular coats, advances
rapidly to suppuration, and the intima, lying in contact with the
resulting thrombus may become itself the seat of the suppurating
process. Cases of this kind are almost of necessity in the nature
of an infection and the danger is greatly enhanced. Small ab-
scesses formed in the vascular coats may burst into the vein and
passing on with the blood produce general infection (pyaemia).
Even when the pus enters the vein at a point covered by the
thrombus, it may escape by the partial loosening of the clot from
the serosa, or through the interior of a honey-combed coagulum
and thus lead to general infection. This is especially liable to
follow in erysipelas and metritis, in which the tendency as in the
solid tissues is to diffuse suppuration without any investing limit-
ing membrane. There are other forms of bacterial colonization
of the vascular walls, of ulceration, and of the extension of mor-
bid growths into or through the venous walls, producing inflam-
mation niDre or less localized, and leading or not to general
infection. The presence of phlebolites in the vein is a conceiva-
ble source of phlebitis, though no such case has been so far
recorded.

The sympto7ns in localized cas;s of simple adhesive phlebitis
may be purely local. The vein if within reach may be felt like
a firm, rounded cord, which extends in a direction from the heart.
If there are no free anastomosis with neighboring veins on the
distal side of the thrombus, venous congestion and dropsy of the
tissues ensue, and in some cases moist gangrene. When, how-
ever, such anastomosis is abundant these peripheral symptoms

362 Vetci'inary Medicine.

may bs absent, especiall}^ if the affected vein returns blood from
a higher level than the heart, and then the symptoms are confined
to the vein and its immediate surroundings. From lymphangitis
which shows similar hard cords, it is distinguished by the absence
of an extended network of diseased vessels, by the lack of a
diffuse, doughy swelling, and by the fact that the adjacent lymph
glands remain free from inflammation, pain and swelling. In the
more extended cases there is fever, which may be of a very high
type and may merge into pyaemia. In deep-seated cases it may
be difficult to identify the disease, but it may be suspected if in
the course of erysipelas or metritis there is a sudden increase of
fever with pain and swelling, and distension of veins leading into
the part.

The treatment of idiopathic phlebitis is largely that of the par-
ticular infecting disease on which it depends. In simple cases
due to trauma absolute rest and the application of ice and anti-
septic solutions, or where these cannot be applied, the u,se of anti-
septics internally, will be indicated. Hyposulphite of soda and
sulphide of calcium are especially indicated. From the early days
of veterinary medicine, flying blisters of Spanish flies, over the
inflamed vein or veins have proved very successful, and under
the lead of Nonat the .same was in 1858 and .since adopted with
gratifying .success in the human subject. Abscesses formed in
accessible .situations should be promptly opened and treated anti-
septically, and swelling of the affected part should be checked by
elevated position, or if that is impossible, by a smoothly applied
bandage. Rubbing and active movement are dangerous, as tend-
ing to detach clots which float off to start new emboli and inflam-
mations in the lungs.

VARICOSE VEINS. DILATED VEINS WITH
ALTERED WALLS.

Rare in animals. Angioma Varix. Superficial. Deep. Causes, ob-
structed circulation, compression, congestion. Symptoms, enlargement,
elongation, tortuosity of veins, stiffness, lameness, complications. Treat-
ment, compression, coagulants, cauterization, ligature.

Varix is not so common in the lower animals as in man, and is
generally observed in the superficial veins, so that it comes under
the domain of surgery. In the form of angioma, which affects
the veins, there is extensive dilatation and elongation, but it in-
volves a large group of connecting and anastomosing veins,
whereas varix usually affects but one or a few connecting vessels.
In the horse the most common seat of varix is in the saphena
vein, as it passes obliquely over the inner side of the hock. Less
frequently it appears on the flank or other superficial part. In
cattle the mammary veins are the most frequent seat. Varices,
however, occur also in deep-seated veins and in connection with
normal venous plexuses, as in the buccal, palatal, and peneal.
Anatomically they may be simple fusiform dilatations, as in the
saphena ; dilated, elongated and tortuous, branching trunks, as
in the mammary veins ; or dilated veins with thickened walls and
pouch like dilatations.

Caiises. There is usually some obstruction to the circulation
through the affected vessel, it may be by pressure by a tumor, or
a constrained position, obliteration by a phlebitis and thrombus,
extension of inflammation from adjacent organs, increased blood
pressure by gravitation, or from diseased heart or lungs.
Whether from the extension of contiguous inflammation, from
external pressure, or from blood tension, the morbid process has
much in common ; the circulation and nutrition in the vascular
walls are interfered with, degenerations set in (softening, fatty,
connective ti.ssue), which predispose to dilatation under the blood
pressure. The pouch-like dilatations of the jugular consequent
on bleeding, are essentially traumatic. The impaired innervation
which lessens the resistance of the vascular walls is not to be for-
gotten. Varix of the saphena is usually an attendant or sequel

363

364 Veterinary Medicine.

of tibio-tarsal synovitis, and is the result of combined pressure
and congestion. Mammary varices are manifestly connected
with the coagestion and exudations which affect the udder and
environment at the time of parturition, or with a casual
niammitis.

The symptoms in superficial vessels are visible enlargement,
and often elongation and tortuous direction of the vein or veins,
with or without tenderness. Deep-seated varicosities may be
attended by stiffness of the part and a halting in progression
with or without pain on pressure. These cases may recover
spontaneously as the result of adhesive phlebitis, or they may
develop phlebolites, suppuration, inflammation, ulceration and
haemorrhage.

Treatment. Superficial varices have been treated by compres-
sion, cauterization, coagulating injections, and ligature. It
is not often that interference is demanded but in such cases,
pressure with elastic bandage having failed, ligature with antisep-
tic precautions is indicated.

PHIvEBOIvITES. CALCAREOUS BODIES IN THE VEINS.

Nature. Location. Mode of formation. Calcareous plates in two inner
coats. Phlebotomy. Altered sanguification. Treatment. Extraction.

Calcareous bodies have been repeatedly found in the veins of
man and several observations of the same kind have been made
in the horse. Spooner found them in the abdominal veins and
Simmonds in the jugular. Much difference of opinion has ex-
isted as to the mode of formation of these bodies whether by cal-
careous deposit in a coagulum or by degeneration of a neoplasm
in the vascular wall. Andral held the latter opinion, and Tiede-
mann and Cruveilhier found the bodies connected to the inner
coat of the vein by a fine membrane. Morton's cut of one of
Simmonds' specimens (Calculous Concretions) shows a structure
in successive layers having their centre at one end, evidently cor-
responding to a former connection by pedicle. Cornil and Ran-
vier says ' ' .sometimes there are seen in chronic varices, calcare-

Hceinorrhage. 365

oils incrustations in the form of plates, nodules or spheres with
concentric layers . . . calcareous infiltration is seen in the form
of spheres or phlebolites in the varicose diverticula. An exten-
sive calcareous induration several centimetres in length, is also
sometimes observed, the vein being transformed into a calcareous
tube with the ramifications also varicose.

The calcareous plates of the vein are developed in the fibrous
and internal portion of the middle coat. At the beginnirig they
consist of granules deposited in the fasciculi of the connective
tissue or between them ; these soon unite and form transparent
plates with granular strise."

Phlebolites in the jugular suggest a connection with the pouch-
like dilatations, and transformations in the vascular walls that
have been subjected to phlebotomy. It is probable however
that there is usually a morbid condition of sanguification and nu-
trition which predisposes to their formation. In Simmonds' case
the jugular was impervious below the bodies, there was hepatitis
and arthritis of the fetlock joint.

When recognized during life these may be extracted with due
antiseptic precautions, if the vein can be dispensed with it may
be ligatured above and below, if not an attempt may be made to
preserve it, extracting through a clean cut longitudinal incision
and securing as perfect coaptation of the edges of the wound as
possible.

HEMORRHAGE.

Arterial, venous and capillary haemorrhage belong almost ex-
clusively to the domain of surger)\ Internal haemorrhages will
be considered in connection with the organs in which they take
place.

HEMOPHILIA.

Definition. Causes, lack of plasticity of the blood, thin walls, blood
tension, cardiac erethism, hypertrophy and neurosis. Sex. Heredity-
through the female. Treatment, depletive, styptic, astringent. Transfusion.

This is a constitutional infirniit}', usuall}' hereditary and char-
acterized by the occurrence of profuse and continuous bleeding as
the result of otherwise insignificant injuries or even apart from
any recognizable lesion. It has been attributed to a slow coagu-
lation of the blood, but at the start of a hseniorrhage the blood is
rich in corpuscles and coagulates firmly. It has also been as-
cribed to extreme tenuity of the vascular walls, but this has only
been met with in a certain proportion of the cases. Another po-
tent factor is a permanent over-filling of the blood-vessels (Tmmer-
mann, Delafield, Prudden). The same writers attach importance
to cardiac erethism, cardiac hypertrophy, and certain neurotic in-
fluences which temporarily increase the habituall}^ congestive di-
athesis. In man the majority of victims have been males, per-
haps becatise most subject to traumatisms. On the contrary the
hereditary transmission is mainly through the female members of
the family. The families are very prolific, a condition counter-
balanced by the death of the majority of the victims at an early
age. Among the lower animals it has been observed in horses
consequent on castration (Siedamgrotzky, Kohne, Friedberger
andFrohner), setoning (Kohne, Dieckerhoff), and an ulcer of the
leg (Kohne).

Treatment consists in combating plethora and constipation by
saline purgatives. The subject should be carefully protected from
injuries. Locally use styptics such as matico, muriate of iron,
tannin, alum with pressure. Internally ergot, lead acetate, iron
chloride, tannin, alum, or muriate acids. Transfusion is a denier
resort.

366

DISEASES OF THE BEOOD.

Obscurity of blood changes. Red globules, biconcave, embr\onic.
Source. Escape of immature red globules. White globules, eosinophile,
ueutrophile, uninuclear, multinuclear, lymphocyte, granular amoeboid, strap-
nucleated. Conditions of increase. Relation to microbes and their pro-
ducts. Blood plates. Destruction of red globules in the liver. Numbers
in animals, in different vessels and conditions.

The blood is the common medium through which all nouri.sh-
ment is conveyed to the tissues, all material to the glands for se-
cretion, or transformation, and all effete matter to the various
emunctories for elimination. It is beside the carrier of oxygen
for the respiration of the tissues, and the seat of changes, as yet
little known, effected through the white globules. The activities
of the various processes, carried on by the fixed tissue cells and
nuclei would suggest, that any disease or derangement of the.se
processes would be at once cognizable in changes shown in the
blood. Yet so perfect is the balance of sanguification and elimi-
nation on the one hand, and of the remaining vital processes oh the
other, that it has hitherto been impossible to detect in the blood
such changes as would identify the great majority with morbid
processes. Some morbid changes are however recognizable and
it is important that the significance of these should be known.

The blood is a liquid, con.si.sting of a plasma holding in solution
.serum albumen, serum globulin, fibrine-forming elements, sugar,
urea, .salts, and a variety of other .soluble bodies, and floating a
series of semi-solid organized bodies, the red and white globules.

The red globule is however seen in two distinct forms, ist.
The biconcave disc, non-nucleated, containing a colorless .stroma,
and the coloring matter — haemoglobin. 2d. The embryonic red
globule, large, nucleated and rarely biconcave. The latter is found
in the blood of the fcEtal man or animal and persists to a slight
extent for .some time after birth. These are believed to be formed
from the embryonic cell and from the cells of the embryonic liver,
spleen, and marrow, whereas afterbirth they are derived from the
marrow cell, and in healthy conditions pass the nucleated stage
before they escape into the blood. In pathological anaemia and

367

368 Veterinary Medicine.

after severe haemorrhages the}' escape more rapidl}^ probabh- from
both spleen and marrow, and appear in the blood, even of the
adult, of the gigantic size and nucleated appearance of the embry-
onic red globule.

The white blood globules (leucocytes) are spherical, about
twice as large as the red globules, and are readily divisible by tlie
acid eosin stain into two kinds : ist. Cells which are deeply
stained by eosin — eosinophile ; and 2d. Cells that do not take on
the eosin stain —neutrophile (Ehrlich).

Howells further divides these white globules into uninuclear
and multinuclear. Of the uninucleated he describes three varie-
ties : a. The lymphocyte which is non-granular and without amoe-
boid movement ; b. The granular cell with a plotoplasmic envel-
ope and amoeboid movement ; and c. The granular with strap-
shaped, horseshoe or spiral nucleus. Like Lovet he considers
the multinucleated as on the way to disintegration.

We cannot as yet speak with confidence of the pathological .sig-
nificance of these respective forms of white globules, but they in-
crease greatly in numbers in connection with certain diseases of
lymph plexus, and glands, of the spleen and other blood glands,
and in foci of inflammation, and they perform most important
functions in connection with the resistance of microbian invasion
and in elaborating the antitoxines which confer immunity from
second attacks.

The next form of blood solids are the blood-plates of Bizzozero,
the haematoblasts of Hayem. These are nucleated (Semmer) dis-
coid, le.ss than half the diameter of the red globules, and cluster
together in granule masses when the blood is drawn. Their true
significance is uncertain though it has been .surmised that they are
intermediate corpuscles (Semmer), that they are the disintegrated
nuclei of the leucocytes, and that they furnish paraglobulin to the
circulating blood (Schmidt, Howell).

The liver is one centre for the destruction of red blood globules
and in the blood of the hepatic vein there may be a reduction of
a million to a million and a half of red globules per cubic centime-
ter, as compared with the portal vein.

Malassez gives 4,500,000 as the number of globules in a cubic
miUimeter of blood (dog and horse 7,500,000, Nocard). The
white globules are to the red in the proportion of about i to 300

Plethora. PolycBinia. 369

(domestic animals i : 800, i : iioo, Nocard). The variation in
different parts of the vascular system and at different times of tlie
day is striking and suggestive.

In the blood of the splenic vein i : 60 ; in the hepatic vein
I : 170 ; in the portal vein i : 740 ; in the morning, fasting i : 716 ;
half an hour after breakfast, i : 347 ; in boys i : 226 ; in girls
I : 389 ; in men 1:346; in old men 1:381; in menstruating
woman i : 247 ; in pregnant woman i : 281, (Strieker).

PI.ETHORA. POIvY^MIA.

Definition. Transitory only. Causes, kidney disease, drinking freely,
rich feeding, profuse secretion, polycythemia, hyperalbuminosa, excess of
fibrine, sugar or fat. Ratio of blood to body. Variations of globules.
Symptoms, general, local. Appearance of blood. Prevention. Treat-
ment.

Defi7iition. An excess of blood, of the blood globules, or of
the albuminoids.

Formerl}^ accorded an important place in pathology, plethora
has been entireh' eliminated from some recent works. The actual
amount of blood varies greatly at different times, rising after a
free consumption of food or drink, and falling during a period of
abstinence. A healthy activity of the secretory and excretory
organs secures a fair uniform average in the plenitude of the cir-
culatory system. Moreover, large variations are not in them-
selves rapidly injurious. Worm-Miiller and Cohnheini intro-
duced into dogs ten to twelve per cent, of the body weight (fifty
to eighty per cent, of their blood) of canine blood without induc-
ing fatal results. More than this was fatal. In non-fatal cases
a reduction to the normal standard is speedily secured.

But we cannot count on absolute immunity in all circumstances.
Disease of the kidneys, or drinking water to excess, determines a
surplus of water and urinary salts (serous plethora, polyaemia
aquosa). In cases of rapid gain in condition from rich feeding,
and above all after profuse watery .secretion (diarrhoea, diuresis,
24

370 Veterinary Mediciiie.

perspiration), the red globules are relatively increased (plethora
polycj'thsemica). After hearty feeding there is a large increase
of albumins (plethora hyperalbuminosa). Fibrine-fonning ele-
ments are apparently in excess during rheumatism, pneumonia
and other acute inflammations. Sugar is in excess after a sac-
charine or farinaceous meal, fat in obese individuals, after con-
sumption of fat, after injuries to the bone marrow,, and after
severe diseases with much destruction of albumen.

The ratio of blood to the body weight is : In birds 1:12 ; in
Guinea pig 1:19; in rabbit 1:20; in cat 1:21 ; in dog 1:17 ; in
horse 1:18 ; in sheep 1:24 ; in pig 1:26 ; in ox 1:29 (Colin). As
showing the variation under even different normal conditions of
the system Bollinger found the blood but 2.2 per cent, of the
body weight in a fat pig, whilst it was 13.5 per cent, in a draft
horse. Colin found it 2.4 per cent, in the fat ox instead of the
usual 3.4 per cent.

The excess of red globules and usually also of albumins is seen
as a temporary condition, in lean but vigorous animals put sud-
denly on an abundant diet, rich in assimilable albuminoids, in
working animals, put in confinement to feed, and above all in
high conditioned cows after an easy parturition, when the uterine
blood has been suddenly thrown on the general circulation and
the emunctories have failed to establish a balance. Also in the
lymphangitis occurring after a day or two of rest, in a horse that
has been hard worked and heavily fed.

It should be borne in mind that the number of red globules
varies considerably in the different animals. In the dog it was
by weight 148.3 grammes per 1000; in the pig 105.7; ^^ the
horse 102.9; in the ox 99.71, and in the sheep 98.2 (Andral,
Gavarret, Delafond). By count the horse has 5,500,000 per
cubic millimeter (7,500,000, Nocard) ; and the dog 5,000,000.

Symptoms. Under a sudden dangerous increase of the volume
or the organic elements of the blood, there are usually dulness,
lassitude, dropping of the head, strong, full, hard pulse, extra
force in the heart beats, thirst, elevated temperature, and redness
of the visible mucous membranes. At first there is no indication
of local disease, but unless relief comes by free secretion some
local complication is likely to ensue. This may be epistaxis, con-
gestion or apoplexy of the brain, parturition fever, lymphangitis,

Hydrocemia. Ance^nia Oligczniia. 371

or congestion of some internal organ, etc. A drop of blood colors
deeply the finger or other object, it clots firmly in three to five
minutes, and shows more than usualof a buffy coat.

Treatment. As dangerous plethora is usually a very transient
condition the main attention should be given to prevention , in
keeping the diet low and the emunctories active in high condi-
tioned parturient cows ; in lowering the diet and securing free
secretion, or in giving exercise to high fed, hard worked horses
that have been laid off work ; in changing only by slow grada-
tions thin, vigorous animals to a rich diet, etc. When the danger
is imminent prompt relief can be secured by the liberal abstrac-
tion of blood. Purgatives, diuretics, and restricted diet may be
applied to less urgent cases.

HYDRO^MIA. ANEMIA OIvIG^MIA.

Definition. Causes : bleeding, watery repair, hydrosetnia, repair of glob-
ules, changes in red globules, in bone marrow. Cause of chronicity : pro-
fuse secretions, ; moplasms ; parasites ; chronic exhausting diseases ; de-
fective diet or hygiene ; diseases of jaws or throat : overwork : toxic sub-
stances. Symptoms : pallid mucosas, weakness, perspiration, soft tissues,
small pulse, palpitation, anaemic heart — arterial and venous murmurs, depi-
lation, indigestion, costiveness, urine clear, abundant, emaciation. Lesions :
blood poor in globules, embryonic, and other abnormal red globules, fatty
degeneration, blood-clot. Treatment : remove causes, diet, hygiene, sun-
shine.

Definition. Bloodlessness ; Deficiency of blood ; I^ack of red
blood globules. The last named is the condition to which the
term is habitually applied.

Causes. Anaemia is not so much a disease, as a result of a
great many debilitating and exhausting conditions. Haemorrhage
the most direct cause of anaemia determines at first an actual lack
of blood (oligaemia) and of blood pressure, which may be suffi-
cient to cause fainting and death. In case of survival the amount
of blood is rapidl}^ made up by absorption from all available
sources of liquid in the economy, but the blood so restored is es-
sentially hydroaemic having an excess of water and a lack of glob-

372 Veterinary Medicbie.

iiles and dissolved solids. If however the loss has been moderate
the quality may be restored in a few days. Buntzen found that
after moderate bleeding the volume is restored in a few hours ;
after a profuse haemorrhage in 24 to 48 hours. After bleeding to
I.I to 4.4 per cent, of the body weight the increase of the red
globules may be noticed after 24 hours, and is completed in 7 to
34 days. It is noteworthy that during this repair the bone mar-
row becomes much redder and more cellular, and that new red
cells found in the blood are nucleated (Neumann) and contain
less haemoglobin (Ott). The absence of haemoglobin is nearly in
proportion to the amount of the haemorrhage (Bizzozero, Sal-
violi). If the haemorrhage is slow and continuous this repair is
counterbalanced and the anaemia is much more persistent.

Profuse secretion as of milk (cows, goats, ewes, bitches, on
poor feeding), of liquid faeces, urine, or pus often determine a
marked and even dangerous anaemia.

The rapid growth of multiple tumors as of melanosis in gray
horses has been noticed to cause profound anaemia (Bouley).

Perhaps no cause is more potent than the attacks of parasites
and especially such as live by sucking the blood. The numerous
strongyli of the lungs, stomach, and intestine, the tricocephalus,
and allied round worms, the trematodes of the liver, and the cyto-
dites of birds furnish striking examples of the bloodless and de-
bilitated condition which they may produce. In man ankylosto-
mata causes anaemia in Egypt, Italy (St. Gothard) and elsewhere,
and bothriocephala in different countries.

Chronic exhausting diseases especially those which affect
the digestive organs and mesenteric glands are prolific causes. So
with Bright's disease.

Connected with these are defects in diet or hygiene. Starva-
tion, unsuitable, innutritions, or indigestible food, too laxative
food, damp, dark, draughty or unventilated stables, and irregu-
larity in feeding, watering and work are all potent factors in in-
ducing anaemia.

Diseases of the masticatory apparatus (broken jaw, dis-
eased teeth,) preventing the preparation of food, and pharyngeal
troubles interfering with deglutition are other causes. Finally
overwork is not to be forgotten.

Toxic anaemia may occur from the ingestion of lead, mercury,
or arsenic.

Hydrocemia. Ancsmia Oligcemia. 373

Symptoms. These may be little marked at the outset in slowly
developing cases. Extra pallor of the mucous membranes,
fatigue and even breathlessness on slight exertion, a small, weak,
pulse, with a tendency to become rapid, with violent heart beats,
when excited.

At a more advanced stage the mucosae, especially the buccal,
are pale and thin, the muscles are soft, flabby and weak, fatigue
and perspiration are easily induced, the feet are advanced more
nearl}^ in the median line of the body, and the toes strike on any
obstacles, the pulse is weak, small and quick, and the heart easily
excited even to palpitation, and with an occasional anaemic mur-
mur with the first heart sound. Arterial and venous murmurs
may be present. The hairs are easily detached. Appetite
and digestion fail, there is costiveness, a full secretion of
urine of a clear aspect, the subcutaneous fat disappears and the
skin feels thin and limp (paper skin in sheep), the hair dry and
lusterless, the wool flattened (clapped). The weakness and
emaciation go on increasing and dropsies appear in the limbs, un-
der the trunk and jaw and in the internal cavities.

Pathology. Lesio7is. Apart from the causes, the morbid condi-
tions are mainly found in the blood. The watery state of the
blood, the lack of red globules (even to but 2,000,000 per cubic
millimeter), the absence of albumen (76 per 1000 in place of 83),
the loose coagiilum with excess of buffy coat, and the excess of
serum are characteristic. The presence of large, nucleated
(myelogenous) red cells, of spherical bodies smaller than the
normal red cells (microcytes), and of irregularly shaped red
calls (poikilocytes) is characteristic, the latter especially of
pernicious anaemia. As the disease advances fatty degene-
ration of heart, liver, kidneys, and other organs are compli-
cations and tend to aggravate the disease, by counteracting repair
of the globules — thus establishing a vicious circle. All the organs
are pale and flaccid, the arteries empty, the veins contain a little
blood, forming pale clots. In the cases considered, all the result
of another disease, the lack of blood and of the solid and vital
elements in that which remains, entails itnperfect function in all
the vital processes, including sanguification itself, and in this way
an anaemia once established tends to perpetuate and aggravate
itself.

374 Veterinary Medicine.

Treatment. The anaemia above considered being largely symp-
tomatic, or resultant from other diseases, the first consideration as
regards both prevention and treatment is to prevent or cure such
diseases. Where dietetic or hygienic, a liberal diet, and good
hygiene will meet every demand in the early stages. In the
warm season an open air life is most important. In case of a
drain by over-secretion (milk) this must be judiciously checked.
In bitches it will often be needful to wean several of the puppies.
A rich and very digestible diet (oats, beans, linseed, oil meal,
milk, gruel), in .small compass, and suited to the genus and indi-
vidual, with iron and bitters, and in the herbivora carminatives,
will suit many cases. Muriate of iron, with stry china or nux
vomica ; iron .sulphate, sodium chloride and nux ; or dialysed
iron, or some other soluble ferruginous salt, with quinia, gentian,
or some other bitter will serve a good purpose. For the dog
saccharated carbonate of iron or citrate of iron and ammonia with
quinia or strychnia, in pill form,. is convenient. With poor diges-
tion muriatic acid and pepsin may replace the iron at first. Beef
teas may often be given with advantage, even to the herbivora,
and injections of defibrinated ox blood night and morning have
proved of service. In extreme anaemia, as from haemorrhage,
transfusion, or its equivalent, must be resorted to. A normal
saline solution (0.6 per cent. NaCl), boiled, may be thrown into
the peritoneum or subcutaneous connective tissue, or defibrinated
blood, may be injected into the peritoneum. Transfusion is the
dernier resort.

PROGRESSIVE PERNICIOUS ANEMIA. IDIOPATHIC
ANEMIA.

Definition. Causes, obscure, faulty diet, hygiene, microbes, glycerine,
pyrogallic acid, haemoglobin, deranged sanguification, parasitisms. Symp-
toms, of ancemia of obscure origin. Treatment as for anaemia, special
measures, for intestinal fermentations, dietetic.

Definition. Anaemia which is without any pre-exi.sting appre-
ciable cause.

Causes. As in the corresponding disease in man the real start-
ing point of pernicious anaemia is unknown. Faults in diet and
in general hygiene have been adduced, and while in Berne this
appears to be sustained, in Ireland, in the poorest classes, the disease
is little known, and in Montreal, it find its victims largely in a
class of well to do arti,sans (Osier.) In the domestic animal it is
described on all soils, and on the most varied dietary (Bouleyand
Reynal). Zschokke and Friedberger and Frohner in cases oc-
curring enzootically in stables, found a minute bacillus in the pa-
tients, which would remove these cases into the list of sympto-
matic anaemia. The same is true of the anaemia (Surra) of horses
and mules in India and Siberia, in which Evans, Burke, Steele
and Ignatovsky, found a motile spirilloid organism which destroys
the red globules. Other forms that are apparently purel}- idio-
pathic have been attributed to a failure in the cytogenic proces.ses
in the bone marrow especially. Back of this we know only of
the various debilitating causes in food, hygiene, building, loca-
tion, work, etc., operating on a specially susceptible system, in
which, once started, the morbid process tends to perpetuate itself
and increase.

Ponfick induced anaemia experimentally b}^ the intravenous in-
jection of gl5xerine, pj-rogallic acid, solutions of haemoglobin,
etc., which dissolve the blood globules. This suggests the
probable pathogenesis by the production of unidentified blood
solvents in cases of deranged sanguification, but it still leaves us
in the dark as to the exact seat of such derangements (liver,
blood glands, bone marrow, etc.) and as to the cause, parasitic or
otherv^'ise, which determines such disorder. Pathological investi-

375

37^ Veterinary Medicine.

gation has enabled us to differentiate, according to their respec-
tive causes, a number of diseases (distomatosis, lung worms,
ank3dostomiosis, internal acariasis, chronic trichinosis, strongyli-
asis, etc.,) which were formerly classed as anaemias, and it seems
altogether probable that the onward progress of medicine will en-
able us to go farther in the same direction and to allot the remain-
ing unclassed anaemias to their proper etiological places. Some
may be unrecognized helminthiasis, others microbian disorders,
and still others, disorders in nutrition and sanguification from
different causes.

The Symptoms are those of other forms of anaemia, but being
more obscure in origin and therefore less open to corrective treat-
ment, it is more likely to grow to an extreme development and fa-
tal issue. The weak pulse, irritable heart, debility, unsteady
walk with the hind limbs, hurried breathing and sweating under
exercise, watery, puffy eyes, dropsies in limbs and dependent
parts of the body, progressive emaciation, and weakness are even
more marked than in symptomatic anaemia.

The treatment is in the main as for the other form alike in its
hygienic and medicinal bearing. In man recoveries have taken
place under arsenic combined with the iron. Arseniate of potash
and ferrum redactum in pill form, or tincture of chloride of iron,
and Fowler's solution in food or water, continued for a length of
time. Phosphated pepsin, and peroxide of hydrogen have seemed
to do well in some instances, and phosphorated oil is another re-
sort. W. Hunter attributes idiopathic anaemia to toxins derived
from microbes in the alimentary canal, as Sir Andrew Clark as-
cribes chlorosis to a similar cause. He prescribes beta-naphthol
as the least soluble and best antiseptic, in a dose of 5 grains daily
in mucilage for man (i drachm for horse or ox). Hunter fur-
ther found that a farinaceous diet protected the globules against de-
struction while a nitrogenous diet favored this. It may be noted
that long ago Delafond attributed anaemia in animals to the ex-
tension of the use of artificial fodders of the natural order legumi-
nosae which are rich in nitrogen.

CHRONIC ANEMIA . DROPSY IN CATTLE AND SHEEP.
Definition. Causes, parasitic and microbian. Symptoms. Treatment.

Definition. A progressive aiisemia in ruminants and other ani-
mals, resulting in general anasarca, and dropsies of the internal
cavities.

In veterinary works publi.shed on the European Continent this
affection is given a special place apart from the same train of
symptoms which mark distomatosis, taeniasis, and strongylia-
sis. The disease is described as prevailing in wet j'^ears, after in-
undations, when the vegetation is rank and aqueous, and of course
largely aquatic, in animals that are turned out in early morning
before the dew has evaporated, in the conditions, in other words,
that favor the ingestion of parasites. It prevails also in work oxen
fed on the refuse of sugar factories (beets, turnips) in which the
nitrogenous materials are held to be deficient, but in Great Britain
where cattle are often fattened on an exclusive diet of turnips,
containing even a larger proportion of water, this non-parasitic
disease is unknown. It is also ascribed to close, ill- ventilated,
unwholesome buildings, and to over-kept and tainted fodder, and
so far as a separate disease exists, it seems more reasonable to
charge it to the toxins produced by bacterial ferments or crypto-
gams than to causes which elsewhere appear to be inoperative.

The symptoms are essentially those of distomatosis, and the
treatment, apart from the parasiticides, is the same. When hel-
minthiasis can be certainly excluded />;-^zr«/^?^ would include the
avoidance of the factory refuse, especially when in a state of decay.

377

MEIvAN^MIA. BLACK PIGMENT IN BLOOD.

Definition. Melanin, in normal tissues, abnormal. Melanosis. Bisul-
phide of carbon subcutem. Decomposition of hsenioglobin in leucocytes.
Coloration of tissue.

Definition. Accumulation of granules and .scales of blood pig-
ment (melanin) in the circulating fluid, and in various organs
(spleen, liver, bone marrow, brain, etc).

Melanin — C„. 2, H3, Ny.g, O.^.g — or black pigment (a close rela-
ative of haematin) occurs physiologically in epithelium (choroid,
retina, iris, in the deeper layers of epidermis, and on the surface
of the dog's lung and of the sheep's brain) and in connective tis-
sue corpuscles (lamina fusca of the choroid).

Pathologically it is found in the blood of the victims of malarious
fever, often in great abundance, and in the spleen, liver, bone
marrow, brain, lymph glands and some other organs. It is form-
ed abundantly in the black pigment tumors (melanosis) of man
and animals, and in extensive melanosis is present in the blood of
both man and horse (Schimmeln). So far it has not been found
in connection with the extensive destruction of red globules which
takes place in anaemia. Schwalbe has developed malansemia ex-
perimentally by the hypodermic injection of bisulphide of carbon
in rabbits.

According to one view the melanin is produced in connection
with the destruction of red globules in the liver, .spleen, etc., and
is thence carried into the blood. This is in keeping with
the local formation of the pigment in melanosis. Arnstein how-
ever urges that in malarious cases the destruction of the red cells
takes place in the blood, and that the haemoglobin, absorbed into
the leucocytes, is transformed into melanin, and finally deposited
in the tissues by the migrating white corpu.scle. Why the hae-
moglobin .set free in anaemia is not similarly transformed, does
not appear. The pigmented organ may be quite black in the im-
mediate vicinity of the blood vessels, and in its general aspect in
chronic ca.ses reddish brown, dark gray, or dark olive.

378

IvEUK^MIA. LEUCOCYTH^MIA.

Definition. Nature. Result of other morbid processes. Leucocytes
polynuclear. Lymphatic leukaemia. Spleno-myelogenous leukaemia.
Leucocytes in each. Loss of amoeboid movement. Charcot's crystals.
Haematoblasts. Cell increase in bone marrow. Myelocytes. Enlarged
spleen and lymph glands. Haemorrhages. Lyniphoid growths. Suscepti-
ble genera. Causes obscure. Symptoms, pallor, listlessness, weakness,
apncea, sweating, thirst, emaciation, weak circulation, anaemic murmur,
enlarged spleen, bleedings, diarrhoea, dropsy, excess of white globules,
reduction of red globules, buffy coat, beaten fibrine is granular, china-
white mucosae, hurried breathing, stertor, deranged digestion, marasmus.
Duration. Not inoculable. Treatment, not hopeful, as for anaemia, good
hygiene, tonics, stimulants, antiseptics.

Definition. An excessive and persistent increase of the white
blood globules, and associated with enlargement of the spleen,
lymph glands or bone marrow.

Nature. This must be distinguished from the leucocytosis which
occurs during digestion, or that which attends on tuberculosis,
glanders, pneumonia, and other extensive inflammations and pro-
fuse suppuration. These forms are transient and the cells are of
the polynuclear variety. The cells of leukgemia are various in
character, but bear some relation to the particular organ which is
the seat of hypertrophy or morbid process.

" In lymphatic leukaemia the increase in the number of leu-
cocytes is due to the mononuclear lymphocytes, especially of the
small form. As many as ninety-five per cent, of the colorless
cells may be of this form. In Spleno-Myelogenous leukaemia
the eosinophile cells may be especially increased in number, and
there are also large leucocytes coming apparently from the mar-
row of the bones, and called myelocytes. These most nearly re-
semble the larger lymphocytes of normal blood, but they are usu-
ally larger. They have a single large nucleus which stains feebly
and their bodies may show neutrophile granules. Larger and
smaller nucleated red blood cells may be found in spleno-myeloge-
nous leukaemia. The leucocytes are frequently in a condition of
fatty degeneration, and there may be a decrease in the number of
red blood cells. " (Delafield and Prudden). In splenic leucocy-

379

380 Vetermary Medicine.

thaemia blood plates may be absent and in lymphatic leucocythae-
mia they may be in excess.

Cafavy claims that many of the leucocytes have lost their ac-
tive amoeboid movements.

Bright white crystals in the form of elongated octahedra are
found nor only in the blood but in the diseased glands, spleen or
marrow (Charcot's crystals). Clusters of discoid hsematoblasts
(blood plates) are present in the blood in variable numbers
(Schultze's granule masses).

The bone marrow is marked by an accumulation of spheroidal
cells, which tend to pass into a condition of fatty degeneration.
Most of them are colorless, larger than the lymphocytes of normal
blood and have one large often vesicular nucleus, staining less
highly than the lymphocyte nuclei, and with neutrophile granules
in the protoplasm (myelocytes). There are besides, nucleated
red blood cells, spheroidal cells, containing red blood cells, and
Charcot's crystals. The marrow may be uniformly red, mottled
gray and red, gray, grayish yellow, or puriform (Delafield and
Prudden). This may affect one or many bones. The affected
spleen is usually much enlarged, at first uniformly, later uneven-
ly, firm or softened, and with thickened white capsule. The cut
surface is smooth, brownish red, or yellow, with white lines
(thickened trabeculae) and indistinct Malpighian corpuscles. It
contains glutin, glycocoll, hypoxanthin, zanthin, leucin, ty rosin,
and lactic, acetic, or formic acids.

The affected lymph glands are somewhat enlarged, red or gray,
exceptionally, softened or caseated and otherwise contain an excess
of leucocytes.

Slight haemorrhages may appear in any of these structures.
Lymphoid growths may appear in a number of other organs as
the liver, heart, lungs, kidneys, bowels, tonsils, the different
blood glands, the serosse and the retina.

Genera affected. It has been seen mainly in dogs, but also in
horse, ox, pig, cat and mouse. Nocard has collected the follow-
ing cases : horse 9, cattle 6, pig 5, dog 22, cat i.

Ivcisering found a horse's spleen weighing 2S kilogrammes.
Johne found a pig's spleen of 2.4 kilogrammes..

Causes. The primary causes of leukaemia are unknown. As in
anaemia all unhygienic conditions are invoked as causes. That

Leiikcvmia. Lcucocythaniia. 381

it is not due to simple hypertrophy or irritation of the leukogenic
centers is plain, as it does not follow on ordinary diseases and in-
juries of these parts, but what is the precise nature of the morbid
cause has so far eluded us.

Symptoms. Pallor of the visible mucous membranes, listless-
ness, lack of energy and endurance, breathlessness and perspira-
ration on the slightest exertion, ardent thirst, rapidly advancing
emaciation, unsteady gait, stiffness or lameness, lies most of the
time, walks with pendent head, and jaws open, small, weak
pulse, anaemic murmur in the heart, enlarged lymph glands, or
spleen felt beneath the left lumbar transverse processes in the ox,
or in the left hypochondrium in the horse. Bleeding from the
nose or elsewhere, slight haemorrhage into the conjunctiva, irri-
table conditions of the bowels, diarrhcEa and dropsies are sug-
gestive. The blood when obtained in epistaxis or drawn by a
needle prick may be pale rose, brownish or grayish brown instead
of red, and under the microscope shows the enormous excess of
leucocytes — the ratio to the red being sometimes 1:2, or even
more, in the human subject. In the domestic animals the fol-
lowing ratios have been made by actual count : 1:85 (Leblanc
and Nocard), 1:50, 1:45 (Mauri), 1:20 (Nocard), 1:15 (Siedam-
grotzky), 1:12 (Forestier and Laforque). The normal average
for the domestic animal according to Nocard is 1 1900. This great
relative excess of white globules serves to distinguish this malady
from anaemia, and its persistency is a means of diagnosis from
transient leucocytosis.

The red globules are always reduced in number in the horse
and dog to 5,082,000, and even 2,050,000 per cubic millimetre,
while the normal is 7,500,000 (Nocard).

In clotting, the blood forms an extensive buffy coat, and in soli-
pedes which normally show this, the blood set in a test tube
forms three strata, the upper slightly yellow, semi-transparent
and formed of fibrine ; a median of a dull, opaque white color
and formed mainly of leucocytes and blood plates, and a lower of
a violet red and formed mainly of red globules.

The amount of fibrine is variable. It becomes granular when
beaten. Albumen is variable but usually reduced.

The visible mucous membranes are bloodless and of a
clear porcelain white. The w^alk becomes weaker, fore feet wide

382 Veterina7'y Medicvie.

apart and the hind limbs partly flexed, head and neck extended,
and breathing labored. The breathing may be with constant
stertor, the bowels torpid and tympanitic, or loose and foetid, drop-
sies and haemorrhages ensue, and the patient dies in complete
marasmus.

Duration. The disea.se may prove fatal in less than a month,
or it may last for three, six, or eight months. It is mostly fatal.

Not inoculable. Many attempts have been made to transmit it
by inoculation, but in no case with success.

Treatjnent is not successful. All hygienic measures should be
adopted, as for anaemia ; open air and sunshine, with protection
against chills ; the treatment of all complications; iron, bitters,
phosphorus, arsenic in particular, electricity to the spleen, mas-
sage ; oxygen inhalation ; and locally, iodide of potassium or
mercury, generally and locally.

LYMPHADENOMA. HODGKIN'S DISEASE.

Definition. Relation to leukaemia. Causes. Mainly accessory. State of
lymph glands, spleen, liver, bone marrow, intestine, tonsils, thymus, kid-
neys, liver, lungs, bronchial mucosa, pleura, pericardium, nervous system.
Symptoms, as in leukaemia, with adenoid hyperplasia, but little leucocy-
themia. Relation to glanders. Uric acid, low density, no hippuric
acid. Tuberculin and mallein tests. Treatment, as in leukaemia.
Excision in cases not constitutional. Phosphorus, phosphide of zinc.

Definition. Hypertrophy of the lymphatic glands with little
or no leucocytosis. There may further be lymphoid growths in
the liver, spleen, bone marrow and other organs.

The visceral lesions in lymphadenoma do not differ in charac-
ter from those of leukaemia, and as it does often apparently merge
into that disease by the characteristic changes in the blood, it is
denied by many that it constitutes a separate pathological entity.
In his admirable monograph on leucaemia in the lower animals
Nocard affirms their identity. The main excuse for keeping up
an alleged distinction, is the frequent absence of leucoc5'tosis, and
this often supervenes after the lymphadenoma has existed for
some time.

Lyiuphadcnoina. HodgJdn' s Disease. 383

Causes. As in leucsemia, no definite cause can be found in the
majority of cases. An accessory cause can sometimes be observed
where a local irritation gives rise to swelling of the adjacent lym-
phatic glands and this goes on to distinct Ijanphadenoma.

Lesions in the Lymph Glands. The hyperplasia may affect
but a single group of glands, more commonly a number of groups,
and often nearly all. In one case only of leukaemia in the lower
animals, a dog, has Nocard failed to find the lymph glands
affected. In the horse he has found the sublumbar glands alone
weighing 14.5 kilogrammes, 11 k. and 8 k. They compressed
the posterior aorta and vena cava and had caused extensive ascites.

The enlarged glands are white, gray or in case of rapid growth
veined or pointed with red ; they may be soft or firm according
as the hyperplasia has operated most on the trabeculae or the cells ;
they are homogeneous throughout. The scraping of the cut sur-
face gives a more or less thick milky juice containing a great
number of nucleated or double nucleated lymphocytes, free nuclei
and granules which stain strongly.

Hardened sections show an enormous development of the
follicles at the expense of the medullary walls, and double nu-
cleated white globules packed in a rich reticulum of adenoid tis-
sue, whilst the blood-vessels in the connective tissue are crowded
with white cells, and there are slight ruptures, old or recent.

Lesions of the Spleen. These are nearly always present.
Leisering found a horse's spleen over three feet long and 28 lbs.
weight, and Nocard one of 13 lbs. Bollinger found a pig's spleen
3^ lbs. Siedamgrotzky found dog's spleens over 2 lbs. The
consistency is usually firm (sometimes soft in dog). Capsule
thickened and white, cut surface dry, reddish brown, granular,
Malpighian bodies enlarged like a pea, hazel nut or walnut, with
contents as in the lymph follicles. The capillaries are enlarged
and crowded with white cells.

Lesions in the Liver. The liver is enlarged in one-half of
the cases of leukaemia in the lower animals. It has been found
to weigh 20 lbs. in the horse, and 4 lbs. in the dog. It is of a
grayish brown, or yellowish brown hue, or light red .spotted with
yellow, or mapped out by anastomosing grayish white lines.
There may be enlargement of the acini, or the formation of little
nodes of adenoid tissue, or most commonlj' in the lower animals,

384 Veterinary Medicine.

there is an adenoid thickening of the bands of connective tissue
extending in from the capsule. These are filled with white cells
which stain deeply with carmine. There may also be slight ex-
travasations of blood and infarcts.

Lesions in the Bone Marrow. These noticed in the pig by
Fiirstenberg, and in dogs by Siedanigrotzky, consist in increased
vascularity, great cell hyperplasia, and formation of adenoid tissue
as described under leukaemia.

Lesions of the Intestine. These commence in the agmina-
ted or solitary glands, which become enlarged, causing thicken-
ing of the mucous membrane, and later grow out into more or
less rounded masses of lymph — adenoid tissue up to an inch in
thickness. They are quite subject to ulcerations.

Lesions of the Tonsils. Bollinger, Nocard and Siedam-
grotzky found these enlarged in dogs in connection with adenoma
of the spleen. They were soft, friable, grayish, and consisted of
a very delicate and fragile adenoid tissue.

In one case Siedanigrotzky found adenoid hypertrophy of the
thymus in a cow, and adenoma of the kidneys similar to that of
the liver has been noticed.

Similar adenoid hyperplasia has been found in the lungs, the
bronchial mucous membrane, the pleura, the mediastinal and
bronchial glands, and the pericardium. In man this has invaded
the nerve centres, and it seems that at any point where there is a
lymph gland or a lymph plexus this adenoid hyperplasia may
localize itself.

Symptoms. The general symptoms of failing health are as de-
scribed in leukaemia. The particular symptoms of this disease
consist in the recognition of the adenoid hyperplasia in the ab-
sence of a marked leucocytosis. The submaxillary glands are
usually the first attacked, and the disease maj^ in the horse, be
confounded with glanders. There is, however, no pituitary dis-
charge nor ulcer, the glands are enlarged symmetrically on the
two sides, and a careful search will usually discover other groups
with similar symmetrical enlargement. The parotidean, the
pharyngeal, the prepectoral, the prescapular, the axillary, the
popliteal, the prefemoral, the post and premammary, and the
inguinal should be critically examined. The enlarged mesenteric
glands may be reached and detected by the hand engaged in the

Lymphade7ioma. HodgkUV s Disease. 385

rectum, or in the small animals b}^ external palpation, as may
also the enlarged spleen or liver.

The adenoid hyperplasia in the chest offers very obscure and
uncertain symptoms. The enlarged bronchial and mediastinal
glands may seriously interfere with the functions of the vagus
nerve, causing, in cattle, disturbed digestion and rumination and
tympanies, in horses stertorous breathing, and in the carnivora
and omnivora a tendency to vomiting. In animals generally the
pressure on the cardiac nerves leads to great irritability of the
heart, and violent action under any exertion. The prominent
dyspnoea in the advanced stages may be explained by these
thoracic hyperplasiae.

Nocard claims that the urine furnishes most important indica-
tions in its low specific gravity (horse loio), its constant acidity,
and in the almost entire absence in that of the horse of hip-
puric acid. When there is any suspicion of tuberculosis or
glanders, the tuberculin or mallein test will decide.

Tf-eatment is essentially the same as in leukaemia, and equally
unsatisfactory. Arsenic has in the main given the best results.
In the very earliest stages when the granular hyperplasia is con-
fined to one group, excision is advisable. This should be
avoided in all cases in which the constitutional symptoms have
developed. Phosphorus and phosphide of zinc have seemed ben-
eficial in certain hands. Injections into the glands have so far
proved useless.

25

ACUTE LYMPHANGITIS OF PLETHORA IN HORSE.
ANGEIOEEUCITIS.

Definition. Symptoms and causes. Genera affected. Causes of plethora.
High feeding. Work followed by rest. Fever, hurried breathing, strong,
rapid pulse, anorexia, stiffness and swelling in a hind limb, inguinal glands,
connective tissue engorgement, corded lymphatics, suppuration rare. Mild
forms. Lesions, in lymphatic vessels and glands. Chronic cases. Nature,
plethoric, lymph excess, stasis, excess of cells and fibrine, immunity of the
fore limb. Season of prevalence. Climate. Diagnosis, from farcy, erysipi-
las, etc. Treatment, exercise, friction, resolvents, purgative, bleeding, di-
uretics, astringents, iodine, pressure, diet. Prevention. Treatment of
chronic cases.

Definition. Inflammation of the lymphatic vessels and glands
of one limb usually in connection with rest.

Symptoms. This affection is common in heavy dr^ft horses of
a lymphatic temperament and kept on high feeding and at hard
work. It rarely develops however while the subject is kept at
steady work. But if, in the midst of such work, the horse is
kept at rest in the stall over one, two, or more days on the same
generous diet, he is found shivering violently, with rapid, labored,
breathing, high pulse and elevated temperature, symptoms which
have been frequently mistaken for those of pneumonia. There is
complete anorexia, and often ardent thirst. The patient is indis-
posed to move and if forced to it shows lameness in one hind limb
with an extraordinary abduction of the limb at each step, and
sometimes .so severe as to prevent his putting his full weight upon
it. If an examination is now made high up in the groin close
outside the inguinal ring, the lymphatic glands will be found to
be swollen, hot and tender, so that under even moderate pressure
the leg will be lifted and abducted until the patient threatens to
fall on the other side.

A little later the shivering may have given way to the hot stage,
with it may be general perspiration, and the swelling may have
extended down the course of the saphena vein and lymphatics,
as a distinct ridge and the lower part of the limb from the foot to
the hock may be filled, dropsical and hot. Unless checked the
swelling goes on increasing till the lower part of the limb is two
386

Acute Lymphangitis of Plethora in the Horse. 387

or three times its natural thickness, and the swelling has extended
well up on the thigh. The swelling has a soft oedematous feeling,
easily receiving and retaining the imprint of the finger and is not
only hot, but excessively tender. From the margin of the swell-
ing, firm, tender, rounded cords are found to emerge passing up-
ward along the line of thesaphena vein and its branches toward the
inguinal glands. These represent the swollen and gorged
lymphatic trunks, and may often be traced for some distance into
the substance of the general engorgement.

When the inflammation is violent, suppuration may ensue at one
or several centers, but more commonly the engorgement goes on
increasing and when the febrile attack has subsided the limb is
left permanently enlarged and correspondiiigly liable to a second
attack.

Milder cases are met with which are perhaps even more mis-
leading. There may be little or no rise of temperature, loss of
appetite or general constitutional disturbance, but under some
change of regimen and particularly after one or two days of rest
the subject becomes lame in one hind limb, without any of the
usual injuries to account for it. Examination of the groin shows
swelling and tenderness of the external inguinal glands, with or
without, a tender cord-like swelling running down from them.

Between these two types may be found all grades of lymphatic
inflammation with a varied degree of attendant constitutional dis-
turbance.

Lesions. The coats of the inflamed Ij^mphatic vessels are
thickened by exudate and the outer coat is the seat of ramified
redness with minute spots of blood extravasation. The inner
coat is dull, opaque, or even thickened. The vessel is dilated
and its walls friable. The contained lymph in the intervals be-
tween the valves has coagulated into a very thin diffluent jelly-
like clot, which in old standing cases may have become granular.
The connective tissue from which these vessels lead is infiltrated
with liquid and the lacunar spaces distended. Red patches from
blood extravasations are numerous. The external inguinal
glands and often the internal and sublumbar are swollen, con-
gested, and the seat of active cell hyperplasia. Abscesses are ex-
ception all}^ .seen.

In chronic cases the lymphatic vessels of the affected limb and

388 Veterinary Medicine.

especially of the lower part which is permanently swollen, are
enormously increased in calibre (lymphangiectasis), and have
their walls correspondingly thickened. The connective tissue is
the seat of extensive fibrous hyperplasia, and its interstices are
greatly enlarged.

Causes. Nature. This disease has not been sufficiently studied
to ascertain what toxic agents are produced in the plethoric con-
dition, under the torpid processes of nutrition and sanguification
entailed by absolute compulsory rest. A consideration, hov/ever,
of the relations of the lymph and lymph vessels and glands to
other parts will in part explain the pathology of the malady.
The lymphatics take their origin in the nuclear spaces of the
various tissues, the anastomosing canals of such pericellular
spaces together with the latter forming the actual radicles of this
set of vessels. They receive, therefore, the surplus plasma
which is not used up by the tissue cells in performing their
trophic, secretory and other functions. This lymph carried on
by the vis a tergo, muscular compression and other movements, is
delayed in the adenoid tissue known as lymph nodes, and espec-
ially in the lymph glands, in which the proliferation of lymph
cells is mainly carried on. Thus the lymph cells are very scarce
in the lymph radicles of the connective and other tissues, and are
found in greater numbers after passing through the lymph nodes,
and in still greater after passing through the lymph glands. But
the increase of cells is also in inverse ratio with the rapidity of
the circulation of the lymph. When this is rapid the cells are
hurried on and there is little time for their reproduction. When
slow on the other hand, there is time for cell growth and division
in the glandular detention cavities, and the ratio of cells to the
plasma is materially increased. Consider next that the multi-
plicity of cells determines an increase of the fibrine factors, so
that the more cells the lymph contains there is the more material
for fibrine (lyandois), and we have one good reason why under
enforced rest the overcharged and congested gland may become
the seat of fibrinous coagula or lymphatic embolism. Any over-
distension, toxic element, or other cause of disturbance, which
deranges the functions of the cell or causes its rapid multiplica-
tion by division — as in inflammation — at once sets free the fibrine
ferment and determines the coagulation. In the disease before

Acute Lymphangitis of Plethora in the Horse. 389

us we have the overfeeding of an animal having a strong diges-
tion, we have an absolute compulsory inactivity, with a suspen-
sion to a large extent of the functions of nutrition, sanguifica-
tion, secretion, and elimination ; we have in consequence an in-
crease of the blood pressure, and of the solids of the blood and
of the plasma of the lymph ; we have a suspension of the great
motor force of lymph circulation, namely, the muscular contrac-
tion, and we have the consequent tardy movement of the lymph,
the great increase of lymphocytes, and the distension and en-
gorgement of the lymph glands. As soon as this has reached a
certain stage the congestion and incipient inflammation of the
gland determines the precipitation of fibrine, the obstruction of
the gland, and of the entire circulation of lymph in the lower
part of the limb. The fever, the local swelling, and the subse-
quent steps follow, as a matter of course. This view is sustained
by the fact that incipient cases can be cured by muscular move-
ment alone. The rarity of the disease in the fore limb may be
ascribed to the greater force of the vis a tergo, the lesser height
of the lymph column, and the stronger action of the aspiratory
power of the chest on the lymphatic vessels.

In addition to the causes mentioned above must be noted the
following : The disease is an affection of heavy draft horses, in
which the tissues are more lax, and the lymph plexus in the con-
nective tissue of the hind limb is much more abundant. It is
common in the heavy English, Scotch and Belgian draft horses,
and rare in the English racer, the American trotter, and in the
average light American horse. The malady is most frequent in
spring and autumn, when the work is hardest and the feeding
most abundant. It rarely attacks the horse in steady work, but
appears after an idle Sunday spent in the stable ( Monday morn-
ing disease), or after one or more days of compulsory idleness
from heavy rains or other cause. The damp climate of western
Europe has probably an exciting influence, as it has in producing
the lymphatic constitution. In the same line of thought Zundel
says that many cold weather attacks would be prevented by clip-
ping off the heavy coat which keeps the entire system relaxed.
In some cases a sudden change of food, and in others musty oats
have been claimed as causes.

Diagnosis. Lymphangitis is distinguished from a simple drop-

3go Veterinary Medicine.

sy of the limb by the acute fever, the great local tenderness
especially of the inguinal glands, and by the tender corded
lymphatics that enter these. From cutaneous glanders (farcy) it
is diagnosed by the more acute fever, by the swelling of the in-
guinal glands in the early stage of the disease, followed by the
swelling of the lower limb, and by the absence of the hard, com-
paratively insensible and prone to ulcerate, farcy bud. Farcy
buds usually appear on the pastern or fetlock, with more or le.ss
swelling of the lower part of the limb, while the inguinal glands
are as yet normal in size and without tenderness. From erysip-
elas, with which this has been confounded, it is distinguished, by
the suddenness of the onset, under the circumstances above de-
scribed, by the high type of fever, by absence of early cutaneous
inflammation and the formation of vesicles, and by the fact that
lymphangitis commences in swelling of the inguinal glands.

Treatment. In cases that are seen in the earliest stages, before
the leg has become badly swollen , recovery will u.sually take place
under active exertion continued for hours at a time. The pump-
ing action inside the hoof during exercise, and the alternate com-
pression and relaxation of the lymph vessels by the muscles, tend
to establish a rapid current of lymph, to break up coagula and to
re-establish a healthy condition. Friction from below upward on
the lymphatic vessels and swollen limb will greatly assist in this
restoration. Different agents are employed, such as camphorated
spirits or oil, iodine, mercurial, and even blistering ointments.
These should not replace exercise when this is possible.

When the fever has set in suddenly and runs very high, the
abstraction of four or five quarts of blood, and the administration
of a purgative (8 drs. aloes) will be in order. In cases occurring
in the same stable and in all other respects apparently identical,
the subjects of phlebotomy recovered without any permanent
swelling of the limb, while those that were not bled recovered
with thickened limb.

In cases so advanced that the limb cannot be used, cold irriga-
tion, with friction, may be applied, and when the irrigation is in-
termitted one may apply some astringent (vinegar, alum, lead
acetate) , or an iodine lotion followed by an evenly applied bandage.

The purgative should be followed by full doses of diuretics
(nitre, bicarbonate of potash or soda, colchicum, iodide of potas-
sium) until fever and local inflammation have subsided.

Acute Lymphangitis of Plethora in the Horse. 391

As soon as the patient can use the limb, walking exercise
should be kept up for several hours forenoon and afternoon.

Throughout the disease the food should be of a light and non-
stimulating variety. When appetite returns give at first wheat
bran, or roots, or sweet grass in small amount, and do not return
to a grain diet until fully recovered and ready to go to work.

After one attack there is always an increased liability to a second,
and great care should be taken to give the subject daily exercise,
or where this is impossible, to reduce the feed, give a dose of
saltpeter, and turn into a yard or roomy loose box on the idle day.

In chronic thickening of the limb, an evenly applied elastic
bandage, extending from the hoof up, regular feeding and exer-
cise, washing daily with a weak iodine lotion, and the internal
use of iodide of potassium and other diuretics, with bitters and
even iron tonics may be used.

INFECTIVE LYMPHANGITIS. TRAUMATIC
LYMPHANGITIS.

Infection varied, through wounds, autogenous. Simple irritation, sim-
ple lymphangitis. Causes, sun's rays, bruises, other injuries, lymph co-
agulation from heat, cold, chemical irritants, and coagulants. Germs in
blood act on debilitated tissues, lymphatic constitutions, ansemic, over-
worked, or starved. Insect bites, claws, teeth of carnivora, foul instruments,
fingers or clothes. Bloodless wounds dangerous. Distal parts of the limbs
exposed. Fresh wound exposed, granulating less so. Most microbes enter
by the lymphatics. Symptoms, extension from wound, swollen lympha-
tics,.reticular lymphangitis, tubular lymphangitis, farcy, tuberculous case,
slough. Fever variable. General infection. Joint infection. Chronic
cases. Lesions. Diagnosis, from phlebitis. Treatment, antiseptics, diet,
eliminants, antithermics, blisters, mercurial ointment, iodine, lancing,
tonics, massage, bandage.

Under this heading must be named not one specific disease but
a group of infections entering by the lymphatic vessels and de-
veloping inflammation of their substance. They may be divided
into two classes : those caused by infection through external
wounds and those in which the poison already in the system be-
comes localized on a weak or exposed tissue.

A third class must be included, in which there is no recogniza-
ble poison but simply a local irritation which leads to coagulation
or other alteration in the lymph, or disease of the lymphatic
vessels.

This subject belongs rather to surgery than medicine but it
seems necessary to contrast it here with the plethoric form of
equine lymphangitis. Most of its forms pertain to infectious dis-
eases and will be treated in connection with these.

Causes of Simple Lymphangitis. Formerly many forms of
lymphangitis were ascribed to mere local irritation ; a superficial
form will occur from exposure to the rays of the sun, and an in-
flammation attendant on a bruise or other injury with unbroken
skin, may cause local inflammation of the lymph vessels and en-
largement of the adjacent lymph glands. As we have seen above
coagulation of the lymph and fibrine embolism may induce local
inflammation in the walls, and this may occur in connection with
392

Infective Lymphangitis. Traiiniatic Ly^nphangieis. 393

excessive heat or cold or the presence of chemical irritants and
coagulants. These cases are however rarely serious and the ten-
dency to-day is to trace nearly all cases to infection, from germs
already present in the lymph or blood, or introduced through a
wound cr sore. The effect of germs already circulating was
shown in the beautiful demonstrations of Chauveau in regard to
calves subjected to castration by subcutaneous torsion (bistourn-
age). In the healthy calf the simple operation gave rise to little
disturbance. The healthy calf injected with septic liquids equally
escaped visible trouble. But the calf injected with septic liquids
and then subjected to bistournage had a fatal infecting inflamma-
tion. There is a strong presumption that, in lymphangitis, start-
ing from an injury with no external sore, the germs were already
present in the blood or tissues but were unable to do any serious
damage until the injured and weakened part or organ offered an
area of lessened resistance to their colonization. Following the
same line of thought it has been noticed that animals of a coarse
texture, and lymphatic constitution (heavy draft horses and ani-
mals raised for the butcher), and such as are debilitated by
anaemia, overwork, or poor and insufficient nourishment are above
all liable to be attacked by lymphangitis.

The insertion of the septic poison may take place through the
bites of insects, the claws, or teeth of carnivora that have been
devouring tainted or infecting meat, through the lancet or operat-
ing instrument of the surgeon, by his fingers or the dust from his
hair or clothes. The wound is perhaps more likely to be infect-
ing if it leads to no effusion of blood, but affects only the thick-
ness of the epidermis, as there is less chance for the washing out
of germs by the flowing blood, and there is less care to employ
antiseptics. Wounds in the feet and lower parts of the limbs are
speciall}^ liable to infection by reason of their frequent contact
with manure and decomposing organic matter in the soil.

A fresh wound, in which the lymph spaces are exposed, is some-
what more open to infection than one that has advanced to the
stage of granulation, the layer of unorganized lymph and cells
acting as a slight barrier to the passage of the microbes.

Nearly all microbian diseases make their inroad by way of the
lymphatics, where the sparse cells fail to establish as active phago-
cytosis as do the numerous moving cells of the blood. Hence a

394 Veterinary Medicine.

number of infectious maladies are primarily- and pre-eminently
diseases of the lymphatics, as glanders, strangles, tuberculosis,
cancer, anthrax, swineplague, etc.

Symptoms. The most common form is where lymphangitis ex-
tends from some pre-existing wound — as pricked or suppurating
foot, fistula of foot, withers or poll, chafing of shoulder or back,
cracked heels, boil, sloughing bruise, etc. The swelling around
the sore or injury involves in fact the radical lymphatic plexus in
the connective tissue (reticular lymphangitis). When the swell-
ing extends and becomes more tense, with firm, painful sinuous
cords running out of it in different directions, and especially to-
ward the nearest lymphatic glands, and when these glands are
slightly swollen and tender, tubular lymphangitis is diagnosed.
No more striking example can be found than in skin glanders
(farcy). The rigid cords extend from the side of the face, from
the eye, and nose down toward the submaxillary glands and with
more or less adjacent engorgement. Or on a hind limb, or some
portion of the trunk, a more or less turgid swelling with one or
more firm nodes (farcy buds) and painful, tortuous cords running
towards the lymph glands is very characteristic.

A tuberculous case may show an indolent, hard, comparatively
insensible cutaneous cord leading toward the jugular furrow, the
prescapular, precrural or inguinal glands, and at long intervals
softening, fluctuating, bursting and discharging a thick pus. In
a carcinoma there is the old, hard, nodular, and finally ulcerating
swelling from which the firm cords extend to the mass of steadily
enlarging lymphatic glands.

A simpler form is where a bruise by the harness causes a hard,
thick, slough, embracing the entire thickness of the skin, from
which the firm corded lymphatics extend in different directions.
After the slow process of detachment, the local lymphangitis
usually subsides under simple cooling or antiseptic treatment.

But the grade of such lymphangitis is as varied as the particu-
lar germ or combination of germs present in the wound, and the
susceptibility of the animal attacked, and there will be high,
moderate or no fever, according to the severitj^ of the case, and
in some cases purely local trouble and in others general infection
with purulent or septic localization in distant parts. There is al-
ways danger of extension to a neighboring joint with destructive
results.

bifedive Lymphangitis. Traumatic Lymphangitis. 395

A curious outbreak is described by Wiart as attacking nearly
every horse in the regiment that sustained a slight wound. A
tubercle looking mass formed in the depth of the wound was slow
to heal, and the lymphatics leading out from it became round,
corded, turgid, and at long intervals developed along their course
fluctuating centres which, whether opened spontaneously or by
the lancet, showed the same indolent habit. A single attack
would last from two to six months, and the actual cautery had to
be used on the sores.

The lesions are those already described in the last article for
simple lymphangitis. For infecting cases they are those of the
particular disease which may be present.

Diagnosis. The general diagnosis of lymphangitis is the dis-
tinction from phlebitis. In phlebitis the vein is blocked and can-
not be raised by pressure on the side leading toward the heart ;
in lymphangitis it can be so raised. The swelling and tenderness
are both greater in lymphangitis. The inflamed vein is more
rectilinear, the lymph vessel somewhat sinuous. If suppuration
ensues it is more diffuse in lymphangitis ; more restricted and
mixed with the elements of blood in phlebitis.

For identification of the particular forms of infecting lymphan-
gitis, the reference must be made to the individual infectious
diseases.

Treatment. In general the treatment of lymphangitis is the
antisepsis of wounds. Further than this the treatment of each
case is that of the particular disease which it represents. For all
cases alike it is important to apply vigorous treatment early, so as
to cut it .short bafore it can attain a dangerous extension.

For the simpler forms of lymphangitis the wound should first
be thoroughly cleansed and disinfected. Washing with .soap suds,
or carbonate of soda will remove any greasy agent which would
prevent a thorough antisepsis. Then it may be washed with the
antiseptic lotion : — carbolic acid solution (1:20), or mercuric chlo-
ride solution (1:500), or zinc chloride (1:400) or potassium per-
manganate (1:160). If the infection has been introduced by a
small or punctured wound, the sting or bite of an insect, or the
prick of a sharp instrument it .should be freely cauterized to its
depth with lunar caustic incising it if need be to reach the whole
of the poison, and the surface afterward dressed with antiseptics.

396 Veterinary Medicine.

The diet should be light but nutritious and laxative, and the
free action of the bowels and kidneys should be maintained by
salines. When fever runs high give quinine, or salicylate of soda.
When a large wound has to be dressed it may be requisite to
use a non-poisonous agent like acetate of aluminium or boric acid
to irrigate it thoroughly. In some such cases packing the irri-
gated wound with iodoform gauze has often an excellent effect.

When there is a firm inflamed cord, hot and painful, a fly blister
along its course followed by mercurial ointment often gives excel-
lent results. Or they may be repeatedly painted with tincture of
iodine.

Foci of suppuration must be promptly opened and thoroughly
and persistently disinfected.

With suppuration in multiple abscesses or large open sores
liberal feeding must be enjoined and iron and other tonics should
be resorted to.

The persistent swelling of the part must be met by active rub-
bing or kneading, b};- exercise and by uniform compression by a
flannel or elastic bandage.

LYMPHANGIECTASIS. DILATED LYMPHATICS.

Result of lyiiipliangitis, of heart disease, of pulmonary arterial thrombo-
sis, of external jugular plugging. Causes, obstruction to lymph flow, com-
pression, increased venous blood pressure, fibrinous lymph coagula, action
of sensory nerves, of lymphadenitis, anaemia. Symptoms like dropsy if
in plexus, in large lymphatics, moniliform swelling, sacculation, wounds
discharge lymph, hyperplasia of connective tissue, fatty deposits, lipoma-
ta. Treatment, elastic bandage, cold, astringents, iodine, punctures, liga-
tures, cauterizations, tonics.

The most striking cases of dilatation of the lymphatics in the
lower animals are met with in horses that have suffered repeatedly
and severely from the lymphangitis of plethora. Then the lower
part of the shank and the postern are enormously thickened to
perhaps two or even three feet in circumference, and skin and
connective tissue are the seat of a general dilatation of the lym-
phatic plexus and vessels with great thickening of their walls.
Nocard and Barrier record cases of general dilatation of the lym-
phatics in dogs in connection with heart disease, al.so the case of a
horse with old standing thrombosis of the pulmonary arteries,
hypertrophy of the right heart, and dilatation of the thoracic duct
to the size of the arm and of the lymphatics of the mesocolon to
the diameter of half an inch to nearly an inch. Nocard records
two cases in the horse, one of a reticular lymphangioma of the
sheath, and the other of dilatation of the lymph vessels accompa-
nying the saphena vein on the inside of the thigh. This formed
small, soft, fluctuating, extremely irregular tumors, completely
covering the vein for a space of about four inches.

In both cases the dilatations were surrounded by a thick layer
of connective tissue filled with liquid-. Virchow records a case of
a new-born calf in which a thrombosis of the external jugular
vein caused obstruction of the mouth of the thoracic duct, and a
consequent extreme disten.sion of all the splanchnic lymph ves-
sels with a slightly sanguinolent fluid. The intestines especially
were covered everywhere with broad, bead-like canals, arranged
so closely together that the intervening tis.sue could be scarcely
recognized.

397

398 Veterinary Medicine.

The causes of lyniphangiectasis appear to be generally some ob-
struction to the onward flow of the lymph. Any diseased condi-
tion, therefore, that causes compression of the larger lymph
vessels may cause dilatation of the smaller ones leading into these.
General distension may come from disease of the lungs or left
heart and increased venous blood pressure, or from thrombus of
the jugular, or a tumor obstructing the thoracic duct, while local
engorgments may come from the pressure of tumors, or the oc-
currence of lymphangitis and formation of fibrinous coagula. In
cases of partial obstruction of the lymph vessels the increased
secretion of lymph ma}^ lead to distension and enlargement. It
may be named in this connection that irritation of the sensory
nerves in dogs has been shown to determine a larger production
of lymph (Krause). lyymphadenitis and the obstruction of the
passage of lymph through the glands is an obvious cause, and
hence the disease is specially liable to appear in connection with
diseases which show a predilection for the lymphatics (tuberculo-
sis, glanders, strangles, carcinoma, etc.)

In his work on dilatation and occlusion of lymph channels
Busey shows that in man the majority of cases are in hospital pa-
tients in whom blood and general health hav^e been impoverished
and reduced by unhygenic conditions. One case gave support to
the theory of maternal impression, the pregnant mother having
suffered from over-use of the right limb on a sewing machine,
and the offspring having shown extensive lyniphangiectasis in
the right leg.

Symptoms consist in enlargement of the lymph vessels or
plexus, and often of the glands. If of the lymph plexus it may
appear like a dropsical effusion in the part, with or without saccu-
lar dilatations at intervals. If of the larger ves.sels, their tor-
tuous ana.stomosing trunks following largely the lines of the veins
are usually characteristic. If the distension is slight it is usually
moniliform, as the valves are still intact, and the intervals be-
tween them stand out as bladder-like masses. If the structure is
wounded or if it ulcerates there is the discharge of a straw-col-
ored fluid, often rendered milky by the presence of fatty granules,
and at times tinged with blood. There is always a tendency to
the increase and condensation of the connective tissue surround-
ing the ves.sels, and fatty degeneration and the formation of lipo-
mata are not uncommon.

Lyviphorrhiva. Lymphorrhagia. 399

Treatment. Compression, by flannel or elastic bandage, from
the foot upward, is the simplest and most promising treatment
when the limb is affected. The local application of cold, astrin-
gents or iodine may be added. Punctures, ligatures, and cauter-
ization have not given encouraging results. lyigature of the nu-
trient artery of the part, has succeeded in one or two cases, but
has failed in others. Tonics are to be tried more particularly in
cases due to specific debilitating diseases. Sometimes a sponta-
neous recovery has been noticed when the surrounding connective
tissue has increased and contracted in connection with inflamma-
tion.

LYMPHORRHCEA. LYMPHORRHAGIA. DISCHARGE
OF I.YMPH THROUGH WOUNDS OR SORES.

Result of rupture of liimpliatics. Milky, fatty lymph. Treatment, liga-
ture, excision, cauterizatioa, of little avail. Compression. Tonics.

Obstruction of a lymph duct may lead to rupture and the dis-
charge of its fluid on the surface or into an internal cavity. Dr.
Cayley records a case of fatal peritonitis in man from rupture of
the receptaculum chyli, and the formation of lymph fistulse has
been attributed to filaria sanguinis hominis. We are aware of no
corresponding case in connection with the blood parasites of the
horse or dog. In the larger domestic animals the great thickness
and resistance of the skin offers a barrier to the rupture of sub-
cutaneous lymph vessels, but this no longer applies in case of a
suppurating or ulcerous wound. The escaping lymph has often
a milky hue from the admixture of fat, jnst as its escape in the
kidneys causes chyluria, and in the bowel fatty stools. The
escape is often very profuse and persistent, and results in marked
debility. Ligature and excision of the fistulous vessel, also
cau.stics— actual and potential, have been tried with rather poor
success. Fitzer succeeded in an obstinate case by the extensive
application of nitrate of silver and others by simple compression.
As the victims are usually debilitated a course of tonics is
usually desirable.

LYMPHADKNITIS. INFLAMMATION OF THE LYMPH
GLANDS.

Result of lesions of tributary tissues. Arrest in glands of microbes and
other irritants. Trauma of gland. Inflammation. Symptoms, swelling,
stiffness, gland tender, hot, pitting envelope, corded lymph vessels, abscess,
fever. L,esions. Treatment, antiseptics, astringents, emollients, vesicants,
lancing, antiseptics, antiphlogistics, antitliermics. Chronic adenitis.
Symptoms, enlarged glands without engorgement, if simple affects a single
gland, if infectious, a group. Lesions, gland swelling, induration, shrink-
ing, follicular distension, pigmentation, growth of lymphocytes, caseation,
calcification. Treatment, antiphlogistic, antiseptic, iodine, chloride of
calcium, iodide of potassium.

Apart from traumatic lesions lymphadenitis virtually implies
some lesion of the tissues from which the different vessels of the
glands proceed. The glands however have been referred to as
filtering agents on the course of the lymph vessels and in this
partial view of their functions we find abundant reason why irri-
tants carried in the lymph stream, should be arrested with patho-
genic results in the glands. A particle of pigment gaining en-
trance to the lymph vessels tends to be arrested among the trabeculse
of the gland, and contributes to the pigmentation so common in
old animals. Cells and granules from malignant tumors, and
bacteria from an infection-atrium are arrested in the glands and
make these the great centres of infection-lesions.

Trattmatic inflammation comes from bruises, punctures or in-
cisions directly implicating the glands. There result swelling,
tenderness and the other general signs of inflammation, and in
the case of an open wound possibly lymphorrhagia.

Acute inJiammatio7i more commonly supervenes on inflamma-
tion in the area drawn upon by the afferent ves.sels of the gland.
In inflammations generally the adjacent lymphatic glands become
congested. In lymphangitis it is so in a marked degree. In ex-
ternal parts we can follow this by careful observations during life,
in internal organs we often find the glandular enlargement after
death.

Symptoms consist in swelling and perhaps stiffness in the re-
gion of the gland. Manipulation shows tenderness and heat, the
gland being felt abnormally large, round, or oval, tense, loose
400

Lyi/iphadoiitis. InjJaiiiniation of the Lymph Glands. 401

from \.\\z skin but liaving a distinct envelope of soft pitting exu-
date which tends to increase in a downward direction. There
may or may not be a corded feeling of the afferent lymphatic
trunks. As the pasty swelling increases, it extends into sur-
rounding parts, binds the gland to the skin and adjacent .struc-
tures, and may even conceal the gland in the excess of its invest-
ing engorgement. This is especially frequent in strangles. As
the process advances softening may take place in the centre and
extend toward the circumference, and this may burst like an
ordinary abscess. In some cases the softening is very limited
and tardy, and the pus may be pent up and inspissated, or it
may appear to be entirely reabsorbed while the gland is in pro-
cess of induration. Fever which may run high during the pro-
cess of suppuration, moderates when that has been accomplished.

In the case of glands too deeply situated to be clearly felt the
occurrence of purulent fluctuation in their vicinity suggests abscess.
of the glands, an important induction as the maturation and
healing are usually slow in the gland tissue.

Lesions. At the outset the glands are visibly enlarged, softened,
and of a dark red hue, with spots of a brighter red. The
changes, mainly in the medullary layer, consist in a great pro-
liferation of spheroidal cells in the follicles and also of polyhediral;
cells in the lymph sinuses. The endothelial cells are swollen,,,
the blood vessels gorged, and extravasations of blood into the^
follicles and sinuses are frequent. Abscess or fibroid hyperplasia
with induration may follow. Much depends on the particular
infection (tuberculosis, glanders, carcinoma, etc.) as the special
product of each disease will be found in the affected gland.

Treatment is in the main as advised for lymphangitis and will
vary with each specific causative disease. Locally antiseptics,,
astringents, deobstruents, emollients, and vesicants will be
requisite in different cases. As soon as pus can be distinctly
diagnosed it should as a rule be evacuated, and the cavity treated
antiseptically. General treatment may at first be antiphlogistic
and febrifuge, but must usually embrace tonics and stimulants in
the end.

Chronic Adenitis may be a sequel of the acute, or it ma}-
arise independently. In the latter case it is u.sually the result of
some other disease (tuberculosis, glanders, carcinoma, sarcoma
26

402 Veterinary Medicine.

melanosis inveterate disease of the skin, chronic fistula, abscess,
or mucous inflammation).

The symptoms are those of enlarged glands with no material
surrounding engorgement. In the infections of tuberculosis and
glanders it shows a tendency to affect the whole group, whereas
in simple abscess or in suppuration of the nasal sinuses it may im-
plicate one gland only, the remainder appearing normal.

Lesions. The gland often becomes indurated and even
shrunken, the connective tissue elements undergoing a steady in-
crease at the expense of the follicles and lymphoid cells. This is
a common condition of tuberculous glands (perl-knoten, grapes)
of cattle, but may result from the entrance of pigment or other
cau.se of mild irritation. In other cases pigment entering from
without or developed from blood in the congested gland, finds
permanent lodgment in its tissue and may give it a gray mottled
or quite black aspect. In still other cases, there is a great in-
crease of the round lymphoid and larger polyhedral cells, many
of which degenerate becoming strongly refracting, stain feebly,
or not at all, and pass into a cheesy degeneration. This is a com-
mon condition in tuberculosis and glanders, and the caseous cen-
tres beginning as multiple miliary centres may coalesce to form
masses of six or twelve inches in their greatest diameter as in bo-
vine tuberculosis. In other cases the caseating mass becomes the
.seat of calcareous deposit and the necrotic and caseated gland be-
comes in part calcified. Other degenerative changes such as
atrophy, amyloid, and hyaline are met with but have received
little attention.

Treatment will be subordinated to the primary cause. If that
is a simple local inflammation or irritation its removal will entail
a speedy improvement in the gland, and, in the absence of too
extensive structural change, a speedy recovery. The infectious
cases on the other hand are likely to prove as inveterate as the
disease on which they depend. In case the enlargement or con-
gestion of the gland persists after the removal of its primary
cause local deobstruants especially the preparations of iodine
are usually effective. Tincture of iodine with soap, iodide of
lead, and mercurial ointment have been severally used with ad-
vantage. Injection of a weak solution of iodine into the gland
will at times succeed. The internal use of chloride of calcium or
iodide of potassium will often hasten recovery.

INDEX.

Abomasum, position of in ox, 156.
Abscess in adynamic inflammation, I

71. I

Abscess of false nostril, 92, 97.
Abscess of guttural pouches, 94.
Abscess in heart, 33S, 341.
Abscess in inflammation, 71.
Abscess of the lung in pneumonia, 1

225.
Actinomycosis, 99.
Adynamic fever, 68.
Adynamic inflammation, 68.
Adynamic inflammation, abscess in,

7^- . .

Adynamic inflammation, blistering
in, 70.

Adynamic inflammation, firing in, 70.

Adynamic inflammation, massage in,
71- . .

Adynamic inflammation, suppuration
in, 71.

Adynamic inflammation, local treat-
ment of, 69.

Adynamic inflammation, treatment
of. 68.

Adynamic fever, treatment of, 68.

Air, character of the expired, 353.

Air, eff"ects of vitiated, ]8o.

Air in the pleura, 265.

Air passages, parasites of, 290.

Anaemia, chronic, 377.

Ansemia, idiopathic, 375.

Aiiseniia oligaemia, 371.

Aucemia, pernicious, 375.

Anaemia, progressive pernicious, 375.

Anamnesis, 19.

Anatomy, definition of pathological, 2.

Anetirism

)6, 359

Aneurism by anastomoses 359.
Angeioleucitis, 386.
Angeioma, 359.
Angina, 1 14.
Angina pectoris, 311.
Angina pharyngea, 126.
Angioma in nose, 100.
Apoplex}-, pulmonarj', 21 r.
Arterieclasis. 356.
Arteries, diseases of, 345.
Arterio-sclerosis, 359.
Arteritis, 345.
Arteritis, external, 345.

Arteritis, internal, 345.
Asthma, 274.

Asthma in the dog, bronchial, 270.
Asthma in the horse, 273.
Asthma, pathology of, 270.
Asthma, symptoms of, 271.
Asthma, treatment of, 271.
Atelectasis, 206.
Atelectasis, causes of, 206.
Atelectasis, lesions of, 207.
Atelectasis, symptoms of, 207.
Atelectasis, treatment of, 208.
Atheroma, 349.
Atrophy, 322
Auscultation, 164.
Auscultation of birds, 168.
Auscultalion of cough, 174.
Auscultation of dog, 168.
Auscultation of goat, 168.
Auscultation of horse, 166.
Auscultation, immediate. 164.
Auscultation, mediate, 164.
Auscultation of ox, 167.
Auscultation of pig, 168.
Auscultalion of sheep. 168.
Axillary arter}-, embolism of, 355.

Bacili.us of Friedlander, 216.

Bacteriology of pneumonia, 216.

Baths, cold, 65.

Baths, warm, 64.

Birds, auscultation of, 168.

Birds, percussion in. 161.

Bleeding, in fever, 63.

Bleeding, local. 64.

Blistering in inflammation, 70.

Blood, active determination of, 33.

Blood, arterial determination, 33.

Blood, black pigment in, 378.

Blood, diseases of, 367.

Blood exudations, 52.

Blood globules, 367.

Blood-globules, numbers of, 36S.

Blood, modifications of in pneumoni

226.
Blood, ratio to body-weight, 370.
Bot-fly, sheep, 109.
Bots, 149.
Breast pang. 311.
Breathing, deep, 154.

404

hide:

Breathing, hurried, 153.

Breailiiiig, labored, 154.

Breathing siippleiiieiitrtr}-, 169

Breathing, quick, 153.

Broken wind, 274.

Broken-winded horses, examination

of, 2S7
P>ronchial asthma in the dog, 270.
Bronchial catarrh, 191.
Bronchial glands, diseases of, 290.
Bronchial sound, 170.
Bronchial tubes, polypus of, 289.
Bronchitis, 178.

Bronchitis, acute in horse, 178.
Bronchitis, capillary, 186.
Bronchiiis, chronic in horse, 191.
Bronchitis, in cattle, 197.
Bronchitis in dog, 193.
Bronchitis in ox, 193
Bronchiiis iu sheep, 197
Bronchitis, pseudo-nienibranous, 186
Bro'icho pleiiro pneumonia, 258.
Broncho pneumonia, 258

Cadeac's diplococcus pneumonise

equina, 218.
Cancer of the heart, 341.
Carcinoma in nose, 99.
Carditis, 338.
Carious Teeth, Nasal Discharge from.

Catarrh, bronchial, 191.

Catarrh, chronic, in cattle, 104.

Catarrh, chronic nasal, 87.

Catarrh, coccidian in rabbits, 108.

Catarrh, malignant, 105.

Catarrh, nasal from lin^uatula, 113.

Catarrh, nasal from rhiuaria taeuio-

ides, 1 13
Catarrh, nasal in dog, 113.
Catarrh, nasal in horse, 113
Catarrh, of cattle, 105.
Catarrh of frontal sinuses in ox, loi.
Catarrh of nose, 81.
Catarrh, traumatic, loi.
Cattle, catarrh of, 105.
Cattle, chronic catarrh in, 104.
Cattle, Coryza in, 85
Cattle, croupous bronchitis in, 197.
Cattle, pharyngo-laryhgitis of, 122.
Cattle, pleurisy in, 253.
Cell change, 42.
Cell proliferation, 42.
Cephalemia maculata, 112.
Changes in circulation, 45.
Changes in innervation, 44.
Changes in tissue elements, 41.
Chemiotaxis, 47.

Chemistry, definition of pathological,
I 2.
I Chest, 155

Chest, accidental sounds of, 167.

Chest, bronchial sound of, 165.

Chest, diseases of, 150.

Chest, healthy sounds of, 165, 167.

Chest, mensuration of, 175.

Chest sounds, modifications of
healthy, 169.

Chest, morbid sounds of, 152.

Cliest percussion of in horse, 159.
, Cliest, percussion of in ox, 159.

Chest, contents of in horse, 155.

Chest, respiratory murmur of, 165.

Chest sounds, abnormal, 171.
I Cliest sounds, amphoric, 171.

Chest sounds, cavernous 171.

Chest sounds, morbid, 169.

Chest sounds, mucous, 171.

Chest, tapping the, 261.

Chest, tubal sound of, 165.

Chest, vesicular sound of, 165.

Chronic pneumonia in the ox, 235.

Chyliform exudate, 52.

Circulation, changes in, 45.

Circulation, diseases of organs of, 291.

Clots in the heart, 337.

Cloudv swelling, 41.

Coccidian catarrh in rabbits, 108.

Cold, action of, 74.
( Cold in the head, 81.

Collapse of lung, 206.
[ Collapse of lung, causes of, 206.

Collapse of lung, symptoms of, 207.

Collapse of lung, treatment of, 208.

Congestion, 33.

Congestion of the lungs, 198.

Congestion of the lungs, causes of,
198.

Congestion of the lungs, course of,
201.

Congestion of the lungs, lesions in,
201.

Congestion of the lungs, nature of,
202.

Congestion, passive, 35.
: Congestion of the lungs, symptoms
i of. 199-
i Congestion of the lungs, termination

of, 201.
1 Congestion, treatment, 38,
I Congestion of the lungs, treatment of,
\ 202.

Congestion, venous, 35.

Contagious diseases, of nose, 107.

Convulsive cough, 14S.
, Coryza, 81.

Index.

405

Coryza, causes of, 82.

Corjza, course of, S3.

Coryza iu cattle, 85.

Coryza in dog, 85.

Coryza in horse, 81.

Coryza in pig, 85.

Coryza iu sheep, 85.

Coryza, symptoms of, 82.

Coryza, treatment of, 83.

Coryza, treatment of chronic, 90.

Cough, 150.

Cough, abortive, 151.

Cough, auscukation of, 174.

Cough, broken, 151.

Cough, convulsive, 148.

Cough, croupous, 151.

Cough, dry, 151.

Cough, humid, 151.

Cough, husky, 151.

Cough, loud, 151.

Cough of dog, 150

Cough of horse, 150.

Cough of ox, 150.

Cough of sheep, 150.

Cough, paroxysmal, 151.

Cough, rasping, 151.

Cough, rattling, 151.

Cough, short, 151.

Cough, small, 151.

Cough, soft, 151.

Cough, strong, 150.

Cough, symptomatic, 151.

Cough, weak, 151.

Crepitation, 173.

Crepitation, modified, 173.

Croup, 128

Croup in sheep, 131.

Croup in the horse, 132.

Croup in the ox, 128.

Croupous bronchitis in cattle, 197.

Croupous bronchitis in sheep, 197.

Croupous cough, 151.

Croupous exudate, 52.

Croupous laryngitis, 128.

Croupous pneumonia, 213.

Croupous pneumonia, exciting causes,

215-

Croupous pneumonia in fowls, 238.
Croupous pneumonia iu sheep, 236.
Croupous pneumonia in the ox, 233.
Croupous pneumonia, predisposing

causes, 214.
Cynanche, 114.
Cynanche pharyngea, 126.
Cysticercus cellulosa in heart, 342.
Cysticercus tenuicoUis in heart, 342.
Cysts in nose, 100.

j Death beginning at brain, 5.
I Death beginning at lungs, 4.
1 Death from old age, 5.

Death from syncope, 4.

Death of cells, 41.

Death of tissue, 41.

Death, molecular, 4.

Death, partial, 4.

Degeneration, fatty, 340.

Determination of blood, active, 33.

Determination of blood, arterial, 33.

Defervescence, 61.

Diagnosis, history of the attack in, 16.

Diagnosis, means of, 16.

Diagnosis, medical, 16.

Diagnosis, objective symptoms in, 16.

Diagnosis, usual state of health of
subject, 16.

Diapedesis, 47.

Diaphoretics, 66.

Diaphragm, position of in dog, 157.

Diaphragm, position of in horse, 156.

Diaphragm, position of in ox, 156.

Diaphragm, position of in pig, 157.

Diplococcus pneumonias equina, 217.

Disease, causes of, 7.
j Disease, definition of, 2.
I Disease, exciting causes of, 9.
I Disease, extrinsic causes of, 9.

Diseases, infectious of the throat, 149.

Diseases of nose, 107.

Diseases of the chest, 150.
I Diseases of the lungs, 177.
I Diseases of the nose, 78.
! Diseases of the respiratory organs, 72.
; Diseases, parasitic of the nose, 108.
j Disease, percussion in, 161.
] Disease, predisposing causes of, 7.

Distemper, 114.

Dog, auscultation of, 168.

Dog, bronchial asthma in, 270.

Dog, bronchitis in, 195.

Dog, coryza in, 85.

Dog, laryngitis in, 126.

Dog, nasal catarrh in, 113.

Dog, percussion in, 161.

Dog, position of diaphragm in, 157.

Dog, position of heart in, 157.

Dog, pleurisy in, 257.

Dog, pneumonia in, 237.

Dropsy, ansemic, 377.

Dyspticea, 274.

D\-spncea laryngea, 133.

EcHiNOCOCCUS veteriuorum in the

heart, 341.
Embolism, 345, 347, 350-

4o6

Index.

Etnpyema, 266.

Emphysema, interlobular, 280.
Emphysema, vesicular, 2S0.
Endocarditis, 331.
Epistaxis, 78.
Epistaxis, causes of, 78.
Epistaxis, symptoms of, 79.
Epistaxis, treatment of, 79.
Erysipelas, 361.
Etiology, 7.
Expectoration, 152.
Exudation, 49.

Facies, 25.

False nostril, abscess of, 92, 97.

Fatty degeneration, 57.

Fatty degeneration of the heart, 340.

Fatty tumors in nose, 99.

Fever, 59.

Fever, adynamic, 68.

Fever, alkalies in, 67.

Fever, antipyretics in, 67.

Fever, cold baths in, 65.

Fever, cold stage, 60.

Fever, convalescence in, 67.

Fever, defervescence, 61.

Fever, definition of, 59.

Fever, diaphoretics in, 66.

Fever, diuretics in, 66.

Fever, general bleeding in, 63.

Fever, hot stage, 60.

Fever, laxatives in, 66.

Fever, local bleeding in, 64.

Fever, premonitory symptoms of, 60.

Fever, production of waste matters in
the system in, 61.

Fever, regimen, 62.

Fever, remedies, 63.

Fever, resolvents in, 67.

Fever, retention of water in the fe-
vered system, 61.

Fever, sedatives in, 66.

Fever, stimulants in, 67.

Fever, symptoms of, 59.

Fever, temperature, 61.

Fever, tonic refrigerants in, 67.

Fever, treatment of, 62.

Fever, types of, 62.

Fever, typhoid, condition in, 61.

Fever, warm baths in, 64.

Fibrinous exudate, 51.

Filaria imniitis, 342.

Filaria papillosa hsematica, 342.

Firing in advnamic inflammation, 70,
Firing in inflammation, 70.

Flank, double action of, 153.
Foreign body in nose, 94.

Fowls, croupous pneumonia in, 238.
Frontal sinuses in cattle, catarrh of,

Gangrene, 58.

Gangrene, in pneumonia, 226.

Glander nodules in heart, 341.

Glottidis, oedema, 147.

Goat, auscultation of, 168.

Granular degeneration, 41.

Granulation, 56.

Granule corpuscles, 56.

Granule masses, 56.

Grub in head, no.

Guttural pouches, abscess of, 94.

Gutturomycosis of solipedes, 149.

H/EMOPHII.IA, 366.

Haemoptysis, 209.

Hcemorrhage, 365.

Haemorrhage from the nose, 78.

Haemorrhagic infarction, 211.
j Healing by adhesion, 56.

Healing by first intention, 56.
I Healing by second intention, 56.

Health, definition of, 3.
I Heart, abscess in, 338.
I Heart, atheroma of, 344.

Heart, cancer of, 341.

Heart, calcified, 344.
, Heart, cartilaginous degeneration of,
338.

Heart, chronic disease of, 339.

Heart, congenital malformations and
displacements of, 313.

Heart, cysticercus cellulosa in, 342.

Heart, cysticercus tenuicoUis in, 342.

Heart, diffuse suppuration in, 338.

Heart, dilatation of, 323.

Heart disease, general symptoms of,

i 305-

Heart, diseases of, 291.

Heart, echinococcus in, 341.

Heart, fatty degeneration of, 340.

Heart, fibrous degeneration of, 33S.

Heart, filaria in, 342.

Heart, functional irregularity of, 312.

Heart, glander nodules in, 341.

Heart, hypertrophy of, 315.

Heart, induration of, 33S.

Heart, inflammations in, 325.

Heart, melanosis of, 341.

Heart, morbid sounds of, 303.
■ Heart, neoplasms of, 341.

Heart, osseous degeneration of, 338.
; Heart, polypus in, 338.

Heart, position of, 292.

Heart, position of in dog, 157.

Index.

407

Heart, position of in horse, 155.

Heart, position of in sheep, 157.

Heart, Rainey's cj'sts in, 342.

Heart, relative position of in the do-
mestic animals, 155.

Heart, rupture from concussion, 343.

Heart, rupture from exertion, 343.

Heart, rupture from pithing, 343.

Heart, rupture of, 343.

Heart, sarcocysts in, 342.

Heart, softening of, 33S.

Heart, sounds of, 301.

Heart, strongyli in, 342.

Heart, structure of, 293.

Heart, table contrasting symptoms of
hypertrophy and dilatation, 319.

Heart, table of murmurs of, 304.

Heart, thickness of the walls, 295.

Heart, trichina in, 342.

Heart, tubercle of, 341.

Heart, ulceration of, 338.

Heart, ulceration of, 343.

Heart, valviilar disease of, 339.

Heart, varicose veins in, 341.

Heart, weight of, 296.

Heart, weight of, 317.

Heaves, 274.

Hemiplegia laryngea, 133.

Hereditary roaring, 141.

Hodgkiu's disease, 382.

Horse, acute bronchitis in, 178.

Horse, acute pleurisy in, 239.

Horse, asthma in, 273

Horse, auscultation of, 166.

Horse, chronic bronchitis in, 191.

Horse, croup in, 132.

Horse, laryngitis in, 115.

Horse, nasal catarrh in, 113.

Horse, percussion of chest in, 159.

Horse, pneumonitis in, 213.

Horse, position of chest in, 155.

Horse, position of diaphragm in, 156.

Horse, position of heart in, 155.

Horse, position of intestines in, 156.

Horse, position of liver in, 156.

Horse, position of lung in, 156.

Horse, position ot pancreas in, 156.

Horse, position of spleen in, 156.

Horse, position of stomach in, 156.

Hydrosemia, 371.

Hydrothorax, 259.

Hydrothorax, symptoms of, 260.

Hydrothorax, treatment of, 261.

Hyperseniia, 33.

Hypergemia, definition of, 33.

Hyperaeinia, pulmonary, 198.

Hyperasmia, results of, 35.

Hyperaemia, symptoms, 35.

Hypersesthesia, laryngeal, 148.
Hypertrophy of the heart, 315.

lOAC arteries, embolism of, 354, 355.
Induration of the heart, 338.
Infarction, hsernorrhagic, 211.
Infectious diseases of the throat, 149.
Inflammation, 39.
Inflammation, abscess in, 71.
Inflammation, adynamic, 68.
Inflammation, blistering in, 70.
Inflammation, co'd applications in, 69.
Inflammation, definition of, 39.
Inflammation, firing in, 70.
Inflammation, forms of, 41.
Inflammation, hot applications in, 69.
Inflammation, local treatment of, 69.
Inflammation, massage in, 71.
Inflammation of the lungs, 212.
Inflammation, products of, 52.
Inflammation, results of, 52.
Inflammation, rubbing in, 71.
Inflammation, suppuration in, 71.
Inflammation, treatment of, 62.
Inflammatory, new formations, 53.
Influenza, 114.
Innervation, changes in, 44.
Intermittent roaring, 141.
Interstitial development of lyniph

into tissue, 57.
Intestines, position of in horse, 156.
Inverterate roaring, causes of, 134.

Laryngea, cynanche, 115.
Laryngea, dyspnoea, 133.
Laryngea, hemiplegia, 133.
Laryngeal hypenx'sthesia, 148.
Laryngeal polypi, 132.
Laryngitis, 114.
Laryngitis, angina, 115.
Laryngitis, chronic, 117.
Laryngitis, croupous, 128.
Laryngitis in the dog, 126.
Laryngitis in the horse, 115.
Laryngitis in sheep, 123.
Laryngitis in pig, 124.
Laryngitis, pseudo-membranous, 12S.
Laryngitis, sub-acute, 117.
Laryngitis, treatment of chronic, 121.
Laryngo-pharj'ugitis in cattle, 122.
Larynx, inflamed, 114.
Larva in head, morbid symptom

caused by, no.
Larva in nasal sinuses of sheep, 109.
Larva, mature, no.
Larva, oestrus, 149.
Larva, of oestrus ovis, 109.
Larva, young, no.

4o8

Index

Leeches, 149.

Leech bites, 108

Leucocytheinia, 379.

LeukiLMiiia, 379.

Linguatula taenioides, nasal catarrh
from, 1 13.

Liver, position of in horse, 156.

Liver, position of in ox, 156

Lnng, abscess of in pneumonia, 225.

Lunjj^, collapse of, 206.

Lungs, congestion of, 198.

Lungs, diseases of, 177.

Lungs, inflammation of, 212.

Lungs, parasites of, 290.

Lungs, position of in horse, 156

Lungs, position of in ox, 156.

Lungs, position of in sheep, 157.

Lungs, relative positions of in the do-
mestic animals, 155.

Lymphadenitis, 400.

Lymphadenoma. 3S2.

Lymphangiectasis, 397.

Lymphangitis, acute, 3S6.

Lymphangitis, infective, 392.

Lviiiphangitis of plethora, 386.

Lymphangitis, traumatic, 392.

Lymphatics, dilated, 397.

Lyniph-glands, inflammation of, 400

Lyniphorrhagia, 399.

Lymphorrhoea, 399

Lvmph, interstitial development into
tissue, 57.

Mai<ignant catarrh, 105.

Massage in adynamic inflatnmalion.

Massage in inflammation, 71.
Medical diagnosis, 16.
Melanaemia, 378.
Melanoses of the heart, 341.
Mensuration of chest, 175.
Mesenteric arteries, embolism of, 355.
Mesenteric glands, diseases of, 290.
Metritis, 361.
Microbes, 47.
Micrococcus pneumoniae crouposte,

217.
Migration of white blood cells, 43.
Monday morning disease, 386.
Morbid sounds, 152.
Mucous exudate, 50.
Myocarditis, 338.

Nasal catarrh, 81.

Nasal catarrh, chronic, 87.

Nasal discharge from carious teeth, 93.

Nasal gleet, 87.

Nasal mucosa, 26.

Nasal polypus, 98.

Nasal sinuses of sheep, larva in, 109.

Nasal sinuses, pus in, 90.

Neoplasms in nose, 98.

Neoplasms of heart, 341.

Nervous disorder, symptoms of, 27.

Noevus, 359.

Noevus in heart, 341.

Nose, angioma in, 100.

Nose, bleeding from, 78.

Nose, carcinoma in, 99.

Nose, contagious diseases of, 107.

Nose, cysts in, 100.

Nose, diseases of, 78.

Nose, neoplasms in, 98.

Nose, osseous tumors in, too.

Nose, parasitic diseases of, loS.

Nose, sarcoma in, 99.

OCCASIONAI, roaring, 141.

CEdema glottidis, 147.

CEdema, pulmonary, 204.

CEstrus larva, 149.

CEstrus ovis in nasal sinuses of sheep,

109.
CEstrus ovis, larva of, 109.
CEstrus purpureus, 112.
Omasum, position of in ox, 156.
Organs, relative positions of in the

domestic animals, 155.
Osseous tumors in nose, 100.
Ox, auscultation of, 167.
Ox, bronchitis in, 193.
Ox, chronic pneumonia in, 235.
Ox, croup in, 128.
Ox, croupous pneumonia in, 233.
Ox, percussion of chest in, 159
Ox, position of abon)asum in, 156.
Ox, position of diaphragm in, 156.
Ox, position of liver in, 156.
Ox, position of lungs in, 156.
Ox, position of omasum in, 156.
Ox, position of paunch in, 156.
Ozoeua, 87.

Palpation, 175, 300.
Palpitations, 307.

Pancreas, position of in horse, 156.
Paracentesis thoracis, 261.
Parasites in amcniia, 372.
Parasites of the air passages, 290.
Parasites of the throat, 149.
Parasitic diseases, of the nose, 108.
Paroxysmal cough, 151.
Passive congestion, causes of, 35.
Passive congestion, results, 37.
Passive congestion, symptoms, 37.
Pathology, definition of, i.

Index.

409

Pathology, (lefmiiion of general, i.

Pathology, definition of special, 2.

Paunch, position of in ox, 156.

Percussion, 158, 300.

Percussion, immediate, 158.

Percussion in birds, 161.

Percussion iu disease. 161.

Percussion in dog, 161.

Percussion in p'g>, 160.

Percussion in sheep, i6o.

Percussion, mediate, 158.

Pericarditis, 326.

Pericarditis, chronic, 32S.

Perspiration, suppressed, 75.

Phagocytosis, 47, 48

Pharyngeal polypi, 132.

Pharyngitis, 114, 126.

Pharyngo-laryngitis in cattle, 122.

Pliarynx, 114.

Phlebitis, 360.

Phlebitis, adhesive. 361

Phlebitis, idiopatiiic, 360.

Phlebitis, suppurative, 361.

Phlebolites, 364.

Phlegmasia, 39.

Phlogosis, 39.

Pig. auscultation of, 16S.

Pig, coryza iu. 85.

Pig, laryngitis in, 124.

Pig, percussio 1 in, 160.

Pig, pneumonia in, 237.

Pig, position of diaphragm in, 157.

Plethora, 369.

Plelliora, lymphangitis of, 3S6.

Pleura, air in, 265.

Pleura, parasites of, 290.

Pleurisy, causes of, 239.

Pleurisy, chronic, 267.

Pleurisy, classification of cases in,

246
Pleurisy, dry, 247.
Pleurisy, fibrinous, 247.
Pleurisy in dog, 257.
Pleurisy in cattle, 25 V
Pleurisy in horse, 239.
Pleurisy in sheep, 256.
Pleurisy, pleuritic effusion in, 246.
Pleurisy, post mortem appearances in,

244. "
Pleuris}', prognosis of, 249.
Pleurisy, sero fibrinous, 247.
Pleurisy, sero fibrino-purulent, 248.
Pleurisy, symptoms of. 241.
Pleurisv, treatment of, 249.
Pleuritis, 239.
Pleurodj'nia, 269.
Pleuropneumonia, 258.
Plugging the nose. 79.

Pneumonia, 212.

Pneumonia, abscess in, 223.

Pneumonia, abscess of the lung in,
■225.

Pneumonia, antiphlogistic treatment
I of, 228.

i Pneumonia, antipyretic treatment in,
230.

Pneumonia, auscultation in, 220.

Pneumonia, bacteriology of, 216.

Pneumonia, chronic, 232.

Pneumonia, compresses in, 231.

Pneumonia, consolidation in, 224.

Pneumonia, contagion in, 216.

Pneumonia, croupous, 213.

Pneumonia, croupous in fowls, 238.

Pneumonia, death in, 223.

Pneumonia, derivatives in, 231.

Pneumonia, fomentations in, 231.

Pneumonia, gangrene in, 224, 226.

Pneumonia, gray hepatisation in, 225.

Pneumonia in the dog, 237.

Pneumonia in the ox. chronic, 235.

Pneumonia in the ox, croupous, '23'?.

Pneumonia in the ox, treatment of,

235-
Pneumonia in the pig, 23S.
Pneumonia in the sheep, croupous,

236
Pneumonia, modifications of distant

organs in, 226.
Pneumonia, modifications of the blood

in, 226.
Pneumonia, pathological lesions in,

224-
Pneumonia, percussion in, 220.
Pneumonia, jioultices in, 231.
Pneumonia, progress of, 221.
Pneumonia, red hepatisation in, 224.
Pneumonia, refrigerant febrifuge in,

23 r .
Pneumonia, resolution in, 223.
Pneumonia, sedatives in, 231.
Pneumonia, splenisation in, 223.
Pneumonia, stimulants in, 231.
Pneumonia, sub-acute, 222.
Pneumonia, symptoms of, 219.
Pneumonia, treatment of, 227.
Pneumonitis, 212.
Pneumonitis in the horse, 213.
Pneumothorax, 265.
Pneumothorax, symptoms of, 265.
Pneumothorax, treatment of, 266.
Polynemia, 369.
Polypi, laryngeal, 132.
Polypus in the heart, 338, 341.
Polypus, nasal, 98.
Polypus of the bronchial tubes, 289.

4IO

Index.

Polypi, pharyngeal, 132.
Prevention, 31.
Prognosis, 28.

Prognosis, causes of illness, 29.
Prognosis, definition of, 28.
Prophylactics, 31.
Prophylaxis, 31.

Pseudo-membranous laryngitis, 128.
Pulmonary apoplexy, 211.
Pulmonary hypertemia, 198.
Pulmonary oedema, 204.
Pulmonary oedema, physical signs of,

205.
Pulmonary oedema, prognosis of, 205.
Pulmonary oedema, symptoms of, 205.
Pulse, 23, 296.
Pus, 55.
Pyo- pneumothorax, 266.

Rabbits, coccidian catarrh, 108.

Rainey's cysts in the heart, 342.

Rales, 171.

Rales, bronchial, 171.

Rale, crepitant, 172.

Rale, drj', 171.

Rale, mucous, 172.

Rale, sibilant, 171, 172.

Rale, sonorous, 171.

Rale, subcrepitant, 173.

Rale, submucous, 172.

Red cells, 44.

Resolution, 53.

Resonance, absence of, 162.

Resonance, diminished, 162.

Resonance, increase of, 161.

Respiration, 24.

Respiration, Cheyne-vStokes, 340.

Respiration, creaking sound in, 174.

Respiration, friction sound in, 173.

Respiration, gurgling sound of, 174.

Respiration, juvenile, 165.

Respiration, metallic tinkling in, 174.

Respiration, modification of, 153.

Respiration, slow, 153.

Respiration, splashing sound of, 174.

Respiration, tardy, 153.

Respiratory disease, affected by age,
70.

Respiratory disease, affected by sea-
son, 77.

Respiratory diseases, general causes,
72.

Respiratory mucosa, extent of, 72.

Respiratory murmur, absence of, 170.

Respiratory murmur, diminution of,
169.

Respiratory murmur, general dimniu-
tion of, 170.

Respirator}' murmur, increase of, 169.

Respiratory murmur, partial diminu-
tion of, 170.

Respiratory organs, diseases of, 72.

Retention of water in the fevered sys-
tem, 61.

Rheumatic endocarditis, 337.
' Rhinaria taenioides, nasal catarrh
from, 113.

Rhinitis, 81.

Roaring, 133.

Roaring, hereditary, 141.

Roaring, immediate cause of, 136.

Roaring, intermittent, 141.

Roaring, inveterate, causes of, 134.

Roaring, occasional, 141.
! Roaring, temporary, causes of, 134.
! Rupture of the heart, 343.

Sarcoma in nose, 99
I Sarcocysts in the heart, 342.

vScarlatina, 114.

Senieiology, 18.

Serous exudate, 50.
I Sheep, ausculation of, 16S.

Sheep bot fly, 109.

Sheep, coryza in, 85.
j Sheep, croup in, 131.

Sheep, croupous bronchitis in, 197.
j Sheep, croupous pneumonia in, 236.

Sheep, laryngitis in, 123.

Sheep, percussion in, 160.

Sheep, pleurisy in, 256.

Sheep, ]iosition of the heart in, 157.

Sheep, posiiion of lung in, 157.

Skin symptoms, 24.

Softening, result of inflammation, 57.

Solipedes, gutturoniycosis of, 149.

Sore throat, 114, 126.

vSore throat, croupous, 114.

Sore throat, diphtheritic, 114.

Spleen, position of in horse, 156.

Stomach, position of in horse, 156,

Strangles, 114.

Strongylus subulatus, 342.

Strongylus vasorum in the heart, 342.

Study, objects and methods of, i.

Suppuration, 53.

Suppuration in adynamic inflamma-
tion, 71.

Suppuration in inflammation, 71.

Suppuration in nasal sinuses, 90.
1 vSymptonmtology, 18.

Symptomatic cough, 151.

! Symptoms, constitutional, 18.

Symptoms, definition, 18.
■ Symptoms, direct, 19. «

! Symptoms, facies, 25.

Index.

411

vSymptoms, idiopathic, 19.
Syniptouis, indirect, 19.
Syinptotus, local, iS.
Symptoms, movements, 20.
vSymptoms, objective, 18.
S3'mptoms of coryza, 82.
Symptoms of nervous disorder, 27.
Symptoms, position, 20.
vSymptoms, precursory, 19.
Symptoms, premonitory, 19
Symptoms, skin, 24.
vSymptoms, subjective, iS.
Symptoms, sympathetic, 19.

Tapping the chest, 261.
Temperature in disease, 22.
Temperature, normal, 22.
Temporary roaring, causes of, 134.
Therapeutics, 32
Thoracentesis, 261.
Throat, affections of, 114.
Throat, infectious diseases of, 149.
Throat, parasites of, 149.
Thrombosis, 350.
Touch, 175.

Tracheotomy, 119, 131.

Traumatic catarrh, loi.

Treatment, 32.

Treatment of chronic coryza, 87, 90.
! Treatment of epistaxis, 79.
' Treatment of frontal catarrh, 102.

Trichina in the heart, 342.

Tubal sound, 170.

Tubercle in heart, 341.

Ulceration, 57.
Ulceration of the heart, 33S.

Varicose veins, 363.

Veins, calcareous bodies in, 364.

Veins, varicose, 363.

Vena azygos, rupture of, 343.

Ventricles, internal capacity of, 296.

Vesicular murmur, general increase

of, 169.
Vesicular murmur, partial increase of,

169.

White blood cells, migration of, 43.
Winds, carry disease, 76.

Webster Family Library of Veterinary Medicine
Cummings Sciiool of Veterinary Medicine at
Tufts University
200 Westboro Road
North Grafton, MA 01536