SES MV Aare SSN WY SRR LAY RQ NS NR SNS SS a pers FLOWER-SPRECHER gig Library AN sz iy CCT 3 1924 084 857 832 Cornell University Library The original of this book is in the Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www. archive.org/details/cu31924084857832 CLINICAL DIAGNOSTICS OF TAE Internal Diseases of Domestic Animals BY PROF. DR. BERNARD MALKMUS Professor of Theory and Practice and Director of the Clinic for Internal Diseases at the Royal Veterinary College of Hanover, Germany Translated from the Fourth, Revised German Edition by David S. White, Dean of the College of Veterinary Medicine, Ohio State University and Dr. Paul Fischer, State Veterinarian of Ohio. CHICAGO ALEX. EGER 1924 COPYRIGHTED WASHINGTON, D. C. BY ALEX. EGER 1912 REPRINTED 1923 Authorized Translation Translator’s Preface. N the translation of Malkmus’ “Grundriss der Klinischen Diagnostik” we have endeavored simply to reproduce the author’s ideas with the hope that the English and American Veterinary Students may thus be provided with a text-book for which they have long felt a need. The needs of the students in the College of Veterinary Medi- cine of the Ohio State University have been the direct cause of the hurried undertaking of this work. A few short notes which we thought proper to add here and there, throughout the book, have been placed in [ J. Davip S. WHITE, Paut FISCHER. Author’s Preface to the Fourth Edition. The present fourth edition has undergone in all depart- ments a thorough revision. A few new cuts have been added, some of which graphically demonstrate the respirations by instructive curves. Throughout I have endeavored not only to furnish the student an adequate guide but also to provide the practitioner with a reliable adviser. Notwithstanding the numerous additions, by increasing the amount of printed matter on each page, the former handy size of the book has been retained, MALKMUs. Preface to First Edition HE only safe foundation for the treatment of anima! diseases is a correct diagnosis of the malady. In therapeutic as well as in forensic veterinary medicine everything depends on a correct recognition of the disease. This is the most difficult part of veterinary medicine, and methodical training alone will enable the student to de- velop into a practicing veterinarian who can do justice to this demand. The following little work which offers a great variety of material in a most condensed form is intended as a guide for the diagnostician in recognizing and understand- ing the symptoms of disease. Although it represents the result not only of personal, but of veterinary experience in general, for the sake of clearness and general appearance the names of the numerous authors have been omitted. The results of bacteriological research which have an im- portant bearing on diagnostics have been given due prom- inence. I have also deemed it appropriate to call attention, at the proper places, to those diseases or conditions which are considered as factors in annulling, or setting aside a sale. It was necessary to append a brief description of the most common diseases in order to give the student a gen- eral idea of the character of the maladies that affect the various functional apparatus, thus refreshing his memory and enabling him to institute comparisons between what he learns from his lectures and sees in the clinic. The true to life representations of the horse and cow, which are copied from the “Handbuch der Anatomie der Thiere fiir Kunstler,’ I owe to the kindness of Prof. Dr. Ellenberger and Prof. Dr. Baum of Dresden. I here most kindly thank these gentlemen for their unselfish obliging- ness, The publishing house of Gebriider Janecke have dis- regarded both expense and trouble in order to supply good illustrations and to give the book a neat appearance; to them, too, my gratitude is due. Hanover, November, 1898. MaLkMUus. Table of Contents. . ; PAGE The Diagnosis of Diseases... 0 6... cece eee eee 11 Syl PlOims:. sven olga ey he ee caw eee ee 12 Determining the Diseased Organ ........... 14 The Recognition of the Disease ... ......... 15 I. Anamnesis .... ........ Yeeeatel, jade Serkan due ls Rakes 18 II. Determining the Status Praesens .......... seeped. Method of Examination. InSpectOli no sswe kei ead oe ae ee 21 Palpation snap: adv adi otek meted wets 23 Percussion ....... Sieg? cetudetealae Eyshioae ne eee 24 ATISCUIAHON: o..4 4S ves alts eo en ae er ree 29 A. General Part of Examination H tf, Signalment:s «24 ac00nuhereebevascnse ee saa hee 31 O pa pitust s.centecitea yao AA Rohe het crete pedals 32 J. Attitude of the Patient ........... 38 TVs “GOndviiOwy sce see baa cin Sete 39 TEL: (Conformation 4s. acces. Serena hes 40 TV... Véiiperanient . ace acesse vere dees 40 Diseases which are character ized particularly by change Pat Seles, DASEAL Ge ssi ike acetone mare ase ae @ The SKIN sx caciaveeac dees onaesn sree % I. Condition of the Hair Coat........ +4 II. The Skin’s Moisture ............. 45 III. Swellings in, and immediately under, the: Skiti-vseddiyeseaneee eKits 46 TV. Color of the Skin ......6... 0502055 49 V. Condition of the Skin ...........-. 50 Diseases of thie {S ktitvecsasyeace ets 50 VIII. 4. Examination of the Conjunctiva................ I. Discharge from the Eyelids......... TN. SC@olOr 5239 5 es ate eee eo SA TTT: SCS tas se ays sane Pade Saws oeiece acces 5. Bodily Temperature ................ 000: eeeee I. The Normal Temperature......... Il. Temperature of the Skin... 3 See WE J ARCNGE: causa: scaupnc’eoclasaces Oadateusiend vise hee eet IV. Subnormal Temperature .. ....... General Infectious Diseases.... Special Part of the Examination. 6. Circulatory Apparatus ................0. eee ee Le? GRUNGE: eaten coe Ache des ee ees oieceaa II. Examination of the Peripheral Blood Wessels a.1oset de ccckee rant TT alate SECA oct ihc eles oneeeats Seen: Diseases of the Circulatory Ap- Per BaeWS . 6 geysied wgaeayge ees low eee 7. Respiratory Apparatus ..................0.005 I. The Respiratory Movements....... IM. “Eh6 BReathy oc: areeparae bade ree swe Il. Nasal Discharge 29 x te.s-c ict a craaed araub ate ow IV. The Nasal Cavities and Adjacent DSIMUISESy oy oycncas cane Bard aiwlae irae V. Examination of the Submaxillary Lymph Glands ........... Wil GOOG, tics thn gaeideutn koahe ane danas ots WAT. GHG MiOIC Rs sob perma tneed Cinna eueaee VIII. The Larynx and Trachea.. IX. Percussion of the Thorax........... X. Auscultation of the Lungs.......... Diseases of the Respiratory Ap- PaATAatiwiGass mkerderscndreecex ceades 8. Digestive Apparatus .................000 eee ee L, Mog: att: RHR. oi aie gives nit dene een I, “The Biiecal Cavity. «cxcscceacnwones IIT. The Throat and Esophagus.......... IX. LV... Rutnination: o¢iccs cous S355 See cues 150 Mis MOTIITEA GY Mh Neealind ancien aA Gai Boe 151 VI. The Abdomen .................... 153 VII. Intestinal Discharges or Evacuations. 163 Diseases of Digestive Appa- PAUSE, ok ke Moraceae ogre mngde Paani e ealan 171. 9. Urinary Apparatus ...............0.-c cece eee 176 I. Manner of Voiding the Urine....... 177 II. Examination of the Urine.......- .. 479 A. Macroscopical Examination..... 179 B. Chemical Examination.......... 182 C. Microscopical Examination.. ... 193 A. Crystalline Constituents of Urine 194 B. Organized Elements of Urine... 196 III. Examination of the Urinary Organs.. 199 Diseases of the Urinary Ap- Pid GETS sig seh aiaraaunne sees Ne ae ea Ae Ate thous 201 Diseases of Tissue Metabolism.............. 202 10. The Sexual Apparatus .................0e eee 202 I. Abnormally Increased Sexual Appe- TILED edo dened nd ane ais clalen! again 202 Wey “Lhe VAIN 2 tec uaaoosea tesa cede 203 III. The Vaginal Mucous Membrane..... 204 IV... The Udder: .ccccteceyeaasaatwee 8 204 V. Diseases of the Male Sexual Organs.206 Diseases of the Sexual Organs.. 207 11. The Nervous System.................:00 ee eee 208 I. Psychic Functions ............. ... 210 il. “SQnsibility: «acs csteecto wens Gkeets 212 TU 2 MOtitty ses geenercetanletah waa kta eles 213 Diseases of the Nervous System. 218 C. Specific Examinations. 221 12, Body Movements ..........ccceee cere ce eeeees 221 J. Examination for Immobility......... 221 II. Examination for Heaves............ 224 III. Examination for Roaring...........- 226 IV. Examination for Epilepsy and Ver- HPO! cyae becdake eed ta eon ee 228 V. Examination for Balkiness.......... 229 xX 18. Diagnostic Inoculation .................-2 0065 230 I. “BUB@TCHIOSIS: 22+ s:a ncndeergasuiad 231 We AG anders: ~ swiss ca rek vee seated 235 Il. Anthrax, Blackleg, Malignant Ed- ema and \Wild-und Rinder-Seuche 240 Ms TRAD HES. cedeavadahavtee, -goduserdddees aise ede's 241 14. The Lymphatic Glands ...................... 243 aS. “THE BlOOd) waawvasc eign add dvanoadin di gulerece 245 Diseases of the Blo cxcsenaxs suis 249 The Diagnosis of Diseases. The object of practical veterinary medicine is manifold, but in the main it consists in the restoration of the destroyed health of our domestic animals. For this purpose a knowledge of the affected organ and of the character of the disease is indispensable, because this knowledge offers the only safe basis for a rational treatment and a correct prognosis. Thus the art of making a correct diagnosis is not only the foundation upon which practical veterinary medicine rests, but it is pre-eminently that which elevates medicine to the dignity of a science. — Diagnosisistheart of determining in- ternal changes of the body by the aid of externally visible or otherwise apprecti- able changes in the animal’s condition or some of its organs. It also includes the recognition and name of the disease. Since disease is a deviation from normal conditions and physiological processes, morbid changes cannot be recognized without a knowledge of normal conditions. In the classroom the student has no opportunity to study the physical characteristics and the physiological functions of organs in living animals; he must learn this from personal ob- servation and investigation in the clinic. In the clinic he must cultivate his senses and learn to hear, see, feel and smell in order to be able to judge correctly. In the course of his practice different species of animals are presented to the veterinarian for clinical examination. This gives rise to certain difficulties which, in the main, are based 12 CLINICAL DIAGNOSTICS. on differences in anatomical structure and physiological func- tion of the organs of different animals. The methods of ex- amination are about the same for all species. One who has thoroughly learned the fundamental principles underlying the methods for the proper examination of a horse will have little trouble in adapting them to other animals. However, import- ant differences in this respect will receive due consideration. A further considerable difficulty in diagnostics, for the veterinarian, is his inability to determine the subjective feel- ing of a patient. Still, this is of less importance than the layman usually supposes. On the other hand, to compensate for this, we are in a position, in all cases, to make a complete objective examination of the patient in any direction. In this respect we have an advantage over the physician who is fre- quently denied this privilege and is, besides, liable to be misled by the imagination, whim, shame or vanity of the patient. A diagnosis consists in the determination of 1. The symptoms of the disease. 2 The diseased organ. 3. The character of the disease—its name. A Symptom is any observable deviation from the nor- mal state or condition. Anatomy and physiology treat of the normal conditions and functions; Symptomatology treats of morbid conditions and of perverted functions. The particular object of a clinical examination is the de- termination of symptoms; it must therefore include the exter- nal appearance and general behavior of the animal as well as a careful inspection of every accessible organ. To avoid mistakes or overlooking important factors we must conduct this exami- nation according to a definite plan. The best plan to follow is to take up the different func- tional apparatus in their physiological order and complete the examination of each in its turn. The beginner should memo- rize the scheme and follow it faithfully. This is no difficult DIAGNOSIS OF DISEASES. 13 task since the arrangement is a physiological and therefore natural one. We propose the following order of procedure: I. Anamnesis (ascertaining previous history of case). II. Determining the Status Praesens. A. General examination. 1. Signalment of the patient. 2. Habitus. 3. Skin. +. Conjunctiva. 5. Temperature. B, Spécial ¢xaminations, 6. Circulatory apparatus. 7. Respiratory apparatus. 8. Digestive apparatus. 9. Urinary apparatus. 10. Sexual apparatus. 11. Central nervous system. C. Specific examinations 12. Locomotion, exercise in harness or under saddle, ete. 13. Diagnostic inoculations. 14. Examination of lymphatic glands. 15. Examination’ of the blood. The anamnesis should be procured and the general and special examination should be made at least once during the first visit to the patient. If the diseased organ or organs have been ascertained they must be carefully re-examined at every subsequent visit, at the same time we must be on the alert for the appearance of possible symptems in other organs. The specific examinations are made only when necessary for clinching the diagnosis. The determination of symptoms is at times difficult. Sometimes external influences bring about certain condi- tions of the healthy body which must not be interpreted as 14 CLINICAL DIAGNOSTICS. symptoms of disease, although they might, under other cir- cumstances, be such; e. g., a horse refuses its. feed—this is a frequent occurrence in gastro-intestinal affections or in the course of severe general diseases, but it may also be due to an excitable temperament of the animal or to the fact that the food in itself is undesirable—spoiled, mouldy. Hence the practi- tioner must always endeavor to determine the cause of the symptoms, whether the deviations from the normal are really due to disease or to external conditions. The importance of symptoms depends very largely upon the conditions under which they appear. Rapid respiratory movements may be due to a disease of the respiratory apparatus or to some other affection; again, they invariably occur after bodily exertions, and high tempera- tures, even when the animal is at perfect rest, will cause the respiratory movements to become accelerated. To avoid confusing symptoms produced by muscular ex- ercise, or other efforts on the part of the animal, with symp- toms of disease, the patient should first be examined in a state of rest. Furthermore, all conditions that could possibly influ- ence normal physiological processes must ever be taken into consideration; for example, we will mention age, _ estral period, pregnancy, fright on part of the animal, etc. After noting the symptoms of the disease we come to the most difficult part of clinical diagnostics, viz: The determination of the organ diseased. There are only a few symptoms which point with certainty to an affec- tion of a definite organ, fewer still enable us to recognize the character of the disease; these latter are called pathognomonic symptoms. As a rule all symptoms must be first noted and then considered as a whole, always bearing in mind the prin- ciples of general and special pathology. The symptoms which appear in a disease have for the determination of the affected organ a varied importance. Local Symptoms emanate from the diseased organ and there- DIAGNOSIS OF DISEASES. 15 fore are noted only when certain organs are suffering. For this reason local symptoms are of great importance in diag- nosis. Gencral symptoms originate from the sympathy of the whole organism induced when varied organs are diseased. General symptoms may arise from the primary disease and be called (a) direct symptoms, or they may be due to complica- tions or sequela when they are spoken of as (b) indirect o1 accidental symptoms. To determine the affected organ all symptoms are care- fully reconsidered in the order in which they were determined. The healthy apparatus are for the time being disregarded, the diseased apparatus are given special consideration. A variation in the normal functional activity of an organ does not i itself indicate disease, it may simply be a compen- satory variation (one due to an opposite variation in a similar organ) due to the primary morbid condition. The therapeut- ist’s object is to ascertain the primarily affected organ, bring about a cure in this and secondarily cause the sympathetically affected organ to regain its natural condition and activity. To discover the primarily affected organ requires a knowledge of the morbid processes that take place in each organ and of the local and general symptoms produced by them. This requirement is still more important for the final aim or ultimate purpose of diagnostics, viz: The recognition of the disease itself according to kind, etiology, intensity and duration The method of examination of each organ will therefore be followed by a short description of the most important diseases of each. One who has not yet learned from his school training or practical experience, to appreciate the various symptoms which characterize each of the diseases and who has not a well- defined mental picture of the appearance of each of the dis- 16 CLINICAL DIAGNOSTICS. eases with which he must come in contact, will never become a good diagnostician. Diagnosis per se has a different value depending upon whether it is made for a scientific or wholly practical purpose. It is often symptomatic and thus merely cloaks our ignor- ance; diabetes insipidus, colic, for instance. The purpose of diagnosis is more nearly attained when it includes the cause of the disease (‘etiological diagnosis”), which is of value even if we do not know more of the cause than that it is some specific infection (influenza). An anatomical diagnosis is not conclusive because it does not indicate the cause (nasal catarrh, bowel catarrh). An ideal diagnosis would be “etiologico- anatomical” (skin glanders, acarus mange, verminous bron- chitis). A correct prognosis and rational treatment are largely dependent upon a knowledge of the cause and morbid changes of the disease. It is not enough to diagnose a nodular, itching and spread- ing eruption of the skin, we must also determine the cause or our prognosis and treatment cannot be correct and rational. Such eruptions are due to various causes and an exact knowl- edge of them is an important item. The same may be said of affections of internal organs. A final diagnosis is made either by considering the deter- mined symptoms directly (direct diagnosis) or by a process of exclusion, i. @., We review in our mind all the diseases in which the symptoms determined occur, or in which some of these symptoms occur, and then we exclude those diseases in the course of which, if present, we usually observe additional symptoms (differential diagnosis). The difficulties encountered in diagnosing internal dis- eases vary considerably; in some cases a good anamnesis suf- fices as a basis for making a definite diagnosis: epilepsy, par- turient paresis. In other cases the experienced practitioner requires but a glance at the patient: tetanus. The rule, how- ever, is never to make a diagnosis until a thorough and careful DIAGNOSIS OF DISEASES. 1% examination of the patient has been made; but here, too, care- fully cultivated powers of observation and extensive experience go a good way. To acquire either of these, of course, requires continued carefully and methodically conducted examinations. The same diseases do not always present the same set of symp- toms. Therefore, the more often a disease is seen by the prac- titioner, the more readily will he recognize it. In the course of one and the same disease the symptoms will change, depending upon whether the onset, acme or latter stages are being ob- served. The diagnostician should be like the experienced botanist who recognizes a plant in all its stages of vegetation. There will always remain a few cases the symptoms of which are so atypical that an exact diagnosis is impossible. Not infrequently, however, even the experienced prac- titioner must content himself with limiting his diagnosis to a statement of the general character of the disease and reserve the privilege of expressing his final opinion (special diagnosis) pending further observation and developments. This is par- ticularly the case in the first outbreaks of infectious diseases when localized changes are absent and in many chronic dis- eases showing few symptoms. We also distinguish between a definite, a probable, and @ possible diagnosis. I. Anamnesis. Full statements on the part of the owner or attendant, procured by cautious questioning, concerning the previous con- dition of the patient, the beginning and previous course of the disease (anamnesis) are of great importance in diagnostics. In fact there are some diseases, like epilepsy, for example, that can as a rule be diagnosed in no other way because it is only in exceptional cases that we have an opportunity to observe a typical epileptic fit. As far as the veterinarian is concerned the anamnesis is limited to the observation of the immediate surroundings cof the animal. In questioning attendants speak to them in a pleasant tone and manner and use words and expressions with which they are familiar; this tends to infuse confidence and the result is that the information thus obtained will be more apt to be reliable. Any digression in the testimony of informants should be listened to with patience. One should always remember that every anamnesis, from whomsoever it be obtained, is more or less colored by the personal conceptions of the person offering it. This is quite apart from intentional misrepresentations, which are often encountered. A well drawn up anamnesis speaks for the technical ability of the veterinarian as well as for his knowledge of the etiology of the diseases of our domestic animals which are kept under the most variable conditions. 1. How long has the animal been sick? We may learn by this question whether the disease is an acute or a chronic one, and perhaps also the stage of development ANAMNESIS. 19 which the disease has reached. Frequently the time given by the owner or attendant is much shorter than the actual duration of the disease. *, What symptoms hasthe animal shown? In the beginning? Later on? The objective observation of the owner must be carefully sifted out from his subjective interpretation of them. a What, in your opinion, could be the cause of the disease? We cannot search for the causes until we know the symptoms. Where and under what conditions did the animal get sick? Feed, care, etc., play an im- portant role in the etiology of the internal diseases of ani- mals; therefore the veterinarian must be informed not only as to the kind and character of the feed but also as to soil conditions, water, etc., otherwise he cannot intelligently trace the cause of the disease. The care and attention animals receive wield a great in- fluence upon the genesis of many diseases. It is rare that the veterinarian can obtain from the attendants reliable data con- cerning these. He should judge by the surroundings in this regard. The use to which the animal was put when the dis- ease occurred is of value in tracing the cause, for special uses predispose animals to certain diseases. 4. A number of animals affected by the same disease always points to a common cause, viz.: infection or intoxica- tion (poisoning). The frequent recurrence of a disease in the same stable points to the existence of a permanent cause. 5. It is of especial importance for the veterinarian to know whether any previous treatment has been resorted to and what effect this may have had. Quacks often administer drenches containing solid particles in suspension; these draughts, instead of taking their usual course, may enter the trachea and thus produce a fatal pneumonia. In removing the contents of the rectum its wall or mucous membrane is 20 CLINICAL DIAGNOSTICS. also often injured. In such cases the veterinarian must ex- ercise care and judgment and call the owner's attention to any existing danger. Although the main points in the anamnesis should be de- termined before we begin our objective examination, other questions will present themselves in the course of the latter. Thus, when examining the respiratory tract we may inquire whether the animal coughs, and when examining the diges- tive apparatus inquire as to condition of bowels, frequency of evacuation, etc., in this way gradually completing our exam- ination. The value of a good anamnesis consists in the fact that not infrequently it is sufficient to base upon it a definite diag- nosis, 1. e., careful objective observations of the layman may in some instances be substituted for our examination. How- ever, the veterinarian must always be cautious in complying with the oft made request of owners to treat their animals in absentia. Although the medicines prescribed under such con- ditions may do no particular harm, rational treatment thus delayed may prove to be a positive injury. Sometimes the veterinarian is misled by the anamnesis. This he may guard against by making a careful examination of the patient. When the anamnesis does not conform to the results of the examination, it should be accepted with caution; where the opposite is true, it may be considered reliable. II. Determining the Status Praesens. To determine pathological phenomena we resort to all those methods which throw light upon the physical state and functions of the different organs. In doing this we should endeavor to follow a definite plan and not proceed without system. The following methods are generally employed and in the order given: —< 1. Inspection. In examining the different parts of the body it is always best that we first regard that which can be observed with the unaided eye. Students are apt to lay their hands upon the patient too soon. Superficial abnormalities are described ac- cording to their seat, size, color and other external manifesta- tions ; the size and form usually being compared with common objects, unless an exact description is desired when actual measurements are ‘made. The odor emitted by the se- and excretions and the res- pirations is also noted. In designating the seat of visible pathological conditions the exact anatomical region occupied by them should be indi- cated. Regions of the Body. I. Head. A. Face. 4. Nasal region with dorsum of nose, tip of nose, nasal openings. [Nostrils]. 2. Labial region, with upper and lower lips, inter- labial space and chin. 3. Buccal region. 4. Infraorbital region. CLINICAL DIAGNOSTICS. 5. Ocular region, 6. Masseteric region with maxillary articulation. a Soae 11, 12, 13. 14. 15; 16. Intermaxillary space. Fig. 1. Forehead. Frontal region. Occipital region with forelock. Temporal region with the temporal fossa, infra- temporal groove and auricular region, [Ears]. Parotid region, which merges below into the laryn- geal region. Tracheal region with jugular groove, at the lower end of which is the supra-clavical fossa. Cervical region with crest and mane. Lateral .cervical region, sides of neck. Withers and dorsal region. Lateral pectoral region [side of chest| with scap- DETERMINING THE STATUS PRAESENS. 23 ular region, cardiac region, costal region. 17. Sternal region. 18. .Anterior pectoral region. [Breast]. IV. Abdomen. 19. Epigastric region with xiphoid spacc. 20. Mesogastric region with umbilical space, iliac region (flank with “hollow of flank”) and the lumbar region. 21. Hypogastric region with pubic and inguinal region. V. Pelvis. The different divisions of the pelvis are named according to their anatomical parts; the sacral region is called the croup, the external angle of the ilium the “hip,” just below the anus the perineal region; the anal region, pubic region and inguinal region. VI. Extremities. The different parts of the extremities are designated according to the bones and joints which form their bases. Anterior limb: Shoulder, point of shoulder, arm, elbow, forearm, “knee,” cannon, fetlock joint, pastern, coronet, bulbs of heels, hoof. Posterior limb: Thigh, stifle, leg, hock, hind cannon, ete. —) 2. Palpation. Palpation consists in feeling the part to be examined with the hand or finger tips. Its object is to gain information through the sense of touch as to the consistency, extent, tem- perature and sensitiveness of a part, and permit us to recog- nize abnormalities which do not lie far below the surface. Palpation is of especial importance in taking the pulse. The abdominal viscera can be explored (palpated) through the rectum and the anatomical position, and condition of the con- tents determined. From the difference in consistency of the parts palpated, conclusions as to their physical nature may be drawn. The following peculiarities may be distinguished on palpation: 1. A part is doughy when it feels soft and accepts finger imprints which it retains for a few moments, when the de- pressions are again filled. Tissue is of a doughy consistency when infiltrated with serum: (edema). 24 CLINICAL DIAGNOSTICS. 2. A part is frm when it is of the consistency of normal liver. According to the part’s resistance to the touch it may be firm, tendinous, solid. A cellular infiltration of tissues (phlegmon) or the presence of neoplasms made up of cells, will lend to a part a firm consistency (connective tissue). 3. A part is hard when of the consistency of bone. 4+. A part is Auctuating when it is soft, elastic and undu- lates on pressure. Only fluids admit of such a rapid trans- mission of pressure (pus, blood, lymph, serum). If the tissue surrounding the fluid is not tense, waves are seen to pass over the surface of the swelling (true or soft fluctuations). Soft-elastic (fat) tissue or tissue impregnated with a quantity of fluid may also show fluctuation; this undulating consistency is spoken of as pseudo-fluctuation. 5. A part is emphysematous when it presents a puffy swelling which crackles and shifts on palpation; it is due to the presence of air or gas in the tissue (emphysenia). 3. Percussion. By percussion we understand striking the surface of the -animal body so that the parts thus set in vibration emit audi- ble sounds. The “percussion-sound’ thus produced will differ with the physical condition of the vibrating parts, and these differences are so well marked that definite conclusions can be drawn from them. Methods of percussion. Percussion can be practiced without the use of instruments [so-called anmediate percussion] on small ani- mals or large animals thin in flesh. The index or middle finger of the left hand i is held firmly against the part to be percussed and struck with the middle finger of the right hand. The striking finger should be held somewhat curved and stiff. The advantage of ‘immediate per- cussion lies in the facility with which the finger may be placed between the ribs and amid the long hair of some dogs and the wool of sheep. By this method the sense of hearing is further greatly assisted by that of feeling. For the larger animals the sounds ob- tained from this finger-to-finger method of percussion are not definite enough for practical use. n the immediate method of percussion, however, the sound can be augmented by employing the percussion hammer to strike the finger which is applied to the part (finger-hammer percussion). DETERMINING THE STATUS PRAESENS. 25 ; The pleximeter and hammer (plexor) are most commonly used in practice [so-called mediate percussion] as they permit not only of gentle percussion but the part to be examined can be struck a heavy blow which sets deep-lying parts into vibration. The plex- imeter should be so held that its whole surface is in firm contact with the part be percussed. In thin animals the pleximeter should never be applied across two ribs, but should be made to occupy an inter- costal space that the air between it and the body does not modify the sound, The force with which we use the hammer depends upon the thickness of the walls of the part percussed. [In fat animals it is necessary to use more force than in lean ones.] Usually two or three strokes, not too close together, suffice to bring out clearly the character of the sound. For comparison it is advisable to perctiss corresponding parts on each side of the body. For a better conception of the percussion-sound it is advisable to select a suitable place. A room with closed doors is the best; in rooms filled with furniture, or out of doors the application of per- cussion is never satisfactory. As a rule large animals are percussed while standing, though small ones may be placed in a recumbent position upon a table. Al- though gentle animals may stand quietly during the operation, very nervous horses or stubborn cows sometimes resist. They can gen- erally be quieted by speaking to them in an assuring tone and by omitting all rough usage of the instruments. ‘Dogs and cats may be held by their owners or an attendant. ~+, The Qualities of Percussion-Sounds. A body can only then produce a sound when it has lost its equilibrium and vibrates by virtue of its elasticity. Two principles form the basis of percussion: 1. Solid, airless parts of the body give forth a flat sound of short duration and little intensity. Such a sound is called dull, femoral or flat. Fig. 3. Fig. 4. 26 CLINICAL DIAGNOSTICS. 2. If an air-containing organ is set in vibration it pro- duces a sound of considerable intensity, duration and tone, the so-called resonant sound. The clearness of the sound depends upon the volume of the air-containing organ which is vibrating. a. The stronger the percussion the larger is the part which vibrates and the fuller the sound (Fig. 2). b. The thinner the over-lying tissue of the thoracic wall the more lung tissue will vibrate and the fuller the sound (Fig. 3). c. If the volume of the air-containing organ is small in itself then the sound is correspondingly less intensive (Fig. +). This explains the varying intensity of the sound over dif- ferent portions of the chest wall when the percussion blows are applied with equal force. The resonant sound gradually merges into the dull femoral as we approach the forward and upper portions. The resonant sound may be divided into: 1. The tympanitic sound which is emitted when the vibrations of the tissue are uniform. It approaches a musical sound and is, therefore, spoken of as a tympanitic tone. 2. The full sound which is emitted when the vibrations of the tissue are not uniform. It lacks the musical quality of the tympanitic tone and approaches a noise. The tympanitic tone and the full sound merge into each other gradually. The sound between is called “over-full’ or “over-loud.” The tympanitic tone and the full sound are resonant in character. They may become modified as to clearness until they are absolutely dull (flat). The intermediate stages are dull vesonant and dull tympanitic. DETERMINING THE STATUS PRAESENS. 27 ~/ Occurrence of the Different Qualities of Percussion- Sounds. According to the above classification there are three kinds of percussicn-sounds: The full (pulmonary resonant), the ivmpanitic, and the flat. 1. The full sound is found over normal lung, the air in the alveoh, and the lung tissue, and thoracic walls vibrating. When the intestines are so distended with gas that when per- cussed their walls vibrate with their contents, a full sound is emitted. 2. The tyimpanitic percussion-sound has a varied origin. It is heard: a. Over cavities containing air which communicate with the outside world, their walls being either firm or yielding: trachea, caverns in the lung communicating with bronchi. The pitch of the sound depends upon the size of the cavern and its communicating opening. b. Over enclosed air-containing cavities, hence over the stomach and bowels. c. When air-containing lung tissue is surrounded by solidified portions as occurs in beginning hepatization, edema, atelectasis and tumors of the lung. 3. The flat (femoral, dulf) sound is heard when percuss- ing over solid tissues which do not contain air. As the most forcible percussion does not produce vibrations at a point more than 7 cm below the surface, dullness can be noted over the normal lung when the chest walls are covered with heavy muscles, fat, or edematous swellings. An over-loud sound is emitted when the base of the cecum in the horse or the paunch in the ox is percussed, these organs being greatly distended with gas. The sound is dulled when air-containing parts of limited ‘dimensions are percussed (borders of the lung, and under 28 CLINICAL DIAGNOSTICS thick thoracic wall) or if small airless spaces lie amid those containing air (nodular thickenings in the lung). During the application of percussion we should note the resistance the part offers to the hammer or striking finger. [To understand what is meant by this the student should strike with the plexor some solid object, as a brick wall, and compare it with the feeling experienced when the human chest is percussed.| By placing the index finger on the back of the hammer the resistance can be better appreciated. From the resistance the amount of vibration that can be induced in the underlying parts may be determined, the greater the former the less developed the latter. For this reason solid, airless parts like muscle give a shallow percussion-sound and cause the hammer to suffer a jar when they are struck. Tactile Percussion. The combination of palpation and percussion is called tactile percussion. Through this method we endeavor to arrive at the physical condition of deep-lying parts by stroking the tissues covering them. Method. The wrist and fingers should be held slightly flexed and fixed. The parts to be examined should be pressed firmly with the finger tips, exerting an interrupted stroke. After such a stroke the fingers should be allowed to dwell for a moment to note the recoil of the underlying tissue the consistency of which we wish,to determine. In practicing this form of percussion bear in Seager that the deeper rather than the shallower tissues are to ve felt. : Tactile percussion may also be practiced with the plexor and pleximeter, the index finger being rested upon the back of the hammer. It is usually better, however, to employ hammer- to-finger or finger-to-finger percussion. ‘The thickness of the over-lying fat or muscular layers does not seriously interfere in this» form of fercussion. Through practice we. learn to select the factors of importance to form an opinion. Deep-lying diseased conditions do not present through tactile percussion specific symptoms, but we may thus obtain valuable information in regard to the boun- DETERMINING THE STATUS PRAESENS. 29 daries and consistency of otherwise unavailable organs or parts. Tactile percussion simply supplements and completes palpation and ordinary percussion. Determining the Boundaries of an Organ from the Percussion-Sound. The boundary of an organ can be determined by percus- sion only when the organ lies superficially and emits a percus- sion-sound which differs from that of its neighborhood. For this reason the boundary of the heart against the lung or the lung against the bowels may be defined by percussion. 4. Auscultation. By auscultation, applying the ear to a part, we seek to obtain information, through the sense of hearing, as to the physical state or condition of deep-lying organs. For this reason auscultation is practiced upon the heart, lungs and gastro-intestinal tract. In human medicine auscultation is usually practiced with the help of instruments (mediate auscultation), the so called stethoscope, etc., being employed. [In veterinary medicine. however, the use of such instruments is very limited, the heavy hair coat materially interfering with and so modifying the sounds that false conclusions may be drawn. To a limited extent the phonendescope is useful in auscultating heart sounds, but the hairs over the cardiac region should first be thoroughly moistened or oiled.] By simply applying the ear firmly to the part, better re- sults can be obtained than by the use of instruments. In case the skin is dirty, blistered, or the animal is lousy, a towel can be placed between it and the ear. To guard against being bitten or kicked an attendant should hold the patient by the 30 CLINICAL DIAGNOSTICS. head. In large stables containing a good many animals the noises they produce may interfere with auscultation; if it is essential to diagnosis or prognosis, the patient should be exainined in some quieter place. A. The General Part of the Examination. I. Signalment. By the Signaliment is meant a description of the patient for identification by peculiar marks or characteristics. For forensic purposes and special cases the proper taking of the signalment is of great importance. It is further of some value in a diagnostic sense and is sometimes taken into consideration therapeutically. It includes: I. Kind of animal. Many diseases are peculiar to cer- tain genera while they do not occur in others. This is espe- cially true of the infectious diseases as, for instance, the horse suffers from strangles, and glanders: the ox from contagious pleuropneumonia (lung plague), malignant head catarrh, and swine from hog cholera and swine plague. There are also special sporadic diseases which owe their origin to the pecu- liar anatomical or physical make-up of a genus. As exam- ples, may be mentioned traumatic pericarditis of the ox; rup- tures of the stomach and roaring in the horse. TI. Sex. Diseases of the sexual organs are not com- mon in animals, but sex is of influence in the appearance of some diseases. In stallions inguinal hernias which cause symptoms simulating colic occur; mares during the period of heat may act as if they were suffering from some brain disease (act like dummies) or may balk or show obstinacy when at work. In the ox urethral calculi are not uncommon. The condition of pregnancy is as of great importance from the diagnostic as from the therapeutical standpoint, because this condition may induce physiological symptoms that would be considered pathological in non-pregnant animals. In preg- 32 CLINICAL DIAGNOSTICS. nant animals caution is demanded in the choice of drugs. III. Color and white markings. For diagnosis the color and markings are of less importance. White horses fre- quently suffer from melanotic tumors that are either super- ficial or located in internal organs. \White areas are more pre- disposed to exanthemas, sunburn and “scratches.” IV. Age. Alany diseases occur either exclusively or generally in youth. Rachitis, diseases of the navel, strangles in colts, scours in calves and distemper in puppies are exam- ples. In old individuals diseases due to the animal’s use are more frequent as are also chronic diseases of organs (dummies, heaves). The age is also of influence upon the prognosis in as much as healing, ail things else being equal, is more to be hoped for in the young individual than in the old one. In old animals where the prognosis is a doubtful one all treatment is fre- quently omitted on economic grounds. V. Size. Size is of importance in posology only. VI. Breed. In well bred animals the reaction against the encroachment of disease is more energetic and the symp- toms are more pronounced. Certain breeds are more able to withstand infectious and sporadic diseases than others, this must be considered in making a prognosis. Breed is also taken into consideration in the treatment of diseases. Well bred, fine skinned, sensitive horses vield to the action of cer- tain drugs more readily than those of the opposite type. This is especially true where outward applications (turpentine blis- ters) are to be made. 2. Habitus. By the term /rabitus we mean the general or external as- pect or characteristic appearance of the patient, which is de- termined by its physical attitude, condition, conformation and temperament. It offers a convenient aid in ‘diagnosis, one that can be readily observed and that, in many respects, is of GENERAL PART OF EXAMINATION. 33 great importance. _Not infrequently a diagnostic conclusion im a clinical case is reached largely through the impression the patient makes upon us by its habitus. Obvious physiological abnormalitiés are sometimes of themselves an index to the character of the disease. How- ever, one should guard against reaching hasty conclusions from the first impressions of the patient, to the neglect of a thorough examination. —~_ 1. Attitude of the patient. Healthy horsés as a ‘rule remain standing during the day, or if lying down they imme- diately rise to their -feet at the approach of a stranger. They will frequently lie flat on the side with feet extended, pro- vided the halter strap is long enough and the stall of suffi- cient width. Healthy cattle lie down often during the day, especially just after feeding, and they are not so prone to rise when approached. They seldom lie flat on the side, but in sternal decubitus the limbs folded under them. Healthy sheep jump up when approached and usually run away. The attitude of sick av‘mals whether standing, walking or lying down is often of value in diagnosis. Standing attitudes assumed during disease. The head is held stiffly and extended in pharyngitis, cerebro-spinal men- ingitis, muscular rheumatism, malignant head catarrh of the ox, and in acute encephalitis of sheep and goats. Very sick animals usually hold the head down, and as- sume a relaxed languid attitude, the ears drooping; horses rest their feet alternately. Cows suffering from severe vaginitis stand with arched back, tail held high, and legs spread apart. They do not “stand: over” readily in the stable, and if driven stop repeat- edly to urinate. a . . A stiff, quiet attitude avoiding moving as much as possi- ble, is characteristic of very painful affections in the chest or 34 CLINICAL DIAGNOSTICS. abdominal walls (pleurodynia, pleuritis, peritonitis). Stal- lions suffering from incarcerated inguinal hernia and oxen with peritoneal hernia (gut tie) stand with the hind leg of the affected side held backward and outward. —.. Unphysiological attitudes. Animals afflicted with brain troubles (acute or sub-acute encephalitis, dummies) very often assume unnatural attitudes. Horses stand obliquely in the stall, the head in a corner, resting against the wall or sunk under the feed box. The limbs are drawn well up under the abdomen, and not infrequently one leg is placed in a very unphysiological position, perhaps crossing its fellow of the opposite side. Dummies stand unusually quiet and seem oblivious of their surroundings. They move without energy, and are backed with the utmost difficulty. (See under “Cen- tral Nervous System,” “Examination of Dummies’). In acute brain diseases the horse does not continuously assume these attitudes but only at times. Continued standing is observed in: a. Old, worn-out horses. b. Pneumonia and Pleuritis. As a rule if the animals lie down in these diseases it is on the diseased side, and for the following reasons: because the slight pressure of the ground against the body ameliorates the pain, and the pleuritic exudate (the effusion in the chest) does not encroach so much upon the heart and the still healthy lung. The respirations are always more difficult when the animal is lying down. [In peritonitis resulting from castration horses very commonly remain standing; when forced to move they do so with hind legs held in abduction, advancing very stiffly]. c. Severe Dyspnea. The head is held extended to allow the air the easiest possible access to the lungs, thus facilitat- ing inspiration. d. Horses suffering from acute diseases of the brain. e. Horses suffering from Tetanus. The stand with legs braced like a saw horse, the head somewhat extended and held high, the back held rigid. It is very difficult for them to step sideways. The facial expression is anxious, the mem- GENERAL PART OF EXAMINATION. 35 brana nictitans appearing plainly before the eve; the tail is carried high and stiff, and the gait inflexible and laborious. Restless Standing. Most commonly seen in horses suffer- ing from colic and acute brain diseases. The former are rest- less, lie down, roll, and get right up again. In many cases it is only with difficulty that they can be kept on their feet; when down it may be equally hard to drive them up. They often look at the flanks, paw, strike the belly with the hind feet, switch the tail, and stretch as if to urinate without void- ing urine. At times they sit up like a dog. Like symptoms but of shorter duration are observed in the ox suffering from invagination of the intestines, torsion of the uterus in cows and from urethral stones and peritoneal hernia in steers. Horses with acute brain disease show at times rabiform symptoms, plunging, rearing and breaking loose. When not tied they keep forging ahead or continue aimlessly walking in a circle. Restless, anxious moving about is seen in many cases of severe dyspnea. Gait. 1 Ht 41,9 Tt i Tt 40.0 rat K A aii ¥ al mA i if on E wi 2 A 1 38,0 a + a y- { Pik ral “i 1 t 7 \ 7 87,0 t AV AG AN 2 vi yi try 1 Vv 4 ave tL} Apyrexia. Relapse. Febris intermittens—Flagelosis of the Horse. In the course of most infectious diseases, three stages are distinguished, according to the course of the fever, viz.: Fig. 20. 3 4 5 | 4 9\\t ahs) i 7s] sol 41,0 40,0 aim Wd f \ Fa a 39,0 Prt 7 a ix i 3 4 38.0 ea , he 37,0 Initial Fever. Relapse. Fall Abscess developing after opening bscess. Febris atypica—Strangles of the Horse. GENERAL PART OF EXAMINATION. 71 1. Stage of increasing temperature (stadium incre- menti). 2. deme, temperature at its highest (fastigium). 3. Stage of falling temperature (stadium decrementi). A rapid fall of temperature (within 1-2 days) is called crisis, a gradual decline, /ysis. According to duration we distinguish: ephemeral (one day), acute and chronic fevers. IV. Subnormal Temperature. Hypothermia. Like the high normal, the subnormal temperature may be physiolog- ical. It may come from the fact that the sphincter ani is relaxed, or that the thermometer has not been inserted deep enough, or that the rectum is filled with feces, or that def- ecation takes place just before or during the insertion of the instrument. A subnormal temperature due to disease is uncommon. It is seen to occur, but not constantly, in parturient paresis, certain gastro-intentinal diseases of the dog, anemia, hemor- rhage, icterus gravis. .\ subnormal temperature is most fre- quent in fatal diseases just before death (temperature of col- lapse). General Infectious Diseases. Septicemia. Nearly all forms of so-called “Blood Poisonings” are designated by the collective term Septicemia. Symptoms: suddenly appearing fever, often accompanied by chill; fever of the continued type; mucous membranes highly reddened, often icteric, frequently ecchymosed. Very rapid, small pulse. Food and drink refused; fetid diarrhea. Great mental depression, blank counte- nance, eyes sunken. Acute or peracute course. Pyemia is a general disease due to pus cocci gaining access to the blood, and is characterized by multiple, secondary abscess for- mation (pyemic metastasis) in the various organs, lungs, liver, kidneys, brain, joints, etc. Diagnosis is easy when primary abscess is available; otherwise it is difficult. As each new abscess forms the temperature increases, therefore it is fever of intermittent type. Mucous membranes are congested, icteric. Pulse is continued high. Course subacute. 72 CLINICAL DIAGNOSTICS. Anthrax is an acute infectious disease due to the Bacillus anthracis. Begins suddenly with high fever; tendency toward hemorrhages from mucous membranes. In the ox and sheep the course is often apoplectic; when course is acute it lasts 1-3 days. Brain symptoms, Fig. 21. convulsive twitch- at ings of muscles, rap- iad or id pulse, dyspnea, » on, a7, ne ‘ti hh. pfs Hh | ta i | a ik "it gle | 2 man I nf hie hs i ih og ci ia it, loss of milk, are symptoms some- ee times seen. In horse, colic symptoms oc- 0 cur. Formation of anthrax carbuncle in re skin is not rare in ‘| | the horse. In hog, ‘tl symptoms of severe es laryngo - pharyngitis eat with swelling pre- dominate. Diagnosis ‘ae Rahal y x is positive only after Mo (ee. i i yl hi mt finding bacilli under typ ae i id Wi a a thes the microscope. An wie mH ‘i x ‘ " ne | Mh se ‘ rt anthrax slide is made a oor a) Me fg as follows: A thin Anthrax bacilli Stained according to Olt’s method. layer of blood or a. b., Cadaver bacilli. spleen pulp is smeared over a slide, passed three times through the flame of a Bunsen burner, then covered with a 2% watery solution of safranin and allowed to boil by holding over a Bunsen flame for a few moments. Wash and examine. The anthrax bacilli are from 1 to 2 times as long as the diame- ter of a red blood corpuscle, and are composed of from 2 to 8 bacterial cells, which are stained reddish brown on the slide. Each bacterial cell is cylindrical, slightly longer than broad, appearing almost square in form. The ends are plane or somewhat convex. The bacterial cells are surrounded by a gelatinous capsule, which is stained yellow in the preparation, and which joins the cells together to form the bacillus. The capsule is bounded by a dark line. If the bacilli come in contact with one another they unite, their capsules blending together. Influenza. An acute, infectious disease of the horse, very easily transmitted. Period of incubation 5 to 7 days. First symp- tom is a rise in temperature which continues 3 to 6 days, then crisis. Great debility, slow gait, staggering, great mental depres- sion, head held down or rested on manger, eyelids and conjunctiva swollen, hot, painful, photophobia. Pulse at first strong, little affected, later accelerated. Loss of appetite, diarrhea in about 3 days. In later stages cold, painless edematous swelling of the extremities. Mortality 4%. [Hog Cholera. Infectious disease of swine, caused by bacilli which enter the bod: through the respiratory tract, or via respira: tory tract or mouth— GENERAL PART OF EXAMINATION. 73 with food and water—(hog cholera of Smith). Period of incuba- tion 4 to 21 days. Young pigs most predisposed. One attack pro- duces immunity in most cases. Symptoms: apoplectic form; die very suddenly or after a few hours illness (beginning of an out- break). Usual form: fever, temperature 107°-108°F., appetite im- paired, tremblings of muscles, unwillingness to move, stupid, dull, hide in litter. Bowels at first constipated; later diarrhea. Eye- lids filled with mucus. Respiration accelerated, labored; painful, frequent cough. On pendant parts of body, skin is reddened, con- gested; eczematous eruptions, ulceration of skin. Rapid loss of flesh, unsteady, tottering gait. Death within 48 hours to 2 weeks. Mortality 20-100%. Texas Fever. An infectious blood disease of the ox caused by a protozoén (Pyrosoma bigeminum) which enters and destroys the red blood corpuscles. The disease is spread by the cattle tick, Boophilus bovis, the younger generation of which carries the pro- tozoon. Period of incubation 13-90 days after exposure to tick- infected places. Symptoms: fever (104°-109° F), unnatural recum- bent positions and standing attitudes; animal is dull, stupid; in some cases shows vicious tendencies; horns, ears, and hoofs are hot. Pulse is rapid; dyspnea; constipation, excreta tinged with bile. Visible mucous membranes icteric. In later stages urine red. Ticks of various size to be found on escutcheon, inside of thighs, base of udder or scrotum. Little blood flows from intentional wounds. Characteristic post-mortem changes. Duration 3 days to several weeks. Mortality 20-90%]. Chicken cholera. Attacks all kinds of fowls. Incubation period one day. Birds sit languidly on the ground, feathers ruffled, evelids closed and stuck with exudate. Temperature 42-43.2° C. Respirations increased, jerky, and often noisy. Appetite lost. Thirst increased. Feces watery, greenish, yellow or bloody, mixed with mucus and fetid. Death in three days with sinking temperature. Often apoplectic death. Chicken pest is an acute, very transmissible infectious dis- ease, generally distributed. Affects usually only chickens and clin- ically and pathologically very like cholera. The patients never show diarrhea, the course is slower and apoplectic death does not occur. The virus, contrary to chicken cholera, is ultramicroscopic. Hemorrhagic septicemia (Wild-und Rinderseuche) is an acute, general infectious disease appearing in the exanthematous, pectoral and intestinal form. High fever. In cattle a hard, inflammatory- hemorrhagic edema of the head and swelling of the tongue occurs. Dyspnea. : : é Swine erysipelas (Rotlauf) is an acute, infectious disease, usually fatal. “Incubation period 3-5 days. Sudden fever, great lan- guor, weakness of the hind parts, stupor. Patients burrow in straw. Vomiting. Skin between thighs, under belly, neck and chest diffusely reddened. Dyspnea. Death in four days. Braxy of Sheep. A peracute hemorrhagic inflammation of the abomasum due to the bacillus gastromycosis ovis. In many respects resembles anthrax. G4 CLINICAL DIAGNOSTICS. South African Horse Sickness. A non-contagious (though readily transmittable by blood inoculation) disease of horses and mules. Incubation 7 days. Slowly rising fever with morning remissions. Symptoms of pulmonary edema (Dumperre zickte) or swelling of the head (Dikkop). Great muscular weakness, animals recumbent. Pulse not very rapid but small. Mortality 80-90%. B. The Special Part of the Examination. 6. Circulatory Apparatus. An examination of the circulatory apparatus is of impor- tance not only to diagnose those maladies which affect the organs carrying the blood, ‘but also from the fact that all acute general or infectious diseases of a serious character influence more or less greatly the circulation. A methodical examination of the organs carrying the blood includes: 1 Taking the pulse. ¢ u. Noting the condition of the peri- pheral blood vessels. mm. Examining the heart. I. Pulse. Method of Examination. The pulse is felt with the fingers, which may be gently rested upon any of the superficial arteries having bone or other hard tissue under them. In the horse and ox the sub-maxillary artery is most commonly used, in the latter animal the artery is easily felt on the lateral side of the jaw bone. Other arteries which may be used to take the pulse are the radial, plantar, temporal, transverse facial and coccygeal. In the dog, sheep, goat and cat the femoral artery is most available. [In dogs and cats the brachial artery can be felt on the medial sur- face of the humerus, just in front of and above the elbow.] In the hog and fowl the pulse can not be felt, hence the heart’s beat is used. To palpate the pulse place the first, second and third fingers over the artery, pressing it slightly and rolling it somewhat under the fingers. Before one can judge the pulse, several beats must be felt, best counting them for a full minute. From a clinical standpoint the 1. Frequency, 2. Rhythm, and 3. Quality, are of importance to consider in examining the pulse. 76 CLINICAL DIAGNOSTICS, a. Frequency. By the frequency of the pulse we mean the number of blood-waves (beats) felt in a minute’s time. There is a great variation in the normal frequency, not only in the different species of animals, but also in animals of the same kind. Many physiological con- ditions have great influence upon the pulse-frequency: size, age, sex, race, atmospheric temperature, time of day, pre- hension or digestion of food, exercise, excitement, are all factors. Large animals carry a slower (less frequent) pulse than small ones; adults slower than young; females higher (more frequent) than males; well bred individuals, slower than mongrels; in summer the pulse is higher than in winter; in the morning slower than toward evening; excited animals show a more rapid pulse than animals standing at perfect rest. In nervous animals (horses and dogs) the act of taking the pulse often increases its frequency. Taking these physiological variations into consideration, the following is the average pulse-frequency for the dif- ferent animals. 1. Horses in general............... .. 28— 40. Warm blooded stallions............. 28— 32. Cold blooded stallions............... 28— 36. Colts, two weeks old.............04. —100. four weeks old.. ......... Pe — 70. “six to twelve months old... .. 45— 60. “two to three years old.. ...... +0— 50. 2. Asses and mules................00- 45— 50. Gi: HROVINGES: -n95 22-4e Sees oe 8 Zhi Beha at 40— 89. 4, Slheepvaitd: @0ats ese ved eta augae 70— 90. ee ieg SN LC asim oescreenline (a preyetlus oa sasler in te tag tt 60—100. Os DOES i gewheiniwh toting Gein ee oe eee ies 60—120. Yin CASAS tdi: She”, puter wrecatalan tung ten delta aes 110—130, He TAG ONVIA. a Bcmei th abane eee auigd des she neues 120—160. *NOTE. The numbers refer to the heart’s beat, as the pulse can not be felt in swine and fowls. SPECTAL CLINICAL EXAMINATION. 77 In regard to frequency we distinguish a slow pulse (pulsus rarus) and a rapid pulse (pulsus frequens). The slow pulse (pulsus rarus, bradycardia) is very un- common. It most often accompanies brain diseases attended by great depression (chronic and subacute hydrocephalus, tumors in the brain), icterus gravis, and poisoning from alco- hol or lead. In the horse at times it is seen in gastro- intestinal affections with loss of appetite, probably due to some alteration in the sympathetic nerve. Fig. 22. ee ae Slow, Sluggish Pulse of Horse. Taken with Marey’s Sphygmograph—Art transversa faciei. The fast pulse (pulsus frequens, tachycardia,) is very common in disease. A very rapid pulse, though characteristic of no special disease, is always a sign that the parenchyma of the heart is affected, hence in severe diseases it is an index to the heart’s strength. Rarely in the horse does the pulse frequency exceed 80 beats per minute; if it exceed 100, the prognosis is unfavorable. Jn the ox a pulse of 100, and in the dog one of 120-150 denotes severe illness. Anabnormallyaccelerated pulseoccurs: 1. In all severe diseases, especially when attended by fever. The frequency of the pulse, however, does not always bear the same relationship to the height of the temperature ; whether the pulse be accelerated or not depends upon the fever’s effect upon the heart, which differs with the disease present. In contagious pleuropneumonia of the horse, septi- cemia, anthrax, and severe inflammations of the bowels and peritoneum, the pulse rate corresponds to the height of the fever; in influenza and in strangles, the acceleration of pulse is not marked, compared with the temperature. 78 CLINICAL DIAGNOSTICS. 2. In painful conditions (severe injuries, fractures of bones, abscess in hoof, etc.). 3. In mental excitement (fear, anxiety). 4. In severe hemorrhage. b. Rhythm. When the individual pulse beats are sep- arated by intervals of equal duration, the pulse is regular (pulsus regularis). In the dog and, according to Cadeac, frequently in mules and asses, the pulse is often irregular and intermittent. Fig. 23. Normal Pulse—Horse. Marey’s Sphygmograph—Art. trans. faciei. The rhythm of the irregular and of the intermittent pulse is abnormal, i. e., arhythinic. When the pulse is irregular the intervals between the individual pulse beats are of unequal duration. This is due to lack of innervation of the heart, as well as to exhaustion of the organ. If the pulse of the horse exceeds 80 it is usually irregular. Irregularity is also ob- served in valvular diseases of the heart, and in myocarditis. The pulse is intermittent when a beat fails now and then. When regularly interiuttent, a certain beat can not, be felt, as for instance, every fourth or fifth pulse wave; when irregularly intermittent there is a lapse which does not occur between any certain beats. The intermittent pulse is commonly physiological, and seen in perfectly healthy horses and dogs, where it disappears after exercise and, therefore, probably due to lacking innerva- tion. Pathologically it appears in chronic hydrocephalus (dummies), severe gastric troubles, and during convales- SPECIAL CLINICAL EXAMINATION. i) cence from infectious diseases which have occasioned high pulse (contagious pleuropneumonia of the horse). c. Quality. The pulse beats should be of equal vol- ume. When this is true we speak of an equal pulse (pulsus acqualis). The quality of the pulse varies with the kind of animal. The normal size, strength and hardness of the pulse can only be learned by experience; it can not be defined. In the horse the pulse is large, strong and the artery only moderately tense; in the ox the pulse is smaller, not so strong but the artery is tenser and may be rolled under your finger like a hard rubber tube. In small animals the pulse is quick, strong and hard. (See 76.) In dogs often it is inequal. The normal quality of the pulse can suffer change in various ways. 1. According to whether a greater or smaller quantity of blood is forced into the arterial system, we distinguish a full (pulsus magnus) and anempty (pulsus parvus). The pulse becomes empty when much accelerated and in severe hemorrhages. In fatal diseases the pulse finally be- comes imperceptible (pulsus insensibilis), indicating cardiac weakness or anemia. Fig. 24. Small, Irregular and Inequal Pulse of Horse. Marey’s Sphygmograph. 2, If the pulse waves are not of equal volume the pulse is called inequal (pulsus inaequalis). This is a very impor- tant symptom of cardiac weakness, where it is uniformly associated with irregularity, and of valvular (mitral) heart 80 CLINICAL DIAGNOSTICS. disease. At times there exists a close relationship between an irregular and an inequal pulse. A small wave follows closely a larger one, so that there is a regular alternation of weak and strong beats. It denotes beginning heart's weak- ness. ey 3. By the strength of the pulse we mean the force with which it lifts the finger palpating it. We distinguish a strong (pulsus fortis) anda weak (pulsus debilis). In hypertrophy of the heart the pulse is strong; in parenchyma- tous degeneration of the cardiac muscle, it is weak. The degree of weakness shown by the pulse indicates the severity of the attack. We form an estimate of the strength of the pulse by noting whether it is readily compressible or not. +. The hardness of the pulse is due to the distention of the arterial wall and is greatest at the acme of a wave. The pulse is hard (pulsus durus) in severe pain, peritonitis, tetanus and acute brain diseases. [In inflammation of serous mem- branes generally the pulse is hard]. The opposite of a har] pulse is the soft pulse (pulsus mollis). 5. As combinations of varied degrees of size, strength and hardness of the pulse are noted, special but superfluous kinds are spoken of: Trembling pulse (/p. tremulus), where the wave in the distended artery is so small that only a slight trembling can be felt. Thready pulse (p. filiformis) is one which is so small, weak and soft as to be hardly perceptible. If associated with this pulse the visible mucous membranes are cyanotic, it shows deficient heart’s strength and justifies a bad prognosis. The wiry pulse is a small, tense and very hard pulse. Occurring in colic it is a bad sign. A less marked wiry pulse may be noted in aortic stenosis and in chronic nephritis. 6. The arch of the pulse wave may become changed in cisease. If the wave is very abrupt, we speak of a hopping, swift pulse (p. celer); if, on the contrary, the wave is much nrolonged, it is spoken of as 4 “siuggish” pulse (p. tardus). SPECIAL CLINICAL EXAMINATION. 81 A quick pulse (~. celer) is associated with mild cases of cardiac hypertrophy, plainly marked in aortic insufficiency. In the latter case it is due to the regurgitation of the blood, which occurs at systole, into the hypertrophic left ventricle. In both these instances the pulse is fulland strong. Remarkably in heart's weakness a pf. ccler is often present. However, here the pulse is weak and the artery empty. The “sluggish” pulse (p. tardus) is noted in very lymphatic horses and is character- istic only of aortic stenosis, when it is at the same time small. 7. A pectuiar pu.se is the dicrotic pulse where two expansions can be felt in one beat of the artery. It is seen in cases of lowered arterial tension combined with weak- ened heart's action, and is, therefore, noted in long continued fevers and in all forms of anemia. Fig. 26. Dicrotic_ Pulse—Horse. Marey’s Sphygmograph. II. Examination of the Peripheral Biood Vessels. Arteries. A strong pulse attending wasting disease and emaciation calls for an examination of the small super- ficial arteries. An abnormally strong pulsation in the pert- pheral arteries of small caliber is visible in the horse in the branchings of the external maxillary artery. It appears in hypertrophy of the left ventricle especially when the aortal valves are defective. Veins. The state of distention of the veins is of primary interest. The veins become prominent after any acceleration of the heart’s action in thin-skinned, fine- haired horses; the condition, which is physiological, being a temporary one. «1 permanent distention of the veins is path- 82 CLINICAL DIAGNOSTICS. ological, and is due to an obstruction of the free flow of blood to the right heart. It is mostly plainly visible in the jugulars and their plexus on the head, other superficial veins (external thoracics, milk veins, veins of the extremities) showing it less on account of the edema usually accompanying the con- dition. The jugulars can be distended to the size of the human wrist, or even the arm, appearing as great, round strands. The veins of the conjunctiva can also be distended, being rec- ognized as ramiform, often contorted, bluish strands in the mucous membrane. The veins are generally distended: 1. In valvular disease (tricuspid). It is usually sec- ondary, but in the ox mostly primary. 2. In chronic pulmonary diseases interfering with cir- culation: emphysema. 3. In diseases of the heart’s muscle, the organ having become so weak that it is unable to handle the quantity of blood: traumatic myocarditis of the ox. +. From excessive intrathoracic pressure upon the heart and large blood vessels: tympanitis, pleuritis, pericarditis traumatica of the ox, tumors. Pulsation in veins. Besides being distended, veins can show pulsation under some circumstances. Synchronous with the respirations, and independent of the heart’s action, a slight swelling of the jugulars occurs during the act of expiration, to fall again at inspiration. A so-called jugular pulse is normal in the ox for the following reasons: The jugulars and anterior vena cava in this animal are compara- tively large. The continual flow of the venous blood into the right heart suffers during the systole of the right auricle, which slightly precedes that of the ventricle, a momentary interruption, the blood congesting in the anterior vena cava and jugulars, causing a brief distention of the jugulars, sim- ulating a pulsation. It is therefore not an active pulsation, SPECIAL CLINICAL EXAMINATION. 83 but merely a passive undulation due to a regurgitation of the blood in the form of waves. The presystolic appearance of the pulse movement characterizes it, therefore it should al- ways be compared with the arterial pulse. The collapse of the vein is synchronous with the arterial pulse. The undulation of the jugular vein is intensified in the ox and becomes apparent in other animals when the above cited condition prevails, induced by a morbid congestion of the blood at the heart. In the horse the venous pulse is seen near the aperture of the thorax (lower portion of the neck). A true (positive) venous pulse is pathological. It 1s coincident with the heart’s systole, and is produced by a de- fective closing of the atrio-ventricular valves, the blood re- gurgitating into the auricle. True venous pulse is a characteristic symptom of tricuspid in- sufficiency. Fig. 26. Venous Pulse—Horse. The valves in the jugulars do not prevent the flowing back of the blood, as they are commonly not well developed, and if the vein be greatly distended they cannot close the lumen of the vessel. III. The Heart. The heart is examined by palpation, percussion andauscultation. Anatomical. In all domestic animals the heart lies in the ven- tral portion of the thoracic cavity from the third and sixth ribs, in the dog extending to the seventh rib. The great mass of the organ (3-5) lies to the left of the median line, so that it approaches nearer the left thoracic wall than the right one. It does not occupy a perpendicular position, but an ob}ique one s+ CLINICAL DIAGNOSTICS. directed from the right, in front and above to the left, backward and downward, the left side of the apex reaching the chest wall. Horse. The base of the heart lies below the upper half of the height of the chest cavity, resting against the thoracic wall between the 4th and 5th intercostal space. The point of contact occupies a surface of about 10 cm high and 6-8 cm broad. (See Fig. 27, page 87). Ox andsmall ruminants. The heart is smaller and does not extend quite as far back as the 6th rib, its base, however, extends to the median line of the chest. Between the 4th and 5th ribs 1t comes in immediate contact with the thoracic wall. (See Fig. 26.) Dog. The heart is of rounder form and lies at an angle of 40-45° with the sternum, touching the chest wall along a narrow strip from the 4th to the 7th ribs. The apex is below the 6th intercostal space. (See Fig. —.) Palpation of the heart’s region. The beat of the heart can be felt by laying the flat of the hand over the cardiac region. Inasmuch as the anconeus muscles partly cover the region, the hand should be placed between them and the chest wall. In the depths a dull thud will be felt, produced by the thumping of the heart against the chest wall. The beat is due to a con- traction of the heart’s muscles which causes a slight torsion of the organ to the left, bringing the left side, not the apex, in contact with the wall of the chest. The beat can best be felt in all animals at the 5th intercostal space, just above the union of the ribs with their cartilages. The force with which the beat can be felt depends upon the condition of the animal as to flesh, it being more plainly marked in thin animals, and just after severe exercise or excitement. Only in the dog can the heart’s beat be felt normally on the right side. In swine and fowls the heart is palpated to determine its action, as the pulse in these animals can not be felt. In swine the heart beats 60-100, and in fowls 120-160 times per minute. Great variations are, however, noted due to the excitability of these animals. The force of the heart’s beat can be in- creased or diminished. When the force of the beat is much increased a palpitation of the heart is spoken of. It occurs: 1. In hypertrophy of the heart (here combined with strong pulse). 2. In heart’s weakness, the muscles of the organ un- dergoing spasm-like contractions incapable of properly pro- pelling the blood to the periphery, the pulse being small. The condition is seen in acute myocarditis, endocarditis and peri- carditis. SPECIAL CLINICAL EXAMINATION. 83 3. Where the lung between the heart and the chest wall becomes thickened. The heart’s beat is weakened: 1. When the force is enfeebled from degeneration of the heart’s muscle. 2. Where the heart is crowded away from the chest wall by accumulations of exudate in the thoracic cavity (pleuritis, pericarditis), or in some cases of pulmonary emphysema or tumors. Percussion of the heart. Except in very thin animals (horses) the percussion of the heart is of no great value in the diagnosis of disease, the reason being that with the percus- sion hammer we are unable to determine the boundaries of the organ, the adjacent lung tissues so modifying the sound that the merging of the dull sound of the heart’s percussion into the full sound of the lung’s is a very gradual one. Horse. In the horse, under favorable circumstances, in the region of the 4th and 5th intercostal space a zone of dullness about the size of a hand can be brought out by percussion. Its boundaries, however, are generally indefinite. Ox. Although the chest walls are thinner in this animal, the heart is covered more by the lungs than in the horse. Sheep and Goats. A slight dullness is noted over the fifth rib. Dog. A narrow horizontal line of dullness between the 4th and 7th ribs can be determined on both sides by vigorous per- cussion. Due to unfavorable anatomical position, the percussion of the heart is of diagnostic service only in a few instances. The zone of cardiac dullness is in- creased in hypertrophy of the heart and where fluids col- lect in the pericardium; tumors and thickenings of the lungs also induce it. The zone of cardiac dullness is some- times decreased from pulmonary emphysema because the distended lung extends further over the heart. A tympanitic tone on percussion over the cardiac region is obtained in traumatic pericarditis of the ox, gases of putrefaction accumulating in the pericardium. The percussion of the cardiac region causes the animal pain in pleuritis and pericarditis. 86 CLINICAL DIAGNOSTICS. The Auscultation of the Heart. Method. The auscultation of the heart may be practiced by placing the right ear just behind the left elbow, the leg being drawn forward. Small animals may be laid upon the table and the stethoscope used. Physiology. In the cardiac region and in the neighborhood of the same, we hear at each action of the heart two tones. One of these tones appears at the moment the organ contracts (systole), and the second tone, which quickly follows the first, at the dila- tion of the organ (diastole). The second tone follows so closely the first one that it is difficult to differentiate between them, ex- cept in animals which carry a pulse below 60. In animals which have a rapid pulse it may be necessary to compare the pulse at a peripheral artery with the heart’s beat. The origin of the heart-tones is still subject to dispute, the authorities not agreeing. [The first heart-sound (the systolic) is caused by the con- tracting muscles of the organ and the closing of the auriculo-ven- tricular valves. The second sound is produced by the closing of the semilunar valves]. The first sound in our domestic animals is duller, deeper, more prolonged and usually louder than the second one, which is short, not so deep, well defined (sharper), not so loud, and at times slightly metallic. There is a great variation in the sound produced by the heart in the different animals, and even in animals of the same species, the sounds being in one case sharper (more metallic) and in another deeper and duller. The thickness of the chest walls is also of influence, in ani- mals with well muscled chests the sounds are seemingly more muffled, duller. By pronouncing the syllables Jub-dub one can mimic the sounds of the heart. I II I II - ~ & +4 lub dub lub dub Change in Heart-Sounds Due to Disease. Both sounds are increased in: 1. Hypertrophy of the heart, the valves remaining in- tact. (idiopathic hypertrophy). 2. Anemias. SPECIAL CLINICAL EXAMINATION. 87 3. A thickening of the lung tissue around the heart, producing a better conductor of sound. The second sound only is increased: When the arteries are greatly distended, not infrequently the result of a congestion of the pulmonary circulation com- bined with hypertrophy of the heart. Both sounds are weakened when the normal heart be- comes enfeebled through disease of its parenchyma, or where the hypertrophic organ is exhausted. Metallic tones occurring during systole are very com- mon in anemic animals. In traumatic pericarditis of the ox, the pericardium containing gas, a loud metallic tone is heard at each systole when the heart-muscle is still vigorous. Sometimes the sound can be plainly heard the distance of several paces from the affected animal. This is due to the accumulation of gas in the pericardium acting as a resonant mechanism which augments the sound. The first tone is dul] in heart’s weakness and in myocar- ditis, especially noticeable in acute infectious diseases. A. splitting J~-|—~--| or doubling |~~-|—~-| of the heart sounds, the condition of the circulatory apparatus being otherwise normal, is of no significance. Commonly the first sound is preceded by a short tone -|—~], which is pro- duced by the contracting of an unusually well developed auricle. Heart bruits)s Heart bruits are abnormal sounds and are therefore pathological. They are caused by the sound producing parts of the organ vibrating for too long a time. Endocardial bruits and pericardial bruits are distinguished. 1. Endocardial bruits (noises) come from within the heart and are closely connected with the heart sounds. We can distinguish, therefore, systolic bruits and diastolic bruits, depending upon whether they occur at the first or second sound. If the bruits are produced by anatomi- 88 CLINICAL DIAGNOSTICS. cal changes of the heart itself, they are called organic, other- wise inorganic. a. The organic or endocardial heart bruits are caused either by a narrowing (stenosis) of the atrio-ventri- cular or arterial openings or by alterations on the valves pre- venting them from closing properly (insufficiency ). They form most valuable symptoms in the diagnosis of heart diseases. Instenosisthe bruit occursatthe moment the blood passes the contracted orifice, the walls of which are set in vibration. If the stenosis involves the atrio-ventricular opening the bruit occurs at diastole, if in the arterial openings, at systole. In insufficiency the bruit occursat the momentat whichthe valves should close. In consequence of their inability to close a regurgitation of the blood takes place, which produces a renewed vibration of the valves, and gives a bruit. If the insufficiency involves the atrio-ventricular valves, the bruit occurs at systole; if the semilunar valves are insufficient the bruit appears at diastole. The character of the bruits is varied, they can be bus- cing, blowing, purring, hissing, humming, sawing, rattling, long or short tones. Insufficiency bruits are generally softer than those due to stenosis. Heart bruits are made more pronounced by an acceleration of the heart’s action, therefore the patient should be exercised before examination. Gmelin recommends digitalinum verum subcutaneously to bring out more distinctly heart sounds or casual bruits. The dose for the horse and ox is 0.025—0.05; for the dog 0.002 —0.009. The digitalin is first dissolved in Sccm of 50% alcohol and then diluted with 20ccm of water. SPECIAL CLINICAL EXAMINATION. 89 Insufficien c y of an atrio- ventricular Systolic bruits|~.~|are characteristic of: valve. Stenosis of an arterial opening. Stenosis of an atrio- ventricular Diastolic bruits|—~|are characteristic of: { opening. Insufficien c y of a semi- lunar valve. ° Although the bruits originate in different parts of the heart, the exact point of origin cannot be determined by auscultation. In the horse and dog valvular lesions have their seat most commonly in the left heart, rarely are they primary in the right heart, In the ox valvular diseases of the right heart are more frequent than of the left one. The atrio- ventricular valves are more commonly diseased than the semi- lunar. b. Contrary to the endocardial, organic bruits, the inorganic or anemic bruits occur without that any discernible anatomical alteration appears at the orifices or valves of the heart. Inorganic bruits are systolic, soft, blowing and not constant (accidental). They tend to disappear and reappear again. Their origin is not well understood, They are nearly always noted in anemic animals. It is very important to distinguish between organic and inorganic heart bruits, but in prac- 90 CLINICAL DIAGNOSTICS. tice this is often very difficult. .\s a rule, soit, systolic bruits (they do not occur during diastole) should be very carefully estimated. Organic heart bruits are always accompanied by hypertrophy and often alteration of pulse, further by a con- gestion (stasis) in the pulmonary veins and accordingly an increased pressure in the pulmonary artery, whereby the sec- ond heart’s sound is loud and clapping. Fig. 27. Points at which Endocardial Bruits are most pronounced. a. b.—Line of Shoulder. 1.—Left Auriculoventricular Opening. 2.—Portal. 3.—Pul- monary Artery. 2. The pericardial bruits. These bruits do not come from within the heart itself, but are extra-cardial. They consist in frictional noises due to the pericardium having Lecome so altered that its surface is no longer smooth and slippery, but rough and dry. The bruits are characterized by being scratching, grating or rubbing, frictional tones not in- RESPIRATORY APPARATUS, 91 timately related to either systole or diastole. Pericardial bruits, when present, muffle the regular heart sounds. A pericardial metallic gurgling or liquid bruit, synchron- ous with the heart’s beat, occurs in the course of traumatic pericarditis when fluid exudate and gas commingle in the peri- cardium. Diseases of the Circulatory Apparatus. Palpitation of the heart (palpitatio cordis) is a nervous, transient, greatly increased heart’s action not due to any anatomical lesion in the organ. The loud thumping of the heart may shake the thorax and be heard a distance from the bodv. Acute myocarditis. A diffuse parenchymatous affection of the heart’s muscle which attends severe infectious diseases. Symp- toms: great weakness and debility, mucous membranes cyanotic, high fever, heart’s beat weak, systolic sound muffled. Pulse very rapid up to 120 in the horse; small, weak arhythmic, inequal, finally imperceptible. Course acute or peracute. Mortality high. Hypertrophy and dilatation of the heart. Can be presert for years without visible symptoms occurring. Symptoms: Pulse strong, also heart impulse, zone of cardiac dullness enlarged on percussion. Later when the heart is greatly dilated and the valves can no longer close sufficiently, symptoms of bicuspid insufficiency occur; pulse rapid, arhythmic, inequal; heart’s beat sometimes palpitating, increased dullness on percussion. Systolic blowing bruit, diastolic sound intact or louder than normal. Exercise causes dyspnea from pulmonary venous congestion. Termination as in chronic valvular disease. Most common heart disease of horse and dog. Acute endocarditis. Not very common. Fever, greatly ac- celerated heart’s action, irregular pulse, intermittent, very small. Heart sounds are at first normal, later systolic bruit. Dyspnea. General condition altered. Prognosis unfavorable. Valvular disease, chronic endocarditis. Caused by a chronic valvular endocarditis which leads to an atrophy of the valves (insufficiency) or to a narrowing of the orifices (stenosis). Fol- lowing valvular failure a hypertrophy of the ventricle always takes place; in disease of the semilunar valves the left, ventricle, in defects of the mitral valve a hypertrophy of the right ventricle. The hypertrophy of the ventricle, which is combined with dila- ‘tation, 1s compensatory. Bicuspid (Mitral) insufficiency. Most common ferm of heart disease in dogs and horses. Pulse small, irregular. Sys- 92 CLINICAL DIAGNOSTICS. tolic bruit. Diastolic sound clear, loud. Dyspnea on exercise. Stenosis of the bicuspid (Mitral) valves. Rare when unattended with insufficiency; an uncommon lesion com- pared with insufficiency. Pulse small and very weak. Diastolic and pre-systolic bruits. Great dyspnea. Insufficiency of the tricuspid valves. Rarely primary in the horse, mostly secondary to diseases involving the left ventricle, leading to hypertrophy of the right heart. In the ox frequently primary. Systolic bruits, venous congestion, venous pulse. Stenosis of the tricuspid valves. Happens only in the ox and is then combined with insuthciency. Diastolic bruits, great venous congestion, dyspnea. Insufficiency of the aortic semilunar valves. Full, strong, hopping pulse, pulsation in peripheral arteries. Diastolic bruit. Hypertrophy of the left heart. Stenosis of the aorta. Mostly combined with insuf- ficiency. Harsh systolic bruit. Long-drawn-out, slow, small pulse (28-32 in the horse). Hypertrophy, attacks of vertigo during exer- cise (work). Valvular diseases of the pulmonary artery are very rare. : Termination, of all valvular diseases. In chronic heart diseases the hypertrophy and dilatation of the ven- tricle is followed by a relative insufficiency of the valves. Semi- lunar defects lead to a relative insufficiency of bicuspids; bicuspid defects to a relative insufficiency of the tricuspids. The special diagnosis of the primary lesion is then very difficult. As sequela, finally, the following symptoms appear: small, irregular pulse, sys- tolic and diastolic bruits, congestion of veins, venous pulse, edemas, dyspnea, albuminuria, dropsy, attacks of vertigo, emacia- tion and great weakness. Pericarditis. Mostly a symptom of other diseases. Moderate fever, congestion of mucous membranes. Pulse rapid, heart’s beat weak or imperceptible, zone of cardiac dullness increased, poneanie (frictional) bruits, which disappear when fluid exudate ecomes prevalent. The pressure of the exudate upon the veins causes congestion in jugulars (venous pulse). Traumatic pericarditis of the ox. Begins usually with the symptoms of an acute indigestion (traumatic inflammation of the stomach and diaphragm), which may continue for some time. If the pointed foreign body is driven forward, which is commonly caused by the expulsive efforts of the abdominal muscles during the act of parturition, it usually reaches the heart. The general condition of the patient is greatly disturbed, the expression com- plaining, anxious. The animals stand with back arched and held stiffly, do not like to lie down, and when recumbent rest con- tinually on the sternum. When arising they utter complaints. Temperature variable, external (surface) temperature never quite RESPIRATORY \PPARATUS. 93 normal. Pulse rapid, artery tense. Heart beat cannot be felt, zone of cardiac dullness increased and tympanitic when gas has accumulated in the pericardium. On auscultat’on in the earlier stages pericardial frictional bruits, heart sounds clear, when much exudate is present weak; systolic bruits of a metallic character in consequence of spasm-like contractions of the heart. When putrefactive gases are present the heart sounds can be so loud and metallic as to be heard at a distance. Jugulars distended, pulsating (undulating), edema of brisket, neck and throat. Course chronic notwithstanding severity of the ailment. Prognosis bad. 7. Respiratory Apparatus. The examination of the respiratory tract is one of the most important re sponsibilities of the veterinarian, first because it is frequently subject to disease, and secondly from its availability to thorough inspection. From the complex anatomy of the apparatus, and the value to diagnostics of the varied clinical phenomena it mani- fests in disease, a searching examination of the respiratory tract can only be made by following a definite system. The examination would include attention to the following: I. The respiratory movements (res- pirations). Il. The breath. Ill. The nasal discharge. IV. The nasal cavities and adjacent sinuses. V. The submaxillary lymph glands. VI. The cough. VIL The voice. VIIL The laryngeal region. IX. The trachea. xX. Phe percussion of the thorax. XI. The auscultation of the thorax. 94 CLINICAL DIAGNOSTICS. 1. The Respiratory Movements. [Respirations]. The respirations should be examined in regard to fre- quency, manner in which produced, and any special sounds originating during the act of breathing. These three factors help to determine whether dyspnea _ be present or not. Frequency of respirations. To determine the number of res- piratory movements per minute each rise or fall of the flanks or ribs is counted. Observing the play of the nostrils is not as certain a method, as these organs can be voluntarily moved by the animal. In winter the breath can be seen appearing as steam at each expiration. The respirations should be counted for at least thirty seconds; in restless animals the veterinarian should stand quietly near, count several times and take the average ob- tained as the respiratory frequency. In birds (fowls) the respirations may be counted while tle patient stands or sits quietly and unmolested, by noting the movements of the flanks and abdomen. The smaller the animal the greater the number of res- pirations. In one and the same animal the number of respira- tions per minute will vary within physiological limits. Just after partaking of food, or when the abdomen is very full, and especially after exercise, an acceleration of respirations is a normal consequence. High atmospheric tem- peratures, restlessness and anxiety, also make the breathin: more hurried. In adult animals standing at perfect rest the following number of respiratory movements per minute may be taken as the average normal: TOUS Ee? Bastard tate Suite in peda urand ae aR eee oth nce 8-16 Oper encttereianae Guid anmenl See nc « Pane a ee Cee 10-30 Sheepeand: Oates see seer Mave mua die 2 12-20 SWINE. 204 mot dius dead kes Gandeted 10-20 DDGSSs exigtcseaiahitee dere ed eh Go Os eons Jee. en 10-30 Cats siresaneuhantn csdiiehen eaves eee, Witla: 20-30 (SO OSCR ss ake accas ec Soca Cates e hora Gch att sa daoe Bul els 20-25 GIIGKEINA potash gitly eae ierh Glens pata ds 40-50 PASCO eixe eh eaentineae Gi eae Gtoneaed ted we. «60-70 RESPIRATORY APPARATUS. 95 Fig. 28a. Normal Respiration Curve. Fig. 28b. Pure Inspiratory Dyspnea in Case of Bilateral Paralysis of Larynz. The Breath Is Slowly Drawn In, Accompanied by a Strong Shak- ing of the Thorax. 96 CLINICAL DIAGNOSTICS. Fig. 28c. Expiratory Dyspnea in Case of Emphysema Pulmonum. Fig. 28d. Inspiratory and Expiratory Dyspnea in Case of Inflammation of the Lungs or Thoracic Wall. RESPIRATORY APPARATUS. 97 A pathological increase in the number of respiratory movements (polypnea) is spoken of as dyspnea (see this). «lt decrease in the number of respiratory moveiments (oligopnea) is rarely observed. It is seen in severe brain af- fections (hemorrhage, hydrocephalus, tumors, poisonings, ac- tion of septic substances as in pulmonary gangrene), also where the anterior air passages are occluded (stenosis), which is combined with a pronounced inspiratory tone. Oligopnea associated with respiratory noise is always a sign of severe illness, b. Physiology of respiration. When an animal is at perfect rest, the respirations are produced by the action of the ce The contraction of the diaphragm produces a dila- tion of the thorax. When the muscle contracts it flattens and is drawn backwardly, the false ribs becoming elevated. Notwith- standing that the diaphragm is str : teh transversely between the thoracic ee dominal cavities, its contraction d s cause its points of insertion to appro each other, for the reason that the intestines keep it con- tinually forward, which produces a drawing anteriorly of the ribs rather than to cause them to approach the median line. On account of the double articulation of the ribs with the dorsal vertebrae the forward movement of them is accompanied by a rota- tion. The diaphragm dilates the thorax in that it draws the ribs forward and rotates them outward at the same time. . The expiration follows the relaxation of the diaphragm, which takes place immediately after the inspiration. The dura- tion of expiration is longer than that of inspiration; between them in quietly breathing animals there is a short pause. 1. The normal rhythm of the respirations can be patho- logically altered in that: The inspiratory movement lasts too long, the freé entrance of air, being prevented by stenosis of ‘the. respiratory passages (inspiratory dyspnea). 2. The expiratory act lasts too long, the re- laxation of the diaphragm not sufficing to a complete al tory movement (expiratory dyspnea). 3 As the respirations are in a measure. controllable. by ihe will, which depends upon the cerebrum, excitement or inflam- 98 CLINICAL DIAGNOSTICS. matory conditions occasioning either irritation or depression of this organ can bring about marked change in the rhythm of respiration. The value of these changes to diagnostics is limited. A peculiar change in the rhythm and intensity of the respi- rations, occurring in cycles, is noted in severe intoxications and infections. It is known as Cheyne-Stokes respirations. Following a pause in the respirations the breathing progres- sively increases in frequency and intensity to dyspnea. It then slowly subsides until another pause when the cycle is repeated. 2. The intensity (depth) of the respirations is not marked in healthy animals standing at rest. The alae of the nostrils are hardly moved, and the ribs but slightly raised. The in- tensity is increased by exercise; if it is augmented and the animal at rest, it denotes disease. The horses dilate the nostrils trumpet-like, dogs open the mouth (pant) and pro- trude the tongue. The movements of the ribs and flanks are pronounced. The development of the intensity agrees with the degree of dyspnea. The intensity is diminished when the pleura, chest wall or diaphragm is diseased and painful. The intensity can become asymmetrical in that one side of the thorax undergoes a deeper or more rapid movement than the other side. This is seen in painful uni- lateral pneumonias or pleurites. 3. When the rhythm and intensity of breathing is normal and the ribs and abdomen are moved with even regularity, the type of the respirations is spoken of as costo-abdominal. if the respiratory movements are produced principally by the auxiliary muscles of breathing, which dilate the thorax, the type becomes costal. The costal type is seen to occur where air can not pass freely into the thorax or where the diaphragm or adjacent organs are diseased. (Abdominal tumors, ascites, tympanitis. ) When of the costal type the respirations are slow. RESPIRATORY APPARATUS. 99 When the abdominal muscles are more active in produc- ing the respiratory movement than the thoracic muscles the type of breathing becomes abdominal. The abdominal type prevails when painful conditions of the chest wall are present and where expiration is difficult, as in pulmonary emphysema (heaves). +. There is sometimes observed in animals a condition corresponding to hiccoughs (singultus) in man. It is character- ized by a rhythmic, spasmodic contraction of the diaphragm. (abdominal pulsation) with which a jerky movement of the thorax in the hypochondriac region occurs. Occasionally it is accompanied by a dull sound. Its rhythm is synchronous with neither the heart’s beat nor the respirations. The latter, however, are temporarily arrested by the spasms. Singultus is usually temporary and probably due to a diaphragmatic neurosis. C. Respiratory Sounds. The respirations of healthy animals are performed noise- lessly. Only occasionally do they voluntarily emit audible sounds during the act of breathing. Physiological Sounds. When excited suddenly by perceiving peculiar looking objects, strange persons, unaccus- tomed odors, etc., horses and cattle snort by violently and noisily forcing air through the dilated nostrils. Horses of lively temperament usually snort when led at the end of the halter. Horses blow their noses by causing a forced expira- tion which is accompanied by a vacillating noise. As in man, dust or mucus is thus removed from the nasal organs. Fat, rough coated dogs pant when the weather is warm even when they are at rest. While performing hard work or during forced exercise the breathing is rapid and deep; the air pass- ing in and out of the dilated nostrils at each in- and expiration produces a perceptible puffing sound. Spirited horses while being ridden at a gallop, emit a blowing expiratory sound every time the forefeet come in contact with the ground. 100 CLINICAL DIAGNOSTICS. A yawn is a long-drawn-out, deep inspiration taken with the mouth held wide open. The inspiratory muscles assist in producing it. Pathological Sounds (stridores). When the respiratory apparatus is diseased the following pathological sounds may occur: 1, The wheesing or blowing sound which is stenotic in its character, emanates from the nasal cavities. It is more pronounced at inspiration, and results fromi a narrowing of the nasal chambers due to the presence of tumors, swelling of the alae of the nostrils, septum or chonchae, en- largements of the turbinated bones or fractures of these bones, fractures of the nasal bones, or deposits of exudate on the mucous membrane. Depending upon the condition of the mucous membrane, the stenotic sound may be accompanied by either moist or dry rattling noises. 2. “The Mucous Click” (klatschender Nasalton) is a peculiar metallic, short expiratory sound first described by Dieckerhoff. It occurs during an inspiratory-expiratory dys- pnea if the nasal mucous membrane is very moist. At a forced inspiration that part of the nasal mucous membrane which unites ‘vith the skin of the false nostril, is sucked against the opposite wall to which it adheres for a moment; when an expiration takes place this adhesion is broken, caus- ing a metallic “slapping” tone to be emitted. This sound is of no sivnificance. 3. Sneesing is an explosive expiration through the nose, which originates reflexly from irritations to the nasal mucous membrane. It is heard in rhinitis (nasal catarrh) or when foreign bodies enter the nasal cavities. Sneezing only occurs in the dog, cat, and fowl. 4. Snoring takes place when the act of breathing is ef- fected through the open mouth, the soft palate undergoing a fluttering motion. In swine and dogs it occurs when the himen or the nasal cavities is contracted by swelling or thick- RESPIRATORY APPARATUS. 101 ening of the mucous membrane. Snoring is also noted in the ox when the retro-pharyngeal lymph glands are swollen or enlarged; further in the course of parturient paresis. Horses under chloroform sometimes snore. 5. Rattling is a stenotic laryngeal sound which occurs when the vocal cords are relaxed. It is heard in severe in- flammations of the larynx or of the neighboring pharyngeal mucous membrane; phlegmon of the pharynx and edema of the glottis. 6. The most important pathological re- spiratory tone is the stenotic laryngeal tone. Normally the sound emitted by the larynx is a soft stenotic sound audi- ble when the ear is placed over the organ. [It can be imitated by pronouncing the German “ch"]. If the lumen cf the lar- ynx is narrowed, the noise becomes loud. It is most fre- quently heard in the horse, and is one of the characteristic symptoms of roaring. Ordinarily the tone is emitted when the respirations are increased during exercise, but in cases where the lumen of the larynx is much diminished, it may appear when the patient is at rest. The character of the tone will vary from whistling to a pronounced hoarse or roaring sound. Besides it may be due to a firm swelling of the laryngeal mucous membrane (phlegmonous laryngitis, strangles), tu- mors in the larynx or its neighborhood which prevent the free entrance of air. 7. Loud rattling noises [garglings] are heard when the larynx or the trachea contains loose masses of mucus. 8. Groaning (moaning, grunting) is heard when a long inspiration is followed by a prolonged, audible expiration through a partially closed glottis. The sound is emitted only at expiration. Groaning is not necessarily a sign of disease, for it often occurs in healthy animals, especially cattle after a full feed or when pregnant. Groaning is produced by the 102 CLINICAL DIAGNOSTICS. pressure of the distended abdominal organs upon the dia- phragm, shortening the expiratory moment, which the animais seek to retard by partially closing the glottis. d. Labored Breathing, Dyspnea. The collective term dyspnea is applied to essential deviations from the normal in the frequency andkindof respiratory move- ments, and the occurrence of accompany- ing pathological sounds. Physiologically a dyspnea occurs whenever the blood flowing through the respiratory center contains an abnormal amount of CO,. Accordingly, anything which increases the quantity of CO, in the tissues, or interferes with the exchange of gases in the lungs, can cause a dyspnea. Clinically the presence of dyspnea is recognized: I. If the respirations are accelerated (altered in number ), and the increased frequency is not attended with change in the manner of breathing the dyspnea is simple. In the horse, for instance, the number of respirations can exceed 80-100 per minute and be superficial, onty the nostrils becoming dilated. If the dyspnea is severe, however, the intensity of the respirations is increased. Simple dyspnea appears: 1. In fever; the degree of respiratory frequency de- pends upon the severity and nature of the disease. 2. In all conditions which make the respiratory act painful: diseases of the pleura, diaphragm, thoracic wall, peritoneum. 3. Where the breathing surface of the lung is decreased or where the organ is prevented from properly expanding: pneumonia, pulmonary tuberculosis, abdominal tympanitis, ascites. RESPIRATORY APPARATUS 103 4. In diseases of the heart which have a congestion of the blood in the lungs as a consequence. II. If the respirations are labored (alteredinqual- ity ), though the frequency may be normal, aggravated dysp- nea. The occurrence of respiratory noises always indicates a difficulty in breathing. Depending upon whether the expiration or inspiration is dif- ficult, an expiratory or inspiratory dyspnea is distinguished. The inspiratory dyspnea. If the entrance of air into the respiratory organs is made difficult, the animal seeks to overcome the condition by taking forced inspirations. Notonlyisthediaphragmactivelyemployed, butothermuscleswhicharenormallynot used during inspiration are called into piay. These muscles are: the serratus magnus, serratus anticus, external intercostals, levatores, costarum, scalenus. The following clinical symptoms character- ize dyspnea: The nostrils are widely distended; dogs fowls, cattle and swine breathe with their mouths open. Dogs sometimes close the jaws and breathe through the lateral commissures of the mouth, sucking in the cheek at each inspiration. The head and neck are extended horizontally, the larynx is retracted, the ribs greatly elevated and rolled forward. The forelimbs are spread far apart and the elbows turned out so that the serrati and pectoral muscles can better come into play. If, in aggravated inspiratory dyspnea, the air enters the lung very slowly, notwithstanding that the ribs are greatly elevated, and the thorax is distended to a degree which does not correspond to the quantity of air passing in, a suction pressure will occur, which can be recognized by a sinking of the lower anterior thoracic wall—particularly of its inter- costal spaces. 104 CLINICAL DIAGNOSTICS. Inspiratory dyspnea is observed: 1. Ina pure form in bilateral paralysis (paraplegia) of the larynx and in severe cases of unilateral paralysis of the organ (hemiplegia, roaring). It is characterized by the above cited inspiratory dyspnea and the occurrence of a stenotic laryngeal bruit. In less severe cases of roaring this symp- tom can only be brought out by exercising the patient. The act of expiration is performed without difficulty. 2. In less pure form where a stenosis of the nasal pas- sages, pharynx, larynx or trachea exists due to inflammatory swellings, tumors, etc. In such cases a stenotic sound is emitted at each inspiration and the expiration is more or less difficult. 3. In diseases of the bronchi and lungs preventing the free entrance of air: bronchitis, pulmonary edema, pneu- monia. +. Where the principal respitatory muscle, the dia- phragm, is inactive: rupture or inflammation, tympanitis. Expiratoryv dyspnea appears when the exit cf the air from the lung is made difficult. In this case the expiration ensues not alone passively, but the accessory expiratory muscles actively assist. The muscles aiding expiration are: the abdominal muscles (exter- nal and internal oblique, straight abdominal muscle), the in- ternal intercostals and triangularis.s An expiratory dyspnea is recognized by the following symptoms: The expiration is prolonged and is attended with pronounced movement of the abdominal wall (pumping of the flanks). At first, a limited sinking of the thoracic walls ensues from a relaxation of the diaphragm, then the abdominal muscles become active (contract) and a furrow is formed along the course of their insertion to the costal cartilages— the so-called “heave line.’ The passive and active moments of expiration can be plainly distinguished from each other, so that the movement of the flank appears to be a double pump- RESPIRATORY APPARATUS, 105 ing. The back is elevated at expiration and sinks during inspiration. At the moment of expiration the anus is greatly protruded. When the abdomen is .well filled, these symp- toms appear more prominently. Expiratory dyspnea occurs: 1. In vesicular and interstitial emphysema. 2. In chronic bronchitis and_peri-bronchitis. 3. Where the lung has adhered to the costal wall. A mixed dyspnea is present when accelerated respiratory frequency is combined with difficult inspiration and expiration (inspiratory and expiratory dyspnea). It is the most common form of dyspnea and attends all severe diseases of the respiratory tract (pneumothorax, hydrothorax) and also those diseases which have no primary seat but whose course 1s accompanied by a severe intoxication of the blood with CO,—as in many of the infectious diseases. In pronounced mixed dyspnea there is a marked flap- ping of the nostrils. At the beginning of inspiration both wings (medial and lateral) are greatly distended. At the end of the inspiratory movement they again collapse. How- ever, the forced out-flow of air at expiration, which imme- diately follows, forces the medial wing, which is in its path, outward and upward causing a second movement of this wing to occur. According to the seat of the respiratory obstruction one speaks of a nasal, laryngeal, tracheal and pulmonary dysp- nea. II. The Breath. An examination of the exhaled air is of diagnostic im- portance in many morbid conditions. Normally the air is emitted from the nostrils in two odorless currents of equal size. The two deviations from the normal are: e: 1. The air currents from both nostrils are not of equal size. Where one of the currents is smaller (of less volume) than the other, it points toa narrowing of the nasal 106 CLINICAL DIAGNOSTICS. passage of that side. Not infrequently a blowing sound accompanies the inspiration. The passages may be con- stricted by thickenings or swellings of the mucous membrane or by tumors. 2. The breath has a bad odor. A bad odor from the nostrils is always a sign that putrid decomposition is taking place in the air passages. It may emanate from various parts of the respiratory tract. The odor is either putrid (fetid) or carious. It is observed: 1. Where stagnant masses of putrefying exudate are in the turbinated bones, sinuses, gutteral pouches, or even on the mucous membrane of the upper air passages and bronchi. 2. In putrid decomposition of tumors in the air passages. 3. In suppuration or necrosis of the bones of the head bordering on the air passages: Suppuration in the tooth alveoli, dental caries, necrosis of the turbinated bones. 4. In gangrene of the lungs. It is always important to determine where the odor originates. At first we should be clear as to whether it really comes from the nose or from the mouth. When the mouth is closed, this is usually not difficult; in doubtful cases the odor of the saliva can be tested. The safest way is to make an examination of the buccal cavity, especially of the teeth. When the alveoli of the upper molars are diseased, a carious smell is emitted from both the mouth and nose. (See Examination of the Mouth). If the offensive odor has been found to come from the expired air, it is then necessary to locate the part of the respiratory apparatus at which the decomposition is taking place. For this purpose we should first determine whether or not the odor is equally offensive from both nostrils. When the odor from one nostril is more prevalent than from the other, the process of decompesitioe has its seat in the nasal cavity of that side, and usually Yt is accompanied by a unilat- eral nasal discharge, bulging of the facial bones and swelling of the submaxillary lymph glands. RESPIRATORY APPARATUS. 107 The examination of the upper molar teeth of that side should never be neglected. When the odor is equally offensive from either nostril, the putrid focus is as a rule contained in the lung, more rarely in the pharynx, larynx or trachea. Putrid decomposition in the lung is not always to De ascribed 16 pulmonary gan- grene, for not infrequently a decomposi- tion ofexudateinthe bronchi, (fetid bronchitis) is present. The presence of elastic fibres in the nasal discharge speaks for pulmonary gangrene. JII. Nasal Discharge. Only in the ox a slight nasal discharge is seen to occur in health, which the animal usually removes from the nostrils with its tongue. In the other animals the appearance of a nasal discharge is always a sign of disease, and one of con- siderable diagnostic importance. It can accompany all dis- eases of the respiratory tract which are exudative in char- acter, such as catarrhs of the nasal cavities, sinuses of the head, throat, larynx, trachea, bronchi and lungs. In these cases the discharge is the product of the disease. Some- times the discharge comes from the digestive tract, from the mouth or pharynx, more rarely from the gullet or stomach, when it contains substances such as food particles, wate1 or saliva. The character of the nasal discharge depends upon the organ from which it comes and the nature of the disease pro- ducing it. We should bear in mind that the ox, sheep, goat and dog usually lick off the discharge, hence it is not so noticeable in these animals as in the horse. To correctly judge nasal discharge the following should be considered: a. The quantity, which will vary greatly. The dis- charge is slight in catarrhs that are neither very diffuse nor 108 CLINICAL DIAGNOSTICS, severe. In tuberculosis, notwithstanding the severity of the case, there is little discharge because what little exudate appears upon the surface of the mucous membranes is re- moved by coughing and eventually swallowed. The discharge is copious in strangles and in diffuse catarrhs of the upper air passages and bronchi. Unilateral nasal discharge is characteristic of disease of one side of the anterior air passages as far back as the fauces. A catarrh involving but one side of the soft palate or pharynx may also show a discharge from only one nostril. Of especial importance is the variation in quantity of the discharge. In some cases a copious amount of discharge is ejected when the head is suddenly lowered [unreining after a drive], while for a day or more there is present either no dis- charge at all or only a very slight one. This symptom is characteristic of catarrhs of the frontal and superiormaxil- lary sinuses and of the guttural pouches. b. The color. The color of the nasal discharge de- pends upon the character of the inflammation, and also the presence of foreign mixtures. It will vary from colorless to grey, white, yellow, red, brown or green in all their different tints. During the course of a disease the color of the nasal discharge will change with the character of the inflamma- tion. A serous or mucous discharge is usually colorless; a purulent discharge is grey or yellow or may be of a greenish hue. A colorless and clear discharge is noted in serous and mucous catarrhs. A gray discharge is due to the admixture of epithelial cells; if leucocytes appear in it the color is greyish-white; if red blood corpuscles are present a grevish-yellcw or even yellow color is given to the discharge. A green discharge is usually due to an admixture of the RESPIRATORY APPARATUS. 109 chlorophyll of the food, deglutition being difficult. Food particles are always present in such cases. In rare instances a greenish tinge is seen, due to decomposed blood coloring matter being present in the discharge. A yellow, rust-colored [prune juice” ] discharge is seen in hemorrhagic hepatization of the lungs (contagious pleuro- pneumonia of the horse). It is due to an admixture of blood coloring matter. In rare instances a rusty brown nasal discharge is pres- ent in severe catarrhal affections of the anterior respiratory passages (strangles, pharyngitis). A bloody discharge (cpistaris) is observed only when blood im toto is present. It may be due to: 1. Finger-nail injuries to the mucous membrane of the nose or fractures of nasal bones. In the dog the presence of pentastomuim tenioides may lead to bloody nasal discharge, and in sheep the larve of cestrus ovis. 2. Ulcers; glanders; bleeding tumors in the nasal cavi- ties. 3. Nasal hemorrhages may attend anthrax in the ox, purpura hemorrhagica, or very severe cases of contagious pleuropneumonia of the horse. The discharge may consist entirely of blood, or simply of an admixture of blood. If the hemorrhage is from a nasal cavity, it is unilateral, the blood appears fresh and in- completely mixes with any other discharge present. If from the lungs, it is more or less foamy and in the trachea one may hear moist rales. c. The consistency of the nasal discharge depends upon what it contains. It may be serous, mucous or mucil- aginous, with varied intermediations. It may also be floccu- lent, clumpy, or contain great masses of adhering exudate. In the beginning of a catarrh the discharge is serous (clear), but by admixtures of mucus it becomes mucous and loses its transparency from the quantity of epithelial cells it contains. Its color is then grey. When an admixture of pus is present 110 CLINICAL DIAGNOSTICS. the discharge assumes more of a cream-like consistency and its color changes to grevish-yellow or yellow. A discharge of pure pus only occurs when an abscess ruptures into the nasal cavity. A clumpy, buttermilk-like discharge is observed in chronic catarrh of the sinuses of the head because the exudate has been retained for a time. Adhering massesofexudate are seen in diph- theritic, croupous, or fibrinous inflammations. d. The odor. The odor of the nasal discharge be- comes foul, putrid or carious from decomposing processes. In such cases the breath is also tainted. For the determin- ation of the seat of the disorder, what has been said concern- ing the odor of the expired air applies. e. Foreign admixtures. Most commonly we observe air bubbles of large or small size which cause the discharge to appear as foam. Fine foam. When the discharge comes from the smaller bronchi in pulmonary edema and bronchitis, the foam is composed of small air bubbles of equal size. When there is much foam the discharge is white in color. Horses suffering from chronic bronchial catarrh after exercise show a white nasal discharge partially made up of fine foam. Fig. 28. Egg of Pentastomum Tenioides. Coarse foam. This is not infrequently unilateral and contains an admixture of food particles. It comes from the mouth and consists in part of saliva. The air bubbles are of unequal size. Coarse foam is symptomatic of paralysis of the pharynx, pharyngitis (fungus poisoning). RESPIRATORY APPARATUS. 1ii When food particles alone make up the nasal dis- charge, it is a sign that vomiting has taken place. The dis- charge is then not foamy, is of acid reaction and contains no admixtures of exudate. A microscopical examination of the nasal discharge is rarely of practical value. It may sometimes be of use to determine the presence of the embryo or egg of Strongylus filaria in the lungs of sheep or of Pentastomum taenioides in the nasal passages of the dog, or in fetid nasal discharge, the elastic fibres. The examination for pathogenic micro- organisms yields positive results only in exceptional cases. The tubercle bacilli are one of these exceptions as their char- acteristic way of accepting stains serves to identify them microscopically. Microscopical determination of tubercle bacilli. A cover-glass preparation is covered with Ziehl’s carbolized-fuchsin solution (fuchsin 1, absolute alcohol 10, carbolic acid 5, aq. dist. 95\. and heated repeatedly for about two minutes over a flame. Wash and drain. Gabbet’s solution (methylen blue 2, in 100 grammes of a 25% sulphuric acid) is then applied and allowed to remain % minute. Wash and examine. Fig. 29. ‘a fA a # %s Pe ea Be g ‘ i a as oe x = & ‘ ° . f) os og Vy 16 f ao \ eu 4“ we @ ‘ 4 r ) vs 9 es 4 - t ? . ee « <4 . s as 4 %% & , ‘ Pa a’, Bi RA ? q s “f° 4 : * 8 a 1? Tubercle bacilli. Beeddes the tubercle bacillus, other bacilli (acid-fast), which stain by this method, are found in the feces of cattle and in butter. 112 CLINICAL DIAGNOSTICS. IV. The Nasal Cavities and Adjacent Sinuses. 1. The external appearance of the facial bones will readily betray any deformity. Circumscribed enlargements are due to tumors and a bulging of the sinuses in chronic catarrhs. Diffuse enlargements attend rachitis and osteoporosis, “big head.” Depressions have a traumatic origin. Swellings appearing at the nasal openings and nostrils are common in pupura hemorragica. Tumors (atheromas) are frequent in the false nostrils. The specific pathological conditions which occur about the lips and nose are the pustules and ulcers which attend contagious stomatitis, the pox pustules of sheep pox, and the vesicles on the muzzle of the ox and snout of swine suffering from foot and mouth disease. When a nasal discharge has existed for a long time, the integument of the nose and lips over which it flows loses its pigment. The white streaks thus formed speak for the chronicity of the discharge. 2. The examination of the nasal mucous membrane. ‘The nasal mucous membrane is available to inspection only in the horse. Local lesions occurring on it are often of great diagnostic importance. ; Method of examination. The head of the animal should be elevated and the inner cartilaginous wing of the nostril grasped between the thumb and middle finger which draws it upward and outward; the extended index finger is then inserted under the outer wing, which it distends. The patient should face the light, except when the rhinoscope (an enlarged ophthalmoscope) is used. a. Discolorations. Jndistinct, punctiform, or ramiform redness is not infrequently seen in acute and chronic catarrhs ; they are due to the peculiar anastomosing of the capillaries and are of no diagnostic value. Deep redness is mostly the result of hemorrhages in the mucous membrane. They appear mostly punctiform and can be as large as a ten-cent piece, they are well circumscribed RESPIRATORY APPARATUS. 13 and of round form (fetechiae, ecchymoses). When they become confluent, the redness is diffuse or appears in irregu- lar streaks. Petechiae are most commonly seen in purpura hemorrhagica, but may also occur in severe anemia (rare) and in leucemia. The spots, which are at first dark red, soon fade and assume a brownish hue. Suffusions are observed in septicemic diseases: anthrax, septicemia. b. Swelling of the nasal mucous mem- brane is characterized by the normal surface of the mucous Fig. 30. Examination of the Mucous Membrane. membrane, which is granular from the many glands it con- tains, becoming firm and smooth. As the membrane is usually tense, the swelling is not marked. Its origin is in- flammation, therefore the surface appears turbid. Chronic, connective tissue thickenings are most commonly made manifest by irregular, wart-like prominences which show the characteristics of scars. c. Woundsinthemucousmembraneare usu- ally at the lowest part of the septum, and are very often caused by finger-nails, sharp straws and the like. 114 CLINICAL DIAGNOSTICS, d. Nodules from the size of a millet seed to that of a peppercorn almost exclusively attend glan- ders. Exceptionally they result from contagious stomatitis, but in such cases like nodules are to be found in the mucous membrane of the mouth. To prevent mistaking particles of mucus for true nodules, the supposed nodule should be pal- pated with the finger; if mucus particles, we can thus wipe them off. e. Ulcers. Nexttonodules, ulcers form the most important criterium in diag- nosing glanders. Glanders ulcers have jagged bor- ders circumscribed by rounded, elevated walls. The base of the ulcer is sunken, uneven, grey in color, and of lardaceous appearance. The favorite seat of the glanders ulcer is on the medial border of the inner cartilaginous wing of the nostril, hence this place should always be examined. In rare cases ulceration of the nasal mucous membrane also attends stomatitis and purpura hemorrhagica. For dif- ferentiation the concomitant symptoms must be considered, such as ulcers on the buccal mucous membrane, petechiae, etc. Very superficial pittings with sharp borders—not rounded nor red colored —represent the catarrhal or crosion ulcer. f. Cicatrices at the lower end of the nasal septum are mostly the result of previous wounds. They are often curved ( ( as if made with a finger-nail. Glanders cicatrices are as a rule more or less star-shaped. g. A narrowing of the nasal passages and the presence of tumors may be determined by the use of a hard rubber sound such as is furnished with the Polansky-Schindelka lar- yngoscope. [An ordinary urinary catheter serves the same purpose.] The sound should be passed beyond the posterior nares. In thorough-breds the nasal cavities are usually larger than in coarsely bred horses. Wherever there is unilateral nasal discharge and wheezing, blowing respirations present, the nose should be sounded. RESPIRATORY APPARATUS. 115 3. The examination of the sinuses of the head is often of importance and should be made whenever a chronic nasal discharge exists, especially when attended with an unilateral bulging (enlargement) of the facial bones. Mere enlarge- ments can be defined by palpation. The presence of exu- dates in the sinuses can sometimes be determined by percus- sion. The normal percussion sound of the sinuses is full, but when they are filled with exudate or tumor masses, it becomes flat. When the sinuses are only partially Filled the percussion sound is not changed. Negative results from percussion, therefore, do not exclude the presence of exudate. [A simple method of exploring the sinuses of the head, to determine whether exudate (pus) is present in them or not, is to bore a small hole into them with a “Yankee” drill. If the sinuses contain pus or other exudate, the bit becomes soiled by it and, if the contents are fetid, will smell.] V. The Submaxillary Lymph Glands. Although these glands do not property belong to the respiratory apparatus, the examination of them is significant in the horse. In this animal especially, the glands become sympathetically diseased when pathological conditions exist within the domain of their lymph vessels. Anatomy. The lymph vessels from the nostrils to the ethmoid bone carry their lymph to the submaxillary glands, a small glan- dular packet as broad as and a little longer than a finger, lying on each side of the intermaxillary space. They begin at the point where the inferior maxillary artery passes under the ramus of the lower jaw, and extend forward to the angle of the chin where each unites with its fellow of the opposite side. Each lobule is of about the size of a small bean. In horses of coarse conforma- tion the intermaxillary space is often filled without the glands being swollen. As soon as an absorption of irritant or infectious substances [bacteria] takes place in the region drained by the lymph 116 CLINICAL DIAGNOSTICS. yessels of the submaxillary glands, these organs become secondarily diseased. The primary disease usually has its seat in the mucous membrane of the nasal passages or sinuses. An examination of the glands, therefore, is of great significance in determining the pathological condition of these mucous membranes. In making the examination the following points are to be considered : a. Is one or both glands enlarged? In acute infectious catarrhs the glandular swelling is generally bilat- eral; in glanders frequently wnilateral, and in tumors in the nasal passages, bad teeth and chronic catarrh of the sinuses, it is, as a rule, unilateral. b. Size and form of the glandular swell- ing. Many or a few of the lobules may be enlarged to the size of a bean, pigeon or hen’s egg, depending upon the pri- mary disease in the mucous membranes. Acute swellings are smooth; chronic swellings lobulated (nodular), which is espe- cially marked in glanders. Well marked, clearly defined, smooth enlargements of individual lobules are observed in leucemia (a hyperplasia), and when malignant tumors are developing in the glands. c. Consistency of the swollen glands. The swelling is soft in serous, fense and firm in cellular infiltration of the glands. Acute diffuse swellings (stran- gles) often lead to suppuration (ab- sces¢), which can be determined by fluctuation. In glanders diffuse abscess formation never occurs in the glands; only rarely does a small purulent focus (farcy bud) appear in the skin over the gland. Firm, hard enlargements are always due to some chronic irritation and consist of con- nective tissue proliferations. Such attend chronic glanders, catarrhs and dental fistulae. d. Temperature and sensitiveness. When the glands are hot and tender (inflamed), the morbid con- RESPIRATORY APPARATUS, 117 dition is acute (strangles). If the enlargement of the gland is firm, cold and painless, it points to glanders, chronic catarrh, tumors or hyperplasias [leucemia]. e. Movability of the glands. If the irrita- tion is chronic and attended with the formation of new con- nective tissue, the process involves the environing tissue, form- ing adhesions with its neighborhood. In acute purulent in- flammation of the glands there develops in the vicinity, name- ly, directly beneath the skin, an inflampnatory edematous and later a phlegmonous swelling. The extirpation of a diseased lymph gland is recommended where glanders is suspected. Its object is the patho-anatomical or bacteriological examination of the gland. The operation can be performed on the standing animal when local anesthesia is employed, and is not dangerous. VI. Cough. Cough is a sudden expulsion of air from the lungs, following a deep inspira- tion. The glottis is forcibly opened dur- ing the act, causing a sound to be emitted. By coughing accumulations of mucus are removed from the bronchi, trachea or larynx. In animals cough is a reflex action which can to a certain extent be suppressed. Al- though it can be induced by irritation to many peripheral nerves, as a rule it emanates from branches of the vagus nerve in the respiratory apparatus. Most sensitive in this particular is the superior laryngeal nerve, which is the sensory nerve of the larynx, and the first three rings of the trachea. The mucous membrane of the trachea is less sensitive, except at the bifur- cation of the bronchi. The bronchi are just as easily irritated as the larynx; but coughcannot beexcited from the parenchyma of the lungs. It can, however, arise from the pleura when this organ is in a state of irritation. Peripheral irritation is transmitted to the cough-center in the 118 CLINICAL DIAGNOSTICS. brain, which innervates the expiratory muscles and recurrent nerve, inducing the reflex spasm called cough. In exceptional cases cough can emanate from ter- minals of the vagus nerve lying outside of the respiratory appara- tus, as, for instance, from the external auditory meatus [ear], nose, or abdominal organs. According to Albrecht cough can occur from abscess in the liver. These are, however, exceptional cases. Cough from the stomach has never been ob- served in the horse. There is a possibility that cough may have its origin in the brain. These exceptions are worthy of note and should be considered in those cases of cough the cause of which cannot be found to lie in the respiratory apparatus. Cough occurs: 1. If foreign bodies are inhaled: smoke, dust (dusty food), acrid gases (ammonia, sulphurous acid, chlorine, etc.). 2. If cold air is inhaled, especially if the respiratory tract is inflamed: catarrhs of the trachea and bronchi, pleuritis, traumatic injuries to the pleura (traumatic gastro-diaphragm- itis of the ox). 3. If mucus, exudate or foreign bodies (food) and para- sites are present in the air passages: Gastrus larvae in the larynx, Syngamus trachealis in the wind pipe, Strongyli in the bronchi. In no case can cough originate when thesensory ter- minals of the vagus nerve are no longer susceptible to irritation. In severe phlegmonous diseases of the mucous membrane, cough is absent. The cough center in the brain must also be in normal condition. It is disturbed when great mental depression exists. Therefore, when appreciable irritations (rales) are present, unaccompanied by cough, the prognosis is an unfavor- able one. The character of the cough. The character of the cough varies with the species of animal. Healthy horses have a strong, vigorous, loud, full-toned cough; cattle a sharper defined, softer, toneless, prolonged cough, the glottis being held open. The appearance of cough in animals is always ab- normal; its character depends upon the disease which causes RESPIRATORY APPARATUS. 119 it. Whether cough accompanies the disease or not can usually be learned from the anamnesis, although we can not depena upon this to determine its character. It is always best that we induce the patient to cough in our presence; this may be done by pinching the upper three rings of the trachea or pressing the finger ends of both hands against the arytenoid cartilages of the larynx. In sensitive healthy horses one or a few short coughs will foliow the manipulation, while in indolent indi- viduals there is no reaction. Healthy cattle can not be made to cough by simply pinch- ing the trachea, and even those with diseased lungs may fail to react. A better method is to close both nostrils for a minute, which usually has the desired affect. If the ox can be made to cough by pinching the upper trachea or larynx, or if coughing takes place in the horse when only slight pressure has been used, some abnormal irri- tation exists. If cough can ke readily induced by pressing the lower windpipe, a tracheitis is present. The frequency of the cough. A cough may be occasional or frequent, continual or transitory. If the cough is occasional usually only one or a few impulses occur, but when frequent several in succession—a fit of coughing. The painfulness of the cough is recognized by the general behavior of the patient, which seeks to suppress the pain by shaking the head and making masticatory and swal- lowing movements. The animal may also be restless, paw and groan. A painful, painless, burdensome, and torturing cough may be distinguished. The cough is painful in acute bronchitis, pleurisy, pleurodynia, and in so-called “whooping cough” of dogs; painless in chronic laryngitis. The force of the cough impulse depends upon the vigor of the action of the expiratory muscles and the elasticity of the lungs. Accordingly, the cough may be strong, vigorous, or weak. It is weak if expiration is difficult or if the patient is unable to cough vigorously: reduced, debilitated 120 CLINICAL DIAGNOSTICS. animals, pulmonary emphysema, bronchitis, hydrothorax; or if the expiration is painful: pleurisy, pneumonia, pleurodynia. The cough is strong if the elasticity of the lungs is normal and no pain attends the act. Thelength of the cough is determined by the force with which the pulmonary air is held repressed by the closed glottis. If the pressure is great, the glottis will be suddenly forced open and the cough will be short. If the glottis is not completely closed (paralysis of the arytenoid cartilage—roaring) or the repression of the air causes pain (pleurisy), the cough is long—prolonged. The depth and magnitude of the cough depend partly upon the force and duration of the cough im- pulse. The magnitude is influenced by the quantity of ex- pelled air. We speak of a deep and a shallow cough. Thecough sound is dependent upon the force of the cough impulse, the tension of the vocal cords and the spe- cial condition of the surface of the mucous membrane. The sound may be loud, low, clear, dull, sharp, whistling, dense, hollow, loose, moist, dry. The cough is moist when easily movable masses of mucus are collected below the larynx; it is dry when either no exu- date is present or only small, viscid accumulations are ia the air passages. The ‘‘return sound’’ of the cotigh (Hus- tenrueckstoss). Each cough is followed by a short, deep in- spiration. If the glottis is not fully open at the moment this inspiration takes place, the air rushing in causes the partially stretched vocal cords to vibrate, causing a harsh, short, laryn- geal stenotic sound to be emitted. It is heard in paralysis of the larynx (paraplegia, hemiplegia) and in severe inflamma- tory swelling. Expectoration. The act of coughing tends to eject masses of mucus, exudate, etc., from the bronchi, trachea, and larynx. Animals do not expectorate because that which RESPIRATORY APPARATUS. 121 is coughed up into the throat, as soon as it reaches the phar- ynx, is swallowed. Sometimes, however, a part is discharged through the mouth, the lower naso-pharyngeal wall and the soft palate being forced forward by the air passing out, which leaves the opening into the buccal cavity free. The thus ex- pectorated mass is usually mixed with mucus from the phar- ynx and mouth and also with food particles. It is possible to collect “sputum” from horses and cattle for microscopic or bacteriological purposes. The method of obtaining it is to cause the animal to cough, then place a spec- ulum in the mouth and reaching back with your hand as far as the larynx, gather the accumulated mucus in this region. Several times in horses suffering from tuberculosis I have thus succeeded in obtaining bronchial discharge in which tubercle bacilli were found. To obtain bronchial discharge in tubercular suspects it has been recommended to insert a tracheotomy tube and pass a swab of cotton on the end of a wire through the opening wiping the inner wall of the wind pipe down to its bifurcation, Ostertag causes the ox to cough by closing the nostrils for a minute. He then introduces a long-handled, narrow spoon between the left cheek teeth and the tongue as far back into the throat as he can reach, turns the spoon up side down, draws it back about 10 cm., then rights and withdraws it par- tially filled with bronchial discharge. (See also Examination for Tuberculosis.) VII. The Voice. : Cattle suffering from nymphomania keep up an almost continuous bellowing; in advanced cases they moan loudly and constantly. At the approach of death horses sometimes utter a shrill neigh. Change in voice is of little significance in animals. Commonly we observe a hoarse voice in laryngeal catarrhs. 12? CLINICAL DIAGNOSTICS, This is most marked in dogs. In rabies the voice suffers change. In dogs affected with this disease the bark is pro- longed into a long, dismal howl, the voice being at the same time hoarse. In horses a short, squealing tone is emitted. VIII. The Larynx and Trachea. Inspection. Enlargements in the region of the larynx are as a rule not confined to this organ, but to neighboring tissues as the pharynx, lymph glands, subcutis. In birds the larynx may be inspected by simply opening the bill and pressing the larynx upwardly. In dogs and cats, and to a more limited extent in goats and sheep a view of the larynx may be obtained by opening the mouth and drawing the tongue forward. Laryngoscopy. With the aid of the laryngoscope invented by Polansky and Schindelka, the interior of the larynx may be examined directly, For the diagnosis of inflammatory conditions in the larynx this examination is of no practical value. However, Fig. 31. View of the larynx with paralysis of the left side, as seen through the laryngoscope. RESPIRATORY APPARATUS. 123 in paralysis of the arytenoid cartilages the instrument can be used to advantage. [This instrument, which is a modified endoscope, consists of a cylinder 56cm long and 4.7cm in diam- eter, at one end of which is an optical illuminating apparatus. The light is furnished by an electric battery, and undue heat is prevented by a special cooling arrangement. The instrument is inserted through the nostrils and can be used in the horse without casting.] In left-sided paralysis of the larynx (roar- ing) the left arytenoid cartilage is seen to project farther into the lumen of the organ than the right one. This can be more distinctly seen when the larynx is moving. As the larynx of the horse is usually held in the position of “middle inspiration,” it is necessary to induce forced inspiration and expiration. To do this the thorax is encircled with a girth which is slowly and gently drawn tight and relaxed, alternately, imitating forced breathing. The larynx in the meantime is watched through the instrument. At each inspiration the healthy car- tilage is seen to move outwardly, while at each expiration it approaches the middle line. The diseased cartilage, on the other hand, either remains completely at rest (paralysis) or its movements are very tardily performed (paresis). In bilateral paralysis (paraplegia) of the larynx the patient may show dyspnea when at rest—at any rate, slight excitement will induce it. In such cases one will note that both arytenoids protrude into the lumen of the larynx at inspi- ration; at expiration they are suddenly forced laterally and set in vibration. The paralysis can be complete or incomplete ; it may not be developed to the same degree on both sides. Palpation. \Vhen we determine the seat of the en- largements by palpation we may at the same time note their temperature, sensitiveness, and the ease with which cough can be induced by pressing upon them. Where much exudation is found in the larynx, infiltration of the vocal cords or other folds of mucous membrane, a trembling of the organ may be felt (/aryigeal fremitus). 124 CLINICAL DIAGNOSTICS. In examining the trachea we should look out for scars resulting from tracheotomy wounds. The form of the trachea should also be noted. In chronic trachei- tis of the ox the trachea may be shaped like a saber scabbard. Flattening of the trachea in horses is probably due to a paralysis of the transverse muscle. On auscultation of the larynx or trachea, nor- mally a stenotic sound is heard [like a German “‘ch’]. It is due to a vibration of the vocal cords and laryngeal walls which is produced by the air forced through the organ. -It is heard best at expiration. When the mucous membrane of the lar- ynx is swollen and firm, this sound becomes very pronounced and assumes a wrtistling or hissing character. If the swelling of the laryngeal mucous membrane is loose, or deposits of exu- date cover the membrane, the sound produced is ratiling or purring. IX. Percussion of the Thorax. To properly percuss the lungs a knowledge of their topo- graphical position is essential. Anatomy. The lungs and heart do not occupy the whole of the thoracic space. The abdominal viscera encroach upon a greater part of it. The partition between the chest and abdominal organs is the diaphragm. This organ is inserted, in the arc of a circle, to the inner surface of the whole thorax, reaching in an oblique direction from the sternum backwardly and upwardly to the lumbar vertebrae. In the region of the sternum its points of attachment are at the union of the ribs with cheir cartilages, far- ther posteriorly, however, the diaphragm does not extend down as far as the cartilages of the false ribs. but passes obliquely across their inner surfaces until, finally, at the last rib, it finds attach- ment at the superior end. The diaphragm arches forward from its points of insertion, extending into the thoracic cavity in the shape of a cone the apex of which reaches in the various ani- mals, somewhat beyond the middle of the 7th or 8th rib. At expiration the diaphragm lies with its muscular portion directly against the lateral chest wall, the tendinous portion then forming the partition. With the beginning contraction of the diaphragm at inspiration the arch becomes flattened in that the organ is drawn away from the inner wall of the chest. The space left hy the receding diaphragm is.immediately occupied by the sharp RESPIRATORY APPARATUS. 125 borders of the lungs which then lie close to the points of insertion of the diaphragm. At the acme of inspiration the rounded, cone- like form of the diaphragm becomes more pointed and its base and apex approach each other, the ribs having been drawn for- ward. By this drawing forward of the ribs the transverse diam- eter of the thorax is increased and the base of the conc-like dia- phragm broadened. Wig. 82: Dorsal and ventral boundaries of the field of pulmonary percussion — - - Costal attachment of diaphram. H. heart. d.c. dorsal colon. Lv. c. left ventral colon. Accordingly, the lateral border of the lung is continually moving backward and forward, traveling a distance in the larger animals of 1-2 hands breadth, and in the smaller ones from % to 1 hands breadth. On an average the posterior border of the lung may be defined by a line which in the larger animals is the width of a hand from the points of insertion of the diaphragm. In small animals the distance is one-half this. The availableness of the lungs for clinical examination. Dorsally the area of percussion is defined by the thick muscles of the back. This boundary to percussion, which varies with the condition of the animal, is limited by a line drawn from the 126 CLINICAL DIAGNOSTICS. posterior angle of the scapula to the external angle of the ilium. Anteriorly the boundary is formed by the scapula and the massive shoulder musctes. By drawing the leg torward the field of percussion can be somewhat enlarged. J’curra/ly the density of the sternum and muscles overlying it render in this region the lungs unavail- able to percussion. Fig. 33. — — Dorsal and Ventral boundaries of field of pulmonary percussion. — - — Costal attachment of diaphragm. — - - — Curvature of diaphragm in median plane. - - - - Anterior boundaries of stomach divisions. H. Heart. P. Paunch. The field of percussion is a right-angled tri- angle the right angle of which lies at the base of the scapula. In all animals the dorsal and anterior boundaries of the field of percussion are the same, the only variation being in the abdominal boundary. RESPIRATORY APPARATUS. 127 Horse. The abdominal boundary is a line drawn from the 16th intercostal space, crossing the middle of the thorax at the 11th rib, to the olecranon. The vortex of the diaphragm lies slightly above the of the thorax at the 8th intercostal space. Ox. In ruminants the field of percussion is small on ac- count of the less number of ribs (13), which causes the dia- phragm to lie farther forward. The abdominal boundary in this animal is a line drawn from the 11th intercostal space, crossing the middle of the thorax at the 9th rib, to the olecranon. Fig. 34. wm tee Heart, shaded portion not covered by lung. — Field of pulmonary percussion. — - — Insertion of diapragm. L. Liver. M. Spleen, N. Kidneys. R. Rectum. D. Small intestines. Dog. In the dog the shoulder lics well forward, which gives a larger field of percussion. The abdominal boundary of the field extends at the middle of the chest wall over the 9th rib to the lower end of the 7th rib. Swine. In swine, percussion can rarely be employed, as the thick layer of subcutaneous fat and the restlessness of the animal greatly interfere. The abdominal boundary of the field of percussion extends from the 11th rib to the olecranon. 128 CLINICAL DIAGNOSTICS. The normal pulmonary percussion sound is due to the sound of the blow, the vibration of the thoracic wall and of the air contained in the lung. In large animals the sound is generally quite dull (subdued), but clearer in the middle and lower portions of the chest. In small animals the sound is about the same over the whole field. The thinner the chest wall, the clearer the sound. Toward the borders of the thoracic cavity the intensity of the lung sound is diminished. The pulmonary sound is heard over an area larger than normal in vesicular emphysema, in the rarer interstitial em- physema and in pneumothorax, because in these conditions the diaphragm is forced backward. In vicarious emphysema 2 similar increase in area is sometimes noted. The pulmonary percussion sound (pulmonary resonance) is abnormally loud and clear (“‘over-loud’”), due to disease: 1. If the lung is greatly inflated (emphysema). 2. If the lung is abnormally distended with air as it occurs, for instance, at the border of pleural exudate. 3. In pneumothorax. The tympanitic percussion sound is noted over the chest when the vibrating column of air, whether small or large, is surrounded by a rigid wall and there is communica- tion with the outside world. In small animals, therefore, the pulmonary percussion sound is normally tvmpanitic. There is no marked boundary of distinction between the tympanitic and the full pulmonary percussion sound. A tympanitic tone is heard: 1. When a portion of the lung containing air is more or less surrounded by solidified tissue or exudate, whick isolates it from its environment, Therefore: In the beginning and last stages of fibrinous pneumonia. In catarrhal pneumonia. In pulmonary edema and in pulmonary atelectasis. RESPIRATORY APPARATUS. 120 In the presence of small or large tumors which surround lung containing air. 2. If caverns containing air and large bronchiectasis are present. The intensity and clearness of the sound depend upon the size of the cavern and the momentary filling of the same with air or exudate. 3. In pneumothorax. 4. In prolapse of the bowel into the thoracic cavity, through a rent in the diaphragm. The tympanitic percussion sound has a metallic tinkling tone when the walls of the air-containing cavity are smooth and distended. The cracked-pot resonance. [This resembles the sound produced by striking the hands, loosely folded across each other, against the knee, the contained air being suddenly forced out between the fingers—Loomis.] It occurs in the thorax when a large air-containing cavern is in direct communication with a bronchus. Forcible percussion causes some of the air to be suddenly driven out of the cavern into the communicating bronchus, thus inducing this peculiar resonance. The same sound may be heard, however, when a portion of lung containing air is surrounded by a zone of hepatization. The cracked-pot resonance, therefore, does not always indicate the presence of a cavern in the lung. If the dull or flat percussion sound is heard where the sound should be resonant, it always signifies disease. It oc- curs: i, Lf the Iting tissue becomes NAS Sa es MOORES SAUNA 3 AS Lymph glands of the ox accessible by external palpation. 5. The lymphatics of the shoulder (pre- scapular glands) are covered by the mastoido-humeralis muscle in front of the scapulo-humeral articulation. 6. The precrural glands lie at the anterior border of the tensor fascia lata muscle; distinctly visible in cattle. 7. In the upper part of the flank of the ox four or five follicles as large as a lentil can frequently be felt sub- cutaneously. 8 The deep inguinal glands _ lie in the crural canal covering the crural vessels. [The superficial inguinal glands in the male animal at the neck of the scrotum on each side of the penis in the sheath. In the female as follows:] 9. The retromammary glands (glands of the udder) are especially well developed in the cow and are situated behind and above the udder. 10. The mesenteric, lumbar and sacral glands of the horse and cow can be examined per rectum. In the former the bowel should be evacuated by means of a cathartic; for the lat- ter it is at least advisable to do so. THE BLOOD. 245 In the healthy horse we can distinctly feel the intermax- illary glands, in the healthy ox the precrural glands, and no others; if any of the other glands are distinctly palpa ble we assume that they are enlarged. The intermaxillary lymphatic glands of the horse are sometimes extirpated in order to subject them to a special macroscopical, or microscop- ical and bacteriological examination. For diagnostic purposes we resort to it in glanders only. We operate on the standing animal and anesthetize according to Schleich’s method. 15. The Blood. The examination of the blood is of importance in a few rare cases only. A microscopical examination to determine Fig. 54. + Weucemic Blood. the presence of certain Infectious diseases is of value only in anthrax and Rothlauf in pigs, and even in these diseases the circulating blood contains only few organisms. However, 1n Texas fever it is of diagnostic importance, and in con- stitutional blood diseases it is equally invaluable. The best way to obtain the necessary blood is to make a slight incision into the lip, with the point of a knife, observing 246 CLINICAL DIAGNOSTICS. care not to stretch the skin during the operation. If a larger quantity of blood is desired a hypodermic needle, inserted into the jugular vein, answers the purpose better. [As far as an- noyance of the animal is concerned, tapping the jugular vein 1s preferable in all cases.] In practice we may limit our- selves to the microscopical examination; for this purpose a single drop of blood, placed directly on the glass slip or cover, will serve the purpose. From this drop we can make a few cover glass preparations, allow them to dry, take them home, fix, stain and examine them at leisure; or we may add a 0.3% solution of sodium chloride and examine the blood in its fluid condition. Exact blood examinations are difficult and must be carried out with such care and minuteness that the practitioner is obliged to get along with the results of the simplest meth- Fig. 55. ods. For those who care to take G Q e oS up the study of blood examinations @ in detail we recommend “Jacksch- ® So) Y Ag Klinische Diagnostik.” Number of blood corpuscles. @ The absolute number of blood cor- cr (bp ° &_puscles in a given amount of blood a @9 can only be determined with the Abnormal Forms of Red aid of special blood-counting appa- i aia ratus (Thoma-Zeiss). According to the investigations of Storch, the number and proportion of red and white corpuscles per cubic millimeter are as follows: Red Corpuscles. White Corpuscles. Proportion. Stallions 8.2 millions 10,500 1:780 Geldings 7.6 : 11,000 1:690 Mares 71 te 9,900 1:720 Colts 9.3. io 14,000 1:670 Bulls 6.5 os 7,800 1:820 Steers 6.97 9,400 1:720 Cows 5.5 ‘- 8,200 1:660 Calves 8.5 ge 15,700 1:550 Dogs 5.4 : 3,100-2,800 THE BLOOD. 247 Since the results of these investigations show that con- siderable variations occur under normal conditions, extreme variations alone can be regarded as being of importance. An increase in the number of red corpuscles has been observed in serious general diseases with fatal termination: pulmonary gangrene, angina, pleuro-pneumonia. A decrease in the number of erythrocytes occurs in essen- tial anemia, hydremia, leukemia, and particularly in per- nicious anemia. Shape of the red blood corpuscles. We usually group them as follows: 1. Normal red corpuscles, without nucleus. 2. Nucleated erythrocytes. a. Normoblasts of normal size. b. Megaloblasts, two or three times the size of nor- mal red corpuscles. Gigantoblasts, still larger than the megaloblasts. Microblasts, smaller than the normoblasts. When the normal blood corpuscles deviate from their usual biconcave form they are called poikilocytes. Similarly altered nucleated red corpuscles are called poikiloblasts. The red corpuscles frequently undergo considerable change in form in the course of preparation for microscopic examination. This must always be borne in mind when dif- ferentiating between the different groups. Varieties of the white corpuscles. According to Ehr- lich and his pupils the white corpuscles are classified as fol- lows: 1. Lymphocytes. These are from 6 to 9 micra in diam- eter, with a single, large, well-defined nucleus containing an abundance of chromatin. They stain with basic aniline dyes, the protoplasm absorbing more of the stain than the nucleus. 2. Large Mononuclear Leucocytes. These are 12 to 15 micra in diameter, contain a large, not well-defined sin- gle nucleus with little chromatin, and homogeneous, baso- phile protoplasm. a0 248 CLINICAL DIAGNOSTICS. Transition forms occupy a position between the large mononuclear leucocytes and the polynuclear leucocytes, their nucleus being divided into two or three sections. They resem- ble the mononuclears in their affinity for stains. 3. Polynuclear Leucocytes. These are 10 to 12 micra in diameter, are provided with a slender but broken and irregular nucleus containing an abundance of chromatin and a finely granular, opaque, neutrophile protoplasm. 4, Eosinophile Leucocytes. These are 12 to 15 micra in diameter, the body of the cell is filled with large roundish granules which have an exceptional affinity for eosin and other acid stains. They have one or two nuclei which are packed in between the granules. The nuclei contain an abundance of chromatin. 5. Mast Cells. These vary in size up to that of the eosin- ophyles, they have clumsy nuclei of various forms containing little chromatin, and basophyle, coarsely granular protoplasm. According to Wiendick the varieties of leucocytes occur in the following proportions in the blood of the horse: Actual No. per cubic Percentage. centimeter. de bymiphOtytes aye poe taawiward cence 35-45... 2500-3500 2. Mononuclear Leucocytes .......... 1.5-3.5....150-300 3. Neutrophyle Polynuclear Leucocytes 50-70 ....4000-5000 4. Acidophyle Leucocytes ............ 1.5-5.0... .200-350 5. Mast Cells (Basophyle leucocytes) . .0.2-0.7... .20-60 It is not unusual to observe even greater variations than those shown in the table. A temporary increase in the actual number of leucocytes (hyperleucocytosis) may occur after feeding and in animals in advanced pregnancy. Such an increase is also observed in the course of all infectious inflammatory processes, especially during the formation of abscesses in the course of strangles. The actual number of leucocytes is reduced (hypoleucocy- tosis) permanently in the course of pernicious anemia. In THE BLOOD. 249 this disease the relative proportion of red corpuscles is less than normal. _ The normal color of blood serum is a light golden yellow (straw color). After the destruction or breaking down of a large number of red corpuscles their coloring matter is dissolved in the plasma of the blood and is partially converted into methemoglobin. This causes a reddening of the serum (Hemoglobinemia). The presence of the coloring matter of the muscles may produce a similar result. Diseases of the Blood. _ Essential (idiopathic) anemia. Bloodlessness. Consists in a diminishment of the quantity of blood without a determinable cause. Blood pale and coagulates poorly. Mucous membranes pale and low temperature. Pulse small, heart tones metallic sound. Appetite poor. Tendency to dropsical swellings. General weakness. Mostly in young animals. Leucemia. Chronic alterations of the blood and increase in number of white corpuscles. Animals are languid, lazy, sweat easily, pale mucous membranes. Appetite grows less, pulse increases, small. Heart tones, metallic sound. Enlargement of lymphatic glands usually present. Sometimes ecchymotic hemorrhages in the mucous mem- branes. Infectious anemia of the horse. Transmissible, usually fatal disease, coutse acute or chronic. Fever, 40.5° C. [104.9° F.] appears after a period of incubation of 5-9 days, subsiding as the disease ad- vances. Marked weakness, especially in hind quarters, dirty yellow- ish red coniunctiva, some petecheae. Impaired appetite, emaciation, swellings. Red corpuscles reduced in numbers. Hemoglobinuria of cattle. An acute non-contagious infec- tious disease of cattle caused by the presence of the protozoon Pyroplasma bigeminum in the blood, and characterized by hemo- globinuria. About 12 days after the animals have been on an in- fected pasture, the first symptoms appear—fever, loss of appetite, diarrhea. Urine light to dark red, very foamy, urination painful. Urine contains hemoglobin and coagulates into a gelatinous mass when boiled. Gait stiff and clumsy, often attended with pain. Also anemia, icterus, general debility, continuous lying down, edematous swelling of head and neck. The cause of the disease is found in the blood in the form of a protozoon called Pyroplasma bigeminum. The latter has a roundish form which may become very irregular as a result of ameboid movement. ; : When fully developed they are found in the red corpuscles in the form of two pear shaped bodies with the narrow ends ap- 250 CLINICAL DIAGNOSTICS. proaching each other, or in actual contact. They are 2.5-4 micra long and 1.5 to 2 micra wide. Two per cent. of the red corpuscles in the circulating blood are infected, while 50% of the red corpus- cles of the capillaries of the organs contain the parasites. The presence of the parasites is easily demonstrated by fixing smear preparations in absolute alcohol and staining with alkaline methylene blue. Texas Fever. Is an infectious disease of cattle caused by Pyrosoma bigeminum [indirectly by the presence of Texas fever ticks, Boophilus bovis]. Period of incubation 10-15 days. High and continuous fever, rapidly progressing anemia, red corpuscles reduced in number from six million to one million per cc. Hema- globinuria. Fatal termination the rule. Pyrosoma bigeminum is a minute pale protozoon of a roundish form found in the red corpuscles. It possesses ame- boid movement and can therefore assume irregular shapes. When fully developed the parasites occur as two pear-shaped bodies with Fig. 56. OOO® Different stages of development of Pyrosoma bigeminum in red blood corpuscles. their pointed ends, converging. They are 2.5 to 4 micra long and 1.5 to 2 micra wide. In the circulating blood 1 to 2% of the blood corpuscles are infected, in the capillaries of the various organs more than half of them contain the parasites. Malaria A non-contagious infectious disease caused by Plas- modium malariae. Remittent fever, pronounced icterus, petechiae, cerebral depression, small rapid pulse. Loss of appetite, increased thirst, dark-colored urine staining white hair yellow. The malaria parasites which occur in the blood constitute a special group of protozoons. They differ from the Pyrosoma in being pigmented. They may be stained with methylene blue. They are bright roundish bodies with distinct outline, occurring singly in the red blood corpuscles. Flagellosis of horses. Mal de Caderas. Gradually rising re- current fever rarely exceeding 40° C. (104° F.) Rapid emaciation in spite of good appetite. Paralysis of the hind quarters, bladder and rectum. Edema, hemoglobinuria, continuous lying down, coma, death. The specific cause of the disease, Trypanosoma equina (Flagellata) is found in the blood as an actively motile parasite. Smear preparations may be stained in 15-20 minutes with carbol-fuchsin to which has been added one-third volume of glycerine. Magenta red, however, is a better stain. The parasite has the form of a whip lash and is three or four times the length [Malkmus regards this disease and hemoglobinuria of cattle (Europe) as very proba- bly identical. ]—Translators. THE BLOOD. 251, of the diameter of a red blood corpuscle. The convex border of the body contains a delicate membrane which extends to the end of the body, forming a tail. The body of the parasite contains bright round granules which do not take the stain. Very destruc- tive in South America. Fig. 57. Nagana, Tsetse Disease, Surra. Occurs in cattle, solidungula, camels, dogs and cats. This is a pernicious anemia caused by Trypanosoma Evansi (introduced into the tissues through the me- dium of the tsetse fly). Fever, muscular weakness, edema, affec- tion of the eyes, pronounced anemia. A flaggellate parasite, like the above, 20 to 40 micra long, 1 to 2.5 micra in diameter, actively motile, Dourine. Maladie de coit. Lesions of the genital organs and skin. Trypanosoma equiperdum in the blood. INDEX. Abdomen 140, 153. Abvormal sensitiveness 156. Accumulation of food 153, 161. Achorion Schoenleinii, see Favus 55. Acne contagiosa equor, see Canadian horsepox 57. Actinomycoma 149. Actinomycosis 148. Albuminuria 67, 184, 185. Albumosuria 186. Alkales, craving for 141. Alopecia 45, 51, Alveolar periostitis 144. Anemia 47, 60, 249, Anesthesia 213, Anamnesis 18. Anasarea 46. Angina pharyngea 171. Ante-and post-partum pare- sis 38. Anthrax 72, 240. Anus 105, Apoplexy 216, 219, Appetite 141. Arteries 81. Ascites 40. Asearides 63. Atelectasis 27, 130. Attitude 33. Auscultation 29. —of abdomen 161, —of heart 86. —of lungs 130. Azoturia 37, 42. Bacillus pyelonephritis 199. Balkiness 229. Bird lice 52. Blackleg 58. Bladder, diseases of 176. —, examination of 200. Blind staggers 219, 221. Blood 245, 246. Blood sweating, 51. Blowing sound 100, 106. Bodily temperature 63. Bovine pest 58. Broken back 37. Bronchial eatarrh 136, Bronchiectases 129. Bronchitis 107, 137. —yverminosa 137. Bruits, anemic 90. —, diastolic 87. —, inorganic 88, —, systolic, 87. Cachexia 39. Canadian horsepox 57. Carbonate of lime 193. Cardiac dullness 85. Catarrh of maxillary sinuses 136. —, of gutteral pouches 136. Caverns in lunes 129. Cerebral congestion 218. —depression 210. —hemorrhage 219. Cerebrospinal meningitis 38, 42, 220, Chills 67. Choleurea 189, Cireulatory apparatus 75. Coital exanthema 208. Colie 42, 164, 172. Collapse, temperature of 71, Colostral milk 205, Colpivis 207. Coma 211. Condition 39. Conformation 40. Congestion, cerebral 218. Conjunetiva 59. Constipation 162, 164, 174. Convulsions 213. Cough 117. —, return impulse of 120. Cracked pot resonance 129, Cramp of the neck 388, 42, 214. Crisis 71. Crusts 51. Cystitis 201, Defecation 163, 164, 218. Degultition, difficulties of 145. Diabetes 180. —insipidus 202. —mellitus 202. Diaphragm, rupture of 129. Diarrhea 155, 164. Dicrotie pulse 81. Differential diagnosis 16. Digestive apparatus 140. Dilatation of the heart 91. Direct diagnosis 16. Dislocation of bowel 129, Li3; Distemper of dogs 140, 213, 216. —of horses 139. 253 Distoma, eggs of 169, Diverticula of esophagus 150, 173. Dizziness 212, 219, Drowsiness 211. Dropsy 46. Dummies 31, 34, 219, 221. Dyspepsia 172. Dyspnea 34, 102. Dysuria 178. Eechymoses 113, 114, 147. Echinococeus disease 187. Eclampsia 219. Eezema 51. Edema 23, 47, 58. —of glottis 136. —collateral 47. Emphysema 24, 48. —, alveolar 131. —, cutaneous 24, 48. —, interstitial 137. —, of skin 47. —, septic 48. Encephalitis 34. Endocarditis, acute and chronic 91. Endometritis 207. Enteritis, hemorrhavic 167. Enteroliths 159. Epilepsy 214, 219, 228, 229. Epistaxis 135, Eoithelial casts 199. —eells 198. Eructation 151. Esbach’s albuminimeter 185. Esophagus 149. Excitability, abnormal 222. Exhalations 105, Expired air, odor of 106. Facies hypocratica 42. Facial nerve, paralysis of 216, Fagopyrism 51. Fainting 212. Favus 55, Feces 163, 165. —, retention of 164. —, voiding of 164. —, volume of 165. Fermentation test 192. Fever 66, 68. —, eatarrhal 139. Fowl cholera 73. —, diphtheria 140. —, pest 73, —curve 68. —, types of 70. Fluctuation 24, Flagellosis 250. Fleas 52. Food, manner of taking 142. Foot and mouth disease 56. Foot eczema 51. Foreign bodies in intestines 174. —in esophagus 171. Fowl cholera 73. Friction bruits of pleura 135, Garglings 101. Garget 207. Gastro-enteritis 172. Gastro-intestinal eatarrh. 172. Glanders 139. —uleer 114. —cicatrices 114. 254 Gmelin’s test 190. Gram’s method 199, Granular casts 199. Granule casts 198. Grape sugar 192. Groaning 101. Grunting 101. Guttie of ox 34, 173, Habitus 32. Hematopinus 52, Hair coat 44. —-, shedding of 45. Heart 83. —hbeat 84. —sounds 86, 87. Heave line 104, Heaves 224. Hematuria 188, 261, Hemidrosis 46, 51. Hemiplegia 104. Hemiplegia, laryngis sinis- tra 136. Hemoglobinuria 187, 188. 201, 249, Hepatization 27, 129. Herpes tonsurans 55. Hippurie acid 195, Hives 51. Hog cholera 72. Hyvaline casts 198. Hydrocephalus 214, 218. THypesthesia 213. Hyperemia of kidneys, pass- ive 201, Hyperesthesia 213, Hypertrophy of heart 91. Hyperidrosis 46. Hyperthermia 219. ‘Uypidrosis 46, 255 Icterus 61, 62, 212. Liver 170. Immobility 221, Lockjaw 220, see tetanus. Impaction of intestines 158. Loco weed poisoning 176. —, rectum 216. Lordosis 48. Inearceration®158. Louse flies 52. Incontinentia urinae 201. Lumbago 37, 42, see azotu- Indican 188. ria. Influenza 72. Lungs, congestion of 187. Inoculation 230, 234. —, gangrene of 187, —for anthrax, etc., 240. —, edema of 137. —for glanders 235. Lupinosis 175, —for rabies 241. Lymphatic glands 248, —for tuberculosis 231. Lysis 71. Insufficiency 88. —of mitral valves 91. Mast cells 248, —of semi-lunar valves 88,91. Macula 50. —of tricuspid valves 91. Mal de Cederas 250, Intermaxillary lymph glands Mal du coit 208. 115. Malaria 250. Intestinal catarrh 172. Malignant catarrhal fever —evacuations 163. 139, —gases 170. —carbuncle 47, —noises or sounds 161. —edema 58. —peristalsis 163. Malingerers 36. Intoxication 19. Mallein inoculation 235. Invagination 35, 159. Malleus 139. Ischury 179. Mange 54, —, acarus 55. Kidneys, passive hyperemia —, psoroptic 54, of 201. —, sarcoptie 54. Kyphosis 48. —, sacoptie, of fowis 54 —, symbiotic 54, Laryngeal catarrh 136. Mastiecation 141. Laryngeal fremitus 123. Mastitis 207. Laryngitis, croupous 136. Melanosarcoma 149. Laryngoscopy 122. Microcytes 248. Leucocytosis 248. Milk fever see parturient Leucemia 249. paresis 38. Lice 52. Mites 52. Licking disease 178. Mold poisoning, see mycosis, Lime easts 170. 147. Monoplegia 216. Morbus maculosus, see pur- pura hemorrhagieca. Motility 210, 213. Mouth cavity 146. Mouth speculum 148. Mycosis 147. Mydriasis 217. Aucous click 100. Muscular rheumatism 42, Muscular sense 214, Myocarditis, acute 91, Nagana 251. Nasal ecatarrh 135, —discharge 93. —mucous membrane 113. —tone, see mucous click 100. Nephritis 201. Nettle rash 57. Nervous system 218. Nodules, see papules 50, 114. Nymphomania 202. Obesity 39. Ocular vertigo 212. Estrus ovis, larva of 109. Opisthotonus 213. Orthotonus 213. Osteomalacea 43. Overfeeding 153, 156. Oxalate of lime 195. Palpation 23. —of bowels per rectum 156. Panting 99. Papules 50. Paraplegia 104, 216. Paralysis 215. —of bladder 179. —of facial nerve 219, 256 —of the larynx 136. —of esophagus and pharynx 145, 171. —of paunch 150. —of recurrent nerve 226. Parasites, intestinal 169. —in cavities of head 135. Paresis 215. Parturient paresis 38, 71, 220. Pathognomic symptoms 14, Paunch, paresis of 156. —, peristalsis of 156. —, gases in 153. Pentastonum tenioides 109, Percussion 24. Percussion, field of 126, —of abdomen 159. Pericarditis 85, 92. —, traumatic, of ox 92, Peritoneal hernia 159. Peritonitis 34, 174. Pernicious anemia 246. Peruphigus acuta 57, Petechia 113, 114, 147. Pharyngitis 149, 171, Pleuritis 34, 85, 138. Pleurodynia 34, 137. Pleuropneumonia of cattie 139. —of the horse 138. Pneumonia 123. ‘ —, catarrhal 137. Pneumothorax 1381, Poikilocytes 247. Polyarthritis 42, Priapism 202. Proctitis 147. Prurigo 219, 51. Pseudo fluctuation 24. Psychic functions 210, Ptyalism 171, Pulmonary, congestion and edema 137, —hemorrhage 137. —gangrene 137. —resonance 128. Pulse 67, 73, 75. Pumping of flanks 104. Purpura hemorrhagica 57, 114, Pustules 50. Pyemia 71. Pyelonephritis 201. Pyrosoma bigeminum 250. Pyrocatechin in horse urine 192. Quality of percussion sounds 27. Quibbing 144. Rabies 216, 220. Rachitis 43. Rales 133. —, erepitant 134. —, dry 134. —, moist 134. Reflex excitability 217. Reflex spasms 214. Regions of the body 21. Regurgitation 127, 131. Resistance in percussion 28 Respiration, types of 99. —, amphorie 133. —, bronchial 133. —, vague or indefinite 133. —, vesicular 131. —, Gheyne-Stokes 98. Respiratory apparatus 93. Retentio urinae 201. Return sound 120. 257 hiding school movements 214, Rinderpest 174, Rinderseuche 240. Ringworm 55, Risus sardonicus 214. Roaring 98, 136, 226. Rothlauf 212, 245, Rumination 150. Saliva, secretion of 147. Satyriasis 202. Saw-horse attitude 34, 214, Seabs 51. Scalma 138. Sensibility 210, 212. Septicemia 71, 73. Serum diagnosis 237, 238. Sexual apparatus 202. —desire 202. Sheep pox 57. —, braxy 73. Signalment 31. Skin 43, —, color of 49. —, moisture of 45, —, odors of 50. —, reflexes of 217. —, sclerosis of 50, Skoliosis 43. Sleepiness 211. Sneezing 100. Snoring 100. Snorting 99. Somnolency 211. Sopor 211. Spasms 213. Spinal paralysis 37, 216. Spinal meningitis 214. —, reflexes 217. Spine, fracture of 37, 216. 258 Spleen 171. Stasis 46. S.arvation 154. S.enosis of air passages 226. —of cardiae valves 88, 89. —of esophagus 171. Stenotice laryngeal tone 101. Stethoscope 29. Stomacace 147. Stomatitis 171. —pustulosa contagiosa 175. Strangles 139, see distemper. Stranguria 178. Strongylus filaria 197. Submaxilary lymph glands 93, 115. Suffusions 113. Sulphate of lime 196. Summer surfeit 51. Surra 251, Sweating 45, 46. Sweeny 48. Swine erysipelas 73. Swine plague 65, 72, Symptoms 12. Syncope 212. Teeth 148. —, caries of 106. —, diseases of 172. —. gnashing of the 144. Temperament 40, Tetanus 37, 219. Texas fever 73, 245, 250. Thirst, see ‘‘Desire for water’’ p. 142. Ticks 52. Torsion of colon 159, Torsio uteri 207. Trembling 213. Trichodectes 52. Trichoerhexis nodosa 56. Tricophyton tonsurans 55. Triple phosphate 196. Trismus 213. Trommer’s test 192. Tubercle bacilli 111. Tubereculin test 231. Tuberculosis 138, 203, 207. —, of brain 220. Tumors in cavities of head 1386. Turnsick 212, 214, 219. Tympanitis 173. —acuta, 151, 173. —chronica 151, 173. Tzetse disease 251. Udder 204, 206. Uleers 147. —catarrhal or erosion 114. Upper air passages 112. Uremia 212. Urethral caleuli 200. Urie acid 195. Urinary apparatus 176. casts 198. Urination 176. Urine, sediment in 194. —, odor of 182. Urolithiasis 202. —, voiding of 177. Urticaria 57, Vaginal mucous membrane 204. Vaginitis 207. Valvular diseases 91, Veins 81. —, undulation of jugular 82. Venous pulse 83. Verminous bronchitis 137, 209 Vertigo 212, 228, 229. Water, desire for 142. Vesicles 50. Whistling 102, 227. ' W 143. Vesicular eruption 203, 208. ee Ye (ee. Vesicular murmur 131, Wool in feces 169, —respiration 132. Wheezing 100. Voice, change in 121, Wild-uad Rinder-seuche 58, : 240, Vomiting 151, —in horses 151. 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