LIBRARY OF THE University of California. Class ^K \ i DISEASES OF CATTLE, SHEEP, GOATS AND SWINE G. MOUSSU Professor at the Veterinary College of Al fort; Doctor of Medicine, Doctor of Science, etc. AND JNO. A. W. DOLLAR, M.R.C.V.S., F.R.S.E., M.R.L President of the Royal College of Veterinary Surgeons; Vice-President of the Royal Institute of Public Health; Corresponding Member of the Central Society of Veterinary Medicine of Paris; Associate of the Society of Veterinary Medicine of Brabant {Belgium); Life Member of the Royal Italian Society of Hygiene, etc. OF THE "^ UNIVERSITY I OF NEW YORK WILLIAM R. JENKINS VETERINARY PUBLISHER AND BOOKSELLER 851 AND 853 Sixth Avenue 1905 iAll Rights Reserved^ ,4 r-'rgiMi Copyright, 1905, by William R. Jenkins All Rights Reserved PREFACE No apology seems called for in presenting to English-speaking veterinary surgeons and students a treatise on the diseases of cattle. To those entrusted with the onerous task of preventing or curing disease in cattle, sheep and swine the scantiness of permanent literature dealing with the subject must always have proved a matter of some embarrassment, while to teachers and students alike the want of a concise and modern text-book has long been a difficulty of the first order. It is hoped that the present volume may go some way towards remedying this state of affairs. As on previous occasions, the writer has freely availed himself of foreign sources of information. Two years ago he purchased the literary rights in Professor Moussu^s " Maladies du Betail," which had even then attained an European reputation, and which forms the backbone of the present volume. To obtain further information, the more important German treatises have been laid under contribution, while all accessible English, American, and Colonial literature of recent date has been referred to. (The references practically extend up to the moment of writing— the latest being June, 1905.) In this way the work may in some degree claim to have assumed an international character. The extent of the additions is indicated by an increase in the number of illustrations of 140, and of the text of nearly 50 per cent. Professor McQueen has performed the greatly- valued service of reading proof-sheets and advising the writer as the book passed through the press. To Dr. Salmon, of the United States Department of Agri- culture, special thanks are due for his generous permission to quote from the annual reports of that body. Other acknowledayBflBifiUfiilIiifi-£iIU.nd in the text. |(>2336 VI PKEFACE. Once again the writer, wlio on this occasion chances also to be the President of the Royal College of Veterinary Surgeons, appeals for lenient judgment on work performed under no common stress of duties, professional and political. JNO. A. W. DOLLAR. CONTENTS SECTION I. DISEASES OF THE ORGANS OF LOCOMOTION. CHAP. PAGE Methods of Examination 1 I. DISEASES OF BONES. 3 General Diseases 4 Eachitis 4 Osseous Cachexia .7 Local Affections 20 Fractures 20 Fractures of the horns 21 Detachment of the horns . 23 Fissuring of the horns . ... . ' . . . .24 Fractures of the horns 25 Exostoses . . . ... . . . . ■. .27 Spavin in the ox. ......... 27 Eing-bone 28 Suppm-ating ostitis 29 Bone tumours 30 II. DISEASES OF THE FOOT 31 Congestion of the Claws 31 Contusions of the sole .31 Laminitis 32 Sand crack ...,.,.,,.. 34 Pricks and stabs in shoeing 36 Picked-up nails, etc. (" Gathered nail") 37 Inflammation of the interdigital space (Condylomata) ... 38 Canker 40 Grease 41 Panaritium — Felon — Whitlow . , , . . , .41 Foot rot ,..,,. 43 III. DISEASES OF THE SYXOyiAL MEMBEANES AND OF THE AETICULATIONS .......... ia I. Synovial Membranes and Articulations .... 45 Synovitis , 45 Inflammation of the patellar synovial capsule . , . , 4^ VIU CONTENTS. CHAP. TAGK III. DISEASES OF THE SYNOVIAL MEMBEANES AND OF THE AETICULATIONS— cor.^mwec^. I. Synovial Membranes and Articulations — continued. Distension of the synovial capsule of the hock joint ... 46 Distension of tendon sheaths in the hock region . . . 46 Distension of the synovial capsule of the knee joint ... 47 Distension of the synovial capsule of the fetlock joint . . 48 Distension of tendon sheaths 48 Distension of tendon sheaths in the region of the knee . . 49 Distension of the bursal sheath of the flexor tendons ... 49 Traumatic synovitis — " Open synovitis " 49 Traumatic tendinous synovitis ....... 50 Traumatic articular synovitis — • Traumatic arthritis — ' ' Open arthritis" . . . .51 II. Strains of Joints . 52 Strain of the shoulder ......... 52 Strain of the knee 53 Strain of the fetlock 54 Strain of the stifle joint . . . . . . . .54 Strain of the hock joint 55 III. Luxation of Joints , . 56 Luxation of the femur 56 Luxation of the patella ........ 58 Luxation of the femoro-tibial articulation 61 Luxation of the scapulo-huraeral joint 63 IV. Hygromas 64 • Hygroma of the knee ......... 65 Hygroma of the haunch . , . . . . . . ' 67 Hygroma of the trochanter of the femur 67 Hygroma of the stifle ........ 67 Hygroma of the point of the hock 68 Hygroma of the point of the sternum 69 IV. DISEASES OF MUSCLES AND TENDONS 70 Eupture of the external ischio-tibial muscle (Biceps femoris) . 70 Rupture of the flexor metatarsi . . . . . . . 72 Parasitic Diseases of Muscles 73 Cysticercus disease of the pig . . . ' . . . .73 Beef measles . . . . . . . . . .-79 Trichiniasis— Trichinosis 84 V. RHEUMATISM 89 Articular rheumatism ........ 89 Muscular rheumatism ........ 92 Infectious Forms of Rheumatism or Pseudo-rheumatism . 94 Infectious rheumatism in young animals 94 Infectious pseudo-rheumatism in adults . . . . .99 Scurvy — Scorbutus . . . . . . . . ? 1P4 CON'J'ENTS. SECTION II. DISEASES OF THE ])IGESTIVE APPARATUS. CHAP. PAGE Semiology of the Digestive Apparatus 106 I. DISEASES OF THE MOUTH . . , 121 Stomatitis 121 Simple stomatitis .121 Catarrhal stomatitis in sheep . . . . . . 122 Necrosing stomatitis in calves . . . . . .123 Mycotic stomatitis in calves 124 Ulcerative stomatitis in sheep 125 General catarrhal stomatitis in swine . . . . .126 Ulcerative stomatitis in swine . . . . . .127 Mercurial stomatitis . 128 Glossitis 130 Superficial glossitis 130 Acute deep-seated glossitis , 131 Chronic glossitis . . . . . . . . .132 II. DISEASES OF THE SALIYAEY GLANDS, TONSILS AND PHARYNX .134 Parotiditis (Parotitis) 134 Acute parotiditis . . , . . . . . .134 Chronic parotiditis —Parotid fistula . . . . .136 Inflammation of the submaxillar}^ salivary gland . . .137 Tonsilitis in pigs .......... 138 Pharyngitis. .138 Pseudo-membranous pharyngitis in cattle .... 141 Pseudo-membranous pharyngitis in sheep .... 142 Pharyngeal polypi . . . 143 III. DISEASES OF THE CESOPHAGUS 145 (Esophagitis . 145 Stricture of the oesophagus . . . . . . . .148 Dilatation of the oesophagus . . . . . . . 149 CEsophageal obstructions .' . . . , . . .152 Euptures and perforations of the oesophagus . . . .157 IV. DEPEAVED APPETITE— THE LICKING HABIT— INDIGESTION 158 Depraved aj^petite in the ox. .158 Depraved appetite in calves and lambs 160 Colic in the ox 162 Colic due to ingestion of cold water — Congestive colic . . 162 Colic due to invagination . 163 Colic as a result of strangulation 167 Diseases of the stomach 169 Indigestion 170 Gaseous indigestion . .170 X CONTENTS. CHAP. PAGE IV. DEPEAVED APPETITE— THE LICKING HABIT— INDIGESTION — continued. Indigestion — contin ued. Impaction of the rumen — Indigestion as a result of over- eating . . . . . . . . . . 175 Impaction of the omasum (third stomach) .... 179 Abomasal indigestion ........ 182 Acute gastric indigestion in swine . . . . .185 y. INFLAMMATION OE THE GASTEIC COMPAETMENTS . . 186 Eumenitis — Eeticulitis — Gastritis . . . . . . 18G Acute gastritis 188 Catarrhal gastritis in swine . . . . . . .190 Ulcerative gastritis 191 Chronic tympanites . . . . . . . .194 Gastric disturbance due to foreign bodies . . . .198 Tumours of the gastric compartments ..... 202 VI. ENTEEITIS 203 Acute enteritis 203 Hsemorrhagic enteritis ........ 206 Chronic enteritis (Chronic diarrhoea) . . . . . . 207 Dysentery in calves . . . . . . . . .210 Diarrhoeic enteritis in calves . . . . . . . .212 VII. POISONING 215 Poisoning due to food . . . , . . . . .215 Poisoning by caustic alkalies . . . . . . .216 Poisoning by caustic acids . . . . . . . .217 Poisoning by common salt . . . . . . . .217 Poisoning by the nitrates of potash and soda . . . .217 Poisoning by tartar emetic . . . .• . . . .218 Poisoning by arsenic . . . . . . . . .218 Phosphorus poisoning . . , . . . . . .219 Mercurial poisoning . . . .. . . . .219 Lead poisoning : Saturnism ........ 220 Copper poisoning . . . . . . . . . .221 Carbolic acid poisoning . 221 Poisoning by aloes 221 Iodoform poisoning 222 Iodine poisoning : iodism . . ... . . . 222 Strychnine poisoning ......... 222 List of plants poisonous to stock 223 Colchicum poisoning . . . . . . . . .256 Poisoning by annual mercury ....,,. 256 Poisoning by bryony 256 Poisoning by castor oil cake ,.,,.,. 257 Poisoning by cotton cake . . , . . / . . . 257 Poisoning by molasses refuse ....... 258 Diseases produced by distillery and sugar factory pulp . . 259 VIIL PAEASITES OF THE DIGESTIVE APPAEATUS . . . .263 Gastro-intestinal strongylosis in sheep ..... 263 Lumbricosis of calves .,,....,, 2§7 CONTENTS. Xi CHAP. PAGE VIII. PARASITES OF THE DIGESTIVE AVF AUATVS-continue'l. Strongylosis of the abomasum in the ox 268 Parasitic gastro-enteritis, diarrhoea, and ansemia in cattle, sheep and lambs 268 Intestinal coccidiosis of calves and lambs (Psorospermosis, hsemor- rhagic enteritis, bloody flux, dysentery, etc.) . . . .271 Intestinal helminthiasis in ruminants 275 IX. DISEASES OF THE LIVER 279 Congestion of the liver 280 Nodular necrosing hepatitis 280 Cancer of the liver and bile ducts 282 Echinococcosis of the liver 283 Suppurative echinococcosis 288 Cysticercosis . . . 290 Distoraatosis — Liver fluke disease— Liver rot .... 293 SECTION III. EESPIEATOKY APPAEATUS. I. EXAMINATION OF THE RESPIRATORY APPARATUS . .311 II. NASAL CAVITIES 319 Simple coryza . . . 319 Gangrenous coryza . . . . . . . . . 320 Tumours of the nasal cavities 325 Purulent collections in the nasal sinuses. Nasal gleet . . 326 Purulent collections in the frontal sinus 327 Purulent collections in the maxillary sinus 329 (Estrus larvae in the facial sinuses of sheep 330 III. LARYNX, TRACHEA AND BRONCHI 333 Laryngitis 333 Acute laryngitis '. . 333 Pseudo-membranous laryngitis ...... 333 Tumours of the larynx . . . . . . .335 Bronchitis 336 Simple acute bronchitis . . . . . . .337 Chronic bronchitis . . . . . . . .337 Pseudo -membranous bronchitis ...... 339 Verminous bronchitis in sheep and cattle (Husk, hoose, etc.) 340 IV. LUNGS AND PLEURA 343 Pulmonary congestion 343 Simple pneumonia ......... 343 Pneumonia due to foreign bodies — Mechanical pneumonia . . 347 Pneumonia due to the migration of foreign bodies from the reticulum .......... 348 Pneumomycosis due to Aspergilli 350 Gangrenous broncho-pneumonia due to foreign bodies . .351 Infectious broncho-pneumonia 354 Broncho-pneumonia of sucking calves ...,., 356 Xll CONTENTS. CHAP. PAGE lY. LUNGS AND TL'EUnM— continued. Sclero- caseous broncho -pneumonia of sheep . . . . 858 Pulmonary emphysema . . 359 Diseases of the pleura I^Gl Acute pleurisy . . . 361 Chronic pleurisy 362 Pneumo-thorax . . 362 Hydro-pneumo-thorax and pyo-pneumo-thorax . . . 366 V. DISEASES OE STEUCTURES ENCLOSED WITHIN THE MEDI- ASTINUM 368 Tumours of the Mediastinum . . • 369 SECTION lY. THE OEGANS OF CIRCULATION. Semiology of the Organs of Circulation 370 I. CAEDIAC ANOMALIES 374 Ectopia of the heart 374 II. PERICARDITIS . . . . .375 Exudative pericarditis due to foreign bodies . . . .376 Chronic pericarditis ......... 389 Pseudo-pericarditis ......... 390 III. ENDOCARDITIS 394 IV. DISEASES OE BLOOD-VESSELS . . . . . . .396 Phlebitis 396 Accidental phlebitis 396 Internal infectious phlebitis (Utero-ovarian phlebitis) . . . 398 Umbilical phlebitis of new-born animals ..... 399 Umbilical phlebitis or omphalo-phlebitis 402 V. DISEASES OF THE BLOOD 406 Septicaemia of new-born animals ...... 406 Takosis : a contagious disease of goats . . . . .412 Blood-poisoning (Malignant oedema) in sheep and lambs in New Zealand 415 Piroplasmosis 416 Bovine piroplasmosis . . . . . . . .416 Bovine piroplasmosis in Erance ...... 424 Ovine piroplasmosis ........ 425 Diseases produced by trypanosomata . . . . . . 426 Louping-ill 429 Suggested measures for prevention ..... 435 Braxy . . . . • . . . . . . 435 Bilharziosis in cattle and sheep . . . . . . .439 Heat stroke— Over-exertioi^ , . , .' , . ,442 CONTENTS. XIU CHAP. PAGE VI. DISEASES OF THE LYMPHATIC SYSTEM 444 The lymphogenic diathesis ........ 448 Caseous lymphadenitis of the sheep 453 Goitre in calves and lambs 453 SECTION V. NEEVOUS SYSTEM. Cerebral congestion 456 Meningitis 456 Encephalitis 458 Cerebral Tumours .459 Insolation 460 Post-parfcum paralysis — Milk fever — Mammary toxaemia — Par- turient apoplexy — Dropping after calving . . . .461 Coenurosis (Gid, sturdy, turn-sick) . . . . ^ . 467 " Trembling," or Lumbar prurigo, in sheep .... 475 SECTION YI. DISEASES OF THE PERITONEUM AND ABDOMINAL CAVITY. I. PEEITONITIS . . . 478 Acute peritonitis . . . 478 Chronic peritonitis . .481 Ascites ............ 483 Peritoneal cysticercosis 485 II. HEENI^ 487 Congenital hernise . . . 487 Perineal hernia of young pigs ...... 487 Umbilical hernia 488 Acquired hernise 489 Hernia of the rumen ......... 490 Hernia of the abomasum. 493 Hernia of the intestine 494 Treatment of hernise ......... 495 Diaphragmatic hernia 496 Eventration 499 Fistulse of the digestive apparatus . . . . . . 500 SECTION YII. GENITO-URINARY REGIONS. Diseases of the Urinary Apparatus 502 L POLYPI OF THE GLANS PENIS AND SHEATH . . .506 Inflammation of the sheath ........ 506 Persistence of the urachus 508 XIV CONTENTS. CHAP. II. DISEASES OE THE BLADDEE Acute cystitis .... Chronic cystitis .... Urinary lithiasis. Calculus formation Calculi in bovine animals Urinary calculi in sheep Paralysis of the bladder Eversion of the bladder Haematuria ..... III. DISEASES OF THE KIDNEYS Congestion of the kidneys Acute nephritis . Chronic nephritis . Hydro -nephrosis . Infectious pyelo-nephritis Suppurative nephritis and perinephritis The kidney worm {Sclerostoma pinguicohi] of IV. GENITAL APPAEATUS Vaginitis Acute vaginitis Contagious vaginitis Croupal vaginitis . Chronic vaginitis . Metritis Septic metritis Acute metritis Chronic metritis . Epizootic abortion in cows Salpingitis — Salpingo-ovaritis Torsion of the uterus . Tumours of the uterus . Tumours of the ovary . Genital malformations . Imperforate vagina Nympho-mania . V. DISEASES OF THE MAMMAEY GLANDS Physiological anomalies Wounds or traumatic lesions Chaps and cracks . Milk fistulse .... Inflammatory diseases . Congestion of the udder Mammitis .... Acute mammitis . Contagious mammitis in milch cows Chronic mammitis Gangrenous mammitis of milch ewes Gangrenous mammitis in goats Contents. xv Chap. pagr V. DISEASES OF THE MAAIMAEY GTANDS— co>,^/,/u(?. Cysts of the udder . . . . . . . . .585 Tumours of the udder ......... 585 Verrucous papillomata of the udder ...... 586 VI. DISTURBANCE IN THE MlLK SECEETlON AND CHANGES IN THE MILK 587 Microbic changes in milk. Lactic ferments .... 588 VII. MALE GENITAL ORGANS 594 Tumours of the testicle ........ 594 Accessory glands of the genital apparatus ..... 597 SECTION YIII. DISEASES OF THE SKIN AND SUBCUTANEOUS CONNECTIVE TISSUE. L ECZEMA 599 Acute eczema .......... 599 Chronic eczema . . . . . ... . . . 600 Sebaceous or seborrhoeic eczema . . . . . . .601 Eczema due to feeding with potato pulp ..... 603 Impetigo in the pig ......... 605 Acne in sheep 606 Fagopyrism (Buckwheat poisoning) ...... 606 II. PHTHIRIASIS .608 Scabies— Scab— Mange 611 Scabies in sheep . .611 Sarcoptic scabies . , .612 Psoroptic mange — Sheep scab 614 The tobacco and sulphur dip 626 Lime and sulphur dips 627 Arsenical dips ........ 632 CarboHc dips 633 Chorioptic mange — Symbiotic mange — Foot scab . . . 636 Mange in the ox 638 Sarcoptic mange . . . 638 Psoroptic mange 639 Chorioptic mange .640 Mange in the goat 641 Sarcoptic mange . . . 641 Chorioptic mange . . . . . . . . .642 Mange in the pig . 642 Demodecic mange . .643 Demodecic m^inge in the ox . . . . ... . 644 Demodecic mange in the goat ...... 644 Demodecic mange in the pig ....... 644 Non-psoroptic forms of acariasis 645 Hypodermosis in the ox (warbles) 64^ XVI CONTENTS. CHAP. • P^rjK III. EINGWOEM 649 Eingworm in the sheep, goat, and pig . 653 IV. WAETS IN OXEN 655 Urticaria in the pig . . . . . . . . . 656 Scleroderma .......... 657 V. SUBCUTANEOUS EMPHYSEMA 659 SECTION IX. DISEASES OF THE EYES. Foreign bodies ...... Conjunctivitis and keratitis .... Verminous conjunctivitis .... Verminous ophthalmia of the ox . 661 662 662 663 SECTION X. INFECTIOUS DISEASES. -Preparation of vaccine Cow-pox — Vaccinia Cow-pox and human variola - Tetanus Actinomycosis . ... Actinomycosis of the maxilla Actinomycosis of the tongue . Actinomycosis of the pharynx, parotid Tuberculosis Tuberculosis of the respiratory apparatus Tuberculosis of the serous membranes Tuberculosis of lymphatic glands . Tuberculosis of the digestive tract Tuberculosis of the genital organs Tuberculosis of bones and articulations Tuberculosis of the brain Tuberculosis of the skin Acute tuberculosis — Tuberculous septicaemia Swine fever — ^ Verrucous endocarditis and pneumonia of the pi^ Swine fever ......... Verrucous endocarditis of the pig ..... Pneumonia of the pig ....... Hsemorrhagic septicaemia in cattle ..... 665 669 670 672 673 674 675 682 690 694 696 699 700 701 702 703 7C4 710 710 713 714 716 SECTION XL OPEEATIONS. I. CONTEOL OF ANIMALS 720 Control of oxen . . 720 Partial control 720 Control of the limbs ........ 720 CONTENTS. XVll I. CONTEOL OF ANIMALS— continued. Control of oxen — continued. General control Control by casting Control of sheep and goats Control of pigs Ansestliesia . II. CIECULATOEY APPAEATUS Bleeding Bleeding in sheep . Bleeding in the pig Setons, rowels, plugs, or issues III. APPAEATUS OF LOCOMOTION Surgical dressing for a claw Amputation of the claw or of the two last phalanges IV. DIGESTIVE APPAEATUS . Einging pigs . . . . . OEsophagus . . . ... Passing the probang Crushing foreign bodies in the oesophagus QliSophagotomy .... Sub-mucous dissection of the foreign body Eumen ...... Puncture of the rumen . Gastrotomy . . ... Laparotomy Hernise . . . . . . . Inguinal hernia in young pigs Imperforate anus .... Prolapsus and inversion of the rectum V. EESPIEATOEY APPAEATUS . Trephining the facial sinuses Trephining the horn core Frontal sinus Maxillary sinus . Tracheotomy VI. GENITO-UEINAEY OEGANS Urethrotomy in the ox Ischial urethrotomy Scrotal urethrotomy Passage of the catheter and urethrotomy in Passage of the catheter in the cow Castration ...... Castration of the bull and ram Bistournage ..... Martelage ..... Castration by clams. . . . , the D.C. XVlll CONTENTS. CHAP. VI. OENITO-URINAEY OnGA^S—conthiued. Castration — continued. Castration by torsion . Castration with the actual cautery Castration by the elastic ligature . Castration of the ram . Castration of boars and young pigs Castration of cryptorchids Female genital organs . Castration of the cow Castration of the sow . Suture of the vulva Trusses .... Section of the sphincter of the teat Dilatation of the orifice of the teat Ablation of the mammae DISEASES OF CATTLE, SHEEP, GOATS AND SWINE. SECTION I. DISEASES OF THE ORGANS OF LOCOMOTION. METHODS OF EXAMINATION. Accidental and local diseases of the aj^paratus of locomotion are matters of less urgency in the case of cattle than in that of the horse. On the other hand, general affections, such as rheumatism and osseous cachexia, demand a larger share of attention, and are of the utmost importance. As the accurate diagnosis of any disease demands careful and systematic examination, the practitioner usually observes a certain order in his investigations, as indicated below : — (1.) Inspection, from the side, from the front and from behind, re- veals the existence of deformities of bones, limbs, muscles and joints, articular displacements, and irregularities of conformation or of gait. By inspection of an animal as it walks various forms of lameness, and their particular characteristics, are rendered visible. (2.) Palpation and pressure will detect changes in local sensibility, the softness or hardness of tissues, 'the existence of superficial or deep fluctuation, oedematous swelling, and abnormal growths like ring-bones and exostoses, as well as the exact character of articular enlargements. (3.) Percussion is of little value in examining the apparatus of loco- motion. Nevertheless, percussion of the claws, and of certain bones of the limbs, or of flat bones, may afford valuable information in cases of laminitis, ostitis, and periostitis. Percussion along the longitudinal axes of the limb bones is also useful in diagnosing intra-articular frac- tures, sub-acute arthritis, osteomyelitis, etc. (4.) The gait. Lame animals should be made to move, in order to assist both in discovering the cause, and in estimating the gravity of the condition. Sometimes it is advisable to turn the animal loose, but most frequently it is moved in hand, either in straight lines or in circles. D.C. B 2 DISEASES OP THE ORGAKS OF LOCOMOTIOX. Information so obtained should always be supplemented by local manipulation and by passive movement, such as flexion, extension, abduction, adduction and rotation of the joints. A knowledge of the characteristics of normal movement in any given joint, renders it comparatively easy to detect abnormality, such as increased sensibility, articular crepitation or friction, and to diagnose fractures with or without displacement, ruptures of tendons or ligaments, etc. ^ OF THE '^ \ UNIVERSITY OF CHAPTER I. DISEASES OF BONES. The diseases affecting bony tissues may broadly be divided into local and general. Local diseases like ostitis, periostitis, necrosis, fracture, etc., are somewhat rare, and are less important in cattle than such general diseases as rachitis and osseous cachexia. Rachitis is a disease of young animals, and occurs during the growing period. Osseous cachexia is a disease of adults. Nevertheless, there is a relationship between these two morbid conditions, for they frequently co-exist in one family. Moreover, brood mares and cows suffering from osseous cachexia give birth to foals and calves, which, if left with their mothers, almost inevitably become rachitic. The general characteristic common to both rachitis and osseous cachexia consisting in diminution in the normal proportion of mineral salts entering into the constitution of the bone, numerous theories have been advanced to explain this irregularity in nutrition. The theory of insufficiency is one of the oldest. It presupposes that the young animals' food contains insufficient mineral salts necessary for building up the skeleton, hence rachitis ; or again, that the daily food of the adults does not afford sufficient mineral salts to compensate for the normal transformation which is continually going on within the organism, and for the direct losses which occur through the medium of the urine, milk, etc. This extremely simple theory appears perfectly logical, but unfortu- nately does not fit in with all the observed facts. In reality, rachitis attacks children whose supply of milk, from a chemical point of view, leaves nothing to be desired. The same is true of animals, particularly of young pigs. The so-called "acid theory" has therefore been ad- vanced to explain the points left obscure by its predecessor. The acid theory. According to this theory, the food may contain more than sufficient mineral material without, however, preventing the development of rachitis or of osseous cachexia. In animals suffering from digestive disturbance the alimentary tract may become the seat of excessive fermentation or of changes in secretion. There is thus produced an excess of lactic acid which passes into the u 2 4? DISEASES OF BONES. circulation and accumulates in the tissues, checking the processes which end in ossification or, in the case of adults, even leading to decalcification. It seems fairly well established that experimental administration of lactic acid to animals causes diminution in the quantity of calcium salts contained in the bones (Siedamgrotsky, Hofmeister). On the other hand however Arloing and Tripier failed to produce rachitis experimentally. Bouchard revived this theory in a somewhat modified form. He con- siders that calcium salts are absorbed as carbonates and chlorides and phosphoric acid as phospho-glyceric acid. The reaction which these compounds undergo within the organism ends in the formation of the phosphate of calcium necessary to ossification, but this " phosj)hate of ossification " cannot be deposited if the organism contains an excess of lactic acid. ■ Theory of inflammation. A third theory which until now has received very little support is that called the theory of inflammation. The general lesions which characterise rachitis are regarded as resulting from primary attacks of ostitis and osteo-periostitis. The cause of these forms of inflammation is not suggested. To the above views may be added that more recently emitted by Dr. Chaumier, according to which rachitis is of an infectious nature. Unfortunately no proof of this has yet been adduced. GENERAL DISEASES. RACHITIS. Eachitis is a disease of youth, and is common both to the human species and to all domestic animals. It is characterised by irregularities in development and by imperfect consolidation of the bones. The boundary between rachitis and osseous cachexia is difficult to define and in fact at the present moment the two diseases can scarcely be defined with exactitude. Eachitis again is often complicated with softening of the bones, disease of the limbs, arrested development, etc., but it must not be forgotten that although the irregularities in ossification and development of the skeleton are the symptoms most striking to the eye, they do not stand alone, and that from the point of view of development all the tissues, including the muscles, are more or less affected and that most of the physiological functions such as digestion and the secretion of urine are deranged. Etiology. One of the principal causes suggested is that of heredity, and so far as human beings are concerned, one seldom fails to. discover the rachitic taint. Certainly the offspring of individuals marked by any debilitating disease like alcoholism, tuberculosis, syphilis, etc., are poorly RACHITIS. 5 equipped for their future development. Their tissues lack the necessary quaUties and, cceteris parihus, their physiological functions are performed less perfectly than are those of normal individuals. It is difficult to apply such information to domestic animals, because badly developed subjects are not used for reproduction and the import- ance assigned to heredity can therefore scarcely be sustained. The conditions of life, on the contrary, have an unquestionable influence, and if rachitis is so frequent in young animals living near towns, for example, it is undoubtedly due to that want of air, light and liberty, which first affects the mother's health and later that of her offspring. The same may be said of insufficient and improper food ; for in this connection quaUty is of even greater importance than quantity. Even free feeding is insufficient if the fodder does not contain the material necessary for sustaining and building up the developing frame, a point which readily explains the occurrence of rachitis when young animals receive a diet deficient in certain chemical constituents. This occurs in young lambs and pigs where the mothers are given too little variety or too small a quantity of food. In calves and foals rachitis is rare but occurs when the mothers are exhausted or cachectic or are debilitated by chronic wasting diseases like tuberculosis or osseous cachexia. The milk is then no longer of normal chemical constitution. One fact appears to dominate the whole subject of the causation of rachitis, viz., the failure to assimilate sufficient of the mineral salts required in building up the skeleton. This failure to assimilate may be caused by too meagre feeding, but even when the food is sufficiently rich, some digestive disturbance may reduce the amount absorbed below normal. This appears the only plausible explanation unless we admit Dr. Chaumier's theory that the disease is of an infectious character. Symptoms. The onset is absolutely insidious and the diagnosis of rachitis is never made until nutrition has long been abnormal. This disturbance of nutrition is revealed by irregularity and abnor- mality in appetite, by difficulty in rising and moving about, and by the animals lying down for long periods. The subjects are feeble, sluggish and badly developed. Next supervenes the second phase characterised by deformity of bones. This is of two kinds — deformity in the neighbourhood of joints (deformity or enlargement of the epiphyses) and deformity of the diaphyses. The former results from irregularity in ossification of the articular cartilages. The latter is followed by loss of rigidity in the bones of the limbs which, under the influence of the body weight and of muscular contraction, bend in different directions. The bones appear of increased thickness principally towards the RACHITIS. articulations. The latter are deformed, and on palpation are found to be surrounded by uneven and irregular growths. The front limbs are distorted. In young pigs, lambs, and less frequently in foals, calves and dogs, the jaws become deformed, and mastication is rendered difficult. The vertebral column may also be affected, and lordosis (bending downwards of the back) or skoliosis (lateral bending of the back) is some- what frequent. Cyphosis, or upward bending of the back, seldom occurs, and when seen, sometimes results from disease other than rachitis. General development is always in- terfered with and the young creatures are generally dwarfed. The digestive apparatus is dis- ordered, the appetite is irregular and sometimes depraved, while indiges- tion, gastritis, and enteritis are not exceptional. Physiological and patho- logical. research has shown that the quantity of phosphoric acid elimi- nated in twenty-four hours in a rachitic child is double the quan- tity passed by a healthy infant. The amount of urea in the urine (which is a criterion of nutrition, and usually varies in proportion to the amount of food ingested) is, on the contrary, diminished even when highly nitrogenous food is given, thus suggesting diminution in nu- trition. Lesions. The lesions are represented by abnormal and irregular thickening around the inter-articular cartilages. The cartilage is thickened, compressible, very spongy and without regular ossification. Diffused periostitis exists principally towards the extremities of the bone. Beneath the periosteum the surface of the bone appears rough and softened. On section the medullary canals are seen to be enlarged and filled with marrow of a gelatinous character. The Haversian canals are dilated, and the entire tissue appears very vascular. Chemical analysis proves that the mineral constituents of the bone, particularly the phos- phates, have diminished by one-half ; the organic constituents on the other hand are increased in a similar ratio, but tbe ossein is abnormal, Ossification has, in a word, been incomplete, Fig. 1. — Rachitis in a young goat. RACHITIS. 7 Diagnosis. Diagnosis presents no difficulty except in the early stages before deformity has occurred. Eachitis can scarcely be mistaken for any other condition except perhaps infectious rheumatism, but the rapid course of the disease in the latter case, the persistence of fever and the swelling of the joint cavities sufficiently differentiate the conditions provided care is exercised. Prognosis. From an economic point of view the prognosis is very grave for if the lesions are extensive there is nothing to be gained by keeping the animal. Treatment. Treatment differs very little, whether the animals are still being suckled or have been weaned. In the former case it is necessary to improve the quality and chemical constitution of the mother's milk by giving food, richer both in mineral salts and in nitrogenous material. Cooked grains, milk, and forage of good quality should be given freely. When the mothers are exhausted and anaemic it is better to feed the little animals artificially or to change them to a foster-mother. Those already w^eaned should be given good rich milk, eggs, boiled gruel, and drugs, such as the phospho-chlorate of lime, 1 to IJ drachms per day (for a calf) ; lacto-phosphate of lime, 1 to 1^ drachms ; bi-phosphate of lime, 1 drachm, or simply ordinary phosphate of lime. Oil containing 1 per cent, of dissolved phosphorus may be given in doses of 1 to 2^ drachms, according to the size of the calves, but its use calls for much care, and it should only be given for alternate periods of a fortnight. The glycero- phosphates are not very active. Beef meal in doses of 6 drachms to 1^ ounces and chloride of ammonium in doses of 30 to 60 grains have also been used advantageously. The above drugs, but particularly the bi-phosphate of lime and chloride of ammonium, stimulate nutrition and diminish the quantity of phosphoric acid eliminated. OSSEOUS CACHEXIA. " Osseous cachexia " is a general disease which develops slowly and progressively, producing its most marked effects on the bony tissues. It has received a great many different names, such as osteoporosis, osteoclastia, osteomalacia, fragilitas ossium, enzootic ostitis, bone softening, etc., but none of these ajDpears so appropriate as the term osseous cachexia, suggested by Cantiget. All the above-mentioned names are applicable to some phase of the disease, but none to the disease in its complete development. Thus the name "osteoporosis," accepted by German authors, is quite applicable to the phase of rarefying ostitis seen at the commencement, but this condition occurs in other diseases. The expressions *' osteoclastia " and 8 OSSEOUS CACHEXIA. '' fragilitas ossium " suggest the fragility of the bones and the common- ness of fracture. The term " osteomalacia " is warranted during the period of bone softening. The term "gout," though in practice confusing, has been held to be justified by the frequent appearance of synovitis and arthritis ; while that of " enzootic ostitis " indicates the appearance of the disease in all the stables in 'one district, without however pointing to its nature. It is possible that under certain circumstances the train of symptoms might be incomplete, and then the terms above indicated would be quite inappropriate. "Osseous cachexia," on the other hand, is very comprehensive, and appears to cover the entire development of the disease, for which reason it here receives preference. Law defines the disease as " a softening and fragility of the bones of adult animals, in connection w^ith solution and removal of the earthy salts." He describes it as an enzootic disease of mature animals — mainly cows — in which the decalcifying process proceeds most actively in the walls of the Haversian canals and cancelli of the affected bones. In consequence of the removal of the earthy salts the bones become soft and more or less fragile. The disease has been observed in England, Scotland, United States, France, Belgium, and Jutland, and generally in districts with low- lying damp pastures. It attacks cows which are heavy milkers. Susceptibility appears to increase with advancing age. History. Having been described by Vegetius, the disease was again observed about 1650 in Norway where it was treated by the administra- tion of crushed bones. It is fairly frequent in some parts of Germany and Belgium. In France it was studied in 1825 by Roux, and in 1846 by Dupont, but Zundel in 1870 was the first who gave a good description of it, founded partly on the authority of German authors and partly on observations made by himself in the Valley of the Lower Ehine. Since that time it has successively been reported in the Yonne by Thierry, in the Nievre by Vernant, in the Aube by Collard and Henriot (1893), in the Indre by Cantiget, as well as in La Vendee by Taj)on in 1893. In that and the succeeding year Moussu also saw numerous cases in the districts of Indre-et-Loire, Loire-et-Cher, Berry, Sologne, and in some parts of Beauce. Symptoms. The first symptoms are difficult to detect and interpret, especially at the commencement of an outbreak and in parts where the disease is rare they may lead to confusion and errors in diagnosis. On the other hand, in regions where the disease is common the practitioner will be able to form his diagnosis from the appearance of the first signs. To render clear the mode in which the symj^toms develop we may divide the progress of the disease into four phases, though this grouping is somewhat arbitrary, OSSEOUS CACHEXIA. 9 1. The initial phase is not well marked, and is announced by digestive disturbance and by wasting. The former of these symptoms may be referred to some other cause, but consists in irregularity, diminution and sometimes perversion of the appetite. These earlier signs are soon followed by loss of spirits, and some interference with movement, but the symptoms only become of importance or attain their full develop-, ment when the animals remain lying for a long period in the stable. 2. The second phase is characterised by more precise signs, which' become almost pathognomonic. Difficulty in rising is added to the Fig. 2. — Horse suffering from osseous cachexia. already existing tendency to remain lying, and to the interference with movement. When lying down the patient no longer responds to the trifling stimulus, wliich a healthy animal needs to cause it to rise. It remains languid and aj^parently lazy, though in reality it experiences pain and difficulty on attempting to get up. The least muscular effort when lying down often causes it to moan, as do efforts to change its position or to walk. Even when standing still, it may appear to be in pain, and patients often assume a position similar to that of a horse suffering from laminitis. At the end of this second phase, swellings appear, due to synovitis or arthritis of the extremities, synovitis of the sesamoid or navicular sheaths or to inter-phalangeal arthritis or arthritis of the fetlock joint. Weakness becomes marked, and the appetite is very irregular. 10 OSSEOUS CACHEXIA. Secretion of milk diminishes or ceases and abortion is not un- common. 3. The third phase is characterised by fractures, and it is this peculiarity of the disease which has procured for it the names of fragi- litas ossium, and osteoclastia. These fractures may affect any portion of the skeleton. Animals so suffering sometimes break a leg whilst trotting or the pelvis in simply jumping over a ditch ; a collision with a fixed object like the jamb of the stable door, or a fall on the ground, may result in the fracture of one or several ribs. Such shocks would be of no importance to a healthy animal, but to one suffering from osseous cachexia, any violence, or even the slightest Fig. 3. — Pig suffering from osseous cachexia (fourth stage). muscular effort may be followed by fracture of the gravest character, involving even the vertebral column. In cows the pelvis, femur, and tibia are most frequently injured. In horses, particularly in riding horses, fractures are commonest in the region of the forearm, cannon bone, and anterior phalanges. So extremely fragile are the bones at this, stage that the horse represented herewith broke twelve ribs at one time by simply falling on its side. It is interesting to note that such fractures are never accompanied by any extensive bleeding. They have little tendency to repair, no real callus formation occurs, and on post-mortem examination one often finds the ends unconnected by temporary callus, worn, and rounded by reciprocal friction. At this stage but under other circumstances, the animals show great reluctance to rise, remaining down for twelve to twenty-four hours without shifting their position. If forced to get up, they stand as though fixed in one position, the respiration and circulation become rapid, and they soon grow tired and fall, OSSEOUS CACHEXIA. 11 4. The fourth phase, or period of osteomalacia, i.e. softening of the bones, is also the last. It is rarely seen in large animals like horses and oxen, because accidents so often accompany the preceding stages and necessitate slaughter ; but it is common in goats and pigs. In this phase the bones become elastic, soft and depressible, yielding to the pressure of the operator's fingers. The flat bones are particularly liable to this change, which is common to domesticated animals. The bones of the head are the first to suffer ; later those of the pelvis. The lower jaw becomes swollen, par- ticularly about the centre of the branches which may attain three, four, or five times, their normal thickness. The depression in the submaxillary si3ace disappears. The upper jaw undergoes similar changes, becoming deformed and thickened until the cavities of the sinuses and the hollow aj^pearance of the palate are lost, while the face is so changed that it cannot be recognised as that of a horse, goat, etc. The molar teeth are almost buried, their tables alone being visible at the bottom of a depression, the edges of which rise above the neighbouring parts (pig). Mastication is clearly impossible, the jaws appear paralysed, the muscles powerless, and only swallowing is possible, a fact which explains why life is only prolonged to this stage in animals which can be fed with a spoon or bottle (pigs and goats). The bones of the cranium, although greatty changed in texture, are always less deformed than those of the face. The changes are such that it is often easy with a mere post-mortem knife to cut the head completely in two. Osseous tissue, properly so-called, has disappeared. All the constituent tissues, with the exception of the skin and muscles, i.e., the bone, periosteum and aponeuroses, have the appearance and consistence on section of the fibro-lardaceous tissue seen in chronic inflammation. The following is a condensed description of the disease as given by Law : — Symptoms. Poor condition or even emaciation, with very visible projection of the bones. The coat is rough, skin tense^ inelastic ^nd Fig. 4. — Deformity of the face in the horse shown in Fig. 2. 12 OSSEOUS CACHEXIA. hidebound, appetite variable, sometimes impaired, and nearly always perverted (or depraved) so that the patient will lick the manger con- tinually or pick up and chew^ all sorts of objects : bones, leather, clothing, wood or iron, stones, etc. The amount of food consumed may, however, be up to the normal. The most marked feature is the difficulty and stiffness of locomotion. . . . Temperature and yield of milk may remain normal. " Later, appetite and milk secretion fail, temperature rises a degree or two, the animal refuses to rise, remaining down twelve to twenty-four hours at a time, and . . . when rising . . . remaining on the knees for a time, moaning and indisposed to exert itself further. At this stage many cases begin to improve and may get well in five or six weeks. Some will remain down for several weeks and finally get up -- ••■■■- C»;£^l^ Fig. 5. — Head ot n pig Miiieiuiy iruiii osseous cachexia. and recover. With constant decubitus, however, the animal falls off greatly, becoming emaciated and weak, the appetite may fail altogether, and the patient is w^orn out by the persistent fever, nervous exhaustion and poisoning from the numerous bed-sores . . . which are common over the bony prominences. It is in these last conditions, above all, that fractures and distortions of the pelvic bones, and less frequently of the bones of the legs occur." " The disease may advance for two or three months, and in case of pelvic fractures and distortions, there may be permanent lameness, and dangerous obstruction to parturition, even though the bones should acquire their normal hardness through the deposition of lime salts." In horses, the different phases of the disease develop precisely as in bovines. The apparent differences between affected horses and cattle result in reality from differences in their capacity for continuing work. In the first phase, horses are incapable of work, their movements being OSSEOUS CACHEXIA. 18 badly co-ordinated. They are inclined to stumble, and appear as though suffering from strain of the lumbar muscles. In the second phase pain referable to the bones sets in. Lameness develops without visible lesions and is rapidly followed by synovitis and arthritis in the lower portions of the limbs, and by wasting and anaemia. The animals seem unable to move rapidly, or if forced to do so may sustain fractures even at a trot : the limb bones sometimes break or ligamentous insertions in the neighbourhood of joints are torn away, resulting in sudden falls on the ground and fracture of ribs or even of the vertebral column. This corresj)onds to the third phase, osteoclastia, in oxen. From then onwards, horses become useless and, if not destroyed, may, after a few weeks or months, develop the condition known as osteomalacia, in which the flat bones become softened, the head, the branches of the lower jaw- and the face become deformed, while mastication and other functions are impeded. Germain gives the above symptoms as characteristic of the mode of development of the disease in French and Algerian horses imported into Tonquin, and his description, written several years ago, is fully confirmed by more recent observations. Since Tonquin was taken over by the French, however, improved methods of culture have resulted in the produc- tion of better cereals and forage; the fodder plants have been vastly improved, to the great benefit of imported animals. In the goat, the disease show^s some slight peculiarities. Thus, in the second phase, during which goats and sheep suffer so markedly from lameness and pain in the bones, goats often walk on the knees. The disease, however, is uncommon in these animals. The phase of osteoclastia is also less marked and fractures are rare, because the animals weigh less and also because they are less exposed to falls and violent shocks. The bones, nevertheless, are extremely fragile and fractures may be produced at will. Osteomalacia, on the other hand, is always well marked. Regarding the development of the disease in pigs, we may repeat what has just been said res^Decting the goat. Walking on the knees is often one of 'the first signs, fractures are somewhat rare, and the period of softening and deformity is always very noticeable. Fig. 6. — Osseous cachexia. This condition developed in two months, the last month of gestation and the first of lactation. 14 OSSEOUS CACHEXIA. Course. The development of the disease is slow, lasting from one to three months as a rule, and is little influenced by hygienic conditions. Good milking cows, however, seem to be most frequently attacked, probably because of the great losses of nutritive material which occur through the milk. The calves borne by such animals are often rachitic. Oxen are less commonly attacked. Horses rarely suffer from the disease in France, but frequently in Tonquin. Pigs reared on very poor soil seldom escape attack. If treated from the beginning, or even before the second phase has become well developed, the disease may be cured, but after this period little improvement need be expected. Causation. The problem of why osseous cachexia occurs has natu- rally given rise to numerous explanations, some plainly inad- missible, others, however, of greater or less plausibility. The fact which, from the earliest times, appears to have attracted most attention is the relation defective nourishment bears to development of the disease. In Norway, as early as the year 1650, the plant known as sterregraes (which renders animals dull and heavy) was thought to be the cause of the disease ; two centuries later, in 1846, the Anthericum ossifragum was similarly regarded. Zundel, in 1870, claimed that the Germans first referred the development of the disease to chemically incomplete forms of nourishment. This opinion seems fully confirmed by the remarkable observations of Germain on European horses imported into Cochin- China, and it is finally placed beyond question by the work of Cantiget. Basing his researches on analysis of the soil, he proved that osseous cachexia only occurs in cattle depastured on land which is too poor in phosphoric acid and calcium phosphate, and that it can be banished by enriching the soil with suitable manures up to a point when the proportion of phosphoric acid becomes normal. In good land, suitable for raising cattle, the proportion of phos- phoric acid, according to the best exponents of agricultural chemistry, should not fall below 4,000 kilograms to the hectare. Cantiget and Fig. 7. — Osseous cachexia : softening of the maxillae. OSSEOUS CACHEXIA. 15 Brissonet have shown that where the soil contains less than 1,500 kilo- grams to the hectare, osseous cachexia is almost permanently present. As soon, however, as this proportion is raised above 2,000 kilograms by suitable culture, the losses diminish, and the cachexia finally disappears. This view was greatly strengthened by fodder analyses, which showed that in all cases where the soil is poor in calcium phosphate, the forage is poor in phosphoric acid, and vice versa. The food is too poor in mineral salts, firstly for normal development ; and secondly for the proper nutrition of the skeleton. Germain is of a similar opinion with regard to the occurrence of osseous cachexia in horses in Cochin- China, where the soil is very poor in lime. The fodder and cereals are poor in mineral salts, and even w^hen given in large quantities do not furnish proper (chemical) nutri- tion. Clear proof of the correctness of this view is afforded by the fact that feeding with forage and cereals obtained from France or Algeria prevents the disease appearing, or diminishes and finally removes the previously existing symptoms. Furthermore, Germain show^s that Europeans, living solety on the products of the country, to some extent suffer like the horses. This theory though based on sufficiently solid foundations to carry conviction, has been questioned, and it may be desirable to record briefly the criticisms advanced against it. One of the most important is as follows : — As osseous cachexia of oxen occurs in certain well-defined districts in France, and seems due to the feeding, why does it not attack horses in the same regions in an enzootic form ? The answer appears to be that horses receive a greater amount of rich food, particularly of cereals, which contain much larger amounts of mineral salts, including phos- phates, than does ordinary forage. The most serious objection was made by Tapon, who states that in 1893 he saw osseous cachexia in oxen on farms in La Vendee where superphosphate had been used for years, whilst the disease did not exist on other farms where such chemical manures were not employed. Before attaching much weight to this objection, however, it would be necessary to know^ the richness in phosphoric acid of the soil on the respective farms, for it is possible that, in consequence of natural condi- tions and in spite of the use of certain mineral manures, the richness of the soil on the first-mentioned farms, though manured with superphos- phates, was still below^ that of the others which had received no artificial, manure. The system of culture is also of importance, for at the present day, even with the use of artificial manures, cropping would rapidly im- poverish soils which were not suitably and sufficiently enriched. O- THE ^ '- ^^'VERSITY 16 OSSEOUS CACHEXIA. Abundance or apparent richness of food signifies nothing if quality is lacking. It may also be asked : if the question of nourishment is of such prime importance why are animals of European origin in Cochin- China affected, whilst the indigenous races prove immune? The answ^er would appear to be that, in addition to the defective quality of food, other factors, such as adaptation to environment and relative digestive powder, play a considerable part in the production of the disease. FaYOuring causes. Whilst conceding that the disease is due to one determining cause, viz. the food, it is unquestionable that other causes may favour its aj^pearance. Abundant milking is one, so that the disease most frequently appears six to eight weeks after calving. Gesta- tion may also determine an attack. The disease is rarer in oxen than in milch cows. Starvation and bad hygienic conditions also have a certain influence; it is well known that during dry years, particularly when fodder is scarce, osseous cachexia makes the greatest ravages. Law states that the disease has been attributed to excess of organic matter in the soil, to succulent w^atery foods, as rank watery grasses, potatoes, turnips and other roots deficient in nutritious solids. Some agent — microbe or toxin — swallowed with the food has been suspected but not yet isolated. Other explanations have been advanced but uj) to the present time they scarcely deserve to be regarded even as hypotheses. Thus Anacker in 1865 declared that the disease Commenced as muscular rheumatism, was succeeded by destructive or atrophic ostitis, and ended as osteo- porosis. So far as the order of the osseous lesions is concerned, this view is quite correct, but the ossific changes are consequences and not causes. The idea that the disease w^as due to an infectious agent has been advocated by Leclainche, without, however, having been proved. Petrone is the only person who has hitherto suggested that osteo- malacia in man is due to infection with a nitric ferment {Micrococcus nitrificans). According to him, pure cultures of this organism injected into dogs, produce osteomalacia. These statements, however, require confirmation. Lesions. The chief lesions are to be found in the bones. They consist in rarefaction of the compact tissue, increase in size of the medullary cavity and Haversian canals, and enlargement of the areolae of the spongy tissue. The bone marrow loses its fatty constituents, appears red and gelatinous, and contains a greatly exaggerated number of blood-vessels. When heated, the bones do not yield oil as in healthy subjects, and when dry, they seem abnormally porous. In the osteo- clastic phase, the bones become very friable and even the shafts assume OSSEOUS CACHEXIA. 17 fi spongy appearance. They diminish in density. These changes correspond to the stages of eccentric rarefying ostitis and osteoporosis of German authors. The flat bones often show well-marked periostitis, but the great thickening sometimes seen in certain of the bones of the head appears to be the result of a special osteo-periostitis. It is quite certain that the disease is due to something more than a mere want of mineral constituents in the bone, and poverty in this respect certainly does not explain the hypertrophic changes. The nutrition of the bones as n whole is disturbed, resulting in alterations both in the ossein and Fig. 8. — Transverse section through the middle region of the face in a pig suffering from osseous cachexia. in the mineral salts, the whole process being accompanied by symptoms of osteo-periostitis. The fractures which occur so frequently during the osteoclastic phase have well-marked peculiarities. The extravasation of blood is trifling, and no callus forms, even when the ends of the bones are immobilised by external aid ; if the ends are left free, they soon become worn an(^ polished by rubbing against one another. r I In the neighbourhood of the articulations and ligamentous insertions the periosteum soon undergoes change, and it is not uncommon to find sub-periosteal and intra- osseous extravasations of blood, Germain has also noted in horses the disappearance of the interver- tebral and articular cartilages, and the frequent occurrence of anchylosis, true or false. D.c. 0 18 OSSEOUS CACHEXIA. In the final stages, the bones may be cut with a knife, and a time arrives when bony tissue seems completely to have disappeared ; thus, as shown in Fig. 8 herewith, it w^as possible to cut the entire head of a pig into thin slices without the slightest difficulty. All parts of the head had been affected by the softening change. From the chemical point of view, the diminution in mineral salts and in phosphate of calcium has long been recognised, but the degree of this change varies according to the phase. In human beings the proportions have been estimated as follow^s : Normal bone, 50 to 80 -pev cent, of phosphate of calcium ; bone in persons suffering from osteomalacia, 5 to 20 j^er cent, of phosphate of calcium. The changes in the ossein have not been carefully studied. We only know that histologically the ossein becomes fibrillar, and that chemically it no longer retains its normal comj^osition. Tlie diagnosis is difficult, particularly on the first occasion of seeing the disease, and especiall}^ if this is of an enzootic character. The practitioner may also have some hesitation in diagnosing isolated cases in regions where the disease seldom occurs. Otherwise, diagnosis is usually easy, as soon as lameness or synovitis, or arthritis of the low^er regions of the limbs appears. Only in isolated cases are the lesions likely to be mistaken for accidental injuries, and it is also fairly easy to differentiate them from the localised lesions of rheumatism. The latter disease seems more frequently to attack the upper joints of the limbs, and is often accompanied by intense fever and cardiac disturbance. Prognosis. In a general sense the disease is very grave, because it appears as an enzootic, and, in dry years and those during which there is a scarcity of forage, inflicts enormous losses on the breeders of certain countries. When advice is sought towards the end of the second phase of the disease the prognosis is therefore very grave. Under such cir- cumstances it is often better to slaughter rather than to treat, provided that the affected animals, like cows, pigs, or goats are still of some value. The prognosis is much more hopeful if treatment is attempted at an early stage, w^hen improved diet and the use of suitable drugs sometimes lead to recovery. Treatment. We know that in the Middle Ages this disease was often treated by the administration of crushed bones, and even at the present day ground bones are frequently recommended. Treatment must be subordinated to proper feeding, no system of medication being of any value whatever unless the food is suitable. Germain states that imported horses in Cochin-China recover if simply returned to their former diet, i.e. to cereals and forage obtained from France or Algeria. Cantiget shows that such improvements in OSSEOUS CACHEXIA. . 19 cultivation as the free distribution of superphosphate manures on impoverished soils modify the chemical composition of the forage, and render it capable of building up and sustaining the organism and bony tissues ; treatment should therefore be essentially prophylactic in character. Animals suffering from osseous cachexia should be fed on cereals and forage obtained from rich districts where the disease has never occurred ; but, as in times of scarcity questions of expense almost always receive first consideration, it may be necessary to substitute bran for such products, or give oats, maize, beans, rice, and oil or cotton cake, etc., all of which can be obtained commercially, and are of sufficient nutritive richness. It is often advantageous to give such food cooked and slightly salted. Commercial ground bones and calcium phosphate (bi- or tri- basic), in doses of 1 ounce per day for oxen and 1|- to 2 drachms for pigs or goats, have given excellent results in. the hands of most practitioners. Some recommend the addition of iron salts or bitter tonics like gentian or nux vomica in doses of 2J drachms per day for a full-grown ox. Law declares that the treatment should be varied " wdth the pre- dominance of the causes, essential or accessory. . . . Green clover, alfalfa, and other leguminous products, ground oats, beans, peas, linseed or rape cake . . . and vetches may be especially recom- mended. . . . The free access to common salt and a liberal supply of bone meal are helpful. . . . Apomorphia is especially valuable in correcting the perverted appetite and stimulating digestion. A change of pasture is always advisable. In all cases where possible the water should be changed as w^ell as the food. Attention to the housing, grooming, and general care of the animals should not be neglected. Finally, every drain upon the system should be lessened or stopped. The milk may be dried up, and the animal should not be bred." Meat meal also renders good service, but the use of cod liver oil, suggested by Zundel, is too expensive, and phosphorised oil is too dangerous to be adopted in ordinary treatment. Local treatment for synovitis and arthritis has been recommended. It is ineffective unless accompanied by good feeding and internal medication. On the other hand, the lesions often diminish rapidly or totally disappear under the influence of general medication alone. c2 20 FRACTURES. LOCAL AFFECTIONS. FRACTURES. Although oxen, sheep, goats, and pigs are much less subject to fractures than the horse and dog, nevertheless, they do suffer from such accidents. Eei^air is perfectly possible, but the cases are often not worth treating, unless the subjects are young or of considerable value. On the other hand, in fat and heavy subjects, it is difficult to fix the parts in position. Slinging produces bad results, and generally should not be encouraged. Apart from fractures accompanying general chronic diseases, like rachitis and osseous cachexia, the vertebrae, the pelvis, the ribs, or any of the limb bones, may be fractured in consequence of accident. Such fractures may be either complete or incomplete (fissures), simple or compound. The general signs which indicate fracture are always the same, viz., loss of function, local pain, abnormal mobility, crepitation, due to rubbing together of the ends of the bones, and deformity of the part. Diagnosis is generally easy ; prognosis on the other hand is very variable. The vertebral column may be accidentally fractured in the region of the neck in consequence of the animal falling on its head ; in the dorso- lumbar region, from falling into ditches or ravines, or, in the case of bulls fighting, from violent muscular efforts. Fractures of the first kind are immediately fatal ; those of the second result in paraj^legia of the hind limbs, and necessitate immediate slaughter. Fractures of the pelvis comprise : — 1. Fractures of the angle of the haunch, resulting from external violence and characterised by sinking of the external angle of the ilium, deformity of the hip, and lameness without specially marked characters. This fracture is rarely complicated. The symptoms of lameness diminish with rest, but deformity continues. 2. Fractures of the floor of the pelvis, usually extending from the anterior margin of the pubis to the foramen ovale and from the posterior margin of the foramen ovale to the end of the symphysis. They result from obstetrical manipulation, as in forcibly removing a foetus which is too large, or a monstrosity. As a rule, the animals cannot rise, or if they succeed in doing so, are incapable of moving. Diagnosis is made by exploration through the rectum. Such fractures always necessitate slaughter. Fractures of the neck of the ilium and of the base of the cotyloid cavity, even in cases of dislocation, are rare despite what has been said to the contrary. FRACtURES. 21 In the fore limb, fractures of the scapula and humerus are usually of traumatic origin, are seldom accompanied by marked displacement, and are capable of uniting if a long rest at grass is allowed. Pitch bandages should be applied to the surface, covering all the surrounding regions, viz. the withers, upper portion of the forearm, girth and chest, to assist in immobilising the region of fracture, and to promote union. Fractures of the forearm are more difficult to treat, because the bandage applied must extend as far as the hoof. In this case displace- ment often occurs. It is therefore necessary, firstly, to reduce the fracture, and bring- the ends in perfect contact, for which purpose it may be requisite to cast the animal, and give an anaesthetic; and, secondly, to apply a pitch plaster in the form of a shallow gutter, leaving the inner surface of the limb uncovered along a line about two inches wide following the course of the veins of the forearm. Fractures of the metacarpus and metatarsus usually heal well in all animals of moderate weight, such as heifers, steers, goats or sheep, provided a simple plaster bandage, covering the entire limb or prefer- ably with an opening in the position above indicated, is applied and continued downwards as far as the claws. In sheep and goats it is sometimes even sufficient to use a splint formed of straw-boards, and in the case of oxen, of wood, applied over a cotton-wool padding and retained in position by straps, or in the case of the heavier animals by dextrine or pitch bandages. In the hind limb, fractures of the femur are more serious, because the apparatus that can be used to secure immobility is seldom or never effective ; excepting in young animals, it is therefore usually better to slaughter. Fractures of the tibia are treated like those of the forearm when it appears desirable to keep the animals alive. Plaster bandages can very easily be prepared by saturating tarlatan in a mixture of equal parts of thoroughly dry plaster and water. Six to ten thicknesses of tarlatan, arranged alternately longitudinally and transversely, are sufficient. When adjusted they can be kept in position until the plaster has hardened by means of dry bandages applied from below upwards, which can be removed after a lapse of half an hour to an hour. FRACTURES OF THE HORNS. Anatomy of the horns. The horns form organs of defence, and project on either side of the frontal bone at the poll. Each consists firstly of a bony basis generally known as the horn core ; secondly, of a horn-secreting membrane ; thirdly, of a horny sheath, the horn properly so called. 22 FRACTURES. (1.) The horn core projecting from the frontal bone does not develop until after birth. About the third month a little prominence appears under the skin, which, as it develops, assumes a conical shape, and may be seen to be covered with a horny substance. In proportion as the horn core grows, there develops within it a cavity which may either be of a simple character or divided by a longitudinal partition. This communicates with the frontal sinus, a fact which explains the collection of pus in the sinuses as a result of injuries to the horns. The sinus of the horn core does not exist in young animals, and is not completely developed before the third or fourth year of life. (2.) The horn-secreting membrane is formed by the skin, which under- goes special development around the base of the horn and comes to Fig. 9. — C, horn ; P, modified skin forming the keratogenous membrane ; 0, horn core, exhibiting a double sinus. resemble that of the coronary band, from which the hoof or claw is secreted. The band is about one-fifth of an inch in breadth. The papillae of the dermis are specially developed at this point, and the epithelium which they secrete eventually forms the horn. The internal surface of the growing horn is adherent to the horn core through the medium of another tissue formed by a specially differentiated periosteum which is continuous with the periosteum covering the frontal bone. It is not a true periosteum, but a vascular tissue formed of papillary layers analogous to those of the podophyllous tissue of the ox's claw or horse's hoof. This keratogenous membrane receives a rich vascular supply from the arterial circle formed at the base of the horn core by a division of the external carotid, the blood conveyed by which i-s freely distri- buted to the enlarged papillae. The great vascularity of these parts FRACTUKES. 23 explains why lesions of the horns are often followed by such profuse bleeding. (3.) The horn secreted by the papillae of the horn band (which is analogous to that of the coronary band of the horse) forms a cone varying in its curve in various breeds. Its base is hollow, and contains little depressions holding the papillae from which the horn is secreted. From its base up to the end of the horn core the walls pro- gressively increase in thickness. From this point it is solid; in a fully-grown horn the bone does not extend more than one-half or two-thirds of the entire length. In the adult, the development of the horns varies with different breeds and is affected by sex. In the bull the horns are short, but in the cow and ox long. Short and fine in animals of improved breed like the Durham, they are long and thick in breeds of working oxen. Injuries affecting the horns are of three classes, determined by the part affected. 1. Detachment of the horn or sheath. 2. Laceration : — (a) Of the horny sheath alone. (h) Of the horny sheath and of the horn core. (c) Of the horn core alone, the horny sheath remaining intact. 3. Fractures : — {a) Of the terminal half of the horn. (b) Of the lower half. {c) Of the base. DETACHMENT OF THE HORNS. When the yoke is badly fitted or padded, it is liable to cause a continual strain or a succession of shocks producing chronic inflam- mation of the keratogenous membrane. Should the end of the horn then be struck heavily, it is quite possible that the horn will either partially or wholly be detached. In this case it falls away without there necessarily being any important lesion of the horn core. Such accidents are not infrequently caused by the driver striking the ox on the horn with the yoke in order to keep it quiet while it is being harnessed. The prognosis of this condition is not grave, except for the fact that working animals cannot be used until the horn is completely regrown. The treatment simply consists in thoroughly cleansing and disin- fecting the horn core and then applying a protective dressing. The bony basis is surrounded with a mass of tow saturated with an antiseptic 24 FISSURING OF THE HORNS. solution, like 2 per cent, creolin or carbolic acid solution, which is kept in position by a spiral bandage passed around the horn, and secured in a figure of 8 on the opposite horn. Instead of applying such a dressing, some practitioners content themselves with using an antiseptic ointment or even a simple dressing of tar. FISSURING OF. THE HORNS. Causation. In a general sense fissures may result from any violence affecting the centre portion of the horns, such as blows with the yoke or accidental bruises inflicted^ by the animals themselves in fighting with their neighbours. Symptoms. Whether the fissure is confined to the horny covering itself or whether it extends to both the portions constituting the horn, that is, the horny covering and the horn core, two very noticeable symptoms are alw^ays present : 1. A straight fissure resembling a sand crack, and appearing usually on the convexity of the horn, and, 2. A very trifling haemorrhage, which does not appear until some hours or even a day after the accident. Diagnosis. If the lesion only affects the horn core, diagnosis is always difficult, for one can hardly perceive any sensitiveness of the horn near the fissure. Prognosis. Provided that the horn core is not injured, the prognosis is favourable ; but in the contrary case, it should be reserved ; for haemorrhage extending to the interior of the frontal sinus not infrequently causes suppuration in that cavity. Treatment. Attempts should first be made to check haemorrhage by applying masses of tow saturated with cold water and frequently wetted with slightly antiseptic solutions, such as 2 per cent, creolin or carbolic acid. If haemorrhage persists in spite of this simple treatment, astringents may be employed, which, by causing the formation of a clot, mechanically arrest further extravasation of blood. " These astringents vary considerably in value, and we should particularly warn practi- tioners against perchloride of iron, which causes necrosis of the tissues, and later, formation of pus. A 5 per cent, solution of gelatine is haemostatic and excellent for the purpose named, as also is hydroxyl solution. When once haemorrhage is arrested, the keratogenous mem- brane rapidly heals in consequence of its vascularity, and soon secretes fresh horn. FRACTURES OF THE HORNS. 25 FRACTURES OF THE HORNS. Etiology. Fractures of the horns, Hke fissures, are produced by violence, but of a more marked character. They are termed complete or incomplete, according as the entire thickness of the horn or only a portion of that thickness is involved. The fracture may affect either the terminal half or the basilar half ; or, again, it may have its seat in the frontal bone below the origin of the horn core, in which case a flake of bone will be detached. Such fractures assume varying forms, and may either be deeply excavated, oblique, smooth, regular or dentated. Symptoms. The symptoms are extremely simple. They consist mainly in the mobility of the frac- tured end, and such phenomena as sensitiveness, haemorrhage, etc. When the fracture extends to the frontal bone, crepitation may also be noted. Prognosis. The prognosis is not grave unless the fracture extends to the basilar half of the horn or affects the frontal bone. Treatment.' (1.) If the fracture is confined to the horn core, it is only necessary to bring the frag- ments into regular apposition, after having removed the broken end of the horn itself. (2.) In treating a fracture affect- ing the middle portion of the horn or in treating animals destined for the butcher, the best method is to make a simple wound by dividing the parts with a saw below the fracture. This is a painful operation, neces- sitating anaesthesia, and requiring the animal to be cast or firmly fixed to a post or placed in a trevis. To diminish the painful stage of the opera- tion, it was formerly recommended to make a circular incision extending through the entire thickness of the horn proper, and then to remove with a fine, very sharp saw the portion of the horn core. This, however, is scarcely practicable, and it is much better to make a direct section. Haemorrhage is checked with compresses, moistened with cold water, after which a dressing known as the " Maltese cross dressing " (Fig. 10) is applied according to general principles. The surface of the section, after washing with an antiseptic solution, is powdered with iodoform or a mixture of iodoform and boric acid. Fig. 10. -Dressing for fracture of the horn. 26 FRACTURES OF THE HORNS. covered with a mass of tow or cotton wool, saturated with liquid anti- septic, and then surrounded with a flat pad of wadding, which extends completely around the horn as far as its base. A second pad of larger size, intended to protect the wound against external violence, is arranged around the free extremity of the horn. This is kept in position by two small cross bandages. Another bandage, the loop of which is fixed to the base of the opposite horn, is then ai:)plied in spiral turns, completely enveloping the former pads and extending from the base to the point. Arriving at the free end, the operator reverses the bandage, draws it tight, and continues down to the base of the horn, fixing it by figure of 8 turns passed around the base of both horns. (3.) In dealing with fractures of the lower third of the horn in working oxen, it is necessary to seek consolidation of the horn by callus formation, so that the animals may again become useful in the yoke. Very great difficulty accom- panies attempts to immobilise the horn in such cases, since the least shock to the extremity of the horn destroys the union, on account of the length of the lever represented by the horn itself. The first method of treatment consists, after the wound has been carefully disinfected, in fixing the ends in place by tightly applied pads, surrounded These are supj)orted by several Fig. 11. — Splint for fractured horn. by splints, curved to fit to the horn, turns of a spiral bandage. Were one certain of the cleanliness of the wound and of its perfectly aseptic condition, it would be better at once to have recourse to a fixed bandage, strengthened by plaster or silicate of soda. These bandages are applied longitudinally and should extend a con- siderable distance on either side of the fractures. If the horn is long and thick, it is best to use a fixed dressing of this kind secured by bandages in the form of a Maltese cross. All these methods, however, are more or less inconvenient, and the most practical procedure often consists in removing the horn. Treatment should only be attempted w^hen the owner specially requests it in order to render the animal useful for working or show purposes. Moreover, however strong the dressing, accidents are frequent, for accidental shocks to the fractured horn interfere with the co-aptation of FRACTQRES OF THE HORNS. 27 parts, and diminish the chance of perfect] union. To avoid these draw- backs, the apparatus shown in Fig. 11 has been invented. This apparatus consists of a splint, the middle of which fits the back of the animal's poll, the sides being gouged out to receive the lower half of the horn and notched, to enable the fractured horn to be well supported by bandages. (4.) Fractures of the base of the horn are more serious, because a fragment of the frontal bone is usually torn away with the horn core. As a rule, the fracture is subcutaneous or without ex- ternal wound. The horn is displaced, and swings loosely. On examination, a charac- teristic crepitation sound is easily detected. In such frac- tures haemorrhage is subcu- taneous and often extends to the frontal sinus, in conse- quence of which it is not uncommon for pus to form in the sinus as a complica- tion. Treatment includes reduc- tion of the fracture, and the application of a fixed j^laster or silicate bandage cover- ing the fronto-occipital and superior auricular regions. When a skin wound exists, it is better to remove the horn and bony fragment, and to apply an antiseptic dressing in order to prevent infection of the frontal sinus. Fig. 12. — Dressing for fracture of the base of the horn. EXOSTOSES. SPAVIN IN THE OX. Exostoses are somewhat uncommon in the bovine species, and when they occur are rarely of great clinical interest. Nevertheless, in cows and old working oxen one sometimes sees metatarsal spavin. Its gravity, however, appears to be very much less than in the horse, on account of its position. Very commonly there is only trifling lameness. Treatment by application of biniodide of mercury ointment or the actual cautery gives good results. The principal precaution required is to prevent the animals licking the parts. 28 RING-BONE. RING-BONE. Eing-bones only occur in working oxen, and particularly in aged animals used in hilly regions. They result almost exclusively from wounds, ligamentous and tendinous strains, and articular injuries. They are preceded (as can usually be proved by dissection of limbs) by Fig. 13. — Tibia. Lesions due to open fracture and displacement. Irregular callus formation and segnestrum. fibrous or fibro-cartilaginous induration in or about the coronet or one of the phalanges. These thickenings increase the diameter of the pastern in all directions. Eing-bones are seldom very large ; but as they SUPPURATING OSTITIS. 29 partially or entirely surround the insertions of the lateral ligaments, inter-phalangeal articulations or insertions of the digital extensors, they are painful, and produce lameness of varying intensity. Diagnosis is easy, partly because the tension of the skin and the fibrous thickening render palpation painful. Prognosis is grave, because the effect of ring-bone is sometimes to render working animals useless. Treatment. To relieve the diseased claw of pressure due to its bearing on the ground, the shoe should be removed and the claw freely pared. Fig. 14. — Sarcoma of the periosteum beneath the scapula. FiG. 15. — Sarcoma of the periosteum covering the upper end of the tibia. If necessary, the healthy claw of the same foot may be raised by placing a piece of thick leather between the sole and the shoe. It is advisable at once to apply an energetic plaster, or, better still, to resort to firing in points, SUPPURATING OSTITIS. In addition to the changes in bone resulting from rachitis, osseous cachexia, tuberculosis, and actinomycosis, one sometimes sees cases of periostitis or ostitis pure and simple. As a result of external injury or 30 BONE TUMOURS. direct wounds, the bone may be contused and injured, becoming the seat of diffused periostitis, necrosis, suppurating ostitis or osteomyelitis. Open fractures may produce the same results. Treatment comprises disinfection of wounds, antiseptic injection of fistulae, the application of antiseptic pencils, curettage, the removal of sequestra, and vesicant or resolvent complications. When such condi- tions extend to neighbouring joints and produce suppurative arthritis, the animals ought to be killed. BONE TUMOURS. The only bone tumours of real imj^ortance from a practical point of view are malignant growths represented by rapidly spreading epithelio- mata or sarcomata, originating in the periosteum. Fortunately such tumours are rare. They are not difficult to diagnose, as they develop rapidly, are accom- panied by pain and lameness ending in diminution or loss of the power of movement, and frequently attack neighbouring lymphatic glands. Even when in good condition, animals lose flesh and appetite, and finally die of general wasting. The diagnosis is sufficiently guided by the deformity of the parts, the bosselated appearance of the tumours, the absence of fluctuation, the haemorrhage which follows exploratory punc- ture, the character of the little fragments of tissue removed through these punctures, and finally the leukocytosis, which accompanies the development of malignant tumours. The prognosis is grave, for it is usually difficult or out of the question to have recourse to removal, resection or amputation, when the tumours have acquired any considerable size. Success is impossible unless intervention is early, and the growth is in a readily accessible part. In other circumstances early slaughter is indicated. CHAPTER II. DISEASES OF THE FOOT. CONGESTION OF THE CLAWS. Congestion of the claws is not infrequently confused with contusion of the sole. It is, however, essentially different, and presents closer analogies with laminitis. The condition is characterised by congestion of the entire vascular system of the claw and j^rincipally of the velvety tissue. Like laminitis, it affects all four limbs ; in rare cases the two front or two hind. Congestion of the claw^ results almost exclusively from enforced move- ment on hard, dry and hot ground. It is commoner in animals unaccustomed to walking, and in heavy beasts which have been travelled considerable distances to attend fairs or markets. It is commonest in the bovine and porcine species, and less common in sheep. The symptoms appear after animals return from a long journey by road. They are characterised by unwillingness to bear w^eight on the feet and difficulty in movement. Standing is painful, and the animals resist being moved; as soon as released they lie down. Diagnosis presents no difficulty, though the condition is sometimes mistaken for sliglit laminitis. Prognosis is favourable. Absolute and prolonged rest is always followed by recovery, no internal medication being necessary, though this result is promoted by enveloping the claws in wet comj)resses or by using cold foot baths, etc. CONTUSIONS OF THE SOLE. Contusions of the sole are only seen in animals which work without shoes or in such as are badly shod. Work on rocky ground, movement over newly metalled roads, and wounds produced by sharp stones, are the principal causes of contusion of the sole. Badly applied shoes, flat or slightly convex on their upper surfaces, may also produce bruising in the region of the sole. The anterior angle of the claw is rarely affected. 32 CONTUSIONS OF THE SOLE. Lameness is the first symptom to attract attention. It is slightly marked, unless the bruising has been overlooked until suppuration has set in. It affects only one or two limbs, and is rarely accompanied by general disturbance, such as loss of appetite, fever, exhaustion during work, etc. Locally the claw or claw^s affected are abnormally sensitive to per- cussion of the wall, and particularly to compression of the sole. The parts are hot to the hand; and thinning the sole with a knife shows little perforations, irregular points and crevices in the horn. One may also find softening, infiltration and haemorrhage within the horn similar to those of corn in the horse, undermining of the sole over limited areas, and sometimes suppuration, if the animals have been forced to work when lame. Complications like necrosis of the velvety tissue or of the bone, though comparatively common in the horse, are rare in oxen. Diagnosis is not difficult provided the history of the case is known. Confusion with laminitis is scarcely possible, for the gait of this lameness and the local symptoms are all different. Examination of the sole will usually dispel any remaining doubt. Prognosis. The prognosis is favourable. When the horn is simply softened and a blackish liquid transudes, the lesion is trifling; if the discharge is reddish grey the lesion is graver, and implicates all the velvety tissue; finally, separation of the horn from the secreting membrane and the discharge of true pus point to death of the keratogenous tissue or of the bone. Treatment should be commenced by carefully thinning the sole around the wound and applying moist antiseptic dressings or cold affusions. Eemoval of loose portions of horn hastens repair by allowing discharge, which has accumulated between the living tissues and the horn itself, to escape freely. The extirpation of necrotic tissue and the appli- cation of surgical dressings are only called for in specially grave cases. This treatment usually gives good results. The acute complications which are so common and so dangerous in the horse seldom occur in the ox. Most of these operations can be performed without casting, provided the animal is placed in a trevis or is sufficiently secured. LAMINITIS. Laminitis is characterised by congestion, followed by inflam- mation of the horn- secreting tissues of the foot. It is now rare in oxen and very seldom assumes an acute form. The slow pace at which animals of the bovine species move may sufficiently explain this rarity ; LAMINITIS. 33 nevertheless, prolonged travel on stony roads with heavy vehicles, rapid and repeated marches to towns or important fairs, are sufficient to pro- duce attacks. Before the days of railways, and for some time after their introduction, in Britain cattle were travelled by road, and laminitis was common. Long journeys in crowded railway trucks may also produce the disease, although the animal has not been forced to walk. Persons engaged in exhibiting cattle at shows are well aware of this. Prolonged main- tenance of the standing position wall produce the trouble, to which the joltings of the railway journey may also contribute their share. Prolonged standing on board ship may induce laminitis. " Show condition " and the consumption of highly nitrogenous, and particularly of farinaceous, foods favour the occurrence of laminitis. Breed is also considered to have some influence, and laminitis is said to occur more frequently in animals raised in flat districts, because in their case the space between the digits is larger than in mountain-bred cattle. In this connection the body weight may perhaps play a certain part. The symptoms vary somewhat, depending on whether laminitis is general and aft'ects all four feet, or restricted to the two front or the two hind feet. The internal claws always seem more severely affected and more sensi- tive than the external. In very rare cases the animal remains standing, but usually it lies down, and will only rise under strong compulsion. When standing, the symptoms are similar to those noted in the horse ; the animal appears as though absolutely incapable of moving. If all four feet are aft'ected the animal assumes a position as though just about to rise ; if the front feet alone are affected the animal kneels in front whilst it stands on its hind legs, a very unusual position for the ox to assume ; finally, if the hind feet alone are affected, the animal seems to prefer a position with the feet under the body both in front and behind. (See Veterinarian, 1894, case by Bayle}^, and note by Nunn.) It is always difficult to make the animal move. Walking seems pain- ful, and most weight is thrown on the heels. The body swings from side to side as the limbs are advanced, and each limb is moved with a kind of general bodily effort. The claws are hot, sensitive to the slightest touch, and painful on percussion. Throughout the development of laminitis the general symptoms are very marked. The appetite falls off early, fever soon aj^pears, and in grave cases the temperature rises to 105*^ or to 106° Fahr. Thirst is marked, and the animal seems to prefer cold drinks. The muzzle is dry, the face anxious and expressive of pain. Wasting is rapid. The ordinary termination is in resolution, which occurs between the D.C. D 34 ^ DISEASES OF THE FOOT. eighth and fifteenth day, provided the patient has been suitably treated. The disease rarely becomes chronic. On the other hand, the claw occa- sionally separates, as a consequence of haemorrhage or suppuration, between the horn proper and its secreting membrane. Should this complication threaten, the pastern becomes greatly swollen, the ex- tremities become intensely congested, and separation commences at the coronet. Loss of the claws, however, like suppuration, is rare. Diagnosis. Congestion of the sole, the early stage of infectious rheumatism and osseous cachexia may, at certain periods of their development, be confused with laminitis ; but the history and the method of development of the above-mentioned diseases always allow of easy differentiation. It should, however, be added that, in certain exceptional conditions (suppurating echinococosis, producing chronic intoxication, tumours of the liver, and tumours of the pericardium and mediastinum), symptoms may be shown that suggest the existence of laminitis, although it is not really j)resent. In these cases pain may possibly be felt in the bones of the extremities. The prognosis is usually favourable, but necessarily depends on the intensity of the disease. Fat stock always suffer severely. The treatment varies in no important particular from that prescribed for the horse, and is usually followed by rapid improvement. The chief indications are free bleeding from the jugular, the application of a mustard plaster over the chest, and the administration of a smart purga- tive (1 to 2 lbs. of sulphate of soda, according to the size of the animal) at first, followed by laxatives. This treatment may be completed by giving salicylate of soda j^cr os in doses of 5 to 8 drams, or arecoline in subcutaneous injection, 1 to 1^ grains. Local treatment consists in cold affusions or poultices to the feet. Failing cold baths, clay plasters applied to the feet are useful. To ensure success all these methods should be utilised simultaneously^ In cases of separation of the claw, antiseptic dressings, with a thick pad of tow placed under the sole, become necessary. Chronic laminitis may perhaps occur in the ox as in the horse, but, as a rule, oxen are slaughtered before the disease can assume this form. In dealing with fat, or even with fairly well-nourished, oxen it would clearly be more economical to slaughter early, and so prevent wasting and the resulting loss from disease. SAND CRACK. Sand crack — that is to say, the occurrence of vertical fissures in the Wall of the claw — is not absolutely rare in bovines. It is commonest in SAND CRACK. 36 working oxen drawing heavy loads, though in very exceptional cases it affects animals which have never worked. (Moussu describes one case in a young ox where four sand cracks existed simultaneously.) It may also result from injuries to the coronet. In contrast to the case of the horse, and owing to the different conditions under which the ox performs its work, the disease is commoner in front than in hind feet. In drawing, the ox's front limbs play the principal part, and the animal pivots, so to speak, on the claws of the front limbs. The position of the crack may vary. It is commonest on the inner surface of the claw, rare at the toe, and still rarer at the quarter. It is often superficial and complete, extending throughout the entire height of the claw, but not throughout its thickness ; sometimes it is complete and profound, the fissure then extending to the podophyllous tissue. The symptoms are purely local in the case of superficial lesions. AYhen the injury is deep seated, or when it originates in a wound of the coronet, lameness is present. Intense lameness, swelling of the coronet, and blood-stained or purulent discharge point to grave injury and probable complications. Diagnosis is easy. The prognosis naturally varies with the symptoms. It is favourable when the fissure is merely superficial, but becomes grave when it is deep seated and the animal is exclusively used for heavy draught. Treatment. AYhen the lesion is superficial and unaccompanied by lameness, no surgical interference is necessary. Rest or very light work is alone required. As soon as lameness appears, rest is obligatory. The application of antiseptic poultices, containing 2^ to 3 per cent, of carbolic acid, creolin, etc., usually alleviates pain in a short time, and facilitates healing in the depth of the fissure. In exceptional cases, where complications have occurred in conse- quence of suppuration beneath the fissure, suppuration in the coronary region, or necrosis of the podophyllous tissues, an operation becomes necessary, and is of exactly similar character to that performed under like circumstances in the horse. Over a space of 1 to 1^ inches on either side of the fissure the horn is thinned "to the blood," and the subjacent dead tissue removed. The claw is then thoroughly cleansed with some antiseptic solution, the wound freely dusted with equal parts of iodoform, tannin and boric acid, and covered with pads of tow or cotton wool, fixed in position by appropriate bandages. After such operations a long rest is essential for complete recovery, during which, however, the animal may be fattened. The object of operation is to prevent complications, like chronic D 2 36 DISEASES OF THE FOOT. suppuration and necrosis, which would endanger the animal's life, rather than to effect perfect restoration of usefulness for the work previously done. PRICKS AND STABS IN SHOEING. The wall of the ox's claw is so thin that shoeing is always somewhat difficult, more especially as nails can only be inserted in the external w^all. Moreover, as very fine nails must be used, they are apt to bend, penetrate the podophyllous tissue, and cause injuries of varying import- ance. The ox is often very restless when being shod, and, even though firmly fixed, usually contrives to move the foot every time the nail is struck. The farrier, therefore, may easily overlook the injury which he has just caused, and by proceeding and ignoring it may transform a simple stab into a much more dangerous wound. Symptoms. In most cases lameness appears immediate^ the animal leaves the trevis, but, although this is more- difficult to explain, lameness is sometimes deferred until the day after, or even two days after, shoeing. Though little marked at first, lameness may become so severe that the animal cannot bear the pain caused by the foot touching the ground. When this stage is reached general disturbance becomes marked, fever sets in, rumination stops, and appetite is lost. These symptoms point to the occurrence of suppuration. The pus, confined within the horny covering of the foot, causes very acute suffering and sometimes grave general disturbance ; later it burrows in various directions, separating the podophyllous tissue from the horn, and ends by breaking through " between hair and hoof " in the region of the coronet. In exceptional cases, complications such as necrosis of the podoj)hyllous tissue extending to the bone, and suppuration of its spongy tissue, may be observed. Diagnosis. When the farrier suspects he has pricked an animal the immediate withdrawal of the nail will remove any doubt, because bleeding usually follows. If the condition is only detected at a later stage, the early lameness having been misinterpreted, examination of the claw and tapping the clenches of the nails will cause the animal to show pain at a given point, thus indicating the penetration of the nail. Removal of the offending nail is painful, and is often followed by discharge of pus or blood-stained fluid, which clearly points to the character of the injury. In obscure cases the shoe should not be reapplied. When the horn wall is separated from the sensitive structures, there is marked general disturbance, and pus is discharging at the coronet, it is practically impossible to err in diagnosis. Prognosis. In cases of simple nail puncture the prognosis is hoi)eful, provided that the condition is at once diagnosed. The longer it remains PRICKS AND STABS IN SHOEING. 37 unrecognised, particularly if complication like necrosis has occurred, the graver becomes the outlook. Treatment. In cases of simple puncture the nail should immediately be withdrawn and the animal placed on a perfectly clean bed to prevent the wound becoming soiled or infected. If lameness appear and become aggravated, the shoe should be removed and antiseptic poultices applied. In the majority of cases the lameness will then diminish, and in a few days completely disappear. In cases of discovery within the first few days the same treatment is applicable, and is often sufficient. If, on the contrary, pus is discharging at the coronet, if lameness is intense and the general symptoms marked, it may be needful to operate. The stages of operation comprise : thorough thinning of the horn in the shape of an inverted V over the affected portion of the wall, removal of the loose necrosed parts, disinfection of the wound, and the application of a surgical dressing covering the entire claw. PICKED-UP NAILS, Etc. ("GATHERED NAIL/0 Penetrating wounds of the plantar region are, as in the horse, usually included under the heading of " Picked-up Nails." They are only seen in oxen or cows which are not shod. Pointed objects, like nails, harrow teeth, sharp fragments of wood or glass, etc., may produce injuries of the character of that now in question. In considering the position of such wounds we may for convenience divide the plantar region into two zones, one extending from the toe of the claw to the point of insertion of the perforans tendon, the other comprising the region between this insertion and the bulb of the heel. Symptoms. Lameness occurs immediate!}', and varies with the in- tensity of the existing pain. If the offending body has not remained fixed in the wound, this lameness may in a few moments disappear, either for good or merely for a time. The recurrence of lameness on the following day or a couple of days later marks the commencement of inflammatory changes in the deeper seated tissues. This lameness in many instances is accompanied by a movement suggestive of string- halt, the foot being kept on the ground only for a very short time, or sometimes not being brought into contact with the ground at all. The depth to which the offending object has penetrated, and the direction it has taken, may sometimes be discovered by a mere casual examination of the sole. In other cases only the orifice by which it has penetrated can be found. If the injury has existed for several days, the discharge from the puncture will be thin and blackish, purulent, or blood-stained, according to the case. Fever and general systemic dis- turbance suggest an injury of a grave character. 38 DISEASES OF THE FOOT. Diagnosis. The diagnosis is easy, inasmuch as the lameness ahiiost directs examination to the foot. Prognosis is rarely grave. The direction, the situation and mode of insertion of the flexor tendon, which forms the plantar aponeurosis, ensure this aponeurosis being rarely injured by objects penetrating from without. The points of the offending bodies usually pass either forwards to the phalanx or backwards in the direction of the plantar cushion. Treatment. The first stage in treatment consists in removing the foreign body and thoroughly thinning the neighbouring horn. An antiseptic poultice consisting of linseed meal saturated with 3 per cent, carbolic acid or creolin solution is then applied. Considerable and pro- gressive improvement usually takes place in a few hours. If lameness persists, surgical interference becomes necessary ; in the anterior zone it is confined to removing any dead portions of the velvety tissue and to extirpating the fragment of bone which has undergone necrosis. In the posterior zone the sinus must be probed and laid open, so that all the diseased parts can be treated as an open wound. If, as happens in exceptional cases, the plantar aponeurosis is found to be severely injured, the complete operation for picked-up nail, as practised in the horse, may be performed, or the claw may be ampu- tated. In the former operation the horn covering the sole is first thinned " to the blood." The stages of operation are as follows : — (1.) Ablation of the anterior portion of the plantar cushion. Trans- verse vertical incision at a distance of IJ inches in front of the heel ; excision of the anterior flap. (2.) Transverse incision and ablation of the plantar aponeurosis by the same method. (3.) Curettage of the point of implantation of the aponeurosis into the bone. (4.) Antiseptic dressing of the claw. Finally, if the primary lesion, wherever it may have started, has become complicated by arthritis of the interphalangeal joint, it will be necessary to remove the claw, or, better still, to remove the two last phalanges, the latter operation being easier than the former, and providing flaps of more regular shape and better adapted for the production of a satisfactory stumj). INFLAMMATION OF THE INTERDIGITAL SPACE, (CONDYLOMATA,) Condylomata result from chronic inflammation of the skin covering the interdigital ligament. Any injury to this region causing even superficial damage may result in chronic inflammation of the skin INFLAMMATION OF THE INTERDIGITAL SPACE. 39 and hypertrophy of the papillae, the first stage in the production of condylomata. Injuries produced by cords slipped into the interdigital space for the purpose of lifting the feet when shoeing working oxen are also fruitful causes. Inflammation of the interdigital space is also a common complication of aphthous eruptions around the claws and in the space between them. Continual contact with litter, dung and urine favour infection of super- ficial or deep wounds, and by causing exuberant granulation lead to hypertrophy of the papillary layer of the skin. When the animal stands on the foot the claws separate under the pressure of the body weight and the condylomata are relieved of pressure. When, however, the limbs are rested, the claws mutually approach, compress the Fig. 16.— Condylomata of the interdigital space and sidebones. abnormal vegetations, flatten, excoriate, and irritate them, thus favouring their further development. The symptoms are easy to detect." The animals appear in perfect health, but have difficulty in walking, and show pain. They walk as though on sharp, rough ground, and .lameness is sometimes severe. Locally, the anterior surface of the claws and the interdigital space are markedly congested and sensitive, or painful on pressure. The growths are of varying size, isolated or confluent, bleeding, excoriated, or covered with horn, and are visible between the claws when the animal stands on the limb. In many cases they form a perfect cast of the vertical interspace. When the superficial layers have undergone conversion into a horn-like material, lameness diminishes or disappears. Diagnosis presents no difficulty. Prognosis is only grave in so far as the condition interferes with animals working, but it may render working oxen entirely useless. Treatment in the early stages is of a preventive character, and consists in placing animals which have been accidentally injured or attacked with foot-and-niQuth disease on a perfectly clean bed. 40 DISEASES OF THE FOOT. Surgical treatment is the only reliable method in cases where hyper- trophy of the papillary layer is well marked, and is extremely simple. The animal should be fixed in the trevis, the foot to be operated on separately secured, and the growths completely removed with sharp scissors or with a bistoury and forceps. When bleeding has subsided the wound is covered with a mixture of equal parts of iodoform, tannin, and pow'dered boric acid, and an interdigital dressing is applied. The dressing is removed after five to ten days, according to circumstances. If the cicatrix shows signs of exuberant growth it is dusted with powdered burnt alum, and the parts are treated as an open wound. When the growths are covered with horn and no longer painful it is not desirable to interfere with them. CANKER. Canker — i.e., chronic suppurative inflammation of the podophyllous or velvety tissue — is accompanied by hypertrophy of the papillae and pro- gressive separation of the horn of the sole. It is much rarer in the ox than in the horse, although it occasionally occurs. Prolonged retention in dirty stables, where the bedding is mixed with manure and continually moistened with urine, ia the principal cause of the disease. Individual predisposition and the action of some specific organism may also have some influence. Canker in oxen, like the same disease in horses, is recognised by softening and separation of the horn of the sole, and by progressive extension of the process towards neighbouring parts. The usual course consists in invasion of the podophyllous tissue, separation of the wall and of the heels, and pathological hypertrophy of the horn-forming tissues, producing condylomata. The new growths do not attain the same dimensions as in the horse, but, on the other hand, the disease very frequently takes a progressive course, invohdng the whole of the claw. A trifling accidental injury may be followed by infection of the subungual tissues, and thus become the point of origin for canker. Canker may attack only one claw ; on the other hand, it may extend to both claws of one foot, or to the claws of more than one foot in the same animal. Diagnosis. Diagnosis is easy. The separation of the horn, the presence of a caseous, greyish-yellow and offensive discharge between the separated parts and the horn-secreting tissues, the appearance of the exposed living tissues, etc., leave no room for doubt. Prognosis. The prognosis is grave; for, as in the horse, the disease is obstinate. PANARITIUM — FELON — WHITLOW. 41 Treatment consists in scrupulously removing all separated horn, so as full}^ to expose the tissues attacked by the disease. The parts should then he thorouglily disinfected with a liquid antiseptic, and a protective pressure dressing applied. As a rule, cauterisation with nitric acid, followed by applications of tar or of mixtures of tannin and iodoform, iodoform and powdered burnt alum, etc., effect healing, without such free use of the knife as has been recommended in the horse during the last few years. GREASE. Grease in the ox seems only to have been described by Morot and Cadeac, and even in these cases the descriptions appear rather to apply to elephantiasis or fibrous thickening of the skin than to grease proper. The descriptions are not sufficiently clear, and the symptoms described differ too much from t*he classical type seen in the horse to convince us without further confirmation of the occurrence of the disease. PANARITIUM-FELON-WHITLOW. An}' injur}^ in the interdigital space or flexure of the pastern may, under unfavourable circumstances, be complicated by death of the skin, necrosis of the interdigital ligament, of the fibro-fatty cushion in the flexure of the pastern, and of the terminal portions of the tendons. These lesions are sometimes regarded as panaritium. In reality, they correspond exactly to what, in the horse, are known as "cracked heels " and " quittor." The primary injury becomes infected with organisms which rapidly cause death of the skin or the formation of a deep-seated abscess and necrosis of the invaded tissues. Causation. Neglect of sanitary precautions and filthy stables con- stitute favouring conditions, the feet being continually soiled and irritated b}' the manure and urine. Animals reared on plains, and having broad, flat, widely-separated claws, are more predisposed than animals from mountainous regions, in which the interdigital ligament is stronger and the separation of the claws less marked. Any injury, abrasion, or cut may serve as a point of origin for such complications. Panaritium may even occur as an enzootic with all the characters noted in isolated cases. In Germany it has received the name of ''con- tagious foot disease." These enzootic outbreaks of panaritium follow epizootics of foot-and-mouth disease, with lesions about the claws. Through the superficial aphthous lesions the parts become inoculated with bacteria, and the severity of the resulting injury is in some measure an indication of the virulence of the infecting organism. 42 DISEASES OF THE FOOT. Symptoms. The first important symptom consists in intense local pain, rapidly followed by marked lameness. The affected region soon becomes swollen ; the coronary band appears congested ; the skin of the interdigital space projects both in front and behind ; the claws are separated, and all the lower portion of the limb appears congested and (Edematous. The engorgement usually extends as high as the fetlock, and the parts are hard and extremely sensitive. The patient is feverish, loses appetite, and commences to waste. After five to ten days sloughing occurs at some point — if the ligament is affected, in the interdigital space ; if the tendons, or the fibro-fatty cushions, the slough aj^pears in the flexure of the pastern. The dead tissue may separate and fall away, or remain in position macerated in pus. Separation is generally slow, requiring from twelve to fifteen days, and, unless precautions are taken, complications occur. If only the interdigital ligament or fibro-fatty cushion be necrotic, recovery may be hoped for ; but, on the other hand, if the tendons, tendon sheaths, ligaments, or bones are affected, complica- tions like suppurating synovitis, suppurating ostitis, arthritis, etc., super- vene, with fatal results. Death may occur from purulent infection, unless the animal is slaughtered early. The diagnosis is easy. The intensity of the lameness, separation of the claws, sw^elling of the pastern region, sensitiveness of the swollen jmrts, and absence of lesions in the ungual region sufficiently indicate the nature of the condition. The prognosis is grave, for complications may result, in spite of proper treatment. Treatment. Treatment consists, first of all, in thoroughly cleansing the affected limb and placing the animal on a very clean bed. The parts are next subjected to antiseptic baths containing carbolic acid, creolin, sulphate of zinc, or sulphate of copper. It is often more convenient, and quite as efficacious, to apply antiseptic poultices to the foot and pastern, and to allow them to remain for some days, being moistened several times daily with one of the solutions indicated. The effects are: rapid diminution of the pain, delimitation of the necrotic tissues is hastened, and the abscess is more readily oj^ened. Many practitioners recommend early intervention in the form of deep scarification in the interdigital space or pastern region. The local bleeding, and the drainage which takes place through the wounds so made, is said to hasten recovery or to prevent complications. When the abscess has opened, and the dead tissue separated, the abscess cavity or wound should be regularly washed out with a disin- fecting solution, to prevent complications, in case fragments of necrotic tissue have been retained. If, however, complications have occurred, no hesitation should be felt in freely incising the parts, and, if necessary, in FOOT ROT. 43 removing one or both phalanges. When both joints of one foot are affected, and arthritis threatens to or has set in, there is no object in treating the animal, and early slaughter is to be recommended. In cases where the disease follows foot-and-mouth disease, and threatens to become enzootic, it can generally be prevented spreading by keeping the foot-and-mouth subjects on very clean beds, and frequently washing the feet with antiseptic solutions. Disinfection of the sheds is also very desirable. FOOT ROT. Foot rot is a disease of sheep, and, like canker, is confined to the claws. Thanks to the progress of hygiene, it tends to become rarer, but is still seen in the enzootic form in some portions of England and Scotland, in the mountains of Vivarais, the Cevennes, and the Pyrenees. It affects large numbers of animals at once, animals belonging to one flock or to neighbouring flocks in one locality, and when it invades a sheej^ farm, all the animals may successively be attacked at intervals, according to the local conditions. Symptoms. The disease develops rather insidiously, and the patients always retain an excellent appetite. It begins with lameness, which is at first slight, later becomes accentuated, and in the last periods is very intense. On examination, the coronet and lower part of the limb as high as the fetlock are found to be swollen. Palpation reveals exaggerated sensibility, and on direct examination, a foetid discharge is discovered in the interdigital space. This discharge, which is peculiar to the onset of the disease, only continues for a week or two, and is succeeded by a caseous exudate which is always offensive, which moistens and macerates the horn, the skin, the tissues in the interdigital space, and the region of the heels. From the 20th to the 30th day after onset the claw separates above in the interdigital space. The separation extends towards the heel, then to the toe, exj)osing ulceration of the subjacent podophyllous tissue. From this time the patients experience very severe pain, and, as in other diseases of the feet, remain lying for long periods. Movement becomes extremely painful, and the animals frequently walk on the knees. The subungual lesions become aggravated, separation of the claw extends, necrosis of the podophyllous tissue and of subjacent tissue becomes more extensive, and the interphalangeal ligaments and the extensor or flexor tendons become involved. Finally, the claws are lost, and synovitis and arthritis are added to the complications already existing. In an infected locality the development is always the same. The 44 DISEASES OF THE FOOT. animals lose flesh, become anaemic, and, unless vigorously treated, soon die. The ordinary duration of the disease is from five to eight months, sometimes more. If, however, patients are isolated and well treated they recover. Causation. The specific cause of foot rot still remains to be dis- covered, although everything points to the conclusion that it consists in an organism capable of cultivation in manure, litter, etc., for foot rot is transmissible by cohabitation, by mediate contagion through infected pasture, by direct contact and by inoculation. The chief favouring influences are bad drainage, filthy condition of the folds, and herding in marshy localities. Diagnosis. The condition can scarcely be mistaken, for the sheep suffers from no other disease resembling it, excepting, perhaps, foot-and- mouth disease. Prognosis. The prognosis is grave, for the disease usually assumes a chronic course, affects entire flocks, and the patients require individual attention. Treatment. The primary essential to success in treatment consists in se23arating and isolating the diseased animals in a scrupulously clean place and providing a very dry bed. In the early stages the disease may be checked by astringent and antiseptic foot baths. It is then sufficient to construct a foot-bath at the entrance to the fold, containing either milk of lime, 4 per cent, sulphate of iron, copper sulphate, creolin, etc. Through this the sheep are passed two or three times a week. These precautions rarely suffice when the feet are already extensively diseased ; and when the horn is separated to any considerable extent, surgical treatment is indispensable. All loose portions of horn should be removed and antisej^tic applications made to the parts. When a large number of sheep are affected the treatment is very prolonged, but it is absolutely indispensable, and the numerous dressings required necessarily complicate the treatment. It would be valuable to experiment with small leggings, which would retain the dressings in position, and, at the same time, shelter the claws from the action of the litter, while favouring the prolonged action of the antiseptic. When the lesions are not extensive, a daily dressing is sufficient. Among the materials most strongly recommended are antiseptic and astringent ointments containing carbolic acid, iodoform, or camphor. Vaseline with 5 per cent, of iodine is very serviceable, and much to be preferred to applications like copper sulphate, iron sulphate, etc. Its greatest drawback is its expense. CHAPTER III. DISEASES OF THE SYNOVIAL MEMBRANES AND OF THE ARTICULATIONS, I.— SYNOVIAL MEMBRANES AND ARTICULATIONS. SYNOVITIS. Inflammation of the synovial membranes, or synovitis, may affect the synovial sacs either of the joints or of the tendon sheaths. It may be acute or chronic and occur either idiopathically or follow the infliction of an injury. Its two chief forms are simj^le, or " closed," synovitis and suppurative, or " open," synovitis, the essential distinction between which is that in the latter micro-organisms are present, whilst in simple synovitis they are absent. In all cases the disease is characterised by distension of the sac affected. Synovitis produced by a wound communicating with the outer air may be complicated by suppuration, and if the synovial membrane of a joint be involved the primary synovitis is almost always followed by traumatic arthritis. The commonest forms of chronic simple synovitis are : — INFLAMMATION OF THE PATELLAR SYNOVIAL CAPSULE. Liflammation of the synovial membrane of the femoro-patellar joint is most commonly seen in working oxen as a consequence of strains during draught. It is also found in young animals which have injured the synovial capsule through falls, slips, or over-extension of the limb. Symptoms. Development is slow and progressive, and injury may not be discovered until the lameness which follows has become fairly marked. This lesion is characterised by swelling in the region of the stifle. On palpation, fluctuation may readily be noted both on the outer and inner surfaces of the joint. The exudate is sometimes so abundant and distension so great that the straight ligaments, the neighbouring bony prominences, and the ends of the tendons are buried in the liquid swelling. Lameness, which is at first marked, often diminishes with exercise. The length of the step is lessened. 46 DISEASES OF THE SYNOVIAL MEMBRAXES AND ARTICULATIONS. Diagnosis. The diagnosis presents no difficulty, but the lesions must be distinguished from those due to tuberculosis in this region, rheumatic arthritis, and the specific arthritis seen in milch cows. The prognosis is grave, for the disease renders animals useless for work. Treatment. Best, cold moist applications, and massage constitute the best treatment in the early stages. Should swelling persist, one may afterwards apply a smart blister or even tap the joint aseptically, drawing off the fluid and then applying the actual cautery. Irritant injections must be avoided. DISTENSION OF THE SYNOVIAL CAPSULE OF THE HOCK JOINT. Bog Spavin in the Ox. Bog spavin is frequent in working oxen and in oxen from three to five years old. It is due 1o strain in draught or to strain produced in rearing up at the moment of covering. Old bulls, heavy of body, and stiff in their limbs are predisposed to it. Symptoms. The symptoms usually develop gradually and without lameness, but sometimes declare themselves more rapidly wdth lameness, accompanied by marked sensitiveness on palpation. At first the hock show^s a generalised doughy swelling, soon followed by dilatation of the articular synovial sac. Somewhat later four different swellings appear — two in front, separated by the tendons of the common extensor and flexor metatarsi, and tw^o at the back, extending inside and outside to the flexure of the hock. Diagnosis. The only precaution required in diagnosis is to avoid' confusion with articular rheumatism. Prognosis. The prognosis is rather grave in the case of working oxen, and even of bulls ; often slaughter is preferable to treatment. Treatment differs in no respect from that of distension of the stifle- joint. In young bulls aseptic puncture and drainage of the joint, follow^ed by the application of the actual cautery, probably give the best results. DISTENSION OF TENDON SHEATHS IN THE HOCK REGION. Like the preceding, this condition is rarely seen except in bulls and w^orking oxen. It is characterised by dilatation of the upper portion of the tarsal sheath, one swelling appearing on the outer side, the other on the inner. The differential diagnosis is based on the position of these synovial sacs, which are quite close to the insertion of the tendo-Achillis, and on the absence of any swelling in front of the joint. DISTENSION OF THE SYNOVIAL CAPSULE OF THE KNEE JOINT. 47 Treatment is identical with that indicated in the last condition. Massage and cold water applications should be employed at first, to be followed by aseptic puncture and withdrawal of fluid, supplemented if necessary by firing in points. DISTENSION OF THE SYNOVIAL CAPSULE OF THE KNEE JOINT. This is one of the rarest conditions now under consideration, because the synovial membranes of the knee joint are everywhere strongly Fig. 17. — Front view of the ox's hock, showing the relations of the tendons and synovial sacs. Fig. 18. — Side view of the ox's hock. The syno- vial sac of the true hock joint has been injected to show the relations of the sacs. supported by very powerful ligaments. The synovial capsules of the carpo-metacarpal and inter-carpal joints are incapable of forming sacs of any size. On the other hand, the radio-carpal may become moderately prominent in front, especially towards the outside above the superior carpal ligament. When weight is placed on the limb, the excess of synovia is expelled from the joint cavity towards this little sac, which 48 DISEASES OF THE SYNOVIAL MEMBRANES AND ARTICULATIONS. then becomes greatly distended. If, on the other hand, the knee is bent, the sac shrinks or disappears. Treatment. Treatment is restricted to the application of a blister or to firing in points. DISTENSION OF THE SYNOVIAL CAPSULE OF THE FETLOCK JOINT. The synovial capsule of the fetlock joint in the ox is strongly sup- ported in front and at the sides, but may protrude under the anterior ligament, producing a swelling behind the metacarpus under the five branches of division of the suspensory ligament and slightly below the sesamoid bones. These distensions, like bursal swellings, are commoner in hind limbs and in old working oxen. Their development is always followed in time by a certain degree of knuckling over. At first the metacarpus and phalanges come to form a straight line, but later the fetlock joint itself, is thrust forward. The diagnosis necessitates careful manual examination of the region of the fetlock joint. The prognosis is somewhat grave, for the disease sooner or later necessitates the destruction of certain animals. Treatment is practically identical with that used in all such con- ditions : friction with camphorated alcohol, cold affusions and massage in the earlier stages, followed if needful by blisters or firing in points. DISTENSION OF TENDON SHEATHS. Distension of the synovial capsule which surrounds the superior suspensory ligament, like distension of the articular capsule of the fetlock, occurs in working animals, and most commonly affects the front limbs. It is indicated by two swellings, one situated on either side of and behind the branches of division of the suspensory ligament and in front of the flexor tendons. These two swellings extend higher than the articular swellings, which, however, they sometimes accompany. The surface of the fetlock is then swollen, doughy on pressure, and some- what painful. These enlargements may produce more or less marked lameness and cause knuckling. The diagnosis is clear from local examination. The prognosis is unfavourable, as the animals after a time become useless for work. Treatment. The beginning of the disease may often be cured by baths of running water, combined with massage. At a later stage, local stimulants, blisters, or firing are necessary. The best treatment TRAUMATIC SYNOVITIS — "OPEN SYNOVITIS." 49 probably consists in puncturing the parts with antiseptic precautions, washing out the synovial cavity with an antiseptic, and immediately afterwards lightly firing the surface of the region in points. DISTENSION OF TENDON SHEATHS IN THE REGION OF THE KNEE. Any of the numerous tendon sheaths which facilitate the gliding of tendons in the neighbourhood of the knee may become inflamed and give rise to a chronic synovial swelling. The commonest of such swellings is due to distension of the sheath of the extensor metacarpi magnus, which appears as a vertical line in front of the knee, extending from the lower third of the forearm and slightly to the outer side of the central line. This synovial enlargement arises in oxen working on broken roads, in clay or marshy soils, where the animals are liable to stick fast, and are often obliged to struggle vigorously in order to extricate themselves. The diagnosis is based on the position and direction of the dilated synovial sheath. Treatment is identical with that of other cases of chronic synovitis. DISTENSION OF THE BURSAL SHEATH OF THE FLEXOR TENDONS. This condition is rare. It is announced, as in the horse, by a dilatation of semi-conical form, the apex of which is situated opposite the lower margin of the carpal sheath, the base extending as high as the infero-posterior third of the radius. The dilatation is more marked on the inner than on the outer side of the limb. Distension of the synovial sheath of the common extensor of the digits in the fore limb and of the extensor of the external digit is still rarer than the preceding conditions. TRAUMATIC SYNOVITIS-" OPEN SYNOVITIS.'^ When an injury in the neighbourhood of a joint penetrates deeply, it may implicate either the synovial sheath of a tendon or the synovial membrane of a joint. If the body inflicting the wound is aseptic, a condition which in accidental wounds is rare, the w^ound may have no grave consequences. Usually, however, the body producing the injury is infected, and the infection rapidly extends throughout the tendon sheath or synovial sac. In the first case, traumatic suppurating synovitis of a tendon sheath is the result ; in the second, a suppurating articular synovitis arises, which soon becomes complicated with injury of the articular cartilages, ligaments, etc. (traumatic arthritis). D.c. E 50 DISEASES OF THE SYNOVIAL MEMBRANES AND ARTICULATIONS.- The primary lesion may only affect the periarticular region, not directly extending to the synovial membranes, and only after an interval of some days may symptoms of supj)urating synovitis or supi^urating arthritis appear, in consequence of progressive invasion of the parts by specially virulent microbes. TRAUMATIC TENDINOUS SYNOVITIS. Suppurative inflammation of the synovial bursse of tendons in conse- quence of wounds most commonly affects the sesamoid sheaths of the front or hind limbs ; more rarely, the tendon sheaths of the hock or knee ; and, exceptionally, the small synovial sheaths of the extensors of the metacarpus and phalanges, etc. Such inflammation follows injuries with forks, harrow teeth, or any sharp foreign body. It is characterised by the existence of a fistula or wound, indicating the course taken by the body inflicting the injury, from which at first normal synovia escapes. Later, however, the discharge becomes turbid, and after the second day gives place to a clotted, serous, or purulent fluid. A diffuse, oedematous, warm, painful swelling very raj^idly develops around the injury. The animal is more or less feverish and lame. The swelling soon extends throughout the entire length of the infected synovial sheath. The patient loses appetite, and unless treatment is promptly undertaken, complications supervene which often necessitate slaughter. The prognosis is always grave. Treatment. Continuous irrigation has long been recommended. It is worthy of trial, but in the majority of cases occurring in current practice it cannot be carried out. Moussu prefers a form of treatment which he claims has always succeeded in horses and oxen — viz., irrigation of the parts, followed by injection of sublimate glycerine solution. He first washes out the infected synovial cavity with boiled water cooled to 100° Fahr. A counter-opening may become necessary, and the washing should be continued until the escaping water appears perfectly clear. Immediately after each such irrigation he injects from 7 to 14 drams of glycerine containing 1 part in 1,000 of corrosive sublimate. He repeats this treatment daily. By reason of its affinity for water and for the liquids in the tissues or suppurating cavities into which it is injected, the glycerine penetrates in all directions, reaching the finest ramifications of the synovial sacs, a fact which explains its superiority over aqueous antiseptic solutions. SujDpuration is rapidly checked and repair becomes regular. The pain and lameness progressively diminish, and recovery may be complete. TRAUMATIC ARTICULAR SYNOVITIS — TRAUMATIC ARTHRITIS. 51 It is advisable to assist this internal antiseptic treatment by external stimulants and by the use of a blister. Solutions of greater strength than 1 part of sublimate to 500 of glycerine are only required during the first few days of treatment and until suppuration diminishes. Later, they prove irritant, and interfere with healing. TRAUMATIC ARTICULAR SYNOVITIS-TRAUMATIC ARTHRITIS— "OPEN ARTHRITIS/' It has been described above how primary inflammation of the articular synovial membrane produced by a wound may rapidly develop into sup- purating arthritis. Symptoms. The pain is very marked at the moment when the accident occurs, but this pain, due to the mechanical injury inflicted, diminishes or completely dis- appears after some hours. Soon, however, synovial dis- charge sets in, announcing the onset of traumatic syno- vitis. At first limpid, it soon becomes turbid, then curdled, and finally grumous, purulent and greyish in colour. Pain then returns, rapidly becomes intense, continuous and lancinating. It produces lameness, sometimes so severe that no weight whatever can be borne on the limb. A diffuse, oedematous, warm and extremely sensitive swelling then rapidly develops around the whole of the injured joint. General disturbance, with fever and loss of appetite, appears, indicating a very alarming condition. It is sometimes a little difficult to differentiate between this condition and that due to injury of a tendon sheath, but as a rule diagnosis is easy. Prognosis is very grave. Life is threatened, and wastmg occurs very E 2 Fig. 19. — Suppurative arthritis of the fetlock. 52 DISEASES OF THE SYNOVIAL MEMBRANES AND ARTICULATIONS. rapidly. Infection of the synovial membrane is soon followed by necrosis and erosion of the articular cartilages, as well as by softening and inflammatory change in the ligaments, etc. Treatment. Should the patient be in reasonably good condition, but otherwise of no particular value, it should at once be slaughtered. If, on the other hand, it possess a special value, and the owner wish to preserve its life, the same antiseptic ^ .' treatment should be adopted as was indicated in dealing with suppurating synovitis of tendon sheaths. The loss of the articular cartilage of the joint is followed by free granu- lation and union of the apposed surfaces of bone resulting in anchylosis of the joint and /^l 'Tspr''^^''*^ .^^'ll^K qualified recovery. Such re- sults, however, are only likely to follow in relatively light animals w^hich are capable of standing for considerable periods. II.— STRAINS OF JOINTS. When, in consequence of muscular contraction or ex- ternal violence, the bony sur- faces constituting a joint are displaced so as to stretch, lacerate, or partially tear the ligaments, synovial capsule or tendons supporting the joint, so-called sprain, or strain, or w^rench results. The articular surfaces are not sufficiently displaced to cause luxation, but a series of periarticular injuries result, and are followed by the symptoms which we recognise as those of strain. Joints in which movement is restricted within narrow limits, such as the hock or fetlock, are most liable to such injuries, which also occur in very freely movable articulations like the shoulder and stifle. Fig. 20. — Suppurative arthritis following traumatic osteo-periostitis. STRAIN OF THE SHOULDER. This accident is produced by the animal falling on its side, by slipping at the moment of landing, the limb being extended and in contact with STRAIN OF THE KNEE. O^ the ground, by the foot slipping at the moment when it is leaving the ground and the limb is at its extreme limit of backward extension, by side slips, etc. The periarticular lesions will then be found on the front, back, or internal surface of the articulation, depending on the manner in which the accident has occurred. According to some authors, violent muscular efforts, as well as work in soft clay soil, bogs and rice swamps, are also capal)le of causing strain of the shoulder. Symptoms. At first moving appears difficult, the patient lies down a great deal, then lameness becomes characteristic. Movement of the scapulo-humeral joint being painful, the patient endeavours as far as possible to avoid it ; the limb is advanced stiffly in an abducted position and with a mowing movement. This semi-circular movement avoids the necessity of flexing the scapulo-humeral angle, but diminishes the length of the stride. Locally, the region of the scapulo-humeral angle is swollen, doughy, and extremely sensitive on manual examination. If the practitioner endeavours to flex it by lifting the limb the animal flinches. Diagnosis. The diagnosis is not very difficult, although the peculiar mowing movement is also seen in other cases, such as cracked heels and mallenders. Prognosis. The prognosis is favourable, for, provided there has been only a moderate strain of the tendons or isolated injury to the muscles, recovery is almost certain. Treatment. Treatment consists in resting the animal and in assisting repair. The parts can be immobilised by the a^jplication of a vesicant or mild blister. A week or ten days later dry friction, muscular and peri- articular massage are indicated, and gentle exercise should be commenced. The same treatment may be employed in strain of the elbow joint and in strains of muscles or tendons in the neighbourhood of joints. Such lesions are, however, very rare in the ox. STRAIN OF THE KNEE. Strain of the knee is commoner in the ox than in the horse, because of the special conformation of the knee in the ox and the mode of working under a yoke. This mode of working gives less individual liberty to the fore quarters, and sometimes interferes with the animal's efforts when moving a load. Strains of ligaments and periarticular injuries occur as a general rule on the inner side of the limb. The symptoms consist in lameness, exaggerated sensibility on pressure, pain on forced flexion of the knee, and swelling of the entire periarticular region. The prognosis is somewhat serious in working oxen. 54 DISEASES OF THE SYNOVIAL MEMBRANES AND ARTICULATIONS. Treatment, when applicable, should consist of stimulant dressings, massage, and douches. STRAIN OF THE FETLOCK. This is one of the commonest accidents of draught oxen. Causation. Working on rough, irregular, rocky ground, or on roads with deep ruts, is the commonest cause of this condition. When the animal moves on irregular surfaces the two claws do not bear an equal share of w^eight ; sometimes the whole weight is for a moment throw^n on one claw. The phalanges, therefore, are displaced inwards or outwards, or are twisted around their vertical axis, causing the fetlock joint and its sup- porting ligaments to be more or less severely strained. The internal or external ligaments of the joint or the suspensory ligament or flexor tendons may even be lacerated. The fetlock may also be strained by the animal making violent efforts to free the claws or pastern which have become fixed in a hole in the ground, in bogging, in hobbling, or in leaping a fence. Symptoms. Lameness is noticeable from the beginning, but is unaccompanied by any visible lesion. On examination of the limb, the entire region from the fetlock downw^ards is found to be sensitive to pressure, and painful when forcibly extended or flexed from side lo side. This sensitiveness is particularly marked when the phalanges are rotated on the shank. A few days later the entire fetlock becomes the seat of diffused swelling. Diagnosis is facilitated by the fact that the fetlock has an entirely different appearance from that seen when tendon sheaths or the synovial capsules of joints are distended. Prognosis. The prognosis varies considerably, according to the extent to which deep-seated structures are involved, and the gravity of the lesions is usually proportioned to the intensity of the symptoms. Treatment. Frequent cold applications, cold foot baths for an hour or two night and morning, and even cold poultices are useful. When the pain has somewhat diminished, which usually occurs in from three to four days, vesicants may be employed, and, at a later stage, massage. Failing improvement by these methods, the injured 'region may be fired in points. Strain of the hind fetlock occurs under precisely similar conditions to those above described in the case of front limbs. STRAIN OF THE STIFLE JOINT. Strain of the stifle joint results from over-extension of ligaments without displacement of the patella, and also (and 'probably more O-^ THE ^ « UNIVERSITY ] \ OF y STRAIN OF THE HOCK JOINT. 55 frequently) from injuries to the aponeurosis and tendons of insertion of the abdrctor muscles of the femur and tibia. Causation. Strain of the stifle may follow violent collisions, such as occur in entering or leaving the stable, from falls on rough ground, from direct blows, from slips, etc., or even from the sudden and violent contraction of the muscles of the antero-external surface of the quarter. Symptoms. Lameness follows immediately or soon after the accident, and is of a peculiar character ; to avoid using the injured joint, the animal advances the hind limb with a mowing movement. The injured region exhibits diffuse inflammatory swelling, which impedes palpation, and makes it difficult to determine the exact nature of the local lesion. The thigh at the stifle is painful. Diagnosis and prognosis. Diagnosis presents no considerable diffi- culty. The prognosis must be based on the intensity of the symptoms, and becomes grave if the tendons or aponeurotic insertions be injured, or extensive damage have been done to ligaments. Treatment. At first, continued cold applications, douches, and massage are most useful ; blisters are more effective in the grave cases, and comprise not only the ordinary blisters, but the powerful mixed blister containing tartar emetic, powdered hellebore, bichromate of potash, etc. If for any special reason it is of importance to preserve the animal's life, the parts may be fired; but for economic reasons it is usually better to fatten it for the butcher. . STRAIN OF THE HOCK JOINT. Causation. Strain of the hock joint is commonest in young oxen which are being trained to work. Their hind quarters are necessarily more or less free, and the animals are apt to make side movements to avoid the goad, thus exposing the hock to irregular strain. The internal ligaments are more frequently strained than the external, a fact due to the conformation of the hocks. Symptoms. Strain is accompanied by lameness, most marked when the animals endeavour to turn, by exaggerated sensibility of the entire hock region, and, in grave cases, by subcutaneous oedema. Diagnosis and prognosis. Diagnosis is simple. The prognosis is sometimes grave, because a spavin or a permanent chronic enlargement of the capsule of the true hock joint may form. Treatment. It is often desirable at once to apply an extensive blister over the whole hock and to supplement this at a later stage by cold applications, or by continuous cold irrigation for half an hour or more both night and morning. In exceptional cases the use of the actual cautery becomes necessary. 56 DISEASES OF THE SYNOVIAL MEMBRANES AND ARTICULATIONS. III.— LUXATION OF JOINTS. Luxation consists of permanent displacement of the bony surfaces forming a joint, and may follow violent mechanical injury or any other cause. Luxations have been divided into congenital, i.e., such as exist from the time of birth ; spontaneous, i.e., those which result from some defect of conformation or constitution ; and acquired or accidental, which occur as results of falls, wounds, accidents, etc. From the point of view of their duration, luxations are termed temporary when they do not necessitate reduction, progressive when the tendency is towards greater and greater displacement of the surfaces, or permanent when reduction is impossible. Those commonest in bovines are luxations of the femur, luxation of the patella, femoro-tibial luxation, and luxation of the scapulo-humeral joint. LUXATION OF THE FEMUR. Luxation of the head of the femur with displacement beyond the cotyloid cavity is very frequently congenital. The condition also occurs with some frequency in adults or aged animals in consequence of relaxation of the articular ligaments and the absence of the subpubic ligament (pubio-femoral ligament). • Causation. Luxation may be congenital, the head of the femur being displaced backwards and carried above the cotyloid cavity. This form is of no practical interest, because the animals are not usually reared. More frequently in young or adult animals 'it assumes the spontaneous progressive form, in consequence of degenerative changes in and relaxation of the coxo-femoral interosseous ligament. The head of the femur presses on the upper margin of the cotyloid cavity, which it injures, and eventually becomes lodged in the neighbourhood of the neck of the ilium, in the great sciatic notch. This luxation is also found as a purely accidental occurrence in animals which have suffered from falls and from slipping of the hind limbs backwards or sidewards, as occasionally follows awkward leaping movements. The slipping outwards of the limbs, which causes this form of luxation, is comparatively easy, because of the absence of the pubio- femoral ligament. The accident may also be followed merely by subluxation, that is to say, tearing of the inner portion of the capsular ligament and ruj^ture of some portion of the adductor muscles of the thigh without rupture of the interosseous fibres, the head of the femur not quitting the cotyloid cavity. This accident occurs in stables with smooth, slippery floors, and in railway trucks. It may affect one side or both. The latter condition is exceptional. LUXATION OF THE FEMUR. 57 Finally, luxation may be either complete (in which case the capsular and interosseous ligaments are both ruptured) or incomplete. In the former case, the head of the femur becomes displaced upwards and forwards towards the great sciatic notch, more rarely backwards in the direction of the ischium, and in exceptional cases downwards and inwards below the pubis into the foramen ovale. Symptams. The symptoms vary, depending on whether the luxation is of the spontaneous, progressive order or, on the contrary, is accidental. In progressive luxation, the animals are able to rise and walk with difficulty. The affected limb swings when the animal is advancing, not as though it were paralysed, but simply as though displaced at its upper Fig. 21. — Accidental luxation of the hip joint. part. Pain is exhibited when weight is placed on the limb, and there is difficulty in movement. The limb appears shorter than its neighbour when the animal stands on it, and the prominence representing the trochanter is more marked When a false joint has formed, the limb is rigid, is moved stiffly and abducted, and the stride is shortened. In accidental luxations, either of one or both limbs, the attitude assumed by the animal is often characteristic. One of the limbs is ex- tended at right angles to the longitudinal axis of the body, and some- times both limbs assume this position, an attitude which would be absolutely impossible under normal conditions. The animal cannot rise. It lifts the front part of the body by rising on its knees, but the hmd quarters do not follow. The ruptured adductor muscles are unable to bring and hold the limb parallel to the longitudinal axis of the body ; the abductors act unopposed, and at the moment when the animal makes 58 DISEASES OF THE SYNOVIAL MEMBRANES AND ARTICULATIONS. its greatest effort to rise the limb (or limbs) is carried outwards and the body comes to the ground on the udder or groin. Inspection discovers a depression where the great trochanter should be. On applying the open hand over the hip joint, whilst an assistant who grasps the pastern moves the limb in different directions, one can feel and hear, in spite of the mass of muscle covering the part, a modified crepitation due to sero-sanguinolent effusion in and around the joint. This crepitation can also be detected by pushing the hand as high up as possible on the internal surface of the thigh, and thus exploring the neighbourhood of the luxation. Diagnosis. The j)Osition which the animal assumes when one endeavours to make it rise is characteristic. Diagnosis of progressive luxation, however, is more difficult. Prognosis. The prognosis is extremely grave ; for, even though reduction can be effected, one is practically unable to ensure that the parts shall remain in position. Treatment. Treatment comprises reduction of the luxation and fixation of the parts. Reduction can be effected without very much difficulty by casting the animal on the affected side, placing a block of w^ood, or a pail, between the thighs, and manoeuvring the limb in the desired direction. As, however, subluxation is the condition most commonly seen, there is frequently no reduction to effect. More- over, fixation of the joint after reduction is almost impossible in such heavy subjects, and luxation is very liable to recur. From an economic standpoint, slaughter is advisable or imperative. LUXATION OF THE PATELLA. Luxation of the patella is not uncommon in working oxen, and is occasionally seen in cows as the result of a slip when entering or leaving the byre, the reason being the peculiar anatomical arrangement of the femoro-patellar articulation. The internal lip of the trochlea of the femur is very high, the external, on the other hand, being only slightly developed. The patella itself is smaller than that of the horse, and possesses a small cartilaginous prolongation, principally on its inner face, in marked contrast with the large cartilage found in the horse. As in the latter animal, the out- ward displacement of the patella is only prevented by the internal patellar ligament and the femoro-j)atellar aponeurosis. Under the influence of varying causes to which the joint is exposed, these supporting structures often prove insufficient to prevent the patella being displaced outwardly. Causation. From an anatomical standpoint, luxation inwards seems impossible. It certainly must be very rare and be preceded by rupture of the external ligament. On the other hand, as in the horse, it seems LUXATION OF THE PATELLA. 59 230ssible that the patella may be caught on the summit of the internal lip of the trochlea, especially if the trochlea happens to present a flattening at that point. Outward luxation may be spontaneous or accidental. It is termed spontaneous, when produced by relaxation of the ligaments of attachment or by irregular muscular action ; accidental, when resulting directly from any external mechanical cause.* Violent contraction of the triceps cruralis, by lifting the patella beyond its normal limit of travel, helps, or at least permits, the patella to be displaced outwardly at the moment when the muscle relaxes. Pathological relaxation of the ligaments and muscles, by allowing the patella to descend too far on the trochlea, also renders displacement possible, hence spontaneous luxation sometimes occurs even while the animal is at rest in the stable. This luxation is certainly only of a temporary character, or perhaps only of the nature of subluxation, and is often reduced by mere muscular contraction when the animals are forced to move. Should the hind limb slip in a backward direction the angle of the joint becomes more obtuse and the lips of the trochlea are turned down- wards, thus greatly favouring lateral displacement of the patella, which under these circumstances is no longer immobilised on the trochlear pulley; displacement outwards then occurs, constituting the condition termed luxation. Various forms of mechanical violence, like blows, collisions of the stifle with the jambs of doors, falls, etc., may also bring about this luxation. The symptoms of fully-developed accidental luxation are charac- teristic. Immediately the accident occurs, the limb is immobilised in a state of complete extension ; neither the stifle nor the hock joint can be flexed, and only the fetlock joint retains any degree of mobility. Movement is very difficult. The hind limb appears rigid, as though formed of one bone. The pastern is directed backwards and dragged along the ground, and when weight is placed on the limb the anterior surface of the pastern may almost be in touch with the ground. The limb is advanced, but the foot cannot be placed properly on the ground. Locally the patella is found to be outside the external lip of the trochlea, and its internal ligaments are extremely tense. If the luxation is spontaneous and of muscular origin, or a consequence of relaxation of the tendons, it is usually noticeable immediately the animal leaves the stall. The animal cannot move without great difficulty. It grows steadily worse with the lapse of time, because the synovial mem- brane becomes irritated and chronic arthritis is set up. The symptoms are identical with those of traumatic luxation, but are only temporary. 60 DISEASES OF THE SYNOVIAL MEMBRANES AND ARTICULATIONS. Diagnosis. The position of the limb and the displacement of the patella are sufficiently distinctive to render dia.gnosis fairly easy, and to allow of this accident being differentiated from luxation of the femoro- tibial joint or hooking of the patella in the ischio-tibial muscle. Prognosis. The prognosis varies greatly. If the luxation is of traumatic origin and the accompanying symptoms are not grave, reduc- tion may be followed by permanent recovery. On the other hand, in spontaneous luxation recurrence is almost inevitable. Treatment. The indications for treatment may be comprised in a single phrase: reduction, with immobilisation of the parts for a suffi- cient time. To effect reduction, a strip of webbing is fixed around the pastern of the affected limb, passed over the withers, in front of the shoulder of the opposite side, and brought round in froilt of the neck or between the front limbs. By means of this an assistant exercises strong traction on the limb until the fetlock is raised as high as the elbow of the same side. The operator then applies strong inward pressure to the Fig. 22. — Bandage for luxation of the patella. patella, which usually slips back on to the gliding surface of the trochlea at the first or second effort. After-treatment comprises the application of a smart blister, produc- ing oedematous infiltration of all the tissues around the joint, and thus impeding movement and recurrence of luxation. For this purpose various preparations are used — e.g., cantharides, biniodide of mercury, croton oil, etc. It is also advisable to fix the animal so that for a time it cannot lie down, and to secure the pastern to the neck by means of a side-line. As an experiment, cases of simple fixation of the patella on the summit of the internal lip of the trochlea might be treated by Bassi's method — i.e., subcutaneous division of the internal lateral ligament of the patella which holds the bone in its abnormal position. Finally, in spontaneous luxation, occurring in young animals in which blisters have been ineffectually tried after reduction, Benard's bandage may be used, though it is not generally regarded as very practical. It consists of a piece of cloth of elongated lozenge form about four feet in length, six inches in breadth at its centre and two inches at its ends. Its centre is pierced by a transverse opening intended to surround the patella, and carries a loop for the purpose of supporting the turns of bandage. A second longitudinal opening is situated about eight inches from the centre. LUXATION OF THE FEMORO-TIBIAL ARTICULATION. 61 Eeduction being effected, the whole region of the stifle joint is covered ^Yith Burgundy or ordinary pitch and the bandage then applied. The patella projects through the central opening. The end A is passed backwards around the thigh, and through the aperture B ; the two cross ends are then brought forward, crossed again" at the end, the loop over the patella carried a second time backwards, again crossed, and finally fixed in front under the patella. The bandage should be firmly applied, without, however, being so tight as to interfere with circulation, and must be left in place from eight to ten days. Van Denmoegdenberg recommends placing the patient on an inclined plane, with the hind quarters a foot higher than the front, so as to cause permanent contraction of the anterior muscles of the quarter, and thus Fig. 23. — Backward luxation of the fcuioro-tibial joint. (From a photograph by Professor Besnoit.) immobilise the patella. Simple cold baths, frequently repeated, friction with camphorated alcohol or essence of turpentine, complete this original but somewhat questionable treatment, and are said to result in recovery in a fortnight. LUXATION OF THE FEMORO-TIBIAL ARTICULATION. This form of luxation is rare, a fact explained by the strength of the lateral ligaments of the joint, and of the cruciform interosseus ligaments. It may assume different forms, according as the head of the tibia is dis- placed in front of, behind, to the inside, or to the outside of the lower extremity of the femur. In all, therefore, it may appear in four different forms. The commonest is backward luxation. 62 DISEASES OF THE SYNOVIAL MEMBRANES AND ARTICULATIONS. Causation. With the sole exception of luxations or subluxations due to tuberculosis (lateral . luxations, either inwardly or outwardly, occurring during tubercular arthritis, with more or less marked destruction of the condyles), these luxations are always accidental or the result of mechanical violence. They result from leaping into hollows, falling into deep ditches or ravines, or galloping through broken or steep places. Any violent shock affecting the femur, either in front or from the outside, is capable of causing luxation backwards or inwards. Symptoms, The most frequent condition is backward luxation of the upper extremity of the tibia. Movement becomes difficult, the limb is held rigidly, and all the lower part of the leg is extended. None of the joints can be flexed. The leg is dragged forward, without the animal being able to place the foot flat on the ground, and the claws are trailed over the litter or the toe grazes the soil. On local examination the stifle is seen to be deformed. The lower extremity of the femur and the patella appear prominent. The upper part of the tibia is thrust backwards, and seems to have disappeared, leaving a depression below the femoro-patellar region. The muscles form- ing the back of the thigh at this level are thrust out of position, and appear to i)roject abnormally. Viewed from behind, the inner line of the thigh appears more or less convex when the upper extremity of the tibia is luxated inwardly. On local examination the displacement of the bones can be readily detected. In luxation forwards the prominence of the stifle is caused by the summit of the tibial crest and by the patella, whilst the lower extremity of the femur cannot be felt. In outward luxation the upper extremity of the tibia forms an abnormal prominence, above which a horizontal digital depression appears. Diagnosis. Provided that the examination is made soon after the occurrence of the accident, little difficulty will be found in coming to a conclusion, but the diagnosis necessitates more care when examination is deferred for two or three days, because extensive effusion then exists. Luxations or subluxations of tuberculous origin are generally consecutive to old-standing destructive tuberculous arthritis. The prognosis is grave — firstly, because reduction is difficult; and, Fig. 24. — Luxation back- wards and inwards of the femoro-tibial joint. (From a photograph by Professor Besnoit.) LUXATION OF THE SCAPULO-HUMERAL JOINT. 63 secondly, because it is often impossible to maintain the reduction and to preserve complete immobilisation of the injured joint. Treatment should not be undertaken except in young animals which have not yet attained full development. In attempting to reduce outward or inward luxation of the tibia the animal should be cast on the side opposite to the lesion. Counter- extension is practised by passing a length of webbing around the limb in the region of the groin ; extension in the direction of the length of the femur by means of a loop of webbing fixed to the cannon bone : the operator uses both hands in endeavouring to replace the head of the tibia. In forward luxation of the tibia counter-extension is effected by means of a loop of webbing passed above the hock and drawn forward. Extension is made backwards in an oblique direction, the operator again being left free to effect reduction with both hands. Eeduction of backward luxation of the tibia is still more difficult, in consequence of the contraction of the mass of muscle at the back of the thigh. Plaster bandages are the most convenient means of immobilising the parts after reduction. LUXATION OF THE SCAPULO-HUMERAL JOINT. This luxation, like that of the femoro-tibial articulation, is exceptional. It may assume one of two forms, depending on whether the head of the humerus is displaced inwardly, or tow^ards the back of the glenoid cavity ; but as a rule luxation occurs inwardly. Forward luxation of the head of the humerus is almost impossible, in consequence of the resistance offered by the tendons of the flexor brachii and antea spinatus muscles. Similarly, luxation outwards is very difficult, the tendon of the postea spinatus being very powerful and offering enormous resistance. Inwardly, on the other hand, the insertion of the subscapularis is much less powerful, and there is no real opposition to movement of the head of the humerus. Causation. Violent mechanical shocks transverse to the upper third of the arm may, by sheer force, displace the head of the humerus in an inward direction, causing rupture of the internal wall of the capsular ligament and of the subscapularis muscle. Jumping from high to low ground and falling on the front limbs tend to disj)lace the glenoid cavity in front of the head of the humerus, and often result in luxation of the bone in a backward direction, a luxation, however, which almost always assumes a postero-internal direction. The commonest causes of these luxations are the sideward falls of animals which have attempted to 64 DISEASES OF THE SYNOVIAL MEMBRANES AND ARTICULATIONS. cover others. Whether the subject be a bull or a cow, if the stationary animal suddenly moves to one side, or if the moving animal is frightened by the appearance of a dog, one of the front limbs may be violently dragged away from the body ; the resistance of the capsular ligament and internal muscles of the shoulder may be overcome and luxation produced. Symptoms. Symptoms are immediately apparent : no weight can be placed on the injured limb, and the animal moves on three legs. All muscular action is avoided, the limb is slightly shortened as a conse- quence of the head of the humerus slipping behind the shoulder, which is held rigidly during movement ; the points of the claws are dragged along the ground. On local examination the point of the shoulder appears to be deformed and outwardly displaced, in consequence of the pressure exercised by the displaced head of the humerus. Below the glenoid cavity and coracoid process lies a depression, at the base of which the displaced humerus can be felt. This depression, however, is soon filled up by the sero- sanguinolent effusion consequent on luxation. Diagnosis. Bearing in mind the conditions to which the accident is due, the diagnosis presents no great difficulty. Prognosis. The prognosis is grave, for although it is relatively easy to reduce the displacement, it is very difficult to keep the joint fixed in j)osition. Treatment. To effect reduction, the animal should be cast on the sound side, and a loop of webbing passed under the arm, in order to provide for counter-extension. The limb is extended by direct traction on the cannon bone or fetlock, whilst the operator endeavours to effect reduction with one hand placed in front and one behind the joint. In young animals of trifling weight immobilisation may be attempted, the best method being the application of pitch plasters. If, on the other hand, the subject is heavy, there is so great a chance of displacement when lying down and rising, that such cases are usually sent to the butcher, or abandoned to chance. Pielative recovery, sufficient to permit of growth or fattening, may take place without professional assistance. IV.— HYGROMAS. Hygromas result from chronic inflammation of serous bursee, naturally existing, or of serous bursae which form at prominent points where the skin is exposed to repeated friction, blows, shocks, or over-extension. They usually develop slowly, without producing marked pain or alarming symptoms, and therefore the practitioner is seldom consulted until the swelling has attained a considerable size. HYGROMA OF THE KNEE. 65 discharging pus. thickened fibro-cartilaginous The hygroma is usually characterised by its non -painful character and by regular fluctuation throughout. The walls of the serous bursae are merely thickened, so that palpation is easy. Should the hygroma become infected and inflamed, it assumes the same characters as an abscess : it becomes highly sensitive, is surrounded by (Edematous infiltration, shows more marked fluctuation at some specialised point, and eventually breaks. Long-standing hygromas often have and extremely hard walls, which render examination more difficult. Where the hygroma is much exposed to friction the skin covering it undergoes complete transformation, the layers of epidermis becoming converted into a substance resembling horn. The entire substance of the wall of the hygroma then undergoes change, and is often infiltrated with lime salts or encrusted with plates of bone of varying thickness. HYGROMA OF THE KNEE. This condition is very common in bovines, a fact explained by the manner in which these animals rise. Whilst the hind limbs are being lifted, the entire burden of the body weight is transmitted to the knees and the tissues covering them ; so that, if the ground is rough, the skin may be sufficiently displaced to produce lacera- tion of the subcutaneous connective tissue, serous effusion in the layers of connective tissue, and the immediate production of an hygroma beneath the skin and in front of the synovial sheaths of the extensor tendons. Hygroma is principally caused by falls on the knees, roughness of the stable floor, prolonged decubitus during the course of a serious disease, or after an attack of foot-and-mouth disease. Hygromas may be no larger than a turkey's egg or a man's clenched fist, but sometimes assume the dimensions of a child's head. Calcifica- tion and ossification of the walls and cornification of the skin are commonest in old hygromas of the knee. The sensibility and uniform fluctuation make mistakes in diagnosis D.C. F Fig. 25. — Old-standing hygroma of the knee. PE, external coat; CC, cornified coat ; CO, osseous coat ; CP, pus cavity ; PI, internal coat. 66 DISEASES OF THE SYNOVIAL MEMBRANES AND ARTICULATIONS. difficult. The condition can only be confused with distension of the synovial sheath of the extensor metacarpi magnus ; but this (synovial) swelling extends in the same direction as the tendon, i.e., vertically, attains the lower third of the radius, and is broadest above. Hygromas must also be distinguished from tumours. Moussu only mentions a single case of this kind, the tumour being very slightly bosselated and, naturally, revealing no fluctuation. The prognosis is not grave, though the condition may prove trouble- some, because the original injuries may be continued even during treat- ment and prevent recovery. Treatment. Success rarely follows cold applications or blistering, which are only of value at the commence- ment. It is better to puncture the cavity aseptically, remove the fluid contents, and fire the growth in points. Free opening of the lowest portion of the swelling is followed by discharge of liquid, but almost inevitably by in- fection at a later stage, and by suppu- ration. Eecovery certainly may occur, a slight thickening of the anterior surface of the knee remaining; but the process is often very prolonged. Some authors prefer to pass a seton or drain vertically through the swelling. The results are identical with those following free oi)ening and drainage, suppuration being unavoidable. If the animal be sufficiently valu- able to warrant surgical intervention, the entire hygroma, together with its indurated wall, may be excised. An elliptical fragment of skin is removed from the front of the swelling, and the whole mass separated by dissecting away or tearing through the connec- tive tissue. Considerable care is necessary to avoid injuring the synovial sheaths of the extensor tendons. This treatment, which is only applicable in valuable animals, is completed by firmly suturing the lips of the wound, and applying an antiseptic surgical dressing or a plaster bandage similar to that used in operating on broken knees in horses.* The animal must be prevented from lying down until the wound has firmly united. * See Dollar's "A Surgical Operating Table for the Horse." (London: Gay and Bird.) Fig. 26. — Hygroma of the knee. The skin has undergone conversion into a substance resembling horn. HYGROMA OF THE STIFLE. 67 HYGROMA OF THE HAUNCH. With the exception of hygroma of the knee, hygromas are commoner on hind than on front limbs. That of the hamich is limited to the external angle of the ilium. It follows violent falls or collisions with door posts, and results from laceration of the layers of subcutaneous connective tissue and separation of the skin from subjacent parts. The effusion is often of a sero-sanguinolent character. It is more frequent in animals occupying narrow or irregularly shaped stalls, the hygroma being developed through repeated collision of the angle of the haunch with the wall. Finally, it may follow prolonged decubitus. Diagnosis is easy, but the prognosis has a certain element of gravity, because, should suppuration occur, it may be succeeded by necrosis of the aponeurosis inserted into the external angle of the ilium. Treatment should first be directed to removing the cause. Of the various modes of intervention, the best probably consists in disinfecting the parts, puncturing the swelling, and injecting some irritant of an antiseptic character, or simply washing out the cavity. Iodine and carbolic solutions are most commonly employed. Firing is contra- indicated. HYGROMA OF THE TROCHANTER OF THE FEMUR. This condition is rare, except in thin milch cows kept under bad hygienic conditions and insufficiently supplied with bedding. Continual bruising of the prominences of the quarters whilst the animal is lying is the usual cause. This hygroma forms a hemispherical swelling covering the trochanteric prominence. Movement is interfered with, and the stride is shortened. The condition can only be confused with the diffuse swellings due to periarthritis in the coxo-femoral region, which frequently occur in cows suffering from infectious pseudo-rheumatism. The prognosis is somewhat grave, for in case of suppuration the insertions of tendons and fascia into the summit of the trochanter may l^ecome necrotic. Treatment. The first point is to supply the animal with ample clean bedding. The swelling may be repeatedly blistered. If considered neces- sary, a puncture may be made under antiseptic precautions, the fluid drawn off, and the cavity washed out ; but it is better to avoid opening the parts with a bistoury, on account of the danger of suppuration and of necrosis of the tendons and aponeurotic tissues in the neighbourhood. HYGROMA OF THE STIFLE. Hygroma of the stifle or of the patella appears under the skin, outside the external ligament of the femoro-tibial articulation. It usually follows F 2 68 DISEASES OF THE SYNOVIAL MEMBRANES AND ARTICULATIONS. repeated abrasion when lying down, especially if the paving of the stalls is rough or irregular. The swelling varies in size from a hen's egg up to that of a child's head, and exhibits fluctuation throughout. The prognosis is somewhat serious, for here again complications may result from necrosis of neighbouring aponeuroses. Some authors recommend passing a seton dressed with some irritant material through the swelling. Aseptic puncture, however, seems preferable, followed by washing out of the cavity and the application of a blister. HYGROMA OF THE POINT OF THE HOCK. This hygroma usually results from blows with the ox-goad, which cause inflammation of the subcutaneous connective tissue and oedematous infiltration extending down the leg. Afterwards the slightest Fig. 27.— Capped hock. Fig. 28. — Hygroma of the point of the sternum. injury, or even the friction due to the animal lying down, causes liquid to collect and an hygroma to form. This hygroma is readily infected and often suppurates; it then becomes very sensitive, producing intense lameness. More frequently, however, under the influence of prompt treatment, the liquid is HYGROMA OF THE POINT OF THE STERNUM. 69 absorbed, the layers of subcutaneous connective tissue become hardened, and undergo more or less extensive induration. HYGROMA OF THE POINT OF THE STERNUM. Hygroma of the point of the sternum is a rarity. It only occurs in thin animals in which the point of the sternum is prominent, and which are confined to stables with rough floors and provided with insufficient bedding. The swelling should not be opened, for the tissues in front of the sternum readily become the seat of suppuration. If treatment is desirable, the fluid may be drained off by means of an aseptic puncture. CHAPTER IV. DISEASES OF MUSCLES AND TENDONS. RUPTURE OF THE EXTERNAL ISCHIO-TIBIAL MUSCLE (BICEPS FEMORIS). The biceps femoris muscle extends from the superior spinous process of the sacrum to the region of the patella and the external surface of the thigh. Above, it is inserted into the sacrum and the posterior margin of the ischium, below into the supero- external surface of the tibia. It completely covers the coxo-femoral articulation, and its passage over the summit of the trochanter is lubricated by a serous bursa. The whole of its anterior margin is connected with the fascia lata by an aponeurotic expansion. From varying causes this aponeurotic layer may become fissured ; during the backward and forward movements of the limb the summit of the trochanter may enter the fissure and become fixed there by the tension and resistance of neighbouring tissues. This accident has been described as " displacement or rupture of the biceps femoris muscle." According to Cruzel, fixation of the biceps femoris may occur, in very thin animals, without rupture of the musculo-aponeurotic layer, the process being then simply confined to stretching of the aponeurotic layer over the summit of the trochanter. Under such circumstances the musculo-aponeurotic layer presents a cup-like depression, into which the summit of the trochanter fits, and thus effectually prevents movement of the muscle. Whether the accident is due to an actual fissure, or only to stretching of the aponeurosis, the symptoms are the same. Causes. The principal predisposing causes are thin condition and malformation of the limbs (turning outward of the hind toes). The accident may occasionally be caused by a slip backw^ards, or by extreme efforts in draught when ascending hills. Symptoms. Immediately the accident occurs the limb becomes fixed in a position of maximal extension. The trochanter being caught, the femur can no longer be flexed, and the lower joints are also fixed in such a way that the limb can only be moved as a whole. The claws RUPTURE OF THE EXTERNAL ISOHIO-TIBIAL MUSCLE (BISCEPS FEMORLS). 71 are dragged along the ground, and the affected limb, which can never be completely advanced, is brought forward with a mowing movement. On local examination, the trochanter appears to be very prominent, and situated directly above a rigid cord which extends parallel with the anterior margin of the affected muscle. If the accident consists merely in the formation of a depression in the muscle, in which the summit of the trochanter is fixed, and if there is no Assuring, the muscle and the femur are certainly immobilised, but 1— r Fig. 29. — Arrangement of the external ischio-tibialis muscle. 1, Anterior margin of the muscle ; 2, fascia lata. the limb can be moved to a certain extent, the '* mowing" movement is less marked, and there is no well-defined rigid cord along the anterior margin of the muscle. Diagnosis. The condition can only be confused with luxation of the patella ; but manual examination of the affected parts revealing the presence of a rigid cord below the trochanter at once removes any doubt. Prognosis. The prognosis is only grave in working animals. More- over, the accident is now much rarer than formerly, if only because animals are better looked after and better fed. Treatment. If the accident results simply from the formation of a depression in the musculo-aponeurotic layer which replaces the muscle 72 DISEASES OF MUSCLES AND TENDONS. at the point where it passes over the trochanter, there is nothing to be done. Eeduction will occur spontaneously, and entire liberty of action will be regained. Cruzel states that it is sometimes sufficient to force the animal to move down a slope, in order to withdraw the trochanter from the depression in which it has been lodged, and to restore its normal mobility. Rest and good feeding favour the deposition of fat, and soon alter the conditions responsible for the accident ; the muscles of the quarter become surrounded with fat, the external ischio-tibial muscle (biceps femoris) is thrust outwards on account of its superficial position, and then cannot be ruptured by the summit of the trochanter. If, on the other hand, the musculo-aponeurotic lajev is fissured and the summit of the trochanter firmly fixed in the opening, operation becomes necessary. This consists in incising the anterior margin of the muscle over the afore-mentioned rigid cord. The margins of the wound retract, the tension of the cord is diminished, the trochanter released, and the normal play of the limb restored. Numerous methods of operation have been described and a number of special instruments invented. The earlier methods consisted in simple subcutaneous section of the rigid cord formed by the musculo-aponeurotic layer and the muscle. Subcutaneous section is carried out exactly like tenotomy, using straight and curved tenotomes. The seat of operation is about three inches below the summit of the trochanter. In the absence of tenotomes, section may be performed with a bistoury intro- duced from below the muscle by means of a grooved director, which has been inserted through a cutaneous puncture made at the point indicated over the anterior margin of the prominent cord. In better nourished subjects, in which this cord is less prominent, the operator may, to ensure greater accuracy, make a vertical incision an inch or two in length at the point selected over the anterior margin of the muscle, isolate this muscle by means of the director, and after- wards perform the section. Considerable haimorrhage occasionally follows division of some small muscular vessel, but is of no consequence unless the wound has been infected. RUPTURE OF THE FLEXOR METATARSI. The rupture of this tendon-muscle is exceptional, and, according to the description given by Furlanetto, is attended by the same symptoms as in the horse — i.e., flexion of the stifle joint is not accompanied by flexion of the hock or of the metatarsus on the tibia. The cannon-bone hangs vertically when the limb is moved. Eeeovery follows prolonged rest. CYSTICERCUS DISEASE OF THE PIG. 73 Wounds and sections of tendons in the region of the cannon bone, sections of the tendo-Achillis, etc., have been seen and described. All such injuries may heal under antiseptic treatment and after aseptic suture of the divided ends, provided the sutures and dressings are applied immediately. If, on the other hand, suppuration, infection, necrosis of tendons, synovitis or arthritis occur as complications, such injuries become extremely serious, and from an economic standpoint render it better to sacrifice the animal rather than attempt treatment. Strains of tendons and tendinitis occur in the front limbs of oxen, particularly of those used in carts. The chief indications are swelling in the region of the cannon bone and fetlock, uneven contour of the flexor tendons, sensibility on pressure, and lameness of varying intensity. Treatment consists in continuous cold irrigation, massage, the application of a blister or even of the actual cautery. As a rule, how- ever, it is better to rest and fatten the animal. A frequent complication of such injuries of tendons consists in knuckling over at the fetlock. PARASITIC DISEASES OF MUSCLES. INFECTION WITH CYSTICERCI. Infection of the connective and muscular tissues with cysticerci results from the entry into the body of embryos of Tcenia soliitm and Tcenia saginata of man. It occurs in man and almost all animals, but is only of grave clinical importance in the pig and ox. The following table shows the chief cystic (cestode) parasites of animals, though the cysts are not always confined to muscular structures : — Adult. Larva. Name. Host. XaniP. Host. Tcenia saginata Tcenia solium . . Tcenia inarginata . Tcenia coeniirus Tcenia echinococcus Man Man Dogs Dogs Dogs Cysticercus bovis . . . Cysticercus cellulosce . Cysticercus tenuicollis . Coenurus cerebralis . . Echinococcus polymor- phus Cattle. Swine and man. Cattle, sheep, and swine. Cattle and sheep. Cattle, sheep, swine, man, etc. CYSTICERCUS DISEASE OF THE PIG. This disease of the pig is due to Cysticercus cellulosce, the cystic form of the Tcenia solium or Tcenia arniata of man. As a disease of the pig it has been recognised from the most ancient times, and is stated to be 74 DISEASES OF MUSCLES AND TENDONS. the cause of Moses and Mohammed having prohibited the consumption of pork by their disciples. In the Middle Ages it formed the subject of legislation. It was, however, only when the investigations of Van Beneden and Kuchenmeister had completed those of the zoologists of the seven- teenth and eighteenth centuries that the evolution of tsenii^ became well known and the importance of the cystic phase clearly established. Tig 30. — A piece of pork heavily infected with pork measles {Cysticercus cellu- \(e), natural size. (Stiles, Keport U.S.A. Bureau of Agiiculture, 1901.) Fig. 31. — An isolated pork-measle bladder worm {Cysticercus cellulosce), with extended head, greatly enlarged. (Stiles, Report U.S.A. Bureau of Agriculture, 1901.) Causation. The cause of cysticercus disease in the pig may be summed up in one phrase — viz., ingestion of eggs or embryos of Tcenia solium. Young animals alone seem to contract the disease. After the age of eight to ten months they appear almost entirely proof against it. It is very rare in animals reared in confinement^ but is relatively CYSTICERCUS DISEASE OF THE PIG. 75 common in those roaming at libert}' to discover human excrement and the embryos of taenia. The eggs having been swallowed, the six- hooked embiyos are set at liberty in the intestine, perforate the tissues, enter the vessels, and are carried by the blood into all parts of the body. Those alone develop well which reach the interstitial and intermuscular connective tissue. The others in the viscera usually disappear. Their presence in the depths of the muscles produces slight general disturbance and signs of local irritation, due to the development of the cyst itself. At the end of a month the little vesicle is large enough to be visible to the naked eye ; in forty to forty- five days it is as large as a mustard seed, and in two months as a grain of barley. Its commonest seats are the abdominal muscles, muscular portions of the diaphragm, the psoas, tongue, heart, the muscles of mastication, intercostal and cer- vical muscles, the adductors of the hind legs, and the pectorals. Symptoms. The symptoms of invasion are so little marked as usually to pass undetected. Occa- sionally, when large quantities have been ingested, signs of en- teritis may . occur, but these are generally ascribed to some entirely different cause. In some cases there is difficulty in moving, and the grunt may be altered. Certain authors declare that the thorax is depressed between the front limbs, but this symptom is of no particular vaUie, and is because they are much more likely Fig. 32. — Several portions of an adult pork-measle tapeworm (Tcenia solium), natural size. (Stiles, Keport U.S.A. BurepiU of Agriculture, 1901.) 76 DISEASES OF MUSCLES AND TENDONS. Fig. 33. — Large (a) and small (b) hooks of pork-measle tapeworm (Tcenia solium). X 280. (After Leuckart.) also common to osseous cachexia and rachitis. Paralysis of the tongue and of the lower jaw is of greater importance. In exceptional cases, where the cysticerci are very numerous and penetrate the brain, signs of encephalitis, vertigo, and turning sickness (gid, sturdy) may be produced. These signs, however, disappear, and the cysticerci undergo atrophy. Interference with movement may give rise to suspicion when the toes of the fore and hind limbs are dragged along the ground, and thus become worn. This pecu- liarity is due to the presence of cysts in the muscles of the limbs, but it occurs in an al- most identical form in osseous cachexia. One symptom alone is pathognomonic, and it appears only at a very late stage — viz., the presence of cysts under the thin mucous membranes which are accessible to examination, such as those of the tongue and eye. Visual examination then reveals beneath these mucous membranes the presence of little greyish-white, semi-transparent grains the size of a grain of barley, or even larger. Unfortunately, in an animal so diffi- cult to handle as the pig, this visual examination is decidedly troublesome, and is usually replaced by palpa- tion. In many instances the disease does not attract attention during the patient's life, and is only discovered on slaughter in consequence of the lesions by which it is characterised. Diagnosis. As the characteristic lesions of cysticercus disease are to be found in the depths of the muscular and connective tissues, and as the external symptoms may be regarded as of doubtful significance, the diagnosis can only be confirmed during life by manual examination of the tongue. This examination of the tongue has been practised since the earliest times. Aristophanes even speaks of it, and in the Middle Ages it was performed under sworn guarantees. The regulations concerning the inspection of meat have finally led to the suppression of this calling. Fig. 34. — Mature sexual segments of pork-measle tapeworm (T^^wia solium), showing the divided ovary on the pore side, cj), Cirrus pouch ; gp, genital pore ; n, nerve ; ov, ovary ; t, testicles ; tc, transverse canal ; ut, uterus ; v, vagina ; vc, ventral canal ; vd, vas deferens ; vg, vitellogen^ gland. X 10. (After Leuckart.) CYSTICERCUS DISEASE OF THE PIG. 77 In this method of examining the tongue, the operator commences by throwing the animal on its side, usually on the right side, and holding it in this position by placing his left knee on its neck. He then passes a thick stick between the jaws and behind the tusks, opens the mouth obliquely, raising the upper jaw by manipulating the stick. Finally he fixes one end of this last by placing his foot upon it, and holds the other extremity by slipping it under his left arm. In this position he is able to grasp the free end of the tongue and by digital palpation to examine the tongue itself, the gums, the free portions of the fraenum linguae, etc. If he discovers cysts, the diagnosis is confirmed, but failure to do so Fig. 35. — Gravid segment of pork-measle tapeworm {Tcenia solium), showing the lateral branches of the uterus enlarged. (Stiles, Keport U.S.A. Bureau of Agriculture, 1901.) by no means disposes of the possibility of infection. Eailliet declares that about one animal in four or five shows no cysts beneath the tongue, and, moreover, fraud is possible in this connection, it being quite possible to prick the little cysts with a needle so that the liquid contents escape, and examination gives no positive result. For these reasons intra-vitam examination alone is now discounted, and the chief reliance is placed on post-mortem search. Prognosis. The prognosis is very grave, not on account of danger to the lives of the infected, but because infected meat may be offered for human consumption. Should such meat, in an insufficiently cooked condition, be eaten by man, its ingestion is followed by the development of Tcenia solium. If cooking were always perfect it would destroy the 78 DISEASES OF MUSCLES AND TENDONS. Fig. 36. — Eggs of pork- ineasle tapeworm {Tcenia solium) : a, with primi- tive vitelline membrane ; 6, without primitive vitel- line membrane, but with striated embryophore. X 450. (After Leuckart.) cysticerci, but the uncertainty in this respect should prevent such meat being consumed. The cysticerci are killed at a temperature of 125° to 130° Fahr. Lesions. The lesions are represented by cysts alone — i.e., by semi-transparent bladders, each of which contains a scolex or head armed with four suckers and a double crown of hooks. The little bladders are most commonly found in the muscles, lodged in the interfascicular tissue, which they slightly irritate. The number present varies extremely, depending on the intensity of infestation and the number of eggs swallowed. Whilst in some cases difficult to discover, in others they are so numerous that the tissues appear strewn with them. They are commonest in the muscles of the tongue, neck, and shoulders, in the intercostal and psoas muscles, and in those of the quarter. The viscera — viz., the liver, kidneys, heart, lungs, etc. — are less commonly in- fested, and in these organs the cysts degenerate very rapidly. In animals which have been infested for a long time, the cysts may even have undergone caseo- calcareous degeneration, the liquid being absorbed and the lesions presenting the appearance of little oblong firm nodules. On cutting through masses of muscle the vesicles protrude from between the bundles. In young animals, infestation with cysticerci causes wasting and ill-health; subsequently the patients improve in appearance, later on fatten, and gain marketable condition. Of the carcases examined in Prussian slaughter-houses between 1876 — 82, one in every 305 was found infested ; between 1885—93, one in every 537. ^'^- ^^--^^If of hog, showing the _, , i mi • i • , , portions most likely to become Treatment. There is no curative treat- i^f,,^,^ with pork measles. ment. Only preventive measures are of (After Ostertag.) BEEF MEASLES. ?9 value. These are confined to rendering it impossible for animals to ingest eggs of the Tcenia solium. Cjsticercus disease is rare in the north, centre, and east of France, and in districts ^vhere animals are reared in confinement. It is commoner where pigs are at liberty, such as Limousin, Auvergne, and Perigord. It is frequent in North German}-, where the custom of eating half-cooked meat contributes to the propagation of T(enia solium. It is also frequent it Italy. BEEF MEASLES. Causation. The disease of beef measles is due to the penetration Fig. 38. — Cysticerctis celhdosce in pork, c, Cysts; v, fibrous tissue capsule which forms around the cyst. into the connective and muscular tissues of embryos of the Tcenia sagi- nata, or unarmed taenia of man. This disease, unlike that of the pig, has only been recognised within comparatively recent times, and only after Weisse's experiments (St. Petersburg, 1841) on feeding with raw flesh was attention drawn to it, although as early as 1782 the Tcenia saginata had been described by Goeze. Measles in the ox is rarely seen in France, but is common in North and East Africa. Alix has found it in Tunis, Dupuys and Monod in Senegal, and it is common in the south of Algeria. The disease is due 80 DISEASES OE MUSCLES AND TENDONS. simply to oxen swallowing eggs or embryos of the unarmed taenia, a fact which explains the frequency of the disease in places where the Fig. 39. — Anatomy of the Cysticercus cellulose (after Robin). A, Cyst ; B, scolex with hooks ; C, hooks ; D, magnil&ed fragment of cyst. inhabitants are of nomad habits, and consequently disregard the most elementary rules of public and general hygiene. Furthermore, cattle in the Sahara, in Senegal and in the Indies, have a very marked habit of eat- ing ordure, and as no attempts are made to prevent it, the risk to these animals is greatly increased. As in the pig, the embryos w^hich reach the stomach and intes- tine penetrate into the circulatory system, and are thereby distributed throughout the entire organism. The development of the cysti- cercus is complete in forty days, and if swallowed by man in infected meat after this period it again gives rise to the Tceiiia saginata. The age of the animals seems of less importance than in the case Fig 40 -Section of a beef tongue heavily ^^ ^^^ . ^^^, ^^^ ^^^ ^^^^,^^ infested with beet measles, natural size ^ ^ *=• . (Stiles, Annual Report U.S.A. Bureau ^ave seen cases of beef measles m of Agriculture, 1901). animals of ten years old. BEEF MEASLES. 81 Symptoms. The symptoms are still less marked than in the pig, and in ordinary cases of infection always escape observation. Stiles, how- ever, gives the following account of a case experi- mentally infected : — "Symptoms. Four days after feeding seg- ments of T. sagiuata to a healthy three -months - old calf, the patient showed a higher tem- perature (the normal temperature was 39*2° C). The calf ate but little on that day, showed an accelerated pulse, swollen belly, staring coat, and upon pressure on the sides showed signs of pain. The next day the animal was more lively, ate a little, and for nine days later did not show any special symptoms except pain on pressure of the abdo- minal walls, and a slight fever. Nine days after the infection the tem- perature was 40*7° C, pulse 86, respiration 22 ; the calf laid down most of the time, lost its ap- petite almost entirely, and groaned consider- ably. When driven it showed a stiff gait and evident pain in the side. The fever increased D.C. 82 DISEASES OF MUSCLES AND TENDONS. gradually, and with it the feebleness and low-spiritedness of the calf, which now retained a recumbent position most of the time, being scarcely able to rise without aid, and eating only mash with ground corn. Diarrhoea commenced, the temperature fell gradually, and on the twenty-third day the animal died. The temperature had fallen to 38'2° C. During the last few days the calf was unable to rise ; in fact, it could scarcely raise its head to lick the mash placed before it. Pulse was reduced by ten beats. On the last day the heart-beats were very much slower, yet firm, and could be plainly felt. Several days before death the breathing was laboured, and on the last day there was extreme dyspnoea." Diagnosis. In forming a diagnosis we meet with the same difficulty as in the case of the pig. It is always easy to examine the tongue ; but when visible lesions are absent diagnosis in the case of the ox remains doubtful and problematical even more than in the pig. In the carcase, diagnosis is much easier. The cysts are sought for, as in the pig, by making sections of muscle, those usually selected being the pterygoid, cervical, cardiac, and psoas muscles, and those of the quarters. Prognosis. The prognosis is grave, not indeed for the infected animals, which seem little injured by the para- site, but for human beings, who run the risk of contracting Tcenia inermis by eating insufficiently-cooked meat. A temperature of 115° to 120° Fahr. destroys the cysticerci, but in roast meats the central temperature of the mass always remains below this figure. Salting for fifteen to twenty days destroys the vitality of the parasite. Lesions. The lesions are confined to the presence of the cyst and of two little zones of chronic inflammation immediately surrounding it. Unless heavily infested the subjects fatten just as well as others. The vesicles are semi-transparent, -f^ inch to \ inch in length, slightly ovoid in form, and contain a taenia head with four suckers, but without hooks. Fig. 42. — Apex, dorsal, and lateral views of the head of beef-measle tapeworm (Tcsnia saginata), show- ing a depression in the centre of the apex. X 17. (Stiles, Report U.S.A. Bureau of Agriculture, 1901.) BEEF MEASLES. 83 In seven to eight months the cysts undergo degeneration, the liquid is absorbed, and calcium salts are deposited throughout the mass. The lesions ^Yhich remain have, in the ox, the appearance of interstitial disseminated tuberculosis. There is no curative treatment. The infested animal recovers spon- taneously with the lapse of time, for the cysticerci undergo degenerative processes, but the flesh of such animals is of little commercial value. From a preventive standpoint we can only hope to improve matters by a gradual and progressive change in social and public hygienic conditions. When the life of the nomad shall have been entirely replaced by that of the highly-civilised European and private hygienic precautions Fig. 43. — Sexually mature segment of beef-measle tapeworm (tcenia saginata). c.p., Cirrhus pouch with cirrhus ; d.c, dorsal canal; (/.J)., genital pore; n., lateral longitudinal nerves; ov., ovary; s^., shell-gland; ^., testicles ; z^^., median uterine stem, enlarged (in part after Leuckart) ; v., vagina ; v.c, ventral canal, connected by transverse canal ; tc, vd., vas deferens; vg., vitellogene gland. have rendered it impossible for animals to obtain access to segments or eggs of the Tcenia saginata, beef measles will disappear. At present, in the countries where the disease is common, one exj^eriences a feeling of astonishment that it is not far more frequent; for experiment has shown that a person infected with one unarmed tapeworm expels with the faeces an average of four hundred proglot- tides per month, each proglottis or segment of the worm containing about 30,000 eggs, each of which is capable of developing into a tapeworm. G 2 84 DISEASES OF MUSCLES AND TENDONS. Beef measles Switzerland, and is rather common in Germany, but rare in France, Italy. Trichinosis is Trichina spiralis. undergoes sexual trichinosis, which disease. The trichinaB directly deposited TRICHINIA.SIS-TRICHINOSIS. a disease caused by the entrance into the body of the This parasite is swallowed in the larval form, and changes in the intestine, at first producing intestinal represents the first phase in the development of the breed rapidly. The embryos penetrate into or are in the blood-vessels, which convey them to all parts of Fig. 44. — Gravid segment of beef- measle tapeworm {Tcenia sagi- nata), showing lateral branches of the uterus, enlarged. (Stiles, Annual Report U.S.A. Bureau of Agriculture, 1901.) Fig. 45. — Egg of beef-measle tapeworm {Tcenia saginata), with thick egg-shell (embryophore), containing the six- hooked embryo (oncosphere), enlarged. (After Leuckart.) the body, thus setting up the second phase of the disease, known as muscular trichinosis. Trichinosis as a disease has long been recognised. Peacock in 1828 and J. Hilton in 1832 mentioned the existence of the cysts of trichinsG ; Owen in 1835 gave the name of Trichina spiralis to the parasites con- tained in the cysts. Trichinosis being common in Germany at that time, Virchow and Leuckart undertook its investigation, but mistook other nematodes of the intestine for the Trichina spiralis. In 1847 Leydy recognised that trichinosis occurred in American pigs. In 1860 Zenker found muscular and intestinal trichinosis on post- mortem examination of a girl who had been suspected of suffering from typhoid fever, and a carefully conducted inquiry revealed the fact that TKICHTNIASIS — TRICHINOSIS. 85 this girl had some time previously eaten a quantity of raw ham. Virchow and Leuckart returned to their investigations, and the life history of the parasite soon became definitely known. Causation. Trichinosis is capable of attacking all mammifers with- out exception, from a man to a mouse ; and most animals which can be made the subjects of experiment contract the disease in varying degrees. The intestinal form is seen in birds, but the muscles do not become infested by the embryos. Cold-blooded animals are proof against the disease. After the ingestion of meat containing cysts of the parasite, the processes of gastric and intestinal digestion set the larvae at liberty. These larvae become sexual at the end of four to five days, and the females, which are usually twice as numerous as the males, begin laj'^ing eggs from the sixth day, continuing for a month to six weeks. Each female lajs approximately from 10,000 to 15,000 eggs. The embryos perforate the intestinal walls, pass into the circulation, and are hurried into all parts of the system. This i^eriod of infes- tation constitutes the first phase of the disease. Askanaz3% in 1896, suggested that it was not the embryos which perforated the intes- tinal walls and thus reached the blood-vessels, but the fertilised female trichinae themselves, which entered the terminal chyle vessels and laid their eggs directly within them. This observation is of great interest, for it contradicts the view held by Leuckart and proves that treatment is useless even in the first phase. Fig. 46. — :Male trichina from the intestine. (Colin.) The males are about -^^ inch in length, the females J inch to inch, and are ovoviviparous. Symptoms. The symptoms lack precise character, even when the disease is known to be developing, and moreover they have only been carefully observed in experimental cases. As soon as the laying period begins, signs of intestinal disturbance may be observed, possibly due to embryos perforating the intestinal walls (if we accept Leuckart's view), or^ according to Askanazy, to adult females penetrating the chyle vessels and disturbing intestinal absorption. These symptoms are only appreciable in cases of " massive " infesta- tion. If slight, the disturbance passes unperceived. In severe cases the symptoms consist of diarrhoea, loss of appetite, grinding of the teeth, 06 DISEASES OF MUSCLES AND TENDONS. abdominal pain in the form of dull colic, and sometimes irritation of the peritonemn. The embryos carried by the circulation then escape into the tissues and, like the cysticerci, become encysted, preferably in the muscles, in the interfascicular connective tissue towards the ends of the bundles. Each (asexual) parasite plays the part of a foreign body, causing infiltration of serum and exudation of leucocytes in its neighbour- hood, and soon becoming encysted in the interior of a little ovoid space surrounded by a fibro-fatty wall. Fat granules accumulate at each end of the cyst. The parasite, which at first appeared straight, soon assumes a bent form, then that of a figure " 6," then of a figure *' 3," and preserves a Fig. 47. — Free larval trichina. (Colin.) Fig. 48. — Trichinae encys- ted in the muscular tissue. (Colin.) Fig. 49.— Old (degene- rated) trichina cyst. (Colin.) latent vitality throughout the entire period of encystment. These cysts are of very small dimensions, invisible to the naked eye, and their discovery necessitates the use of the microscope. They are about ^yh inch in length and ^-Joth inch in width. Very frequently two or three cysts may be found arranged in line, presenting the appearance of beads on a string : more rarely two parasites may be found in one cyst ; exceptionally, as many as six or seven. The appearance of " beads on a string " is due to the fact that the parasites follow the interfascicular capillaries. In animals which are kept for a long time and fattened the cyst walls TRICHINIASIS — TRICHINOSIS. 87 undergo fatty infiltration. The change is commonest in pigs. In the same way calcareous infiltration sometimes occurs, but only when the parasites have lost their vitality. This calcareous degeneration consists in the deposit of carbonate and phosphate of lime in the walls of the cyst ; it never begins before the seventh or eighth month after infestation, and is sometimes much longer delayed. No man or animal ever becomes infested except by the ingestion of meat or drink containing larval trichinae. The pig and small rodents are most frequently attacked. Man contracts trichinosis by eating in- sufficiently cooked infected pork. The fact that small rodents, par- ticularly rats, eat the bodies of their kind explains the persistence of trichinosis in certain regions. Pigs roaming at large, and thus liable to find and eat the dead bodies of such rodents, may contract trichinosis in this way or from eating ordure. For some weeks after the larvae have penetrated the muscular tissues the animals show stifthess of the limbs, difficulty in moving, and in mastication, etc., but these troubles disappear in a short time. The above facts explain why trichinosis in the pig is almost unknown in France, Italy, and Spain. It is commoner in Germany and in certain States of Europe, such as Holland and Eussia, although investigations had previously shown that in Paris about 7 per cent, of the sewer rats were sufterers from trichinosis and that in Germany the percentage rose as high as 15 to 20. In Chicago and Cincinnati, U.S.A., the proportion* of rats suftering from trichinosis has been as high as 50 to 70 per cent., and as in some of the Northern States pigs were bred in complete i freedom, it follows that at one time very large numbers of American pigs must have sufiered from trichinosis. In consequence of sanitary precautions this proportion has since greatly diminished. Diagnosis. During the animal's life diagnosis is a difficult matter, though, on the other hand, simple microscopic examination of suspected meat is sufficient at once to settle the question. In dealing with the living animal, however, it is necessary, as in examining suspected meat, to obtain a fragment of muscle in order to submit it to microscopic examination. This fragment can be obtained by the method known as " harpoonage " — a trocar provided with a cutting hook, or a trocar the canula of which has a sharp-edged opening near its end, being thrust into the muscle. On removing the trocar the elasticity of the tissues causes a fragment to project into the opening in the canula, and on with- drawing the latter a fragment sufficient for examination is obtained. One may proceed in the same way by harpoonage when examining large masses of suspected meat the surface of which reveals no lesion. The specimen having been obtained, a few fragments of the 88 DISEASES OF MUSCLES AND TENDONS. muscular fasciculi are crushed between two glasses and examined with a low power. The trichinae will be found towards the ends of the muscle near the region of the tendons ; few or none exist in the fat. These parasites are most readily discovered in the diaphragm, in the muscles of the shoulders and quarters, and in the psoas muscles. Prognosis. The prognosis is relatively favourable so long as infesta- tion is only moderate. But it is very grave from the point of view of public hygiene, on account of the possibility of persons becoming infected by eating the diseased meat. Treatment. There is no curative treatment. Formerly it was believed that, f)rovided the condition were early diagnosed, the intes- tinal form might possibly be cured by administering purgatives and vermifuges so as to prevent the embryos penetrating the system. After Askanazy's discoveries this view had to be abandoned, and the practitioner is necessarily powerless in dealing with the muscular form. Time alone effects improvement and a relative cure by causing caseo-calcareous degeneration of the cysts. With a prophylactic object, every precaution should be taken to prevent the possibility of pigs being contaminated. This question particularly interests America, because of the extreme prevalency of pig trichinosis there. From the point of view of public hygiene all infected meat should be seized and destroyed, despite the fact that perfect cooking destroys the vitality of the parasites, which perish at 120° Fahr. Ordinary salting but slightly affects their vitality, which explains why from time to time the importation of meat has to be prohibited and why meat should always be scrupulously inspected. CHAPTER V. RHEUMATISM, In bovine pathology the term " Eheumatism " is applied to a number of different morbid conditions, the sole connection between which is that they seriously affect the organs of locomotion. This reason may perhaps be accepted as sufficient for including the study of rheumatism amongst diseases affecting locomotion. The disease is of considerable importance, and for this reason the study of rheumatism itself necessarily precedes the description of pseudo-rheumatism, secondary rheumatism, or infectious rheumatism in young and adult animals. ARTICULAR RHEUMATISM* Acute rheumatism has a clearly marked predilection for the arti- culations. Sometimes the great serous membranes are simultaneously affected (pleura, pericardium, endocardium), but only in very exceptional circumstances are they primarily attacked. That form of rheumatism known as visceral is as a general rule secondary in comparison with articular rheumatism. Several joints and tendon sheaths may be attacked at the same time. Under such circumstances rheumatism may be defined as a febrile disease, probably of an infectious nature, revealing itself by simple or multiple inflammation of joints and the tissues surrounding them, and capable of becoming complicated with inflammation of the pleura, pericardium, endocardium, meninges of the brain, etc. Causation. All authors agree in recognising the influence of heredity, of wet and cold, of sudden changes in temperature, draughts in the stable, prolonged exposure to low temperatures, or the chilling of animals saturated with perspiration. These are and cannot be other- wise than occasional causes ; but the determining cause remains at present unknown. In human pathology it has been proved bej^ond dispute that a certain relationship exists between arthritism, or the " uric acid diathesis," and rheumatism. This fact is so well recognised that doctors have said that rheumatism was to arthritism what scrofula is to tuberculosis. That, 90 RHEUMATISM. however, does not advance our knowledge of the question in the smallest degree, and it may simply he that arthritism represents one of the principal favouring conditions in the development of rheumatism. In domestic animals the uric acid diathesis is little known, renal lithiasis is no more a rarity than gravel ; but at the j)resent time no one appears clearly to have established the relationship between these diseases and the development of rheumatism. What, however, we must all admit is that rheumatism exhibits all the phases of development of a rapidly progressive infectious disease. Numerous attempts have been made by doctors during the last few years to discover the presence of a microscopic agent and to demonstrate its pathological characteristics. Several microbes have been described, but one is forced to confess that the results have until now been very contradictory and uncertain ; and yet there is little room to doubt that the disease is of an infectious character. Symptoms. The symptoms are generally well defined and well developed. The onset is sudden ; an animal which one day before appeared perfectly well is attacked in one or several joints. Usually the upper joints of the limb are involved — the shoulder, elbow, knee, haunch, stifle, hock. Nevertheless, invasion is probably not as sudden as it appears to be, and, as in the human species, the subject begins by feeling erratic pains, which, however, pass unnoticed. The animal moves with diffi- culty, as though it were suffering from laminitis, and has pain w^hen placing weight on the limb, while the joint attacked soon shows a swelling which extends to the tendon sheaths and the neighbouring serous bursae. The local temperature is higher than that of sur- rounding parts, sensibility becomes very marked, and pain attends the slightest pressure on, or even movement of, the affected joint. Intense lameness follows, which may even at first give rise to the suspicion of fracture. The animals remain lying for long periods, groan from time to time, and -suffer great pain when rising. In some cases the local manifestations appear to be transferred from one joint to another. These local symptoms are accompanied by high fever. The temperature rises to 105° or 106° Fahr., the pulse to 80 or 90, and the breathing is enormously accelerated if the patients are forced to move. Loss of appetite is very marked. Kumination may be suspended, and these grave symptoms are accompanied by constipation, rapid wasting, cessation or marked diminution of the milk supply, decrease in the quantity of urine passed, etc. A few days after the onset, visceral complications may occur, though ARTICULAR RHEUMATISM. 91 fortunately such complications are far from being constant. Auscultation and percussion sometimes reveal the lesions of pleurisy, endocarditis, pericarditis, etc. The development of articular rheumatism varies greatly, and may occasionally continue for weeks or months, the condition of one joint improving only to be followed by inflammation of another. The visceral lesions rarely disappear completely, and it is not un- common to note symptoms of chronic valvular endocarditis. Relapses are somewhat frequent, and the disease may continue in a chronic form after the acute symptoms have disappeared. Lesions. The joint itself is not alone affected. All the tissues sur- rounding it are congested, swollen and painful, particularly the sheaths and insertions of the tendons. Within the inflamed synovial capsules of the joints an increased quantity of turbid synovia accumulates, dis- tending the joint and producing a condition of hydrarthrosis. In animals slaughtered during the course of the disease one finds congestive infiltration of the limbs. The tem23erature of the j)arts near the affected joints is higher than that of neighbouring regions. Sensibility is much more acute, and the slightest external pressure gives rise to pain. In favourable cases the joint may appear scarcely injured. The principal symptoms are those of pain. In old-standing cases certain permanent changes may occur, such as thickening and hardening of the wall of the synovial caj^sule, fibrous infiltration of the tissues around the joint, or even diffuse and irregular calcareous infiltration. Cases of false or true anchylosis are rare, the animals usually being slaughtered before such conditions can develop. Complications. The commonest comj^lications are endocarditis and pericarditis. Valvular endocarditis localised in the auriculo-ventricular valves is revealed by a systolic sound, and by tumultuous or irregular beating of the heart when the animals are forced to move. Pericarditis, which seems rare in bovine animals, is much commoner in sheep. This pericarditis, however, produces none of the external signs of pericarditis due to a foreign body. Like tuberculous pericarditis, it is only accom- panied by a trifling amount of exudate, and is recognised by increased cardiac dulness and diminution in the cardiac sounds on auscultation. Simple pleurisy associated with pericarditis is frequent in sheep, but unknown or little known in the ox. If in animals other visceral complications occur, affecting the peri- toneum, meninges of the brain or intestines, they are at present little recognised. Diagnosis. Articular rheumatism can only be confused with osseous cachexia or laminitis. Osseous cachexia, however, possesses symptoms 92 RHEUMATISM. peculiar to itself, and generally extends to an entire district, whilst rheumatism appears in an isolated form. Again, the arthritis peculiar to osseous cachexia most commonly affects the joints of the extremities (fetlock and phalanges). The disease may be differentiated from laminitis by simply manipulating the joints, which are painful in rheumatism but not in laminitis, and by percussing the claws, which are painful in laminitis but not in rheumatism, and by noting the character of the gait. Prognosis. The prognosis is grave, as in all acute diseases which are capable of assuming a protracted chronic form. It is also necessary to take into account the loss of condition, the possibility of relapse, and the complications due to prolonged decubitus. Treatment. The first indication is to place the patients in a nearly constant temperature, to supply bedding generously, and to arrange for the animal being undisturbed. Among drugs salicylate of soda gives the best results if administered in sufficient doses — 6 to 7 drams per day for oxen or cows of medium size, 45 to 75 grains for sheep. Diuretics, like bicarbonate of soda, nitrate of potash and hay tea or infusion of couch grass, pellitory, etc., also give good results. The joints attacked may be blistered, but it is often preferable to use mild ointments, containing camphor or belladonna, because, as soon as pain diminishes, moderate massage of the affected parts, which favours rapid absorption of the effusions, can then at once be resorted to. The diet should consist of easily digested food and of lukewarm hay tea, etc. When the animals are suffering from kidney disease in any form salicylate of soda is contra-indicated. Antipyrin may also be of service in doses of 45 to 75 grains for bovines and 15 grains for sheep. Preparations of methyl salicylate can only be used for animals of value. MUSCULAR RHEUMATISM, Muscular rheumatism is due to causes similar to those of articular rheumatism. The symptoms, moreover, often occur simultaneously, or may alternate with the articular manifestations, with which they are seldom entirely unconnected. Moist cold seems to be the predetermining cause, whether it acts indirectly on the nerve trunks or affects the capillary circulation in the muscles, through the medium of the vaso-motor supply. The results are revealed by the development of neuralgia, neuritis or interstitial myositis; and these diseases, by producing more or less intense pain, cause difficulty in movement or distinct lameness. Attempts have been made to explain the development of these lesions by ascribing a certain action to the uric acid (which is said to be in excess in the body), and to the MUSCtJLAR RHEUMATISM. 93 lactic acid, which accumulates in the muscular tissue after fatigue or over-exeution, and may occasionally produce temporary myositis. Up to the present time, no satisfactory proof has been furnished enabling us to identify the myositis of rheumatism ^Yith the myositis of over-exertion, which, moreover, appears to differ from it in essential particulars. Symptoms. Muscular rheumatism is often ill-recognised in veterinary medicine, and closer observation would appear to suggest that it is much less frequent than has been stated. Generalised muscular rheu- matism is rare ; patients stand stiffly as though incapable of moving ; the limbs and the back apj^ear rigid, and the animal seems only callable of changing its position b}' a single movement of its whole body. One might readily believe at first sight that the case was one of generalised laminitis or slight generalised tetanus. The animal has difficulty in rising ; when moving the limbs are dragged, and the patient is cautious in lying down. Most frequently the disease is localised in one region, such as the Ishoulder, the loins, or the quarters. The affected part is stiff, tense, painful, hard, and as though in a state of cramp. Palpation and pressure reveal the presence of very exaggerated sensibility, which varies within wide limits, according to circumstances, changes in atmospheric con- ditions, etc. These local signs are accompanied by a general reaction of varying severity, somewhat resembling that seen in articular rheumatism. Appetite is diminished or suppressed, as is rumination ; the muzzle is dry and hot ; the temperature may rise as high as 103° or 104° Fahr. Lesions. The lesions are imperfectly recognised, because those who might most easily observe and study them have often neither the means nor the leisure for the purpose. Possibly one would at times discover lesions of neuritis ; but in any case it is not so very rare to discover lesions of interstitial sclerosing myositis in the depths of the muscles of the quarter, loins, shoulders, etc., a condition rarely found in any other disease. Naturally these are onlj^ the ultimate lesions of muscular rheumatism ; for slight attacks leave no traces visible to external examination. Diagnosis. The commonest error is that of mistaking the condition for laminitis of all four limbs. The history often suffices to eliminate this disease from consideration, while palpation and i:)ercussion of the claws remove any remaining doubt. The prognosis is not usually grave, and recovery sometimes follows the adoption of good hygienic conditions. On the other hand, certain patients lose flesh rapidly. Treatment. Salicylate of soda and antipyrin still form the two most efficacious drugs, particularly the first, which may almost be regarded as a veritable specific in rheumatism. The doses vary with the size of the 94 RHEUMATISM. patients, from 2 J to 7 drams per day. These doses are continued for six to eight days consecutively. Some authors prefer salicylic acid, which, however, is more irritant, in doses of 15 to 75 grains. Tartar emetic, in doses of 2 J to 4 drams per day until purgation is established, is also said to have proved of great value in the hands of the older practitioners. Local treatment comprises stimulating frictions with camphorated alcohol, ammonia, and oil of turpentine. Such applications are usually of great service, particularly when associated with methodical massage of the affected parts. These modes of treatment should be supplemented with a proper dietary and the administration of tepid, diuretic fluids as required. Infectious Forms of Eheumatism or Pseudo-Eheumatism. Under the head of infectious rheumatism or pseudo-rheumatism may be grouped joint diseases of a rheumatic type accompanying various general or local diseases in young animals and adults : diseases of the umbilicus, rachitis, peri-pneumonia, retention of the foetus, dysentery, etc. These diseases are characterised by articular symptoms, which sometimes appear early, sometimes only when the disease itself is declining, and develop suddenly or gradually, the joint cavities them- selves either being directly invaded by the agents of the primary disease or remaining exempt. These pseudo-rheumatic attacks are due to the localised action of microbic toxins on the articular synovial membranes. Sometimes the serous membranes of the large body cavities are also implicated. This theory explains the development of acute arthritis without the presence of gonococci during the course of an attack of blenorrhagia in man, and may be applied in respect of certain forms of arthritis or synovitis without the presence of microbes in domestic animals. INFECTIOUS RHEUMATISM IN YOUNG ANIMALS. Causation. To explain the occurrence of infectious rheumatism in young animals a variety of causes has been invoked, such as bad feeding, the absence of that purgation which usually follows the action of the mother's first milk {i.e., colostrum), and clears the bow^el of meconium, the effect of heredity, of chills,, of insufficient food, and of unduly abun- dant or very rich food, which has been said to produce indigestion and its various complications. All these causes may play a certain part in favouring the develop- ment of infectious rheumatism, but none constitutes the direct cause. Lecoq and Loiset in their investigations regarding this disease in INFECTIOUS RHEUMATISM IN YOUNG ANIMALS. 95 colts mentioned the almost invariable existence of lesions in the umbilical region. Bolinger in 1869 recognised the possibility of infection by way of the umbilical vein. Roll and Guillebeau are of the same opinion, and Morot's excellent study shows that here must be sought the most fre- quent point of origin of the articular symptoms. In animals born in dirty stables the umbilical cord becomes infected at the time of birth, or its cicatrix a few days later. The result is the development of rapidly fatal septicaemia, suppuration in the wound, omphalitis, omphalo-phlebitis, or umbilical arteritis ; and to this infection are due the various complications, which may appear almost immediately, as in the case of septicaemia of calves, or may be deferred for a shorter or longer interval, for so long indeed that the umbilicus may appear to have healed externally (infectious pneu- monia and endocarditis, infectious arthritis, etc.). The umbilical cord and the tissues surrounding the cicatrix form excellent culture grounds for those micro-organisms which alwaj^s exist in such abundance in litter and manure ; and there is, therefore, no difficulty in understanding why in dirty stables infection so readily occurs. The infective agents may be of very varying kinds, a fact which explains the difference in the symptoms which follow umbilical infection ; although ovoid bacteria, streptococcus pyogenes, and the bacilli of necrosis seem most common. Omphalitis and omphalo-phlebitis are not the only diseases capable of producing infectious rheumatism in young animals. Certain infections resembling dysentery and diarrhceic enteritis are also its frequent forerunners. In young animals even rachitis, which is accompanied by various digestive disorders, may serve as the point of origin for infectious rheumatism and all its complications. In older animals — i.e., in animals from five to six months, or even twelve to fifteen months — infectious rheumatism may occur without a clearly defined cause. It then develops with the symptoms and lesions of that condition known as " osteomyelitis of adolescence " in human pathology. These forms of osteomyelitis are due to infection with streptococci and staphylococci. In veterinary medicine the pathogeny has not yet been accurately ascertained. Symptoms. Infectious rheumatism in young animals assumes one of two clinical appearances, possibly due to different causes, viz. — plastic or suppurative arthritis following umbilical infection, and simple exudative arthritis. In the former variety symptoms appear soon after birth, rarely after the age of two months, and as an exception in animals of six to eight months affected with rachitis. The onset is sometimes sudden ; the patient, though healthy on the previous evening, is un- able next morning to rise or move. Hence in France this disease has received the titles, amongst others, of laminitis and paralysis of the newly born. 96 RHEUMATISM. Certain joints, often a pair, appear swollen, hot and painful. The synovial sacs are distended, and in the upper joints of the limb appear much more prominent than in the lower. When the patients are still Fig. 50. — Young bull suffer! iiicLuiiatism. able to move they walk on three legs, but usually they remain lying permanently, and if aroused show great difficulty in rising and very acute pain in moving. General disturbance is also very marked; the temperature varies between 103° and 105° Fahr. The animals are dull, have no appetite, and exhibit intense thirst. The pulse rate and respirations are increased, and not un- commonly symptoms of grave visceral complications, such as endocarditis, pleurisy, pneumonia, etc., can be de- tected. Diarrhoeic enteritis sometimes appears as a secondary development. The animals remain per- manently lying down. They can only be induced to rise with difficulty, and, when moved, exhibit very acute pain. In many cases the disease then takes a rapid course and ends fatally. Death is the usual termination whenever any of the above- mentioned visceral complications exist. Kecovery is exceptional. In Fig. 51. — Attitude when walking of suffering from infectious rheumatism calf INFECTIOUS RHEUMATISM IN YOUNG ANIMALS. 97 certain lucky cases, sometimes without any treatment whatever, the symptoms become less acute, the appetite persists or improves, fever diminishes, the condition of the joints remains stationary, and after the lapse of several weeks there is ground for anticipating recovery. In all cases, however, the convalescents remain thin and sickl}^ exhibit pain and capricious appetite, and in very few cases indeed is there any economic reason for keeping them alive. More frequently infectious rheumatism terminates by abscess forma- tion in the joints. The articular cavity becomes filled with pus, the tissues covering one of the synovial sacs soften, and the abscess opens, discharging fibrinous clots; thin watery pus mixed with sjniovia, and debris of articular cartilages or ligaments. Pyaemia is the final complication when the patients are not slaughtered. In the cases comprised under the second heading the symptoms appear more slowly and develop insidiously, the chief, viz., a tendency to remain lying and difficulty in movement, long preceding the appear- ance of exudative arthritis. The course depends chiefly on the nature of the infective agent. In calves suffering from peripneumonia, calves from stables in which epizootic abortion rages, rachitic calves or calves suffering from severe diarrhoeic enteritis, the joints do not become the seat of suppuration. In such cases the arthritis is of a simple exudative character, but without microbic infection of the joint cavity. This form is less dangerous, and is often curable provided the original cause be kept in mind. Lesions. The lesions are always very marked, and are quite different from those of simple rheumatism. The synovial membranes and the periarticular tissues are always thickened, injected, inflamed, and infiltrated. In more benign cases the synovial exudate from the joint cavities is simply cloudy, contains no infectious germs, and proves sterile on attempts at cultivation. In such cases there is no abscess formation. But most frequently this stage of serous exudation is only temporary, and the articular fluid, which at first seems sterile, may, when tested some days later by means of cultures, reveal the presence of organisms. The synovia accumulated within the joint sometimes contains fibrinous flocculi, which are at first small, but later form veritable coagula, filling up and thickly coating all the prominences of the joint and moulding themselves on the extremities of the bones constituting the articulation. Sometimes the cartilages undergo very rapid ulceration, the subjacent layers of bone become inflamed, and the osteoarthritis which develops is so severe and painful that the patients are forced to remain abso- lutely still, • and are quite incapable of rising. The lesions may D.C. H 98 RHEUMATISM. remain stationary at this point. In other cases suppuration occurs in the articulation itself, the wall of the synovial cavity, the periarticular tissues, and the skin soften ; then the abscess breaks, giving rise to open suppurating arthritis. Animals are rarely kept long enough to become so gravely affected ; many die before this stage, and the others are usually slaughtered. Moreover, they rapidly perish from exhaustion and from visceral complications of a py^emic character. In many cases post-mortem examination reveals nothing whatever in the region of the umbilical cord (through which infection has occurred), but the germs of infection may be found in the blood or general circulation ; or again, careful investigation may show ulceration of the umbilicus, lesions of omphalitis, of ascending umbilical arteritis in Fig. 62. — Ulceration of the articular cartilage in infectious rheumatism. consequence of infection of the thrombus, of umbilical phlebitis, or of infective peritonitis, etc. The infectious agent reaches the liver through the blood-vessels, then attains the posterior vena cava, after which the infection assumes the gravest possible character, producing complications like arthritis and purulent infection, with the formation of multiple abscesses in the depths of the viscera. The Staphylococcus aureus and various streptococci are the most frequent but not the only causes of these infections. The diagnosis is not difficult, provided the disease be not mistaken for true rheumatism. As true rheumatism is very rare in young animals, and as, on the other hand, attention is aroused by the presence of lesions of the umbilicus and by the existence of diarrhoeic enteritis, rachitis, etc., there is seldom room for doubt. Prognosis. The prognosis is extremely grave whenever the case INFECTIOUS PSEUDO-RHEUMATISM IN ADULTS. 99 results from infection of the umbilicus. Firench statistics place the mortality at 90 per cent, and German at 75 per cent. Curative treatment can only be attempted with any chance of success in the simple exudative form. Even then it is necessary to simultaneously treat the primary disease, such as rachitis or diarrhoeic enteritis. The recommendations of former practitioners as to the use of saline purgatives, cream of tartar, etc., were probably due to their having recog- nised that diarrhoea is sometimes the primary cause. Moussu has seen simple exudative arthritis in rachitic subjects disappear, together with the rachitis, under proper treatment. The indications therefore are, firstly, to take measures against the primary disease, treating the local lesions separately with blisters, douches, or simply cold applications and massage. Provided the general condition can be improved, recovery may follow. Unfortunately, this treatment is useless against infectious rheumatism with suppurative arthritis resulting from infection of the umbilicus. In such cases treatment, if undertaken, should be directed towards perfectly disinfecting the umbilical wound or any existing sinuses. Injections of strong carbolic solution, the application of antiseptic ointments or of antiseptic pencils containing iodoform, salol, etc., into the sinuses, followed by a surgical dressing covering the umbilicus, form the basis of this primary treatment, which, it need scarcely be said, has little chance of checking the course of already existing arthritis. The use of internal antiseptics and of antipyretics like camphor, salicylate of soda, etc., is worthy of trial. On the other hand, prophylactic treatment in an infected area has every chance of succeeding. The use of dry, clean litter under the mother and the new-born calf, thorough cleansing of the umbilical cord or umbilical cicatrix, and the application to the umbilicus of a small surgical dressing or even a smear of tar, almost always suffice to prevent the occurrence of these forms of arthritis. INFECTIOUS PSEUDO-RHEUMATISM IN ADULTS. The infectious pseudo-rheumatism of adults differs from infectious rheumatism in young animals in that it never becomes complicated with suppurative arthritis, and rarely affects more than one joint at a time. The hind limbs are the parts usually attacked, and the joints seem predisposed to disease in the following order of frequency : the femoro-tibial, coxo-femoral, and hock joints. On account of its greater frequency in cows, it has been termed " arthritis of milch cows " and *' infectious arthritis of milch cows," etc. In reality it may also attack bulls and oxen, but such cases are exceptional. H 2 100 RHEUMATISM. Causation. First mentioned by Coulbeaux in 1824, and by Pauleau in 1832, this disease has been well-studied by Ph. Heu. Old works mention it as attacking good milkers in the best dairies around Paris, and Heu declares it to be the most deadly disease after peripneumonia and tuberculosis. This form of arthritis usually appears in an insidious form after abortion, retention of the foetus, or post-partum metritis. In cases of epizootic abortion infectious rheumatism sometimes assumes an epizootic form, and completes the devastation begun by abortion. Under other and much rarer circumstances it may follow enteritis of adults or attacks of mammitis, etc. The pathogeny of these forms of arthritis is not Fig. 53. — Infectious rheumatism. Arthritis of the left stifle joint. difficult to understand, for in the greater number of instances they form delayed consequences of local uterine infection. The soluble products secreted by infectious organisms multiplying within the uterus are absorbed by the uterine mucous membrane, causing slow intoxication ; and in consequence of the special elective affinity which the toxins show for the articular serous membranes, and in many cases also for the visceral serous membranes, the special characteristics are developed. Under certain circumstances the joint cavity may even become the seat of true microbic infection. Symptoms. The appearance of the first symptoms is difficult to identify, for many cows abort, fail to " cleanse," or become affected with metritis without infectious rheumatism supervening. It is a long-delayed condition, which may be postponed for weeks or even for several months after an abnormal parturition, and to a time when the symptoms of metritis have almost entirely disappeared. The onset is characterised INFECTIOUS PSEUDO-RHEUMATISM IN ADULTS. 101 by difficulty in rising, and soon afterwards by lameness, or by the animal failing to place weight on one of the hind limbs. The affected joint, usually one of the articulations of the stifle, apj)ears markedly enlarged, is not appreciably hot to the touch, but reveals a certain amount of Fig. 54. — The femoro-tibial joint in a case of infectious rheumatism. All the articular sur- faces of one side have undergone change (the condyle of the femur, interarticular cartilage, and the upper extremity of the femur). Fig. 55. joint. -Normal femoro-tibial painful sensibility on pressure. The periarticular tissues are infiltrated and the synovial sacs slightly distended. After a few days, a week or two at most, the periarticular swelling diminishes, and the condition appears to remain stationary. Appetite is normal or only diminished. The pain continues, and causes progressive wasting and diminution in the yield of milk. If at this time the practitioner makes a careful digital examination of the diseased region, he may find one of two conditions. In the first, the 102 RHEUMATISM. synovial sacs appear distended, fluctuating and in exactly the same condition as in ordinary bog-spavin. This is what has been termed the exudative form of infectious arthritis. In the second, the enlarged joint remains very sensitive, the walls of the synovial sac are thickened, fluctuation is either absent or only slightly marked, but induration is very manifest. This constitutes the plastic form. Exudative arthritis is the form usually seen at first. It may preserve Fig. 56. — Plastic form of infectious rheumatism (pseudo-anchylosis). its primary characteristics, but only too often proves to be the fore- runner of the plastic form, which develops with the lapse of time. If nothing is done wasting becomes more marked, and is accompanied by cachexia. The animals are unable to rise, the complications insepar- able from decubitus occur, and wasting or secondary purulent infection sets in. Lesions. In the exudative form the changes are confined to inflam- INFECTIOUS PSEUDO-RHEUMATISM IN ADULTS. 103 mation and thickening of the sjmovial memhranes, intra-articular exudation, and sometimes grooving of the cartilages without ulceration of the articular surfaces and without disorganisation of the joint. The plastic form, on the other hand, leads to destruction of the cartilages, ligaments, and sub-cartilaginous bony layers, induration and calcification of the walls of the synovial cavity, and even periostitis of the ends of the bones, with the formation of false joints. The internal surface of the inflamed synovial membranes begins to granulate, the fibrous clots distending the articular dilatations are perforated by these extending granulations, and fibrous tracts soon develop even in the articulation itself, undergo calcification, and produce complete anchylosis. Diagnosis. The diagnosis is easy. The animal's history and symptoms, and the stationary character of the pain in the earlier stages are sufficient to prevent any error. Prognosis. The prognosis is grave, but not fatal. In the exudative form recovery may follow early treatment. In the plastic form, however, the chances of success are extremely meagre. Treatment. It is easier to prevent than cure, particularly in these forms of arthritis. The means are simple, and consist in always treating the post-partum infection as soon as it is recognised. The animals can be effectively safeguarded against later articular complica- tions by the free use of intra-uterine antiseptic injections, until the uterine injuries have wholly healed, and by the administration of saline purgatives and diuretics. When infectious arthritis is diagnosed, it is still necessary to resort to the same methods if the uterine symptoms persist, and to complete the treatment by local aj^plications. The best method of local treatment seems to consist in puncturing the articulation aseptically, removing almost all of the liquid exudate, and immediately thereafter firing the skin covering the joint in points or lines. If treatment has been invoked too late, if plastic arthritis with the formation of fibrous bands within the joint and destruction of the cartilages and calcification of ligaments, etc., already exists, there is no economic object in undertaking treatment. Fattening may be attempted, or the animals may be handed over to the butcher, if wasting is not too far advanced. The use of cold douches, plaster bandages, blisters containing nitrate of mercury, painting with sulphuric acid, etc., are too inconvenient and too inefficient to be recommended in actual practice. Similarly, the salicj'late of soda, which is so useful in simple rheumatism, has no real superiority over diuretics in this condition. 104 RHEUMATISM. SCURVY-SCORBUTUS. Definition. '^ Scurvy is a subacute or chronic trophic disorder characterised by debiUty, inanition, anaemia, swelhng and bleeding of the gums, gingival ulceration, dropping of the teeth, and petechial or more extensive haemorrhages and exudations in the skin, serosa, and solid tissues." Causes. "Among the lower animals, pigs especially suffer, when kept in close, foul quarters and fed on a monotonous and insufficient ration. Formerly scurvy . * . . was attributed to an exclusive diet of salt food ; to excess of sodium and deficiency of potassium salts ; to the absence of fresh vegetables ; to tainted food, etc. In pigs the food and en- vironment are usually chiefly at fault, the subjects have been kept . . . in foul buildings, in a hot, moist atmosphere, and with an uniform diet of maize or other unvarying and insufficient ration. Eoll attaches great importance to putrid food. Benion has found the affection mainly in obese swine, the forced feeding and intestinal fermentations manifestly operating as factors. Hess and others attribute the disease in pigs to the germ of erysipelas. Stengel has produced purpuric disease in animals by inoculation of the extravasated blood from human scurvy patients. Miiller and Babes found a slender bacillus and streptococci in the tissues of scorbutic gums. . . . There is considerable presumption of the existence of a microbian cause, the efficiency of which is dej^endent on the unhygienic conditions above stated, while these unwholesome conditions are equally non-pathogenic in the absence of the microbe." Lesions. " The blood is black and incoagulable or clots loosely, rigor mortis is slight, changes may be found in the number and character of the white and red blood globules, but are not constant ; there is usually an excess of sodium salts and deficiency of potassium ones, and there is marked petechiation of the skin, mucosae and serosae. The bone marrow may be abnormally red and the bones fractured at the epiphyses, or carious. . . . The gums are softened, swollen, red and uneven, with haemorrhagic discoloration, erosions, necrotic areas and ulcers." Symptoms. *' Anorexia or fastidious appetite, prostration, debility and sluggish, indifferent movements, are followed by the local lesions on the skin and gums. On the skin appear petechiae and extravasations, which often implicate the bristles, so that they may be shed or pulled out with ease, the bulbs appearing dark and bloodstained (bristle rot). These may be followed by necrotic sloughs, and deep ulcers that are slow to heal. The gums are red and swollen, with haemorrhagic spots, and bleed on the slightest touch. Erosions, sores, and ulcers are not uncommon ; the tongue is dry and furred, and the mouth exhales a foetid odour. The teeth may become loose in their sockets. Swelling of the SCURVY — SCORBUTUS. 105 joints . . . may be noticed, and lameness or stiffness from muscular or inter-muscular extravasation. Blood effusions into . . . the eye have been noticed, and paralytic or comatose symptoms from similar effusions on the brain. In the absence of improvement the patient becomes more and more debilitated and exhausted, and death may be preceded by profuse exhausting diarrhoea." "Prognosis is unfavourable in advanced cases, and when the faulty regimen cannot be corrected." Treatment. " The first consideration is to correct the unwholesome conditions of life, purify the building and its surroundings, and allow a free range on pasture. Subject each patient to a thorough soaj^y wash, and if possible allow clean running water in which a bath may be taken at will. Access to green food and invertebrates (slugs, larvae, etc.) is important, or a varied diet of grain, middlings, bran, roots, fruits, tubers, cabbage, silage, etc., must be furnished. Iron and bitters (gentian, nux vomica) are useful, and sometimes small doses of arsenite of soda solu- tion or cream of tartar are useful. Acorns or horse-chestnuts are recommended. For the mouth a wash of potassium chlorate, soda biborate, or potassium permanganate may be resorted to. . . . In the case of fat pigs it is more profitable to butcher at once, as soon as early symptoms appear." From Law's " Veterinary Medicine," p. 558, Vol. III. SECTION II. DISEASES OF THE DIGESTIVE APPARATUS. SEMIOLOGY OF THE DIGESTIVE APPARATUS. The group of diseases which affect the digestive aparatus is one of the most important in bovine pathology, because almost all animals of the bovine species are bred with the object of utilising to the full their powers of digestion and assimilation. Whether we consider adult fat animals, calves intended for slaughter or milch cows, the object sought is always the same — i.e., to secure the greatest possible economic return through the medium of the digestive functions. Even although in working oxen there is no tendency to overfeeding, the animals remain none the less predisposed to diseases of the digestive apparatus ; the meal-times are often too short, and rumination has to be performed under the yoke or during work — in a word, under unfavourable physiological conditions. Semiology. To ensure correct diagnosis it is necessary here, perhaps more than in any other department of pathology, to be capable of grasp- ing the symptoms or syndromes and signs afforded by the different parts of the digestive apparatus ; to know how to co-ordinate and group them so as logically to deduce the final synthesis, the diagnosis. The diagnosis proving correct, the prognosis becomes easy, and this is the chief object from the economic standpoint. The practitioner who undertakes treatment knows how to deal with the case, and the owner likewise knows what he undertakes to do. Although this classification may appear arbitrary, we shall consider successively diseases of the mouth, of the pharynx, oesophagus, stomach, intestines, etc., firstly describing the symptoms characterising these diseases. At the same time we should state that many symptoms are common to a large number of diseases and in themselves have absolutely nothing characteristic. They are simply sign-posts capable of showing the way. Mouth. External examination reveals the condition of the muzzle, the lips and their commissures, and the surroundings of the buccal SEMIOLOGY OF THE DIGESTIVE APPARATUS. 107 opening, and detects the existence of any desquamation, rents, eruptions, ulcerations, etc., which may be present. In quiet animals the practitioner can examine the cavity of the mouth single-handed, but in troublesome animals it becomes necessary to have an assistant, who seizes the muzzle with one hand and the tongue with the other, or who simply fixes the animal's head. In exceptional cases it will be necessary to secure the patient to a post, tree, or wall. The mere attempt at examination will show whether there is trismus or absolute freedom of movement in the jaws. By introducing the fingers between the commissures and applying them to the bars or to the free portion of the tongue, the prac- titioner will be able approxi- mately to estimate the local and general temperature. The sen- sations experienced will also inform him of the degree of moisture or dryness of the mouth and of its sensibility. On separating the jaws, he will note the odour exhaled and .its possible abnormalities — its acid, sourish, foetid, or putrid character. He will directly ob- serve any anaemia or hyper- emia of the mucous membrane, from the inner surface of the lips and cheeks up to the soft palate, although owing to the thickness of the buccal epithe- lium it is not always easy to estimate anaemia or hyperaemia in the ox. The surface of the tongue should also be examined, and a note made whether it appear dry, pasty, dusty, sooty, etc., though these appearances are occasionally apt to lead one astray. The observer should also inquire regarding want of appetite, depraved or exaggerated appetite, etc. Even the manner in which the animal picks up its food will serve to direct his attention to the development, or possible existence, of some disease of the mouth, although want of appetite is not always charac- teristic of a lesion in the pharynx or oesophagus, but sometimes of a lesion in its neighbourhood, like hypertrophy of the retropharyngeal or bronchial lymphatic glands. This examination will also detect the existence on the lips of wounds, Fig. 57. — Examination of the mouth. 108 DISEASES OF THE DIGESTIVE APPARATUS. cuts, injuries or specific eruptions (aphtha, tuberculous ulcerations, the ulcerations of gangrenous coryza, etc.) on the gums indications of gingivitis, periostitis, mercurial poisoning, actinomycosis of the maxilla, and ulcerations of all kinds ; on the tongue, of wounds, of simple or specific inflammatory eruptions (aphtha, the ulcerations of actinomycosis, tuberculosis, gangrenous coryza, etc.), as well as the swellings due to superficial or deep-seated glossitis. By the same method of examination, though with somewhat more difficulty, one can detect abnormal mobility, irregularity of development, caries, etc., of the teeth, the condition of the excretory ducts of the salivary glands, the state of the hard and soft palate, and the existence of fissures, vegetations, polypi and tumours. SaliYary glands. The salivary glands, particularly the parotid and submaxillary, should be examined by direct inspection and palpation. Direct inspection reveals the existence of swellings, deformity of parts, increase in salivation, or ptyalism, which sometimes occur in conjunction with foot-and- mouth disease, actinomycosis, acute stomatitis and mercurial poisoning, as well as increase in size of the salivary ducts. Palpation reveals the degree of sensibility of the parts, the existence of oedema, induration, cysts, and, more frequently, distension of the salivary ducts as well as the presence of calculi, tumours, the direction of fistulae, etc. Difficulties may occur, particularly when the submaxillary and parotid glands are aftected ; but methodical and complete examination will usually enable one to differentiate the conditions. Pharynx. The pharnyx may be examined externally by inspection and palpation, and internally by direct digital palpation. Inspection reveals possible deformities of the region of the gullet, palpation the condition of the tissues as well as abnormal sensibility and infiltration. Internally, digital examination must be cautiously conducted, and after a strong gag has been securely inserted in the mouth. Under such con- ditions it is without danger. The hand being inserted exactly in the median line will detect obstructions which may already have been partly identified by external palpation, as well as the existence of inflammation Fig. 58. — Examination of the mouth. SEMIOLOGY OF THE DIGESTIVE APPARATUS. 109 with or without the formation of false membranes, and of ulcerations, polypi, etc. (Esophagus. In consequence of its anatomical formation, situation and course, the oesophagus may be divided into two distinct parts — viz., the cervical, which can be examined from the outside, and the thoracic, which cannot so be examined. The cervical part may be examined by inspection, by palpation from one side, or by palpation with both hands and from both sides. Inspection leads to the detection of changes in the shape of the oesophagus and of the jugular furrow. In fat subjects, however, it is of Fig. 59. — Examination of the pharynx. little value. As the position and the course of the oesophagus are known, unilateral palpation, or, better still, bilateral palpation, employing both hands, is of very much greater service. These methods reveal the presence of swellings, infiltrations, changes in shaj)e and sensibility, the presence of foreign bodies, the existence of dilatations or contractions of the tube, etc. Auscultation and percussion, though recommended by some prac- titioners, are not of much -service. Inability to swallow^ due to change in the oesophagus, is also detected by inspection. Its existence suggests a number of possible conditions, such as fissure or ulceration of the oesophagus, compression in the mediastinal region as a result of tuberculous or other disease, contraction or dilatation of the oesophagus, etc. Furthermore, inspection will betray 110 DISEASES OF THE DIGESTIVE APPARATUS. the existence of dilatation of the tube, to which vomiting and regurgitation of food are sometimes due. Internal exploration is the only method of detecting changes in the thoracic portion, and may also be utilised to locate lesions in the cervical region. It is practised by passing a sound of small calibre or any flexible cylindrical object, such as a cart rope, etc. The patient must be fixed with the head extended on the neck and a proper gag or speculum introduced into the mouth. Exploration assists us in recognising the existence of inflammation of the oesophagus, true or false contraction, dilatation and the presence of obstructions. In animals of the bovine species all these lesions — viz., inflammation of the oesophagus, Assuring and ulceration, obstructions, compressions, dilatations and contractions of the tube — although not very frequent, are nevertheless from time to time encountered. Stomach. Exploration of the stomach or of the different gastric compartments presupposes an exact knowledge of the respective positions of the different reservoirs. Topographical anatomy show^s that the rumen is situated in the left flank, and that it occupies the whole of the left abdominal region from the diaphragm to the pelvic cavity. As a con- sequence, it may be explored from the region of the twelfth rib ; it is inclined slightly from above downwards, and from left to right, its ex- treme right border extending as far as, or a little beyond, the white line. The reticulum, the smallest of the four reservoirs, is situated in the sub-ensiform region at right angles to the median plane of the body. On the left it touches the rumen and the diaphragm ; on the right side it is in contact in front with the diaphragm, above with the omasum, and to the right and towards the rear with the abomasum. The omasum is situated above the reticulum and conical right portion of the rumen ; in front it touches the liver, and towards the back and left the rumen. The abomasum is situated obliquely in the right hypochondriac region, its anterior surface resting on the lower wall of the abdomen towards the middle and right side of the body, its pyloric portion extending upwards, behind the right hypochondriac region. Rumen. The rumen can be examined by inspection, palpation, per- cussion, and auscultation. The use of the oesophageal sound and of the trocar and canula is also of value in diagnosis. Inspection affords information of a varying character, according to the moment when it is practised, even in a condition of health. It only extends to the condition of the flank before or after a meal, etc., empti- ness of the rumen being accompanied by hollowness of the flank, and distension, following an abundant meal, by fulness in this region. When digestion is not proceeding normally, the flank may be distended unduly by gaseous accumulations or by the presence of solid food. In SEMIOLOGY OF THE DIGESTIVE APPARATUS. m abdominal and mediastinal tuberculosis and in gastro-enteritis there may be simple tension or slight dilatation. When indigestion or enteritis is i entering on a favourable stage, the flank may appear hollow, and in eases of chronic diarrhoea it may appear retracted. 112 DISEASES OF THE DIGESTIVE APPARATUS. Digital examination or palpation may be practised over the entire region of the flank. It shows whether the rumen is full or empty, reveals the consistence of the contained food in cases of chronic indiges- tion, the sensibility of the walls, and the rate and order of the muscular contractions. Direct or indirect percussion may be carried out on a hori- zontal line from the tw^elfth rib as far back as the flank, and vertically from the lumbar vertebrae to the w^hite line. In health one discovers in young animals an upj^er zone of normal resonance due to gas, a zone of semi-dulness and an inferior zone of absolute dulness, due to the liquids in the rumen. The spleen, which is attached to the supero -anterior sur- face of the left side of the rumen, does not seriously restrict the area open to percussion. In pathological conditions percussion from above downwards may pro- duce a tympanitic sound, due to gaseous indigestion or a clear sound throughout the greater portion of the vertical diameter suggestive of acute gastro-enteritis with the formation of gas in the rumen, or of adhesive peritonitis preventing the rumen from collapsing. Indigestion due to excess of solid food, on the contrary, is characterised by a dull sound throughout the entire region from above downwards. Percussion along a horizontal line permits of the delimitation of certain zones which vary a great deal in area, according to the case. Auscultation is more instructive than percussion. Like percussion, it may be practised throughout the entire depth of the abdomen, from the transverse processes of the lumbar vertebrae as far as the white line, and in a horizontal direction from the eleventh rib to the region of the flank. Auscultation of the upper zone enables one to detect sounds of deglutition, gurgling sounds (glou-glou) , and a sound resembling falling water, due to the movement of solids or liquids in the rumen and reticulum. The sounds heard vary in different cases, and depend on the state of repletion or of emptiness of the rumen. Auscultation of the middle zone reveals : Firstly, a very special crepitation sound, which may be compared to the deflagration of a handful of salt thrown on burning coal. It is believed to result from the bursting of bubbles in the contents of the rumen under the action of normal digestion. Secondly, a churning sound produced by the rhythmic peristaltic contractions of the rumen, by which the substances ingested are very intimately mixed. By applying the ear over the flank region or by palpation the rhythmic contractions of the rumen, two per minute in most cases, can readily be perceived. In practice examination of the rumen is confined to these four methods. Puncture. From an exclusively scientific point of view, exploration of the rumen also comprises analysis of the gas collected through puncture t SEMIOLOGY OF THE DIGESTIVE APPARATUS. 113 md analysis of the liquids removed by aspiration (first stages of gastric digestion). Normally, these gases, in the order of their abundance in the mixture, consist of the following : Carbonic acid, carburetted hydrogen and nitrogen. In disease, and in most cases of abnormal fermentation, the carbu- retted hydrogen is greatly in excess of the carbonic acid. In chronic gastro-enteritis, ammonium sulphide and other offensive gases are found in addition. Chemical analysis. In the rumen the ingested food is macerated in ;ui alkaline liquid at a temperature of 100° to 101° Fahr. (the alkalinity is due to the saliva). This process markedly modifies the composition of the ingested matter. Nevertheless, the upper portion in contact with the gas sometimes presents a slightly acid reaction, probably due to carbonic acid. The sugary and fatty materials contained in the food respectively undergo lactic and butyric fermentation. Only a small quantity of the starch, however, is transferred into sugar. In the calf, and in very young animals, the reaction of the rumen is acid throughout the entire period of sucking. In disease, when rumination has long been suspended and chronic loss of appetite or gastro-enteritis exists, the reaction is generally acid. The sugars, gums, and soluble salts of forage, roots, etc., are dis- solved in the rumen, but fatty materials undergo no modification. The reticulum, which is the smallest of the gastric compartments, is situated in the sub-ensiform and retro-diaphragmatic regions, extending right and left of the middle line to a nearly equal distance. Above and to the left it communicates freely with the rumen, to the right with the omasum. In practice it can only be examined in two ways : inspection and palpation. By inspection changes in the configuration of the ensiform region may sometimes be detected. Such changes are rare, and must be dis- tinguished from congenital deformity. They sometimes accompany inflammation of the reticulum produced by a foreign body, when the lower abdominal wall is directly perforated by such body. In cases of inflammation of the reticulum due to foreign bodies, abscess formation, perforation, etc., it is possible to detect (edematous infiltration, abnormal sensibility, fluctuation and increased heat, etc., by manipulating the parts with the fingers or the clenched fist. If the evidence pointing to the presence of a foreign body in the reticulum is considered sufficient, gastrotomy may be performed and the interior of the viscus examined with the hand, but although the operation is possible it is very rarely practised. Omasum. The omasum occupies, so to speak, a position inverse to that D.C. I 114 DISEASES OF THE DIGESTIVE APPARATUS. of the reticulum, lying deep down on the right side, behind the diaphragm, under the hypochondrium, and above the abomasum and reticulum. It is the only gastric compartment which cannot be examined, although when impacted it may be felt on the right side. Abomasum. The abomasum is lodged in the lower part of the right flank under the circle of the hypochondrium. It extends obliquely from below, upwards from the sub-ensiform to the sub-lumbar region. The smaller curvature is turned towards the rumen on the left side ; the larger curvature is in contact with the abdominal wall. In spite of what has so often been stated by those who have never seen it, the abomasum can be examined and is accessible along the circle of the hypochondrium. In adults useful information can rarely be obtained by inspection; but in sucking calves the abomasum, if distended by indigestion, gastro- enteritis, etc., sometimes appears prominently in the right abdominal region. Palpation wdth the fingers or with the fist will detect exag- gerated sensibilty, irritation, inflammation, or distension. Percussion and auscultation furnish no very precise information. The information obtained by the above-described examination of the stomach is in practice amplified by a search for certain symptoms which are usually easy to detect. They comprise : (a) Suppression or irregularity of rumination. This very important symptom suggests the degree of gravity of the digestive disturbance, and to some extent the gravity of the general condition. Suppressed rumina- tion is a common symptom in many diseases, some of which are purely digestive, though all are not. It is, however, a grave sign in most cases. (b) Eructation, which is usually frequent, may be regarded as normal provided the exhaled gas preserves the fresh odour of grass or of the food swallowed, like brewers' grains, turnips, etc. Sometimes the gas is sour, acid, foetid, or putrid, all of which conditions indicate disease. (c) Yawning is not common. It becomes frequent and attracts attention in certain abnormal conditions ; in others, again, it may be completely suppressed. (d) Nausea and vomiting are rare. Vomiting is commoner in calves, and results from inability to digest the milk, or simply to over-distension of the abomasum. The matter vomited by adults usually consists of partly masticated food, and is derived from the rumen ; while the con- tents of the abomasum are occasionally rejected, in which case the material is of pulpy consistence and has an acid smell. (e) Digestive disturbance is sometimes accompanied by various modi- fications in the breathing, such as immobilisation of the hypochondriac region and of the diaphragm ; abnormal sensibility and reflex coughing on palpation, and, in inflammation of the reticulum due to foreign bodies, costal respiration. SEMIOLOGY OF THE DIGESTIVE APPARATUS. 115 g ^s \