Olljp i. 11 lill ffiibrarg
Nnrtlj (EarnUna ^tatF
This book was presented by
MILTON M. LEONARD, D.V.M.
TO THE
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DESK.
EXCEPTIOM:
*4rlier toidfs 82
Symplektoptes cysticola S3
SECTION lY.
Diseases of the Lungs.
1. Congestion of the Lungs and Edema of the Lungs. Hypenemia et
Oedema pulmonum 84
2. Pulmonary Hemorrhage. HjBmoptoe 88
3. Alveolar Emphysema. Emphysseraa pulmonum alveolare !)0
Acute Alveolar Emphysema 00
Chronic Alveolar Emphysema. Emphysajma pulmonum alveolare
genuinum 92
4. Interstitial Emphysema of the Lungs. Emphysa3ma pulmonum in-
terstitiale '. ' 99
5. Croupous Pneumonia. Pneumonia crouixiusa 101
6. Catarrhal Pneumonia. Pneumonia catavrhalis 125
Pneumonia of Birds 131
Atelectasis of the Lungs 131
7. Enzootic Pneumonia of Young Animals 133
8. Mycotic Pneumonia. Pneumonomyeosis 142
9. Punilent Pneumonia. Pneumonia suppurativa 145
10. Pulmonaiy Gangrene. Gan£iTa?na pulmonum 147
11. Chi-onic Interstitial Pneumonia. Pneumonia inlerstitinlis chi-onica. . 153
12. Echinococcus in the Lungs. Echinococcosis ]nilni(inuin 150
Other Parasites of the Lungs 159
13. Neoplasms of the Lungs. Tumores pulmonum 159
SECTION Y.
Diseases of the Pleura.
1. Inflammation of the Pleura. Pleuritis 101
2. Hydrothorax 17(i
3. Air in the Pleural Cavity. Pneumothorax 178
Hematothorax 181
Diseases of the Digestive Organs
SECTION I.
Diseases of the Buccal Cavity.
1. Catarrh of the Buccal Cavity. Stomatitis catarrhalis 182
2. Vesicular Inflammations of the Mouth. Stomatitis vesiculosa 185
Contents. IX
PAGE
3. Aphthous Inflammation of the Mouth. Stomatitis aphthosa 187
Aphtlious Inflammation of the Mouth of the Young 18S
Infectious Papulous Inflammation of the Mouth of Cattle. Stoma-
titis papulosa bovum infeetiosa 190
Othei- Diseases Similar to Stomatitis 1!)3
4. Thi-ush. Stomatitis oidiea 195
5. Phlegmonous Inflammation of the Mouth. Stomatitis phlegm onosa. . 19(i
6. Ulcerative Inflammation of the Buccal Cavity. Stomatitis Tilcerosa 198
Other Diphtheritic Inflammations of the Mucosa of the Mouth .... 201
SECTION II.
Diseases of the Salivary Glands.
1 . Ptyalism 202
2. Parotitis 203
Inflammation of the Submaxillary Gland 205
SECTION III.
1. Pharyngitis 206
2. Paralysis of the Pharynx. Paralysis pharyngis 214
Enzootic Paralysis of the Pharynx in Cattle 215
3. Animal Parasites in the Pharynx 216
4. Tumors in the Throat. Tumores intra- et peripharyngeales 217
SECTION IV.
Diseases of the Esophagus.
1. Esophagitis 220
2. Spasm "^of the Esophagus. Esophagismus 222
3. Paralysis of the Esophagus. Paralysis oesophagi 223
4. Obstruction of the Esophagus. Obstructio oesophagi 224
5. Constriction of the Esophagus. Stenosis oesoiihagi 231
(). Dilatation of the Esophagus. Dilatatio oesoi^hagi 235
7. Neoplasms in the Esophagus. Tumores oesoj^hagi 240
K. Spiroptera sanguinolenta in the Esophagus 240
Other Animal Parasites in the Esophagus 241
9. Diseases of the Crop in Fowl 242
Catarrh of the Crop 242
10. Occlusion of the Crop. Obstructio ingluvici 243
Animal Parasites in the Crop 244
SECTION V.
Diseases of the Stomach and Intestines.
1. Vomiting. Vomitus 245
2. Diseases of the Fore-stomachs (Iiunien, Reticulum and Omasum)
in Ruminants 249
Dilatation of the Rumen. Dilatatio acuta ruminis ab alimentis. . . . 249
Bloating of Ruminants, Acute 255
Bloating of Ruminants, Chronic 262
Atony of the Fore-stomachs. Atonia ruminis, retieuli et omasi. . . . 265
Foreign Bodies in the Fore-stomachs. Corpora aliena retieuli,
ruminis et omasi 274
Other Inflammatory Diseases of the Fore-stomachs 284
3. Acute Catarrh of the Stomach. Catarrhus ventriculi acutus 285
4. Chronic Gastric Catari'h. Catarrhus ventriculi chronieus 292
5. Acute Dilatation of the Stomach. Dilatatio ventriculi acuta 296
Acute Dilatation of the Stomach in the Horse 296
Acute Dilatation of the Stomach in Other Animals 307
X Contents.
PAGE
6. Chronip Dilatation of the Stomach. Dilatatio ventriculi chronica. .. . 309
7. Foreign Bodies in the Stomach. Cori)ora aliena ventriculi 312
F(irei.iiii Bodies in the Stomachs of Other Animals 313
8. Ulcer of the Stomach. Ulcus ventriculi 314
9. Neoplasms in the Stomach. Tumores ventriculi 316
10. Torsion of the Stomach. Torsio ventriculi 317
11. Hemorrhasre from the Stomach. Hemorrhairia ventriculi 321
12. Intestinal Hemorrhage. Enterorrhagia 323
Rectal Hemorrhace of Cattle ' 325
13. Acute Intestinal Catarrh. Catarrhus intestinalis acutus 325
14. Acute Ga.stro-intestinal Catarrh in Young Animals 333
15. Catarrhal Intestinal Colic. Enteralgia catarrhalis 337
Abdominal Pain in the Uterine Contractions 340
16. Chronic Intestinal Catarrh. Catarrhus intestinalis chronicus 340
17. Membranous Enteritis. Enteritis membranacea 344
Enteritis Pseudomembraiiacea of Cats 346
18. Gastro-enteritis 347
Enteritis in Fowls 356
Meat Poisoning and Botulism in Man 357
19. Bloating of the Intestines. Meteorismus intestinonnn 358
20. Impaction. Obstipatio 364
(a) Impaction of the Intestines in the Horse 364
(b) Impaction of the Intestines in Carnivora 373
(c) Impaction of the Inte.stines in Ruminants 375
(d) Impaction of the Intestines in Hogs 377
(e) Impaction of the Intestines in Rabbits 378
(f ) Impaction of the Intestines in Fowls 378
21. Internal Displacements of the Intestine. Obturatio intestini 379
22. Narrowing of the Intestines. Stenosis intestini 387
23. Occlusion of the Mesenteric Arteries. Thrombosis et emboli arterium
mesenterialum 393
Thrombosis of the Arteria Colliaca 411
24. Internal Strangulation of the Intestine. Incarceratio et strangulatio
intestini " 412
25. Volvulus and Torsion of the Intestine. Volvulus et torsio intestini. . . 425
26. Intestinal Invagination. Invaginatio intestini 438
27. Colic in the Horse 445
Colic in Other Animals 452
28. Animal Parasites in the Stomach 452
(a) Gastrophilus Larva; in the Stomach of the Horse 452
Nematodes in the Stomach of the Horse 456
(b) Stomach Worms in Sheep and Goats. Strongylosis ventriculi
ovum et cajiranim 457
(c) Stomach Worms in Cattle. Strongylosis ventriculi bovum. .. . 459
Stomach Worms in Deer 461
(d) Parasites in the Stomach, Swine 461
(e) Parasites in the Stomachs of Carnivora 462
(f ) Parasites in the Stomachs of Birds 462
29. Intestinal AVorms. Helminthiasis 463
(A) Tapeworms. Cestodes 464
( a ) Tapeworms in the Horse 465
(b) Tapeworms in Cattle 466
(c) Tapeworms in Sheep 467
(d) Tapeworms in Dogs 468
(e) Tapeworms in Cats 472
(f ) Tapeworms hi Rabbits 472
(g) Tapewonns in Birds 473
(B) Trematodes 474
(C) Nematodes. Rnundwoi-ms 475
Cou tents. XI
(a) AscariclEe in Mammals. Ascariasis 4/5
(b) Heterakis Infestation of Birds. Heterakiasis 481
(c) Dochmiasis 482
Doclimii in Carnivora 482
Doelimii in Cattle 485
Dochmii in Other Animals 486
(d) Trichotraehelidaj 487
(e) Oxyuriasis 487
(f ) Palisade Worms in the Intestines 488
Palisade Worms in Horses. Sclerostomiasis equorum 488
Oesophasostomes in the Intestines 403
Other Thread Worms in the Intestines 495
(g) Echinorhynehus Gig'as 495
Echinorhynehi in Fowl 496
30. Coceidia in the Intestiiies. Coceidiosis intestinalis 497
(a) Red Dysentery in Cattle. Dysenteria coccidiosa bovum 497
(b) Intestinal Coceidiosis in Sheep and Goats. Coceidiosis ovum
et caprarum 501
(c) Intestinal Coceidiosis in Carnivora 502
(d) Intestinal Coceidiosis in Rabbits. Coceidiosis intestinalis
cuniculorum 502
(e) Intestinal Coceidiosis in Fowl. Coceidiosis int. avium 502
Perityphlohepatitis Meleagridum 504
SECTION VT.
Diseases of the Liver
1. Icterus 506
Icterus Neonatorum 509
2. Gallstones. Cholelithiasis 510
Foreign Bodies in the Liver and Gall-ducts 512
3. Fatty Liver. Hepar adiposum 513
4. Amyloid Degeneration of Liver. Degen. amyloidea hepatis 515
5. Rupture of the Liver. Ruptura hepatis 517
6. Acute Parenchymatous Hepatitis. Hepatis parenchymatosa acuta. . . 519
Hepatis parenchymatosa acuta diffusa ovum 520
Hepatis enzootica porcellorum 521
7. Acute Yellow Atrophy of the Liver. Atrophia hepatis flava 522
S. Lupinosis 523
9. Suppurative Hepatitis. Hepatitis suppurativa. . ._ 526
10. Nodular Necrosis of Liver. Necrosis nodosa hepatis 528
11. Chronic Interstitial Hepatitis .^ 530
12. Neoplasms in the Liver. Neoplasmata hepatis 539
Carcinoma of the Liver. Carcinoma hepatis 539
Other NcAv-formations in the Liver 541
Tuberculosis and Actinomycosis of the Liver 541
13. Animal Parasites of the Liver 542
(a) Echmocoeci in the Liver 542
(b) Distomiasis. Liver Flukes 545
(e) Cysticerei in the liiver. Cysticercosis hepatis 555
Other Animal Parasites in the Liver 558
(d) Coceidia in the Liver. Coceidiosis hepatis 559
Protozoal Hepatitis in Pigeons 560
SECTION VII.
Diseases of the Pancreas.
Diseases of the Pancreas 561
XII Contents,
SECTION VIII.
Diseases of the Peritoneum.
PAGE
1. Ascites. Hydrops ascites 564
2. Peritonitis ' 572
3. Tumors of the Peritoneum 581
4. Animal Parasites of the Abdominal Cavity 582
Diseases of the Nervous System.
SECTION I.
Diseases of the Brain.
General Symptoms of Brain Affections 584
(a) General Sjanploms 584
(b) Focal Symptoms 588
1. Leptomeningitis .' 596
2. Enzootic Cerebro-spinal Meningitis. Meningilis cerebrosi)inalis en-
zootica 606
3. Hyperemia of the Brain. Hyperajmia cerebri 618
4. Sunstroke and Heat Exhaustion 620
5. Anemia of the Brain. Anaemia cerebri 622
6. Traumatisms of the Brain. Contusio et counnotio cerebii 623
7. Lightning-stroke 627
8. Cerebral" Hemorrhage 628
0. Occlusion of the Vessels of tlie Brain 631
10. Encephalitis 632
(a) Purulent Encephalitis 633
(b) Acute Simple Encephalitis 636
Chronic Encephalitis 644
11. Chronic Hydrocephalus. Hydrocephalus internus chnmicus 644
Congenital Hydrocephalus Go6
1 2. Tumors of the Brain. Tumores cerebri 65Q
13. Gid. Ccenurosis 660
Other Parasites of the Brain 672
14. Bulbar Paraly.sis. Paralysis bulbaris 673
(a) Acute Bulbar Paralysis 673
(b) Progressive Bulbar Paralysis 674
SECTION II.
Diseases of the Spinal Cord.
1. Acute ]\Ieningitis 676
2. Ossifying- Inflammation of the Dura Mater of the Spinal Cord 680
3. Traumatisms of the Spinal Cord. Contusio et commotio meduhe
spinalis , 6S5
4. Inflammation of the Spinal Cord. Myelitis spinalis 680
5. Enzootic Spinal Paralysis of Horses. Paraplegia Equorum 697
Tabes Dorsalis 701
6. Compression of the Spinal Cord. Compressio medul. spinalis 702
7. Syringomyelia 712
SECTION III.
Diseases of the Peripheral Nerves.
Causes and Symptoms of Diseases of the Peripheral Nerves
714
1. Paralj'sis of the Nerves of the Eye 71^
Contents.
XIII
PAGE
2 Paralysis of the Trigeminal Nerves ^2o
Spasm of the Trigeminal Nerve ^
Neuralgia of the Trigeminal Nerve •.••••.••. 70-1
3 Paralysis of the Facial Nerves. Paralysis nervi f aeiah. ^21
Spasm of the Facial Nerves ■•■■■,■■• " ■„V^',,Vf^Vi 7'>6
4 Paralysis of the Auditory Nerve. Paralysis nervi acoustici ^-b
V Pi VI I vsis of the Vagus. Paralysis nervi vagi •• ; '-^^
I Prralysis of the Recurrent Nerve. Paralysis nervi laryngei recur- ^^^
rentis ' 7^7
Spasm of the Larynx • ■ • • r-37
7. Paralysis of the Suprascapular Serves ^^^
s' Paralysis of the Padial Nerves ..... • ■ • • ■ ■. • ■ • • ^" ;,
q Paralysis of the Brachial Plexus. Par. plexus hrac nabs '^■;^
10. Paralysis of the Sciatic Nerve. Paral. nervi ischiadic! . . . . . . . . • • • • • ^4-
Sciatica • • 744
Paralysis of the Tibial Nerves ..^^
Cramp of the Muscles of the Tibia .
Paralysis of the External Popliteal Nerve • '
II Paralysis of the Femoral Nerves. Paralysis nervi iemoralis -4.,
1 'J Paralysis of the Obturator Nerves •
}i- Paralysis of the Sacral Plexus. Paralysis plexus sacralis .48
Paralysis of the Gluteal Nerves ^^g
Prostration A f ter Parturition ^^,^
Prostration Before Parturition ...•••. .■ ' ' V ' V; 740
14 Paralysis of the Pudic Newe. Paralysis nervi pudendi . . . ^4.'
It' Paralysis of Tail and Sphincter. Paralysis sphmctero caudans .oO
16.' Multiple Neuritis. Polyneuritis • • • • • ^^^
17. Trembles in Sheep
SECTION IV.
Functional Nerve Diseases.
702
1. Vertigo 765
Meniere's Disease 765
Paralytic Vertigo .'..........■ ^^^^
2. Epilepsy 774
I ^™Sco,;vuid„„s;-co,;vuhio„.sp„en;e™.es;;:::::: ■ ij^
(a) Puerperal Convulsions m Dogs. ••••.••• 777
b Puerperal Convulsions in Other Animals ..^
5 Parturition Paresis. Paresis pueiTeralis • ^^g
Diseases Similar to Parturient Paresis ;■■.;■... 790
Railway Disease of Cows 79I
6. Catalepsy. Katalepsia '.'.'.'.'.'.'.... ''^'^
7 Chorea : 793
Chorea electrica congenita 793
Chorea in Newborn Animals 794
S. Spasm of the Diaphragm .. ... • • • ■-■■ ■■■■ ■ v" 'tj-^uiities '. '^^^^
0 Local Spasms of Muscles of Head, Neck and hxtiemitie_ ^^^^
Tetany 79S
Tembladera W 'V ' '•; '^•^^
10 Basedow's Disease. Morbus Basedowu c^,^q
Enzootic Cretinism in Animals • • • • • ^00
11. Psychoses
Diseases of the Organs of Locomotion.
1. Articular Rheumatism. Rheumatismus articularum '^jj^
Other Articular Diseases • • • • •••■;■ 01 n
Infectious Inflammation of the Joints m Geese and Ducks e^iu
Vring Paralysis in Pige• t. W. = Deutsche tieriirztliche Wochenschrift (Hannover).
D. Z. f. Tm. = Deutsche Zeitschrift fiir Tiermedizin und vergleichen.ie Patho-
logie (Leipzig).
Diss. ( Inaug.-Diss. ) = Inaugural-Dissertation.
Dresdn. B. — Jahresbericht der tieriirztlichen Hochschule in Dresden.
Ergebn. d. Path. = Ergebnisse der allgemeinen Pathologie und pathol. Anatomie
(Wiesbaden).
F. d. M. = Fortschritte der Medizin (Berlin).
P. d. Vhyg. = Fortschritte der Yeteriniirhygiene (Berlin).
Hb. d. p. M. = Handbuch der pathogenen Mikroorganismen ; roiligiert von
KoLLE & Wassermann (Jena).
H. (Hann.) Jhb. = Jahresliericht der Kon. Tierarzneischule zu Hannover.
Holl. Z. = Ti.jdsehrift voor Yeeartsenijkunde.
Hyg. deviande = L 'hygiene de la viande et du lait (Paris).
J. du Midi = Journal des veterinaires du Midi.
J. of comp. Path.= The Journal of comparative Pathology ananptoms of
acute nasal catarrh and the specific nature of the disease may
only be recognized because other animals show the typical pic-
ture of the disease. (See Vol. I.) In other animals we must
likewise consider the occurrence of specific nasal catarrhs.
Treatment. Acute nasal catarrh usually ends in recovery
without any treatment. It is sufficient to protect the sick ani-
mals against drafts of air, to keep them in a moderately warm
place and to give them feed free from dust. In severe cases
with higher fever, with abundant discharge and snorting respir-
ations, it is well to irrigate the nasal cavities with pure water,
1-2% solution of carbonate of soda or creolin, or make
the animal inhale medicated vapors. When the secretion is
very abundant, turpentine (1-5% evaporated over hot water)
is very serviceable. Crusts adherent to the margins of the
iiares should be removed with warm water and the place should
then be covered with fat or vaseline.
Chronic nasal catarrh requires local treatment with inhala-
(ion and irrigation of tlie nasal cavities.
In larger animals inhalation is lironght al>out by placing nnder the nares o^
the patient a vessel filled with hot water and by wrapping a large cloth around
the heail of the animal and the vessel. If a horse should be frightened by this
manipulation, the lower jtart of its head is placed into a feed sack, fastened to the
head; the bottom of the feed sack is removed and the former conneeteil with the
vessel with hot water (Johne). Smaller animals may be made to inhale in a similar
manner, or by the aid of a Siegel, a Bulling or a Wasmuth apparatus. The use
of these apparatuses appears less serviceable however, since the greater portion
of the sprayed fluid becomes deposited in the lower portions of the nasal cavities
(Poeschel, Freund).
Much better results are obtained in all animals from irrigation of the nasal
cavities with the aid of a syringe connected with a proper rubber tube, perforated
in several places at its free end. This tube is introduced high up into the nares
and the fluid is injected under moderate pressure. A catheter with lateral per-
forations connected with an elevated irrigator may also be used. A Frick or a
Bayer-Kieselbach spray apparatus which may be introduced into the nares of a
horse without difficulty is also quite serviceable. The following solutions may be
used for nasal irrigations: 1 to 2% solution of carbonate of soda or creolin;
% to 19r solution of carbolic acid, tannic acid; 2 to 4% boraeic acid.
Gorodtschaninow produced recovery in a short time in a case of chronic nasal
catarrh by irrigation with alcoholic tannoform and menthol solution, composed of
2 parts of tannoform, 0.:? parts of menthol and 145 ])arts of Q-i'/c alcohol, plus 4n
parts of distilled water. This solution was mixed before use with equal parts of
distilled water.
However, in chronic catarrh of the u])permost portion of
the nose these methods are insufficient, and here as well as in
necrosis of the turbinated bones there is no other procedure left
but trephining of the nasal cavity and irrigation from above
with disinfectant and astringent fluids.
Internal medication appears superfluous ; sulphate of atro-
pine may perhaps be used in case of abundant secretion. In
secondary nasal catarrh the primary affection must be sub-
jected to the proper treatment, which is usually surgical. In
empyema of the upper turbinated bones the removal of these
parts sometimes becomes necessary.
8 Contagious Nasal Catarrh of Birds.
Nasal Catarrh with Cutaneous Desquamation in the Neighborhood
of the Nose in Horses. This disease, occurring fre(iuently among horses, is
probably clue to noxious feed, in such a manner that certain irritating
substances of such food, during ingestion, come in contact with the skin
in the neighborhood of the nose, the mouth and the mucosa of the nose.
Varying Avith the nature of the feed either the changes of the mucosa of
the muzzle are more marked or, on the contrary, those of the nose. An
origin as indicated above was established by Oekresz who found fifty-eight
out of sixty-four horses of one owner affected seven days after they had
been fed with chaff from a certain source. The disease did not spread to
other horses. Aside from the changes of catarrh of the mouth and nose,
desciuamation of the skin was seen at the lower part of the head, the
pigmented epidermis was shed in thin, but fairly large, lamellaB and
flakes, and the skin assumed a peculiarly ragged appearance. Change
of feed in such cases, supported by the usual therapeutic applications
to the skin of borovaselin, brings about recovery within a few davs
(Oekresz, A. L., 1909, 514).
Benign Infectious Nasal Catarrh in Cattle. This disease, by Dieck-
erhoff also called ephemerous infectious nasal catarrh, is contagious
in nature and is usually observed in adult cattle, only exceptionally
in calves. It often occurs as a stable epidemic, frecjuently, however,
also sporadically. According to Dieckerhoff, the period of incubation is,
as a rule, only two days.
The relation of this disease to malignant catarrhal fever or croup of cattle
(see A^ol. T) and to infectious catarrh of the upjier respiratory passages in cattle
(see catarrh of the larynx and bronchi) is still to be established by further observa-
tions.
The first symptoms consist in decrease or even in complete lack of
appetite, also weakness and a more or less febrile temperature, which,
in severe cases, rises up to 40° C. and higher. In milch cows there is
a decrease of milk secretion, laerimation, swelling of the eyelids, a thin
mucoid secretion from the nose, reddening of the conjunctivae and of the
nasal mucosa.
The course is acute and recovery occurs in adult cattle generally
after one to one and a half days, more rarely after two to three days.
Dieckerhoff observed a fatal case in a calf.
Treatment consists in a proper regulation of the diet (good hay
and bran mash).
Literature. Dieckerhoff: Specielle Pathologie, 1892, ii, 86.
3. Contagious Nasal Catarrh of Birds. Coryza avium
contagiosa.
(Ansteckender SchuKpfcn der Yoegel [German] ; Coryza con-
tagieux, morve oii ronpie des ponies [French].)
Contagious nasal catarrh of fowls is an acute infectious
disease characterized anatomically by a catarrhal inflammation
of the mucous membranes of the head.
Occurrence. The disease occurs preferably among young
fowls, especially chickens, during damp, cold weather^ in fall
Contagious Nasal Catarrh of Birds, 9
or spring. It is epizootic in character and often causes the
death of many birds. Its economic importance depends both
upon the great mortality and upon the fact that affected adult
hens are unfavorably influenced as to their egg-laying capacity.
Etiology. Contagious nasal catarrh of fowls is due to an
infection. This is shown not only by the epizootic occurrence
but also by inoculation experiments (authors' observations),
and by the observation that the disease is often imported
through newly bought fowls (Ammenschlaeger, Feld). The
nature of the infectious virus has not been determined exactly,
but it is contained in the secretions of the mucosa of the head.
L. Gallez and later on Gratia & Lienaux found in the mucous secre-
tion from the nose of sick chickens an organism similar to the diph-
theria bacillus of Klebs-Loeffler. Gallez believed these bacilli to be an
attenuated type of the diphtheria bacillus, while Gratia & Lienaux con-
sider it doubtful whether the organism is an attenuated diphtheria
bacillus or a pseudodiphtheria bacillus. Deich demonstrated spirilla-
like organisms and also short bacilli rounded at both ends and occurring
in groups.
The disease has formerly, but also again lately, been considered as a special
clinical variety of fowl diphtheria (Colin, Schrevens, Gallez, Klee) due to the
bacillus of fowl diphtheria.
Natural infection takes place by scattering the infected
nasal secretion by movements of the head and in sneezing of the
sick birds and by the ingestion of these secretions with con-
taminated food or water by healthy birds. Healthy flocks
usually become infected by the importation of infected birds.
The disease may, however, be spread just as in fowl diphtheria,
by free flying birds coming from a distance.
Predisposing causes may likewise play a role. Damp and
cold weather in the fall and spring, the sojourn in cold and
drafty places, may assist in bringing about the infection.
Susceptibility. Young birds or such debilitated from any
cause, especially young chickens, are affected most commonly.
In some epidemics birds are affected without reference to
age.
Deich did not succeed in the experimental transmission of the disease to
chickens and ducks.
Anatomical Changes. Aside from emaciation and anemia
a glassy or purulent mucus is found in the conjunctival sac,
in the nasal cavities and in the pharynx. The mucosa of these
parts is reddened. Pseudomembranous deposits or other or-
ganic changes are absent.
Symptoms. The disease begins with malaise. The sick
animals separate themselves from others and sit quietly with
10 Conta.uious Xasai Catarrh of Birds.
nifflod feathers and drooped wings. The appetite is decreased
after one or two days, hicrimation occurs, also frequent sneez-
ing and sliaking of the head. At first w^atery, later on tenacious,
whitish to yellowish masses are discharged from the nose.
Such secretions are discliarged from both nasal openings, and
they dry there to yellowish crusts which close up the openings.
The birds breathe through the open bill or respiration is rat-
tling or sniffling. Tlie eyes are kept closed and the lids become
matted together by masses of secretion; in the conjunctival sacs
a whitish, tenacious, however not croupous, exudate collects
which makes the eyelids protrude. The cornea appears cloudy.
On account of the matting together of the eyelids the sick
birds are unable to take up their food and they may actually
starve to death. The infra-orl)ital cell, which is filled with
masses of exudate, sometimes protrudes in the shape of a swell-
ing or tumor. In the pharynx we find a muco-serous exudate
and intense reddening of the mucosa. Swallowing may become
difficult. The birds frequently succumb with rapid emacia-
tion.
Hanl)oId saw in a goose-fattening establishment numerous cases
of a disease resembling contagions nasal catarrh and leading to serious
economic losses. After an incubation period of eight to sixteen days
the birds showed reddening of the bill and a nuicous nasal secretion
which easily dried into crusts. The birds fretiuently scratched their
bills, dipped them often into water, curved their necks occasionally or
bent their heads toward the back, shook them, cried out from time to
time, turned around in a circle and finally fell downi almost unconscious,
soon to get up again. Beginning ^^ath the third week there is diminu-
tion of appetite. Sometimes 10 to 15 per cent of the number of all
birds succumb to the disease. It appears that it has lieen imported
into Germany from Russia. Schi-eiber claims to have found as the cause
of the disease a micrococcus, and its toxins are said to affect the cere-
bellum.
Course and Prognosis. The disease spreads rapidly among
the birds of one establishment and leads to death in some epi-
zootics after only one to three days; generally, however, the
course lasts several days, up to three and six weeks. Most
young birds die from the disease (sometimes there are 95
per cent of fatal cases) ; in adult Inrds the disease frequently
ends in recovery.
Diagnosis. The clinical diagnosis is based on the conta-
gious nature of the disease and the mucopurulent character
of the catarrh of the mucous mend)ranes of the head. Simple
nasal catarrh, which imder favorable hygienic conditions may
also occui" among a number of birds, may be distinguished by
the fact that it does not spread widely, that the nasal secre-
tion remains thin, fluid, and that the affection of the conjunc-
tivae and phar>Tigeal mucosa, which may coexist, remains moder-
lufeetiuns Nasal Catarrh of Swine. 11
ate in degree. In fowl diplitlieria pseudoniembranes are found
on the mucosae and also on the skin.
Treatment. Ziirn reconnnends the inhalation of vapors of
tar ; Azarv, irrigation of the nasal cavities with a 3-5 per cent
solution of chlorate of potash, or a 5 per cent solution of
borax; Klee advocates irrigation of the nasal cavities
with a 2 per cent solution of sulphate of copper. The
same solution may be used to brush the conjunctivae and
the mucosa of the pharynx. One should also see that the masses
of secretion agglutinating the eyes and the nostrils are removed
from time to time. The inf ra-orl)ital cell, if swollen, must early
be laid open by an incision and must be irrigated for several
days after the removal of the exudation. One must also attend
to artificial feeding of young birds whose eyes have become
closed and who consequently cannot feed properly. Feld rec-
onnnends that white bread soaked in water or milk be introduced
into the bill of such patients. While the disease lasts the ani-
mals should be kept in warm places.
Prophylaxis. Since treatment of the disease frequently is
without results it is advisable to limit the spread of the disease
by isolation of the sick, or better still, of the healthy birds,
and by cleaning and disinfecting the coops and runs. The
spread of the disease may sometimes be checked by the imme-
diate slaughter of all the sick birds (Ammerschlaeger). The
importation of the disease may be prevented by careful exam-
ination of newly bought birds and by keeping them in quaran-
tine for some time.
Literature. Anmiorsdilacger, W. F. Th., 1906, 27.— Deieli, S. B., lOo:?, 67.—
Feld, Leipzig, Geflztg., 1906.— Gratia & Lieiianx, Ann., 1S08, 401.— Ilaiibold, S. B.,
1908, 76.— Klee, Geflnegelkrkt., 1905, 18; P. \C, 1901, ii, 26.
4. Infectious Nasal Catarrh of Swine. Rhinitis infectiosa suum.
{Schnilffelkrcuiklicif, Bdsarfifjrr Nasenkafarrh der Schweine
[Anacker] [German] ; Rhinitis infectiosa [Imminger].)
Infectious nasal catarrh of swine is an enzootic, infectious
disease of young pigs, caused by the bacillus pyocyaneus, char-
acterized anatomically by a hemorrhagic inflammation of the
nasal and ethmoid mucosa and by hemorrhagic meningitis.
Historical. The disease has been known in Germany for a long
time under the name of "snuffling disease"; it was believed to be
a rachitic afiPection of the bones of the face or osteomalacia (see Vol. I)
(Haiibold, Harms, Wulff, Ostertag) ; others considered it a specific form
of rhinitis (Schneider, Imminger) ; while still others (Anacker)
thought that it was identical with malignant catarrhal fever of cattle or
a form of scorbutus (Plering). Since nasal stenosis due to tuberculous
12 Infectious Nasal Catarrh of Swine.
or actinomycotic changes has also been included nnder the term of
"snuffling disease'' Anacker, and particularly Friedberger & P^rohner,
have advocated to abandon this name entirely. The authors are fully in
accord with Friedberger & Frohner and think that it is bad practice
to throw together entirely different affections under one name merely
on account of the presence of one common symptom; the name should
therefore be abandoned entirely.
Imminger recognized the infectious nature of the disease in 1890
and Koske cleared up its etiology in all of its main points in 1906.
Aside from these authors, Anacker, Schneider and others have furnished
contributions to the symptomatology and pathologic anatomy of the
disease.
Occurrence. Infectious rhinitis occurs dnrin^' all seasons
enzootically among pigs three to six months old ; older liogs are
affected only rarely. Wooden pig-pens appear to be particu-
larly favorable to the appearance and to the spread of the dis-
ease; other observers claim that a rough stone floor favors the
appearance of the affection. So far, only German veterinarians
have reported on the appearance of this disease.
Etiology. Bacillus pyocyaneus is a usually small, slender,
non-motile rod with rounded ends and with a single flagellum
at the posterior pole; its length is between 0.6 to 6 /-i and its
shape is likewise very variable. It does not form spores. The
bacilli have been found in the ethmoidal mucosa and in the brain
of sick animals. They are easily stained with the watery anilin
stains, but they are decolorized by Gram's method.
Cultural Properties. In a gelatin stab culture the bacilli develoji
almost exclusively in the upper part of the stab canal, to form first
a depressed growth on the surface, greenish and fluorescent in color.
Liquefaction spreads dowaiward and the growth collects at the bottom
of the liquefied gelatin as a slimy mass; the surface becomes covered
with a greenish-yellow growth. On gelatin plates there are first formed
small, roundish, yellowish-white colonies growing rapidly in size, their
center darker yello^ash and the periphery greenish fluorescent. On
agar, there is formed a fairly thick, grayish-yellow covering, which
at room temperature later on becomes deep dark green ; the cultures
emanate an aromatic odor resembling jasmin. On potatoes the growth
is at first reddish-yellow and changes from the second day into green.
Bouillon becomes after some time uniformly cloudy and greenish in
the upper strata. Milk is coagulated.
Tenacity. The resistance of bacillus pyocyaneus is considerable, about equal
to that of staphylococcus pyogenes aureus (Wassermann).
Pathogenicity. Small laboratory animals (mice, guinea-
pigs) die after subcutaneous inoculation of pure cultures wdtliin
two to five days ; after intraperitoneal inoculation even after
three to six hours. If young pigs are inoculated directly into
the mucosa of the ethmoid, after a preliminary trepanation, they
develop the same symptoms and anatomical changes as in
Pathogenesis. Anatomical Cliang-es. Symptoms. 13
natural infection. According to the amount inoculated, the
animals die after twenty-four hours or after eight to thirty
days. Intramuscular inoculation leads to death in twenty-seven
to thirty days. Intravenous injection of a bouillon culture only
leads to a transitory elevation of temperature.
Natural infection occurs by the introduction of the bacilli
through the nose. Since bacillus pyocyaneus is a common sap-
rophyte, found especially in manure, straw, feces, etc., it easily
gets into the noses of hogs in rooting. The inoculation experi-
ments of Koske admit also the possibility of different portals
of entrance. If the disease has once made its appearance it is
spread by the nasal secretions of the sick animals.
Young animals are especially susceptible to natural infec-
tion.
Pathogenesis. After gaining access to the nasal mucosa,
the bacilli multiply rapidly and soon get into the upper portions
of the nasal cavities and into the ethmoid bone. They form
powerful toxins and these produce, in the nasal mucosa and
particularly in that of the ethmoid bone, a hemorrhagic inflam-
mation which subsequently spreads to the meninges. Bacterial
toxins, absorbed into the i)lood, soon cause a general elevation
of temperature and petechias and ecchymoses in various por-
tions of the body. Koske showed experimentally that the toxins
of the bacillus pyocyaneus can by themselves produce a typical
picture of the disease.
Anatomical Changes. The nasal mucosa is deep purplish
red and the intensity of the redness is, according to Imminger,
somewhat decreased upward. If the disease takes a short course
one finds blood coagula in the ethmoidal cells ; if the course has
been more protracted a hemorrhagic purulent exudate is evi-
dent ; there may be deviation and atrophy of the bony lamella.
The frontal sinuses usually contain a serous fluid. Hemor-
rhages are seen under the periosteum of the ethmoid and vomer,
as well as in the sheaths of the olfactory and optic nerves. The
congested vessels of the meninges show lilood extravasation;
blood is also seen between the convolutions of the brain, some-
times in the shape of blood coagula. The substance of the brain
appears edematous and the ventricles contain a red-tinged
though clear fluid. Sometimes blood coagula are deposited on
the choroid plexuses. While Imminger did not And any other
changes, Koske found a turbid, reddish fluid in very small
amounts in the peritoneal cavity, here and there diffuse red-
dening of the intestinal mucosa, streaky reddening of the cor-
tical portion of the kidney, subserous hemorrhages and paren-
chymatous degeneration of the internal organs.
Symptoms. The disease is ushered in by a febrile elevation
of temperature up to 41° and above and a diminution of appe-
14 111 recti. MIS Nasal Calanii oC Swiiic.
lite; the sick animals [\'i'i\ very slowly or not at all, though
they root a good deal in the food whieii is placed before them.
They early show a certain degree of anxiety and excitement and
make a peculiar blowing noise, as if they wanted to expel a for-
eign body which had gained entrance into the nose. They occa-
sionally rub their snouts on their feed troughs or on the walls
of the pens. Usually on the second day there is bleeding from
the nose upon sneezing, and there appears a reddish, slimy,
later on and in more protracted cases, a purulent nasal dis-
charge ; according to Anacker, even ichorous secretion flows from
the nose in some cases. Breathing becomes more and more forced
and snorting. If the nasal nmcosa is much affected, there may
be edematous swelling of the region of the nose and of the sub-
maxillary glands. In the further course, generally after one to
three days, marked cerebral symptoms become manifest, there is
restlessness, wdiich may increase to maniacal excitement and
to attempts to scale the walls of the pens; also convulsions,
which cause the animals to fall to the floor. The excitement is
followed by coma and the animals lie apathetically in the straw,
unable to rise.
Course and Prognosis. The disease generally takes an acute
course and frequently ends fatally within from three to six days,
under increase of the disturbances in respiration and of the
general depression. In some epidemics all the animals die and it
becomes necessary to slaughter the exposed animals in time be-
fore they show signs of the disease. Rarely do cases terminate
fatally within one to two days. More frequently a chronic course
is observed, the first tempestuous symptoms become milder, the
appetite, however, remains poor or va liable, there may be slight
epistaxis at intervals and mild convulsions. The nutrition of
the patients suffers gradually and the animals die from inani-
tion after several weeks or months, unless they have previously
been killed. Recovery is rare; different epidemics, however,
vary greatly in this respect.
Diagnosis. The acute onset with high fever, the intense
inflannnation of the nasal mucosa and of the brain without pro-
trusion of the bones of the face, furnish sufficient data for a
diagnosis. Rachitic or osteomalatic extension of the facial
bones is characterized by an afebrile course and ])y the marked
disorder of the facial portion of the head wdtli simultaneous
protrusion of the hard palate toward the l)uccal cavity; there
is in this affection a nasal catarrh only after a prolonged course
and after a nasal stenosis has been existing for some time.
Hog cholera, in its most acute form, might be confounded with
contagious nasal catarrh liecause it is sometimes accompanied
by epistaxis and by sjmiptoms on the part of the ])rain. The
absence of anatomical changes in the nose, and the changes found
in the intestinal tract upon post-mortem examination, should
prevent an error in diagnosis.
Contagious Nasal ("iilarrli of Kal)l)ils. 15
Treatment. This is t'rcHiiioiitly without success. It appears
therefore best to slaughter most of the sick auimals. If the
symptoms are mild from the start, treatment should however be
instituted. Imminger was successful in two cases with instilla-
tions of a 1% solution of corrosive sublimate, 1 tablespoonful
into each nostril every one to two hours. One may also try irri-
gation of the nasal cavities with corrosive sublimate or another
disinfectant solution. (See page 7.)
Prophylaxis. If the disease appears in a herd, it is well to
separate the healthy animals and instill some corrosive subli-
mate or other disinfectant solution into their nares. The infected
pens must l)e well disinfected and kept clean.
Literature. Anackei-j Spez. Path., 1879, 46.— Imminger, W. f. Tk., 1890, 125.—
Koske, Arb. d. G. A., 19n6, XXTII, .542.
5. Contag-ious Nasal Catarrh of Rabbits. Rhinitis
contagiosa cuniculorum.
(Ififuenzaarticje Kanlnchenseuclie [Kraus, Kasparek] ; Infecti-
oser oder Bosartiger Schnupfen, Bosartiges Sclmup-
fenfieher, Bosartiges Katarrhalfieher der
Kaninclien, Kaninchenstaupe [German] ;
Rhinitis Punilentsi [Roger & Weil].)
Contagious rhinitis of rabbits consists in an enzootic con-
tagious atfection of the respiratory passages by a bacterium
similar to the influenza bacillus.
Historical. This disease, which has long been known under the
name of "inaHgnant snuffles," was formerly believed to be a
coceidia rhinitis of rabbits (see page 28). The investigations of Beck
(1891), Kraus (1897), Roger & AVeil (1901), Volk (1902) and Kasparek
(1903), have, however, shown that the great majority of cases known
under this or similar names is of bacterial origin. Affections similar
clinically and anatomically have been observed by Suedmersen (1905)
and Koppanyi ''1906), but they are due to bacteria of a different kind.
Etiology. The cause of the disease is a very small, slen-
der, immotile bacillus of the size of the bacillus bipolaris avi-
septicus, which is decolorized by Gram's method and which does
not form spores.
Cultivation. In the presence of oxygen and at blood temperature
the bacilli grow on all of the usual culture media. On gelatin plates
there are formed after forty-eight hours small granular colonies with
a sharp or, according to Kraus, serrated margin ; the gelatin does
not become li(iuefied. On the surface of agar there is developed a
luxuriant grayish-white, iridescent growth. Milk is not coagulated,
indol is not formed. The bacilli descril)ed by Beck, Kraus, Volk and
Kasparek show some differences, mostly cultural in type, and accord-
ing to Kasparek this points to the fact that different varieties exist.
16 Contagious Nasal ratanli of Rabbits.
The variations arc, however, not eonsidei-ahk; enough to justify a
diflferentiation of the alt'ections caused by tlic various tyjics.
Suedinersen found a l)aciirus of the coli group in pleurisy of
rabbits which is identical in its main characteristics with bacilli found
by Kraus and Tartakowsky in a similar disease of guinea pigs.
The above-mentioned ])aeillus of Koppanyi is distinguished by the
fact that it is polymorphous, rather plump and surrounded by a
capsule.
Pathogenicity. The bacillus is pathogenic for rabbits,
guinea pigs, mice. Rabbits are most susceptible.
Natural infection usually occurs l)y inhalation of droplets
of nasal secretion which are disseminated by sneezing, etc., by
the sick animals and are inhaled by healthy rabbits, directly or
later on with contaminated dust. The spread of the disease is
also favored by feed contaminated with nasal secretion of sick
animals, and by transmission through the hands of attendants.
Rabbits are susceptible without reference to age.
Pathogenesis. After their entrance into the nose, the bacilli
produce a violent inflammation of the mucosa of the nose and of
the accessory cavities and they also get into the general blood
circulation; there then occurs an elevation of the general
temperature and in some epizootics, in fact, in most cases, an
inflammation of the serous membranes and a pneumonia. The
inflammation may spread from the nasal cavities into the
deeper portions of the respiratory tract.
Anatomical Changes. The mucosa of the nose and pharynx
appears intensely reddened, swollen and covered with purulent
material. The accessory nasal cavities, frequently also the
bronchi, contain a purulent exudate. In the pleura we find occa-
sionally a serous, stringy or even purulent exudate, and the sur-
face of the lungs is covered with a fibrinous deposit. The peri-
cardium is rarely affected similarly. The lungs often show,
aside from compression, atelectatic or l)ronchopneumonic foci.
The specific bacilli are found in large numbers in the exudate of
the mucosae, in the other affected organs and in the blood.
Symptoms. Weakness and depression become apparent
after a period of incubation of four to six days ; the nares be-
come moist and there is frequent sneezing. The temperature
rises to 40° C. and above, and the appetite decreases. The nasal
secretion is at first scanty and watery, or thick mucoid, and wets
the hairs in the nasal region, the thorax and the anterior ex-
tremities ; it becomes more abundant and purulent between the
second and fifth days of the disease. Material of this kind is ex-
pelled by sneezing and snorting, and the animals rub their noses
Course. Diagnosis. Treatment. 17
with, their front legs. The appetite diminishes more and more,
there is emaciation and debility and also dyspnea and cough.
In pleurisy with pyemic cachexia of rabbits, as described by
Koppanyi, the clinical picture sometimes varies from the one described
above. There occur very acute cases leading to death in two to three
days, with rapidly increasing dyspnea and great prostration, high
temperature, followed l)y a rapidly increasing subnormal temperature.
Then there are fre(|uently observed chronic cases with the formation
of subcutaneous al^scesses on various parts of the body or abscesses
encapsulated in the internal cavities. After the spontaneous or artificial
opening of such abscesses, the animals may recover, or more rarely
they may die on account of acute exacerbations. Otitis interna some-
times occurs with ol)li(iue holding of the head or acute meningitis with
symptoms of excitement (Barrat).
Course and Prognosis. In many cases the symptoms are
intensified rapidly and the animals die within three to five days
(acute type). In other cases, liow^ever, the symptoms are less
acute from the start and the disease lasts fifteen to eighteen
days (subacute form), or it lasts for a long time with mild
symptoms (chronic form). All acute cases end fatally; a com-
plete recovery is also seen rarely in the subacute or chronic
variety.
Diagnosis. Characteristic for the disease are the severe
local manifestations accompanied by high fever; Koppanyi 's
disease of rabbits can usually be excluded only by a bacteriologic
examination. In coccidia rhinitis, fever, prostration and
dyspnea are less pronounced and microscopic examination
shows the presence of coccidia in the nasal secretion ; there
is also no inflammation of the serous membranes.
Treatment and Prophylaxis. Since irrigation of the nasal
cavity (see page 7) with 1% creolin or 3% boracic acid solu-
tion does not materially influence the course of the disease,
our main efforts have to be made in the direction of prophylaxis.
All sick animals ought to be killed at once and their cadavers
must be destroyed. The cages and the barn, including the avails,
should be thoroughly cleaned and disinfected; newly bought
animals should be kept in quarantine and under observation for
fourteen days.
Literature. Barret, Eev. vet., 1908, 147.— Beck, Z. f. Hyg., 1893, XV, 363.—
Kasparek, O. M., 1892, 333.— Koppanyi, Z. f. Tm., 1907, XI, 429.— Krans, Z. f. Hyg.,
1897, XXIV, 396.— Volk, Centralb. f. Bakt., 1902, XXXI, 177.
6. Croupous Rhinitis. Rhinitis crouposa.
(Nasal Croup.)
Croupous rhinitis represents an intensely inflammatory
process of the nasal mucosa, usually with the formation of ex-
tensive pseudomembranes.
23 ("i-oujxms liliiiiitis.
Occurrence. Xasal croup is usually seen as an independent
disease anioni;- horses, more rarely among- cattle. The disease
not infrequently appears enzootically among horses, particu-
larly among the animals of a breeding establishment, and is
then sometimes associated witli follicular inflammation of the
nasal mucosa (Roell).
Etiology. The disease sometimes appears after the inhala-
tion of hot air and smoke in conflagrations. In most cases, how-
ever, an infection appears to be the causative factor. Koell ob-
served the spread of the disease from sick to healthy horses.
Obolenski, Berndt and Grunth observed a contagious spreading
of nasal croup among cattle. (See Croup of Cattle, Vol. I.) The
suspected infectious virus is not known as yet; in horses, how-
ever, the possibility that streptococcus equi is the etiologic fac-
tor cannot be entirely discarded. In one of the author's own
cases this disease followed after streptococcus mastitis in a
mare, and in a case of Wyssmann, in a cow, it was preceded by
a parenchymatous mastitis.
Nasal croup is seen as a secondary affection in the course of
some infectious disease (rinderpest, malignant catarrhal fever,
morbus maculosus, strangles, etc.).
Symptoms. The disease is initiated with the symptoms of
a severe acute nasal catarrh, followed soon by the formation of
gray or reddish-gray pseudomembranes, several millimeters
thick, which adhere more or less firmly to the intensely red and
intensely swollen mucosa. These pseudomembranous deposits
are either confined to smaller areas or they form larger, more
extensive, continuous patches. They can be easily detached and
after this has been done spots of mucosa are exposed to view
which are void of epithelium, granular, intensely red and easily
bleeding. After a few days the pseudomembranes become de-
tached spontaneously. The epithelial covering is then replaced,
the mucosa becomes gradually paler, and recovery takes place
without leaving any permanent changes.
There is a yellowish, tenacious nasal secretion which is later
mixed with shreds of pseudomembranes. Respiration is forced
and snorting in severe cases. The soft parts of the nasal region,
the submaxillary lymph glands and the afferent lymph vessels
are more or less swollen, hot and tender. Very rarely we see in
the neighborhood of the nares nodules and ulcers similar to
those seen in follicular inflammation of the nasal mucosa. The
body temperature is markedly elevated u]) to the shedding of
the pseudomembranes.
The course is usually favorable; recovery occurs in about
a week, provided that the other portions of the respiratory tract
have not been affected.
Treatment. Treatment is similar to that employed in acute
nasal catarrh. The shedding of the pseudomembranes may be
Follicular lullaiunialiou of the Nasal Mucosa. 19
hastened by irrigation of the nose with a 1 or 2% sokition
of carbonate of sodinm. Since the disease is often contagious, it
is advisable to isolate the sick animals.
Necrosis of the Nasal Mucosa. It occurs very rarely as a primary
disease after traumatic, chemical, thermal iusults or after au iufection
(bacillus necrophorus) ; as a rule there are other underlying primary
affections (morbus maeulosus, acute glanders, also strangles, malignant
catarrhal fever) which have first occurred. After the shedding of the
necrotic portions of mucosa, deeply penetrating, dark red, or grayish-red,
uneven ulcers are formed, with more or less elevated margins, around
which the mucosa is inflamed. The submaxillary lymph glands are in
a condition of acute swelling. The affection can usually be differentiated
from glanders by the absence of glanders' nodules; sometimes, however,
a differential diagnosis can only be made after a thorough bacteriological
examination, as was shown in a case of Rabe.
7. Follicular Inflammation of the Nasal Mucosa.
Rhinitis follicularis.
(Rhinitis piisfulosa; Coryza pustulosa equoruui [Kitt].)
Follicular rhinitis is a peculiar inflammation of the nasal
mucosa with nodule formation of the mucous glands, which nod-
ules break down later on. The sebaceous glands of the skin of
the region of the nose become similarly affected.
Occurrence. This is a disease of solipeds which occurs
enzootically under conditions similar to those which are ob-
served in croupous inflammation of the nasal mucosa.
Etiology. The disease undoubtedly owes its origin to an
infection, as shown by the observations of its contagious nature
by Roell and later by Friedberger & Frohner. Kitt believes
that streptococcus equi is the causative factor; Friedberger &
Frohner likewise believe that this is probable.
Symptoms. The disease begins with the s^anptoms of a
violent nasal catarrh and as a rule with fever, whereupon, after
two or three days, nodules, of the size of a millet seed, develop
on the intensely reddened mucosa of the nasal septum. These
nodules are quite numerous and they can be felt easily with
the palpating linger. The nodules increase in size, become
yellowish and frequently confluent and form a continuous yel-
lowish surface; this disintegrates, becomes pale yellow and
leaves after its removal small, roundish, shallow, intensely red-
dened ulcers with slightly infiltrated margins. The ulcers heal
completely within a few days. In most cases similar nodules
are developed on the skin of the alse of the nose, the upper lips
and the cheeks. These nodules also become yellow, ulcerate and
20 New Growth in the Nasal Cavities.
finally heal williont Icaviiii;- any traces. The hinph vessels,
which drain the aft'ected portions, are nsnally much swollen and
can l)e felt as tender cords leading from the angles of the
month backward, and also down toward the neck. In their
neighborliood abscesses are formed here and there, which
break open, but heal promptly. The submaxillary Ijmiph glands
are always in a condition of acute swelling. Sometimes one
also sees nodules on the generally reddened conjunctiva of the
eyes. The disease lasts two to four weeks and generally ends
in complete recovery.
Diagnosis. The affection is distinguished from glanders
in that the nodules and ulcers appear simultaneously or within
a short time over a larger area in great numl)ers and that they
heal without leaving any trace.
Treatment. Irrigation of the nasal cavities with mild disin-
fectant and astringent fluids (see page 7) and subsequent
applications of desiccating ointments to affected cutaneous re-
gions are very serviceable. Also applications of ointments con-
taining mercury, iodoform, creolin, or iodin to the affected cu-
taneous regions.
8. New Growth in the Nasal Cavities. Tumores narium.
Occurrence. Neoplasms are generally rare in the nasal cav-
ities. Most commonly are found so-called polyps, more rarely
such other neoplasms as myxoma, sarcoma, carcinoma, angioma,
osteoma, odontoteratoma, lipoma, ecchondroma ; in the nasal
cavities of cattle are also found mucous cysts. A similar clin-
ical significance as true tumors have tuberculomata, as they oc-
cur rarely in the nasal cavities of cattle in the shape of nodular
masses which are scattered over the surfaces, covered with a
mucopurulent material and with yellowish spots, (lerspach
saw in a horse tuberculous nodules of pea-size alternating with
tuberculous ulcers covered with yellowish, dry adherent crusts.
Very rarely actinomycomata are found in cattle in the shape of
strawberry-like masses in the lower portions of the nasal cavi-
ties.
Symptoms. A tumor growing in the nose usually makes, in
proportion to its size, one, rarely both nasal cavities more nar-
row, and thereby produces difficulty in respiration, blowing
or snoring. According to the degree of stenosis, these s>aiip-
toms are observed either during exercise or likewise during
rest. If the stenosis is produced by a motile neoplasm, dyspnea
and the noises accompanying it are observed only occa-
sionally, or the character of the noises changes. If the nasal
opening of the affected side is closed the noises cease, while
closure of the healthy side increases them and increases dyspnea.
Animal Parasites in the Nasal and Accessory Cavities. 21
Differences in the volume of the air exhaled from either nostril
may be ascertained by holding the moistened back of the hand
in front of the nose or by placing a mirror in front of them and
watching the deposit of dew, respectively, the difference in the
size and the time of disappearance of the dewy deposit (Kaern-
bach). Labial breathing is observed in more severe cases. It
disappears, however, on opening the mouth. With the exception
of horses, animals breathe either temporarily or permanently
through the open mouth and the respiratory noises men-
tioned above are then not heard. Tumors growing in the lower
portions of the nasal cavities are detected bv direct inspection,
while those in the upper portions of the nasal cavities
are felt upon sounding of the nasal passages.
There is usually a nasal secretion on account of the second-
ary nasal catarrh, which is, as a rule, unilateral, mucopurulent,
often fetid, sometimes mixed with fragments of tissues. Soft
or ulcerating neoplasms may lead to epistaxis, while tumors of
the upper portion of the nasal cavities which extend into the
pharynx may cause disturbances of deglutition. A unilateral,
chronic swelling of the submaxillary lymph glands is rarely
missed; however, it reaches a high degree only in the presence
of malignant or tuberculous tumors. Sometimes a change of
form of the noise is noted, or dullness on percussion of the ridge
of the nose or exceptionally a protrusion of the hard palate
toward the buccal cavity.
Treatment. Exceptionally only is any treatment, aside
from surgical interference, serviceable. An angioma situated
near the anterior nares may be made to shrink by brushing
with a 10% solution of trichloracetic acid.
Literature. Gerspach, Tuberculose eiiies Pferdes, Diss. Giesseii, 1905.
Kaembaeh, Die Neubildiingen der Nasenhohle und der Nebenhohlen des' Pferdes
Berlin, 1909 (Lit.). '
9, Animal Parasites in the Nasal and Accessory Cavities,
(a) (Estrus ovis.
{Bremsenlarvenkrankheif, CEstruslarvenkrankheit, Hornwurm-
krankheit, Bremsenschwindel, Schleuderkrankheit [Ger-
man] ; Vertige d'oestres, faux tournis [French].)
The disease caused by the larva of the sheep flv is character-
ized anatomically by a catarrhal inflammation of "the nasal and
accessory cavities.
Historical. CKstrus larvae were first observed in the head cavities
of sheep by Vallisneri in 1712; later on they frequently became the
object of close studies; CEstrus ovis became well know-n from the
descriptions of Bracy Clark (1797) and Hertwig (1838) and veterina-
rians have since then frequently discussed this subject.
22 Oestrus Ovis.
Occurrence. The disease is found all over the world, ex-
cepting- Australia, especially in young animals (yearlings) ; it
occurs" enzootically, more rarely sporadically. It is exception-
In fat-tailed sheep the larvae of GRstnis purpureus likewise appear to occur.
Ill the nose of buffaloes and camels the larvae of G-]strus iiiaculatus have been found,
and in the pharynx of deer the larvaa of Pharyngoniyia picta and Cephaloniyia
rufibarbis; in roes G. stimulator; in reindeer C. trompe and in moose C. Ulrichii.
M Etiology. The larvae of (Estrus (cephalo-
myia) ovis, sheep fly, are 2 to 30 mm. long,
according to their varying stage of develop-
ment. Their bodies are elongated and oval,
flat on the ventral surface, convex on the dor-
sal and show ten or eleven rings. The young-
Fig. 1. Larva of est individuals are white, and transparent,
(Estrus oris (seen ^j (^^^^y^ yellowish white. The mature ones
frnm thf» linstprior <- ^ ^ J .. PIT • J.1
show a transverse striation or the rings; the
from the posterior
surface at the left
seen from the ven- autcrior end is more elongated than the pos-
terior one. The head ring carries two mouth
hooks (Fig. 1).
tral surface to the
right)
The larvae are developed from the ova of the sheep fly. They are
10 to 12 inni. long, yellowish-gray with transparent wings. The larvae
Avhich leave the ova already in the oviduct are deposited by the female
flies in the neighborhood of the anterior nares of the sheep, whence they
wander into the nasal cavities, frontal sinuses, ethmoidal cells, and even
higher up. They become adherent to the mucosa and progress in
development. They mature after about ten months, i. e., in spring,
migrate out of the middle nasal duct and change in the soil vdthin
twenty-four hours into pupae. The fly leaves the latter after four to six
weeks; after fertilization the females again deposit their ova in the
neighborhood of the anterior nares of sheep.
Sheep flies swarm from the middle of May to October, for
a shorter time in colder clhnates, especially during the noon
hours. They rest preferably in the holes and clefts of sheep
stables and "among the brushes. From here the fertilized fe-
males hunt up herds of sheep to deposit the larva) in the neigh-
borhood of the anterior nares. On the approach of the flies; the
sheep run together, put their heads together or place them on
the ground, or hold their noses between tlieir legs. If the lar-
vae are deposited in spite of this, and after they have begatn
to creep upward into the nasal cavities, the sheep become very
restless, rub their heads on the soil or lietween their feet, shake
themselves, sneeze frequently, and run around restlessly. The
restlessness, however, soon disappears and the animals remain
quiet for about ten months.
Anatomical Changes. The mature larva^ are, as a rule,
found in hirgc numbers (according to Ziirn, GO to 80) in the
Symptoms. Diagnosis. 23
frontal sinuses and in those at the base of the horns ; sometimes,
also in the antrum of Highmore and in the nasal cavities. They
are strongly adherent to the mucosa which here shows small
roundish depressions and in their neighliorhood catarrhal
changes. Exceptionally the brain and its membranes liecome
invaded and likewise exceptionally the larvae are found in tlie
pliarynx and larynx. They get there usually only after the
death of the animal, but may exceptionally get there during life
and cause death by suffocation.
Symptoms. Since the larvae cause irritation of the mucosa'
of the head only after maturity or after their migration, sj'nip-
toms become manifest only in spring or in early summer. The
disease usually begins with the mild symptoms of an acute nasal
catarrh, which increases in intensity within the next weeks.
The first and most constant symptom is nasal secretion,
frequently unilateral, at first clear, serous or seropurulent,
later purulent; or possibly hemorrhagic. The animals fre-
quently sneeze and blow and throw out an abundant secretion,
occasionally also some larvae. At the same time, the sheep rub
their noses on their front legs, on neighboring objects and
on the ground, so that the parts around the nose sometimes
become denuded and subsequently edematous. The head is low-
ered from time to time, then suddenly elevated, bent energetic-
ally backward or laterally ; the gait is staggering and uncertain.
Simultaneous catarrh of the conjunctiva leads to profuse lacri-
mation. The mature larvae leave the nasal cavities after one
to two weeks, and the nasal and conjunctival catarrh then dis-
appear.
In a minority of cases the catarrhal symptoms are com-
plicated by signs of excitement and depression. The gait of
the sick animal becomes markedly disturbed; they raise their
feet high, stagger with the hind legs and repeatedly fall down.
There is depression of high degree and gratiRg of the teeth,
rolling of the eyes, and occasionally forced movements toward
one side (Gilis) arc observed. In such cases death usually
occurs within five to eight days, exceptionally within three to
four days after the first symptoms l)ecome manifest.
The intensity of the symptoms and the eourse of the disease depend largely
\ipon the nnndier of larva\ They may be present in small uumljers and they may,
npon their migration, not ]uodnce any other symjitoms except those of a catarrji.
The location of the larviv also has some influence upon the clinical picture. The
invasion of the ethmoid bone, or the involvement of the meninges, or the migration
of the larva^ into the cranial cavity, bring about serious nervous phenomena;
nervous symptoms may sometimes develop on account of the affection of the
frontal sinuses.
Diagnosis. The rare cases with forced movements may
be confounded with giddiness of sheep. This, however, affects
almost exclusively young animals, and forced movements
24 Oestrus Ovis.
stand in the foreground of the clinical picture, while catarrhal
signs are absent. The differential diagnosis, however, meets
with great difficulties and becomes impossible when OEstrus
larvae situated high up lead to nervous symptoms, while symp-
toms of catarrhal affections of the mucosae are absent, as does
occur though in very rare cases. If larvae of CEstrus are
expelled with the nasal secretion, the diagnosis is always estab-
lished. The disease can be differentiated from lungAvorm dis-
ease by the absence of cough, by the occasional presence of
CT]strus larvae in the nasal secretion, while lung worms and
their ova are not found.
Treatment. The only rational procedure consists in open-
ing up the affected cavities, removing the larvae that are present
and accessible with a pair of forceps and anesthetizing those re-
maining with appropriate irrigations.
Trephining of the Frontal Sinuses. Since the laivfe are found preferably
in the frontal sinuses, these must be laid open in particular. Ziirn recommends
as the place of trephining the two upper, Moussu, however, the lower angles
formed by a line connecting the superciliary ridges with another line drawn at
right angles into the middle of the former line. If the condition does not improve
after trephining in this manner, it is advisable to remove the horns and thus to
lay open the cavities at their base. After the larva^ have been recovered from the
opened cavities, these must be irrigated with a fluid noxious to CEstrus larvae. Ser-
viceable fluids are: benzin diluted with water, oil of turpentine, 3<;/f carbolic acid,
9.5% alcohol, lime water, etc. None of these fluids will kill the very resistant larvae
(Fischer), but they will cause them to contract strongly, so that they will leave
their places of attachment and will be expelled from the nose by strong sneezing.
This treatment, however, can hardly be carried out when
a large number of animals of a herd are affected and the
operative procedure will then perhaps be employed only on
the most valuable animals. The treatment sometimes does
not have the desired effect and most animals, especially in
the presence of severe cerebral symptoms, will, according to
Ziirn, remain sick and will succumb. Speedy killing of the
animals is therefore indicated if the affection is violent, if
trepanation cannot be carried out, or if, in spite of trepanation,
the s^^Ilptoms do not ameliorate.
The insufflation into the nose of tobacco, snuff, heleborus, all of which cause
sneezing, the inhalation of irritating smoke, irrigation with various fluids (aside
from those already named, vinegar or salt water), is frequently recommended.
Considering the great resistance of the larvae and their place of location, one canno*.
expect much success from such procedures.
Prophylaxis encounters very great difficulties. It is ad-
visal)le to destroy the larvae. Sheep flies may be driven out
of sheep stables temporarily by repeated fumigations. It also
appears advisable not to pasture sheep on hot summer days
in such locations where there are brushes and trees and to
exterminate brushes from sheep pastures. Local conditions,
however, usually prohibit the carrying out of such measures.
It is therefore recommended to apply, in places where sheep
Peutastomum Taenioides. 25
flies are common, ill smelling substances to the neighborhood
of the nares of the sheep, such as tar, fetid animal oil, hartshorn
oil, etc. This procedure, however, is likewise impracticable
in the case of large herds. Under these conditions it is ad-
visable, in such neighborhoods where the dangerous flies abound,
to keep the sheep on hot summer days in fumigated barns and
to allow them to visit the dangerous pastures only after sunset
or at night.
Oestrus Disease in Dogs. Ed. Sergent and E. Sergent (A. P.,
1907, 392) have observed in Algeria, in such parts where the number
of sheep is small compared with the number of inhabitants, that sheep
flies deposit their ova into the eyes, lips and nose of shepherd dogs
and of the shepherds themselves, particularly if they eat much sheep's
or goat's cheese. The disease called "Thimmi" in the vernacular
manifests itself soon after the deposit of the ova, after three to ten
days, and during this time there is observed burning of the eyes, dis-
turbance of vision, swelling of the conjunctivae, lacrimation, also a
serous nasal discharge, rul)bing of the nose ; occasionally symptoms
of pain in deglutition, and cough depending upon affection of the
pharynx and larynx. In the conjunctivae and occasionally in vomited
material one finds the very small white, lively, motile larva?. Recovery
occurs without exception. The larva? do not attain full development.
Tobacco smoke has proved effective in keeping sheep flies away from men
and shepherd dogs.
(b) Pentastomum Taenioides.
Historical. This parasite was discovered in 1763 by Wrisberg;
according to Ziirn, however, before him by Chabert (1757) ; its life
historv was ascertained by Gurly, particularly, however, by Leuckart
(I860).
Occurrence. The adult parasite is found preferably among
the dogs of butchers, shepherds and hunters; it is found very
rarely among other dogs, not at all among pet house dogs.
The frequency of occurrence appears to be very variable in
different parts of the world.
Among 630 dogs examined in Alfort with reference to this point Colin found
the parasite among sixty-four (10.2eration requires great dexterity. The inflammatory swelling
which sometimes forms at the site of the injection must be treated with cold
applications. In larger animals the injection may be performed with a Hauptner
syringe or with a trochar; in smaller animals with an ordinary Pravaz syringe.
If the laryngitis is contagious in character, isolation of
the healthy, or at least, of the sick animals, and disinfection
of the stable or barn is indicated.
Literature. Dieckerhoff, W. f. Tk., 1886, 15; B. t. W., 1889, 187.— Freund,
B. t. W., 1907, 57.5. — Poschel, Ueb. d. Anw. d. Inhalation, Inaug. Diss., 1905 (Lit.
on Inhalation).
Epizootic Laryngo-tracheitis of Horses, A usually very contagious
catarrh of the respiratory passages of horses has been known since
1888. It usually affects the mucosa of the larynx and trachea; at
other times that of the bronchi, or again that of the respiratory parts
situated anteriorly to the larynx. According to its variable location
the affection is known as infectious laryngitis, infectious enzootic catarrh
of the upper respiratory passages, enzootic cough, laryngo-tracheite
epizootique (French), bronchite infectieuse, also frequently "la grippe."
To this group probably also belongs the contagious pharyngitis of
Dieckerhoff. According to Meyer "Skalma" (Dieckerhoff) is also a
bronchial complication of this affection. Meyer claims quite properly
that all these affections are only varieties of one and the same etiologic
entity.
44 Epizootic Laiyugo-traclieitis of Horses.
Etiology. In its epizootical and clinical respects the disease is
very similar to eciuine influenza and cannot be separated from it com-
pletely the more so since the etiology of equine influenza is not yet
cleared up. The possibility, however, of the occurrence of contagious
catarrh independently of eciuine influenza cannot be denied, considering
the fact that cattle likewise suffer from an epizootic catarrh of the
respiratory passages and horses may suffer from epizootic laryngo-
tracheitis, even after having previously had an attack of influenza.
On the other hand, this is no conclusive proof since one attack of
influenza confers immunity only for a short time.
The disease is usually observed annually. The extent of its
prevalence, however, varies considerably in different years. Its very
contagious nature is responsible for a frequently rapid extension within
a few days among the horses of the same stable so that it assumes an
enzootic and not uncommonly an epizootic character. The introduction
of the disease occurs vrith newly acfjuired horses, with remounts, etc.
The contagion may also be conveyed by persons or by the air. Younger
horses are most susceptible. In some epidemics, however, horses are
affected without reference to age. The period of incubation is 1 to 5
days according to past experiences.
Symptoms. The most prominent symptom, which is never absent,
is a dry, short, strong, rough cough. If it is painful at all it is only
moderately so. The cough occurs either very frequently or on
the contrary after longer intervals. A marked tenderness of the
larynx and of the trachea can be demonstrated. A serous, later on
mucous, but usually scanty nasal discharge comes on which subsequently
often becomes more abundant and lumpy. If this is the case the lymph
glands of the laryngeal entrance swell moderately and mucous rales
are heard over the trachea. In some cases bronchitic symptoms become
manifest. The conjunctivae often appear normal or if there is an
elevation of temperature they are markedly reddened, often diffusely
rose red or yellowish-red or even dark red ; sometimes, on the contrary,
pale ; according to Meyer edema is seen in the lower portions of the
legs, the abdomen and the sheath of the penis.
Fever is often present. The temperature usually does not rise
above IVJ° C, but it may not uncommonly go up to 41°. Even if
occasionally fever is not present at rest, more intense exercise will
elevate the temperature and at the same time accelerate the respiration
and the pulse beat. Many patients show lassitude and malaise which
contrasts with a comparatively insignificant psychic depression.
Concerning weakness or paralysis of the hind extremities (hmibar cord disease)
following catarrh of the upper respiratory passages as observed by Kull and
Duvinage, see enzootic paralysis of the cord.
The course of the disease is generally benign ; the disturbances
disappear in 8 to 10 days and after 8 or 10 days more the animals
are able to work again. In some epidemics and in foals under two
years old the period of convalescence lasts several, up to 6 to 8 weeks.
Sometimes pneumonia or pleuritis comes on as a complication, especially
if the animals have been worked hard during the disease. One attack
of the disease does not appear to insure any lasting immunity.
The treatment consists more properly in feeding mashes, beets or
a dust-free dry feed, sojourn in the open air during the favorable
Epizootic Laryngo-tracheitis of Cattle. 45
season, even light work in the open. These measures are better than
the administration of medicines. Sometimes change of location brings
about a disappearance of the epizootic. Complications which may-
come on require proper special treatment. The stables must be thor-
oughly disinfected.
Literature. Bachstadt, Z. f. V., 1904, 429.— Christian, Z. f. Vk., 1901, 206.—
Joly, Eec, 1888, 612.— Lignieres, Bull., 1897, 496.— Meyer, Miinch. T. W., 1909,
361.— Pr. Mil., Vb., 1899, 1908.— Schuhmager, H. L., 1909, 135.— Zorn, W. f. Tk.,
1888. 249.
Epizootic Laryngo-tracheitis of Cattle. In 1890 there was observed
in some parts of Bavaria an acute catarrh of the respiratory passages
in cattle which spread enzootically and even epizootically, and which
was believed to stand in some relation to an influenza epidemic which
was then very prevalent in man. More or less similar enzootics and
epizootics have since been observed repeatedly, and they have been
designated as epizootic laryngo-tracheitis (Zimmermann) or as influenza-
like affections (Brauer, Prietsch), or as infectious catarrh of the
respiratory passages (Schmidt, Lewek). According to Lewek all these
various affections are one and the same infectious disease, peculiar
to cattle, which makes its appearance either sporadically or enzootically,
particularly in south Germany. Cattle distemper ( Janson) or influenza
of cattle (Harms) deviates materially from the above affection, but
they may be here considered, since their true etiology has not yet been
cleared up.
The simultaneous appearance in Bavaria of this disease and of human influenza
was undoubtedly only an accidental occurrence. Zimmermann failed to observe
a simultaneous occurrence of the two diseases.
Epizootic laryngo-tracheitis or the influenza-like affections of cattle
are contagious and are often imported by newly acquired animals
(Zimmermann, Schmidt). The disease is evidently of bacterial origin,
(In 8 cases examined Lewek found Gram-positive bacilli four times,
once Gram-positive cocci and three times a mixture of both.) A longer
transportation on railroads or aboard of ships seems to predispose to
the infection and the disease is therefore often observed in cattle after
shipment. According to Zimmermann the period of incubation is
two to three, and according to Lewek, one to four days.
A contagious catarrh of the upper respiratory passages of epizootic character
has also been observed in goats (Pr. Vb.).
Symptoms. We first observe a dry, painful cough coming on in
attacks. The temperature rises to above 41° C, there is marked tender-
ness of the larynx and of the trachea, also marked reddening of the
nasal mucosa and in the further course a watery or mucous nasal
discharge associated with a mild conjunctivitis, occasionally also swell-
ing of the eyelids. Rough, whistling, later on drawn and rattling,
noises are heard over the region of the larynx. If bronchitis is present
there is difficulty of respiration ; the latter may also be due to a broncho-
pneumonia which develops after two to three days in 50% of the
cases (Schmidt). The appetite is usually much diminished. The
disease usually lasts one to two, more rarely, two to three weeks, and
46 Croupous Laryugitis.
ends, as a rule, in reeovery. A fatal teriuination may occur in cases
complicated with ])roneho-i)neumonia.
lu influeuza-like altcctions of cattle one also observes the symptoms of gastric
catarrh, arthritis ami mastitis, to which may l»e added, in some cases, the signs of
inflanunation of the deeper structures of the eyes and a marked depression and
lassitude on motion. Even in these cases, however, tlie course is usually benign.
Treatment is only indicated in those cases in which complications
occur.
Literature. Brauer, S. B., 1893, 117.— Janson, S. f. Tk., 1S94, XX, 27.1.—
Jb. bayr. Tzte., 1890. — Lewek, B. z. Kenntn. d. Erkr. d. Luftw. u. d. Lung. d.
Eind. Diss. Dresden., 1909.— Markus, B. t. W., 1906, 655.— Pr. \'b., 1900, il, 9.—
Prietsch, S. B., 1895, 96.— Schmidt, S. B., 1903.— Zimmermann, B. t. W., 1904, 167.
Japp Disease of Lambs. Under this name Hasenkamp (D. t. W., 1909, 300)
described a disease of lambs observed frequently in the i)rovinces of Hanover and
Westphalia in Germany. This disease only occurs while the animals are stabled
and is characterized by an intense reddening and swelling of the mucosa of the
larynx and trachea ; by albumoid degeneration of the muscles of the larynx and
by congestion of the lungs. Bacteriologic examination of the internal organs
of animals dead from the disease has been negative. The affection has generally
been looked on as mercurial poisoning after treatment of sheep-scab with a mixture
of therosot. This view, however, is contested by Hasenkamp.
2. Croupous Laryngitis. Laryngitis crouposa.
{Hautir/e Brciune, Hahhrdune [German] ; Laryngitis fibrinosa,
angina memhranacea, croup.)
Croupous laryngitis is characterized anatomically by
fibrinous membranous deposits on the laryngeal mucosa and
is frequently associated with a similar affection of the trachea,
occasionally also of the pharynx.
Occurrence. Croupous laryngitis is generally a rare dis-
ease. It is most commonly seen, if met with at all, among
cattle and sheep; more rarely among horses, pigs and cats.
It occurs occasionally in enzootic distribution. Guittard once
saw an enzootic of croupous laryngitis among geese.
Etiology. Croupous laryngitis is primarily caused by the
inhalation of hot air, smoke and other irritating substances
(ammonia, chlorine gas, sulphurous acid, etc.). Cases which
are occasionally observed after conflagrations or after disin-
fection of stables with irritating vapors are of sucli origin.
According to Eoehe-Lubin, the disease is also caused in some places by the
practice of chasing sheep around for twenty-four hours in dusty places in order
to increase the weight of the wool.
Aside from affections of the above nature, there is seen
in cattle, sheep, horses, pigs, cats and young geese, a croupous
Anatomical Changes. Synii^tonis. 47
laryngitis due to an infection. Catching cold appears to play
a predisposing role, because most of these cases are seen in
spring and fall, on damp days or after sudden changes of
temperature, also after a sojourn in the open during cold nights
(according to Forneris often seen in the mountains oi Piedmont).
The microbe causing this infection is not as yet definitely known.
Some observations, however, of Ernst seem to point to the
bacillus necrophorus as the etiologic factor. This bacillus is
frequently present upon the mucosae of herbivora and it mav
do harm if the resistance of a mucosa is lessened or if the bac-
terium has attained a higher degree of virulence. Other bac-
teria, perhaps streptococci, may have a similar effect.
The disease sometimes occurs secondarily in infectious
diseases with similar or diphtheritic inflammations of the
neighboring organs. Such diseases are: malignant catarrhal
fever and croup of cattle, diphtheria of fowls and calves,
rinderpest, sheep-pox, purpura hemorrhagica of horses, acute
glanders, etc.
Anatomical Changes. Elongated, cylindrical or tubular
fibrinous pseudomembranes are found at the base of the
epiglottis, at the epiglottic-arythenoid bands, and also at the
other portions of the larynx, and not uncommonly farther down
an the trachea and even in the first portions of the bronchi.
The membranes are 1-3 mm. thick in smaller animals ; in larger
animals considerably thicker grayish-white, or brownish in
color. They are sometimes quite loose, almost liquid; at
other times firmer and dryer. They are freq^uently partly
detached, especially at the periphery, and still adherent in other
portions. Under the pseudomembranes the mucosa is intensely
reddened, sometimes containing extravasated blood, and in the
deeper layers infiltrated serously or purulently. Sometimes
the inflammation shows a diphtheritic character and deep losses
of substance are then seen after the removal of the pseudo-
membranes.
The substance of the pseudomembranes presents an amorphous or reticular
mass which contains white and some red blood corpuscles, also here and there
epithelial cells in lumps, and various bacteria in the more superficial strata. The
membranes swell up under the influence of acetio acid or ammonia, while they are
dissolved by the caustic alkalies, lime water or lactic acid.
Post-mortem examination also shows other changes, namely,
purulent bronchitis, catarrhal or croupous pneumonia, atelec-
tasis of the lungs, acute swelling of the cervical and intra-
thoracic lymph glands in cattle, also frequently croupous
gastritis and enteritis. There are also usually signs of death
from suffocation.
Symptoms. Croupous inflammation of the larynx begins
with the symptoms of an acute laryngitis which increases
48 Croupous Lai-yn.-iitis.
rapidly in intensity; the respiratory difficulty reaches a high
degree within 1 to 2 days.
The temperature is considerably elevated from the start,
at the same time the animals are much depressed, the appetite
is suppressed, and rumination has ceased completely. Cough
comes on soon; it is at first dry, short and strong; after a
short time, however, it becomes peculiarly hoarse, convulsive
and very painful. The respiration assumes a character pointing
to stenosis of the larynx sometimes during the first day;
the inspiration is markedly forced; the intercostal spaces and
the lower portions of the "thorax sink in strongly during in-
spiration. Each inspiratory act is accompanied by a peculiar
whistling and rattling sound. Over the region of the larynx
and the trachea stenosis sounds can generally be heard asso-
ciated with moist rales and the hand placed over the larynx
feels distinctly a laryngeal fremitus. The animals betray great
anxiety. The nostrils become dilated to the utmost in horses ;
other animals keep their mouths open^ or stretch out
their tongues, hold their heads stretched forward, tremble,
move their elbows away from their thorax, stand still with
staring eyes; the mucosae are cyanotic; the superficial veins
are strongly congested; foamy, tenacious mucus is abundantly
voided from the mouth. Increased laryngeal tenderness is per-
manently present, and even mild pressure brings about a con-
vulsive cough ; the difficulty in respiration may become so severe
that it may lead to an attack of suffocation. In some cases
the region of the larynx feels warmer and appears infiltrated
with an edematous exudate.
During the attacks of cough the animals expel an abundant
mucopurulent or purely purulent secretion through the nose
and mouth. Toward the third to fifth day membranous shreds
of fibrin are thrown out in addition or also longer fibrin
cylinders, the caliber of which agrees with that of the larynx
and trachea. The difficulties in respiration cease markedly
directly after the expulsion of such masses and the general
condition of the patient improves rapidly and may go on to
complete recovery. In other cases the improvement is only
temporary or amelioration and aggravation alternate re-
peatedly.
The neighboring lymph glands are swollen and tender;
the pulse is rapid, small, and later on almost filiform. The
appetite is poor; the feces are sometimes mucoid or mixed
with shreds of fibrin. The secretion of milk ceases from the
start.
Course. In a part of the cases laryngeal stenosis increases
very rapidly and death occurs on the third and, in young geese,
even during the first two days. Except in the last mentioned
birds^ the course is generally somewhat slow^er; does not,
however, as a rule, extend over more than ten days. The end
Diagnosis. Prognosis. Treatment.
49
comes usually in consequence of increasing laryngeal stenosis
or m consequence of tlie lodg-nient of detached portions of
pseuapmembraues; in tlie cleft between the voQ9l,.<2ords A
miwr^l^y.Wityis^.the affected animals recover. ^ij^^^lnifur-joB an
Diagnosis. Croup of the larynx can only be diagnosticated
dehnitely when the anmials cough up shreds of pseudomem-
branes or void them during an attack of vomiting, or if the
membranes can be seen directly in the larynx of the smaller
anmials. The laryngeal stenosis, however, which develops
rapidly withm one to two days with fever and in connection
with a, peculiar hoarse cough, usually furnish enough data to
arrive at a correct diagnosis. In consequence of simple catarrh
such marked stenosis does not develop while after the lodg-
ment of foreign bodies or in acute edema of the glottis a high
degree of stenosis is manifest within a few quarters of an
hour. In stenosis due to neoplasm, there are no symptoms of.
an acute affection. . ,
r
Prognosis. In small or younger animals the prognosis is
very unfavorable, and recovery is the exception even in large
and adult animals. In making a prognosis the general con-
ditions of the animals should be considered; weak and other-'
wise diseased animals will hardly ever get over an attack. The
expulsion of abundant masses of fibrin is a favorable symptom.
The involvement of theau^ngs eJtcludes recoverv absolutelv
Treatment. The expulsion of the croupous membranes
may be hastened in smaller animals by the use of emetics
(sulphate of copper 0.05-0.5 gm., ipecacuanha 0.5-2.0 gm., tartar
emetic, 0.1-0.3 gm.) ; if difficulties in deglutition exist these drugs
are applied in the form of clysmata, or apomorphia mav i)e
given hypodermically (dogs 0.003-0.01 gm., cat 0.002-0.005 gin.)
in aqueous solution. Hogs receive veratrine (0.02-0.03 gm. di^)
luted in alcohol), likewise hypodermically. Vomiting must par-
ticularly be lirought about in the presence of a sudden attack of,
suffocation, which is generally due to the lodgment of frag-'
ments of pseudomembranes in the rima glottidis. Detachment
of the membranes is also favored by repeated inhalations,
ev^ry one to two hours, of finely divided alkalies; lime water
IS. ^principally used. If suffocation threatens tracheotomy must
b^,. performed. This operation may save the life of the animaji.
whenever the inflammatory process is confined to the larvnx'.
or to the larynx and trachea, while the lungs are not affected.
Qiie may also try inunctions with mercurial ointment in !he
regioji of the larynx, moist : warm or warm fomentations, ex-
citantia (alcohol, wine.),, ^i)d the. I?atients , mi^st sometimes be
nourishe4,a,rtifiQiafly,, ,,5.;;:,. ,,'■;, ,,/' ■ : ,i'iii h,
Literatii:e.''lnacW/kochs^iizyki;;'n, 262.— Guitard,''f>r.^vet'.l' 1902, II, 222.' '
Vol. 2-4.
50 Edema of the Laryi
3. Edema of the Larynx. Oedema glottidis.
By edema of the larynx, or oedema glottidis, is understood
an accumulation of serous fluid in the loose submucous con-
nective tissue of the epiglottic-arythenoid folds and of the
ventricles of Morgagni, in consequence of which stenosis of
the larynx is brought about.
Etiology. Edema of the larynx occurs as a primary affec-
tion after the inhalation of hot air, irritating acrid gases or
dust-like substances; also after injury of the laryngeal mucosa;
its development may be favored by preceding hard work, es-
pecially by excitement which has led to hyperemia. In this
manner one may explain the occurrence of edema of the larynx
after forced marches on dusty country roads (Bugiiiet) and
at conflagrations. In young clucks fatal edema of the larynx
is sometimes caused by the sting of bees which have fallen
into the water when they were tired out and have been ingested
by the young ducks.
In the overwhelming majority of cases, edema of the larynx
is a secondary affection, coming on principally during severe
disease of the larynx or of the organs in the immediate neigh-
borhood of the former (pharynx, tongue, parotid gland,
laryngeal and retropharyngeal lymph glands). As a collateral
edema the affection is seen in certain infectious diseases
(anthrax, hemorrhagic septicaemia of deers, of buffaloes, hogs
and in hog cholera, petechial fever, pox, etc.) ; urticaria in
cattle is sometimes associated with oedema glottidis (Wyss-
mann, All)recht).
Congestion (chronic heart disease), compression of the
jugular vein, traumatic pericarditis (Liebetanz) or cachexia
may give rise to edema of the glottis; such cases are however
rare when compared with various edemas in other places of
the body.
The fat collecting in large amounts around the entrance to the larynx in
fattened hogs produces, according to L. Weisz, an enlargement of the thyroid gland
by coni])ression of the veins, and the pressure of the thyroid upon the larynx causes
a whistling sound (animals so affected are called "lung-whistlers.")
Anatomical Changes. The epiglottic-arj^thenoid folds, the
lateral bands of the vocal cords, the folds between the epiglottis
and the tongue, form trembling gelatinous ridges with either
a reddened or a pale surface. These ridges collapse after an
incision, and discharge a clear, more rarely turbid, serous fluid,
and the mucosa then forms folds. Exceptionally the connective
tissue of the ridges is found infiltrated with a purulent exudate,
especially if the edema occurs in connection with deeper in-
flammation of neighboring parts (perichondritis, abscess for-
mation). Simultaneously with oedema glottidis or independently
Symptoms. Diagnosis. Treatment. 51
of it, an edematous infiltration of the suhniucosa is occasionally
seen on the dorsal aspect of the trachea.
Symptoms. The development of inflammatory edema of
the glottis takes place very rapidly; the symptoms of stenosis
of the larynx appear within one quarter of an hour or within
a few minutes. The animals are attacked by rapidly increas-
ing difficulty in respiration; the inspiration especially is very
forced and takes place with a marked sinking in of the inter-
costal spaces and of the other yielding structures of the thorax ;
it is accompanied by a whistling, rattling sound; expiration
however is comparatively easy. The animals betray great
anxiety, the eyes are staring, the eyeballs protrude, the mucosae
become cyanotic, the superficial veins are enormously con-
gested, the skin is covered with perspiration, the pulse is small
and rapid. If the condition becomes worse, the animals usually
succumb, generally after a preliminary fall in temperature and
with convulsions.
In congestive edema the fully developed clinical picture
is similar; however, its development takes several days and
remissions are often noticeable.
Diagnosis. Croup of the larynx can be distinguished from
primary acute edema glottidis because in the former case
stenosis of the larynx occurs much more slowly, only after
two to three days, and in connection with fever. Cough is
markedly hoarse. Consecutive acute edema glottidis after a
longer course of a primary disease leads either suddenly or
gradually to stenosis of the larynx; the more chronic cases
are distinguished from croup by the existence of the primary
disease and by the absence of fever. Laryngeal stenosis due
to lodgment of foreign bodies or pediculated neoplasms cannot
be distinguished from edema of the glottis except by the history
of the case; frequently the true nature of the affection is
recognized only subsequently.
To avoid mistakes, the larynx should, in smaller animals,
be inspected with the nnaided eye, in horses, with the electric
rhinolaryngoscope ; in cattle, on the other hand, palpation of
the larynx with the hand introduced through the pharynx is
to be highly recommended, provided it can be done in the
presence of the existing dyspnea.
Treatment. If there is danger of suffocation, tracheotomy
should at once be performed, which will immediately alleviate
the difficulties of respiration, and will be followed by recovery
in primary cases or in cases with moderate inflammation, pro-
vided that there is no complicating edema of the trachea.
Where, in smaller animals, the symptoms are not so threaten-
ing, one may try the ingestion of small pieces of ice, the in-
halation of water vapors, or painting with astringents,
off. Neoplasms ol.' the Larynx.
imiiiction with i-'ray oiiitiiieiit. Xaiii sncoceded in one case,in>
caiisini*- tlie (li8ai)pc'araijce of edema of the glottis by re])eatedly
IHiIling out the tongue of the patient.
'1 o .Tkei 'prim'aly i disi^ase knuSt j > lo-f j cbuT&e, be i prapecLy- tr^eated.
■/r<«Jl\"l' '!" >Mril(il;;7^ Mih ;7l!'|(f(n •/•l''V 't-iJii'I ,-,-;/•(•.? r-.ljidi'" u
?^aln, Kec, 1908,369 (i:?evue).—\VeIsz, AI'L., 1-909, '489. '7,W> '^ ' '.T/" ''^j .<>
^>:(;'');'. ; ■. .• . , w-i .; .,il ! .H^^I-'-iiM r-\< i;
V'lyv Hi . '';••;!;;;>'•( I
''^*'^4."' Neoplasms of the Larynx. Tumores LaryngisJ'' ■
iioi iOccurrence. Tmnoit^rof ,tlie ^istrfnx (are*lc6m|])airotit%
siiarfBcei. -»i[t yd iqooz^ aiitofg oil.t 'io Bmob^) mo-il b9£l8if/)2nr;tafb od
Symptoms. Neoplasms arising from the epiglottis cause
difficulties in respiration and deglutition; tumors developing
in other parts of the larynx give rise to stenosis sounds and
to difficulties in , respiration. In either case occasional or
periodic attacks of cough occur. Tumors of the e])iglottis in-
terfere with respiration, particularly during drinking, while
other tumors of the larynx, unless pediculated, produce a,
gradually increasing dyspnea, which comes on during exercise
only in the i early stages. Pediculated tumors, on the contrary,
produce attacks of dyspnea, since they are. aspirated from
time to time into the cleft between the vocal cords. According
to the seat and the mobility of the neoplasm, either inspiration,
or .expiration or l)oth may be accompanied by difficulty and
by a rattling or a whistling sound. The dyspnea which comes
on in attacks, suddenly disappears or diminishes considerably;
i." :e.^- when the neoplasm becomes displaced out of the aiT;
Diagnosis. Treatment. 53
channel by a powerfnl attack of cough. Holterbach observed
complete aphonia in a head of cattle with a tnbercnlons tumor
in the larynx. Nasal discharge, sometimes streaked with blood,
is not uncommonly present. Tumors situated in the anterior
portion of the larynx in smaller animals can be immediately
seen; in horses, however, the inspection of the larynx must
be made with the rhinolaryngoscope, or they may be felt in
horses and cattle with the hand introduced into the pharynx.
(Horses must be laid down before manual exploration; a pre-
liminary tracheotomy is indicated to avoid the danger of suffo-
cation.) A swelling in the external aspect of the larynx is seen
very rarely, aiid theh' only in laryngeal tuberculosis.
Diagnosis. Tlie presence of tumors in the larynx can be
ascertained beyond doubt only by an internal examination of
the larynx; suspicion is, however, strongly aroused by the
afebrile, chronic course, by dyspnea, coming on in attacks or
gradually, with increasing intensity, occasionally accompanied
by difficulties in deglutition, by stenosis sounds, by convulsive
paroxysmal cough which sometimes relieves the dj^spnea, and
finally by non-tender swelling adherent to the skin on the out-
side of the larynx, with the signs of laryngeal stenosis! Some-
times it may be necessary to perf oirn. ;Ia!ryhgot6iiiia ^ jnter-
cricothyroidea (Plosz). ''''''' " ' '•''
■' Treatment. The difficulties of respiration can be rebeved
only by operative procedure. Pediculated neoplasms, or sitcA
at least as are not spread out over a large surface, may, aft'et
a preliriiinary tracheotomy, be removed with the ecraseur in-
troduced through the pharynx. (Almy removed cystic tumors
of the epiglottis in this manner, in two horses.) The extirpa-
tion of flat, spreading neoplasms, or of those situated more pos-
teriorly, requires laryngofissure. In actinomycotic tumors in-
ternal treatment with iodide of potash may be tried.
Y^'ii^^>'liiWi^t^iaii Holterbach, D. t. W., 1906, 541.— L. May, B. t. W.; IQOS.^Ojrkii-
ii:.';.' 'to'icf Imnliifi 'lisdi 'lo fjaddo': 'id xloiriv;' sinm'mB lo
T ■^ ''otoTlc Y^jnsrjpsil: eie'^ ^' juiBeds x^
.J ' /nla loilii q^sfla ,: 'ivhb fyiBil
lo ydiJii-j •[^di'iij'i xj ai li^ boj^i.n'i.'-.jiiuL k- ■'■ ■■■'"•'
01 B -tooqae-i aidi nl afjOTegrisb Yf^fi^^Q*!^^
9lG'iion9q iino Y9di sfgfJBoad ,aeibod anossb,. » > h^^n^i., /_.-^au
-hoqxo 8^ isiiiiodisJ. .99ii f Jiirfono'id edi 'lo al'iisq leqesb eill olnr
Xiqosb »lB*il9fr9q riBo isub sldfilQ'gsv Ifirll nwoda evBd aln9xn
larrb Ix^tgM .n9mrif isirlDfio'id 9ill ni smil ^nol b -io^ niBm9'i bnjs
eiB blifom ^0 S9'roq8 .iIiifitBO oinoiifo 99rjboTq ol iqB s'lom ai
,h99l bolioqa to vtaufit ^yblffoift 'lo noil89'ftiii edi -giii'iub bolBdai
.iBfrnsni ;^: -1 rr? h9orrboiq 9d Y,^m dTtniBO oinoB hb bnB
■iiii 9rft olni ly Idv/ 89ibod bifoa IlBma -lo eAnul"^
i^5
Section III.
DISEASES OF THE BRONCHI.
1. Bronchial Catarrh. Catarrhus Bronchiahs.
{Bronchitis Catarrhalis. )
Bronchial catarrh consists in an inflammation extending
to a variable extent into the tissue of the mucosa. It may
either affect the larger bronchi (macrobronchitis) or only the
finer ])roncliial branches (microbronchitis, s. bronchiolitis, s.
bronchitis capillaris), or it may extend all over the bronchial
tree (bronchitis diffusa ). Catarrh of the larger bronchi is
usually associated with catarrh of the trachea and larynx.
Occurrence. Bronchial catarrh is one of the most common
affections of domestic animals and is seen in all kinds of
animals, particularly in horses, dogs and cattle. Sometimes
it occurs in horses, cattle and goats in epizootic form.
Etiology. Taking cold plays an important role in primary
acute bronchial catarrh. Cold and wet weather, north and east
winds, staying in the open air, pasturing during cold nights
frequently give rise to colds, and therefore many animals are
affected simultaneously in spring and fall. The detrimental
influence of cold under these circumstances, and that of drafty
air affects especially very young or very old, overheated animals
or animals which have been robbed of their natural protection
by shearing. Horses are therefore frequently affected after
hard driving, dogs after hunting, sheep after shearing.
The inhalation of contaminated air is a further cause of
bronchial catarrh. Especially dangerous in this respect are
finely divided or gaseous bodies, because they can penetrate
into the deeper parts of the bronchial tree. Lubenau's experi-
ments have sho\\Ti that vegetable dust can penetrate deeply
and remain for a long time in the bronchial lumen. Metal dust
is more apt to produce chronic catarrh. Spores of mould are
inhaled during the ingestion of mouldy, musty or spoiled feed,
and an acute catarrh may be produced in this manner.
Fluids or small solid bodies which may get into the air
54
Bronchial Catarrh. 55
passages, while eating, may likewise irritate the mucosa more
or less. Non-acrid, non-corroding and pure fluids are less
dangerous since they are rapidly absorbed by the mucosa, as
was shown by intratracheal injections. However, dried par-
ticles are often contaminated with saprophytic and other bac-
teria and they cannot easily be removed from the bronchi.
Since substances are often aspirated in difficult deglutition,
pharyngitis, paralysis of the pharynx or unconsciousness, these
conditions also often lead to bronchial catarrh ; aspiration may
also occur when fluids are poured in in an awlovard manner.
Larger foreign bodies (stones, ears of cereals, needles, etc.)
may exceptionally get into the bronchi.
* Bronchial catarrh undoubtedly also owes its origin to an
infection, and it is then liable to assume an enzootic character.
Under this type are to be mentioned the common contagious
bronchial catarrhal affections seen in studs, among army horses,
described under the designation of enzootic catarrh of the
respiratory tract. Its true nature, however, is up to date not
vet known (see page 43). The bacillus pyocyaneus frequently
causes enzootic, purulent bronchial catarrh in young pigs and
in cattle. Other forms of enzootic infectious bronchial catarrh
however occur likewise in cattle and in goats. (Pr. Vb., Grimm,
Martens, Lewek, Eeisinger.) The bronchial catarrh observed
by Schmidt in cattle in transit may likewise be due to an in-
fection. (For further details see the chapter on .catarrhal
pneumonia.)
Secondary bronchial catarrh is quite common, particularly
in connection with diseases of the lungs. Rarely, however, does
inflammation of the larynx or trachea extend to the mucosa
of the bronchi.
Finally bronchial catarrh is frequently seen as a part of
the clinical picture of specific infectious diseases (strangles,
hemorrhagic septicemia, smallpox, foot-and-mouth disease, dis-
temper, etc.).
Chronic bronchial catarrh is caused by the same factors
which bring about the acute form if the detrimental cause acts
permanently or if it leads to repeated attacks of the acute form.
However, even then the affection of the bronchi is more com-
monly secondary in nature. Every continuous disturbance _ of
the respiratory mechanism or of the pulmonary circulation
brings about chronic bronchial catarrh, because not only de-
ficient ventilation of the air passages and the decomposition
of mucus due to it but also stasis of blood will cause a dis-
turbance of nutrition of the mucosa. Consequently a bronchial
catarrh is almost always seen accompanying chronic pulmonary
emphysema, chronic interstitial pneumonia, organic heart dis-
ease, and chronic infectious diseases affecting the lungs (tuber-
culosis, glanders, actinomycosis, etc.). Animal parasites may
also produce chronic bronchial catarrh (see lungworm disease).
56 Bronchial Catarrh.
Predisposition. Particularly predisposed to bronchial
catarrh are very young, or on the contrary, very old animals,
pet animals, anemic or cachectic animals. These may contract
the affection after jijainQ:|:,,^x,t^rpal causes and their recovery..j^
difficult to secure. ", , ;' ,,. it
, ^ , Pathogenesis. The mucosa of the bronchi possQ^ses pro-
tective features which will prevent noxious effects of external
influences within certain limits. Cough excited by an irritation
of the mucosa and the epithelial ciliary movements which are
directed outward favor the expulsion of particles and micro-
organisms out of the trachea and bronchi which have gained
access to the bronchial tree. The covering of the mucosa with
mucus protects the latter against the immediate effect of sub-
stances which have gained access, while the numerous Ij^nph
follicles that are situated in the wall of the bronchi favor the
destruction by phagocytosis of small elements which may have
penetrated into the bronchial wall itself. The very smallest
bronchi lack these protective structures; they are, however,
sufficiently guarded by the larger bronchi situated anteriorly
to them. The protective agencies become, however, insufficient
if the noxious insult has been very intense, if the protective
apparatus has been parah^zed, or if the detrimental stimulus
travels along the blood current. Whenever the harmful agencies
have gained the upper hand against the protective apparatus,
the blood vessels in the mucosa become dilated, the latter swells
and an increased production of mucus occurs, the substance of
the mucosa becomes infiltrated with a sero-cellular .exudate
which also collects in the lumina of the bronchi. The substances
acting as inflammatory irritants get in the further course into
the pulmonary tissue with the Mnpli current, where they again
excite an inflammatory process. If inflammation lasts for a
longer time, it leads to an increase of connective tissue and to a
reduction of elasticity of the bronchial wall. If the catarrh
is confined to the larger bronchi, the bronchial air current is
not influenced ; on the other hand, there is considerable disturb-
ance in bronchiolitis and there is the possibility of an ^xjt^fl,-
sion of the process to the pulmonary parenchyma. ijti.ri-n
Anatomical Changes. In acute catarrh of the larger broiir
chi (macrobronchitis catarrh, ac), we find the mucosa redr
dened uniformly or in patches, either everywhere or only in
some branches, sometimes studded with small dark red extrava-
sated blood, more or less swollen, loosened and covered with
mucus or with a more purulent secretion. The size of the
mucous glands is from that of a millet seed to that of a hemp
seed and they discharge translucent drops of. Vn^ucii§^^f^|)4^
pressure. , ■' ,;i'^."; . ' -Tuo
Catarrh of the finer bronchi (bronchitis capillaris, s. bron-
chiolitis, s. microbronchitis catarrh, ac), can frequently, be
Symptoms. 57
recognized on autopsy by the fact that the lungs do not collapse
well after opening the thorax, since the air cannot escape from
the bronchioles which are filled with an exudate. Emphysema
of the margins of the lungs (emphysema vicarians) has the
^ame significance, and also the wedge-shaped, dark, sunken-in
areas of the consistency of meat (atelectasia), while similar but
firmer areas which protrude above the general pulmonary sur-
face indicate an involvement of pulmonary tissue (broncho-
pneumonia). Mucous or purulent drops containing more or
less numerous fine air bubbles are seen on the cut surface.
: In chronic catarrh, the bronchi likewise contain a serous,
mucous or purulent, occasionally a caseous, exudate. The mu-
cosa, however, appears grayish red or brownish, unequally
thickened and sometimes, on the contrary, pale and thinned out.
The connective tissue proliferation may in spots become so
intense that villous excrescences are formed in varying degrees,
Sometimes, tough nodules of the size of a millet or pea, are seen
outsiele of the bronchial wall, but in connection with it, which
may contain caseous material (peribronchitis nodosa). These
processes may be accompanied by a proliferation of the inter-
stitial pulmonary connective tissue, i. e., by an interstitial pneu-
monia.;. .^
In the deeper portions of the lungs, especially in the an-
terior and lower parts, bronchiectasias are formed occasionally
which are variable in shape (b. cylindriformes, fusiformes,
sacciformes, etc.), and which, in larger animals, may assume
tlie size of a fist. They always contain an abundant dirtj^-gray-
ish, mucopurulent secretion, which is occasionally fetid.
In aspiration-bronchitis, in the presence of bronchiectasias,
occasionally also in simple chronic bronchial catarrh, the exu-
date and later on the bronchial wall itself decompose with thp
development of a dirty-greenish color and of a fetid smell
(bronchitis putrida). According to the nature of the case, the
bronchial glands sometimes show a,cute, sometimes chronic,
sweiiin^^^^-^^f,^'^ '■-'-':; - '■' '^^i;^^- Ji^^-^^^^-^^y ^
■:!;;- ;?lni{ 'tilt H^^.ii') n*!' .'-(''ifrrrl ^xlt io H^^nnbni
Symptoms. An invariable symptom of acute catarrh of the
larger bronchi is cough. It is short, dry at the beginning, as
iqiig as there is no secretion in the bronchi, and later moist,
with. the increase and liquefaction of the secretion; then masses
of secretion are expelled through the mouth or nose. Cough
sometimes occurs in paroxysmal attacks. Eespiratory difficulty
occurs.only whenever the process is more extensive, especially
in the initial stage. Percussion of the thorax shows nothing
abnormal; auscultation reveals various rales. At the very be:
ginning, before any secretion whatever has occurred (bronchitis
sicca), these rales are absent, and one may perhaps only
hear a rough, vesicular breathing sound, but rales appear on
the second or third day and remain present throughout the
whole course of the disease. The rales are sharp and crackling
58 Bronchial Catarrh.
as lon^ as the secretion is thick and tenacious ; they becoilie
more dull, moist and more numerous after the secretion has
become more abundant and more fluid. Coarse and dull rides
suggest, to a certain degree, tlie involvement of the larger bron-
chi, while high fine rales speak for involvement of the small
In-onchi. Very loud strong noises indicate, in general, an affec-
tion of the more superficial parts, those which are less audible
disease of the deeper portion. Sometimes the sounds are so
pronounced that they can be heard in the vicinity of the patient
without auscultation and the rales arising near the surfaces
may be detected by the hands placed on the surfaces (fremitus
bronchialis). Commonh^ also such other sounds as whistling,
Jiissing, spinning are excited by the vibrations of lamellae of
tenacious masses of secretion.
Nasal discharge, which is often present, has generally a
grayish-white mucous or mucopurulent appearance. It contains,
at the beginning, few formed elements; in the further course,
however, we find cell detritus, ciliated epithelia and many pus
corpuscles.
The disease is generally initiated by a febrile elevation of
temperature; enzootic cases which are due to an infection are
particularly characterized by elevations reaching to 40° and
42° C. Sometimes a fall of temperature occurs as early as the
second, generally on the third day. Increased pulse-beat, dull-
ness and lassitude are likewise observed.
The symptoms of acute catarrh of the finer bronchi are
usually preceded by the signs of macrobronchitis, the clinical
picture of the former rarely coming on immediately ; the cough,
which is likewise always present, is weak at the start and may
persist until the end, accompanied by little if any expectoration.
The respiration is accelerated and forced especially during ex-
piration; sometimes paroxysmal attacks of suffocation are ob-
served.
The percussion sound is sometimes highly resonant toward
the boundaries of the lungs, and in such cases the pulmonary
boundary is usually displaced backward. This may also be so
pronounced that the boundaries as mapped out by percussion
may be in a line with the costal arches (observed by Marek in
horses and dogs). Atelectatic portions of the lung rarely pro-
duce dulness on percussion, and whenever sucli is distinctly pres-
ent it usually indicates that a l)ronchopneumonia has occurred.
Auscultation demonstrates fine rales (high pitched), sharp
crackling sounds or crepitant rales, often in connection w^ith
other sounds. The vesicular breathing sound is accentuated in
many places, in others less distinct or absent, in consequence of
the permanent or temporary closure of some bronchial branches
with masses of secretion.
Bronchiolitis is generally accompanied by fever lasting
sevei-al days or persisting throughout tlie whole course of the
Course. 59
disease. The pulse is accelerated, there is dullness; lassitude
and marked diminution of appetite are also always present.
Chronic bronchial catarrh develops in some instances from
acute catarrh. As a rule, however, it arises very insidiously
and develops slowly from the start. For a long time only cough
is observed. It comes on at first during exercise or after the in-
halation of cold air or after the effect of other irritating fac-
tors. Generally drawn and moist, rarely painful, it appears
occasionally in longer paroxysms, eventually with the expulsion
of a thick mucous or mucopurulent secretion. The respiration
is not interfered with in the beginning stage ; later on, however,
it becomes forced, and work or rapid motion bring about sneez-
ing, which in older animals is so frequently caused by chronic
bronchial catarrh.
Auscultation gives the same sounds as in acute catarrh;
although dry rales and especially purring and whistling sounds
are particularly prominent. Fever is absent aside from the not
uncommon cases with acute exacerbations and from cases of a
secondary nature where the primary affection is accompanied
by fever. The general condition sometimes remains undis-
turbed for a long time; but if the catarrh exists for several
months emaciation and anemia are seen, particularly in older
animals.
The bronchial catarrh which is frequently seen in cattle, and
which is probably due to an infection with the bacillus pyocyaneus
differs from the above-described picture only in this respect that the
wheezing, whistling, and purring sounds and crepitation, are best heard
at the portions of the lung covered by the shoulders. One can also
demonstrate tenderness of the anterior intercostal spaces. The respira-
tion is variably affected according to the duration and is either forced
or accelerated. The general condition and the production of milk
remain undisturbed. In some cases, bronchial catarrh is followed by
bronchopneumonia (see there).
For details about bronchitis scleroticans of horses, as described by Griiter,
see in the chapter on chronic interstitial pneumonia.
Putrid bronchial catarrh is characterized by a peculiar, dis-
agreeable, sweetish smell of the exhaled air, or of the occasional
nasal discharge which is particularly abundant after paroxysms
of coughing, and by a dirty discoloration of the nasal secretion.
Otherwise the symptoms are the same as in other forms of
bronchitis; however, gangrene of the lungs frequently follows
upon putrid bronchitis. In very rare cases one is able to
obtain tympanic sounds on percussion, in some part of the lower
thoracic region l)ronchial or amphoric respiratory sounds, or
possibly metallic rales as signs of an existing bronchiectasia.
Course. Acute catarrh of the large l)ronchi generally runs
a course of two to three weeks ; but occasionallv recoverv takes
60 Bronchial Catarrh.
place after a few days. Broncliiolitis, liowever, is characterized
by a slower course and is frequently accompanied by broncho-
pneumonia, which not uncommonly leads to a fatal issue;
bronchiolitis, however, may alone be the cause of death.
Chronic catarrh always lasts several weeks and may last
a number of months and even years. This depends upon
whether the catarrh is a primary or a secondary atfection, and
under what conditions the patient lives. In protracted cases,
acute exacerbations are occasionally seen, also attacks of suffo-
cation, and these may lead to a great impoverishment of the
condition of the patient.
-■•>■-' Diagnosis. The diagnosis of bronchial catarrh meets with
no difficulties, the presence of rales or of whistling or purring
sounds being characteristic. One also hears rales in edema of
the lungs and in pulmonary hemorrhage, but these atfections
come on suddenly with very grave symptoms and generally with
a foamy or hemorrhagic nasal secretion. The character of the
rales and the degree of respiratory difficulty point to the af-
fected bronchi, while the onset and course of the disease indi-
cate its acute or chronic character. It is, however, sometimes
difficult to determine whether a bronchial catarrh is primary or
secondary in character. Only a very careful examination of
all organs can secure against error. The absence of symptoms
pointing to any other disease speaks in favor of a primary
bronchial catarrh, and the absence of metallic rales, aside from
the rare cases of bronchiectasias, as well as the generall}^ f avor-
al)le course, likewise speak in favor of primary catarrh, while
high fever and great difficulty in respiration point to an affec-
tion of the lungs. However, catarrh of the finest bronchioles
also leads to symptoms similar to those last mentioned, so
that it is sometimes difficult to decide whether we are dealing
with a simple bronchial catarrh or whether catarrhal pneumonia
is already present.
Prognosis. Idiopathic catarrh of the larger bronchi is in
general a benign affection. Catarrh of the finer bronchi, how-
ever, may in itself lead to suffocation, or it nuiy become com-
plicated with catarrhal i^neumonia. Since experience has shown
that this form of catarrh preferably affects very young or very
old and debilitated animals, the prognosis in such animals is
always dubious and is decidedly unfavorable in the presence of
intense dyspnea and high fever. Diffuse bronchitis, which is
seen after conflagrations, is likewise of very grave significance.
Enzootic bronchial catarrh usually takes a favorable course
and only comparatively rarely leads to death of the animals,
usually after a complicating jjneumonia or pleuritis has devel-
oped; even these latter complications do not exclude the possi-
bility of recovery. In enzootic bronchial catarrh of cattle of
commerce Schmidt observed a mortality of 30%.
Treatment: '■' 61
The prognosis of secondary brbn^ChM'-eJltteli' 'dl^peiidk'
upon the nature of the primary disease.' *^'''''' '>IoHo';i'> 1)>.:.if , ;;;|
.•''> (•■ ■ Mtrpi; ,04 I'xIooIk ,0. f 'itoHO'Vf')) jf'nnt
'" 'Treatment. Rest and pure" ^ir are 'tllb' nfloWpot^n-tfactcyrs'
in securing speedy relief from bronchial catarrh. Hence the
patients must be kept in uniformly warm, clean places, the
barns must be well aired and the sojourn in the open, in sunny
places free from draft, is to be favored. Larger animals
should not be used for work during the whole duration of an
attack of bronchial catarrh, even if it is confined to the larger
bronchi. The feed should consist of easily digestible, dust-free
material containing an abundance of water; as a drink the pa-
tients should have pure, if possible slightly alkaline, not too cold
water. Frequent and tormenting cough, particularly in the
initial stage, should be ameliorated by the same narcotics which
are recommended for laryngitis (see page 42). In the further
course, after the secretion has become more abundant and more
liquid, its expulsion must not be prevented by a suppression
of the cough.
In dry bronchitis sojourn in moist air exerts a favorable'
influence and this treatment is particularly serviceable in the
case of smaller house animals which are usually kept in rooms.
The contents of the air in water vapor can "be increased by
placing flat vessels filled with water hear the stove or radiator
or by the use of a spraying apparatus. The object of fre-
quent inhalations is the same. The benefits derived from them
must, however, not be overestimated, because it has been shown
experimentally that vapors and finely divided fluids are depos-
ited already in the nose and pharynx, so that only a small part
of them can get into the deeper respiratory passages. For in-
halation purposes the same substances may be used which were
recommended against laryngitis (see page 42). If the exhaled
air has a fetid odor, one may usei a finely divided spray of cor-
rosive sublimate (1 :2000) ;" 2-3% solution of creolin; 1-2%
solution of carbolic acid. Tn intense dyspnea due to ah exten-
sive bronchiolitis the administration of oxygen may become
necessary.
The intratracheal injection of drugs can only have an in-'v
significant place in practice. Aside from the fact that the method-"-
ical carrying out of such treatmeht meets with difficulties the
ingested fluids (as shown by Earner) only get into the larger
bronchi of the anterior pulmonary portions and the watery
solutions are there absorlied too rapidly. A certain success
might be expected after the injection of larger masses of fluids
or after oil in emulsions. The following are adapted for intra-
tracheal injections: sodium bicarbonate (2-3%); zinc sul-.
phurate (Vi'%) ; argentum nitrate (0.1%), also LugoPs solution
(1:5: 100-200), and oil of turpentine (with olive oil al).
Larger animals receive from 20-40 gm. of the watery solutio^ns ; .
sm'^lter animals 2-3 gm. at one dose injected into the trachea?)
62 Bronchial Croup.
of the oil mixtures, of each ]5-20 or 1.0 i^iii. Masson & Vazeux
have used creosote with good success in putrid bronchial ca-
tarrh (creosote 1.0, alcohol 40, aqua 40, of this mixture 20 cc.
twice daily). A 4% formalin solution might be used instead of
the creosote; sometimes, however, the former produces a pro-
longed irritation, which causes cough. To each one of these
solutions 1-2% tincture of opium might be added in order to
lessen the irritability of the mucosa.
The value of internal medication is very doubtful. Expec-
torants and solvents of the mucus are in general use, for large
animals in the form of pills and electuaries, for small animals
in the shape of solutions. Such drugs are : stibium sulf . auran-
tiacum (10-20 or 0.5-1.0 pro dosi), ammonium chloratum
(8-15 or 0.2-1.0 gm.), root of senega (in a decoction 10:15 for
dogs) and root of ipecacuanha (0.5:15.0 in tablespoonful doses),
etc., 2-3% of liquor ammonii anisatus is added for smaller
animals. In a horse with bronchiolitis, Hermann had good
results by the repeated subcutaneous injection of iodipin (40-50
gm.). When there is al)undant secretion of mucus, especially
in the smaller bronchi, and difficulty in respiration depending
on it, emetics are indicated in smaller animals, since vomiting
raises the pressure and produces a stronger air current in
the l)ronchi, which favors the expulsion of masses of secretion.
Such drugs are: apomorphine hydrochlorate (0.005-0.01:50.0,
combined "with 0.05 gm. morph. hydrochlor. ; every three hours
a tablespoonful for dogs); tartarus stibiatus (1:100.0 every
fifteen minutes one tablespoonful); ipecacuanha (1-20:150
aqua), etc. Atropine (horses and cattle 0.03-0.05 gm., dogs,
0.002-0.01 gm., subcutaneously) has a tendency to suppress
excessive secretion and to relieve dyspnea for some time.
Priessnitz's applications may be made to the chest.
The general condition must ])e watched in very young and
in very old animals and stimulants must be given in the pres-
ence of debility (camphor, ether, alcohol, caffeine). Larger
animals must be rublied down two to three times a day.
Literature. Earner, A. f. Tk., 1899, XXV, 67.— Behreiis, D. t. W., 1904,
fio_Berj>er, Z. f. Infkr., 1907, ITI, 101.— Grimm, S. B., 1888, 69. — Griiter, Beitr.
7. Keniitiiis d. Bronehitis ohr. d. Pferdes, Diss. Ziirich, 1909 (Lit.).— H. Holt,
Z. f. Jnfkr., 1907, III, 155. — Lewek, Beitr. z. Kenntiiis d. Erkraiik. d. Luftwege
iind d. Lungen d. Rindes, Diss. Dresden, 1909 (Lit.).— Lubenan, A. f. Hyg., 1907.
LXIII, 391.— Martens, B. t. W., 1906, 655.— Petropawlowsky, A. f. Vet.-Wiss.,
1906, 14. — Pr. Vb., 1900, II, 9. — Reisinger, Monli., 1908, XIX, 193 (Lit.). — Schmidt,
S. B.', 1903, 79.
Bronchial Croup (Bronchitis crouposa). Cattle and sheep suffer
from a croupous inflammation of the bronchial mucosa under the same
conditions which bring about croup of the larynx, or it may be
secondary to nasal or laryngeal croup. In idiopathic bronchitis
crouposa the mucosa of all bronchi or of the majority of them is
covered bv tubular masses of fibrin. These masses interfere more
P.roiu'hial ( "atarrh of Fowls, Contagious lutlammatiou of Air Sac iu Geese 63
or less with the exchange of gases and they close the huer brouchi
completely.
Hence the symptoms of this affection consist in a very grave
dyspnea which reaches a high degree, either suddenly or more rarely
after a preliminary fever which is not well marked. One hears rattling,
whistling and purring sounds over the thorax. They are as a rule very
loud and may be felt as a pectoral fremitus. The disease is recognized
in its true nature only after the patients have coughed up croupous
membranes, the source of which is made obvious by their tubular shape
and branching arrangement. This does not, however, occur in all
cases, because the animal may suffocate without any expulsion of mem-
branes or the latter may not be thrown out but may be swallowed
and so escape notice.
The disease may reach its full development within 2 to 3 days
and may then lead to suffocation, especially in young animals, while
older and stronger animals may occasionally recover after the expulsion
of the membranes.
The treatment is similar to that recommended for laryngeal croup ;
tracheotomy, however, is of no avail, and the chances of successful
treatment are not as good since we cannot reach the deeper portions
of the respiratory tract.
[The disease of cattle and sheep described above is similar to one
occurring in man and now generally called bronchitis fibrinosa. It
is, however, a very chronic affection in man, w^hicli usually leads to
a fatal issue. Translator's note.]
Bronchial Catarrh of Fov^^l. This disease manifests itself in cough
and accelerated respiration, accompanied by r-ales formed in the trachea
and audible at a distance; on flying the rfdes may be increased to
a rattling sound. Very marked difficulties in respiration point to an
affection of the pulmonary parenchyma.
Internal treatment is not promising. Ziirn recommends the
administration of the following : Amnion, chlorat. 0.5 ; mel. 0.5 ; aqua
foenic. 50.0 (table or tea spoonful doses 8 to 4 times daily). More
successful is the inhalation of hot water vapors, or of a fine spray
of mucosolvents (1% sol. common salt, sod. carbonat. or bicarbonat.').
These are employed in such a manner that the opened bill of the bird
is held over a vessel with hot water or over an inhalation apparatus.
Birds kept in the room may be treated so that a vessel with hot water
is placed next to the cage, while both are covered \^dth a cloth. Sprays
must be directed into the cage. Care must be taken that the birds
get enough air for breathing.
Contagious Inflammation of the Air Sac in Geese. This is a general
infectious disease which has been observed in epizootics among geese
imported from Russia. It is characterized anatomically by a fil)rinous
inflammation of the air sacs and of the serous memliranes.
The cause of the affection is, according to Bugge, a slender bacillus
of about the same morphology as the bacillus of hog erysipelas. It
does not, however, form colonies on ordinary nutrient agar like the
bacillus avisepticus.
The most marked anatomical changes are found in the air sacs,
which appear yellow in color while their internal surface is covered
with thick, leathery, whitish-yellow masses. Similar deposits are found
on the serous membranes of the liver, spleen, intestines, peritoneum
64 Narrowing of the Large Bronchi. "'•
and kidneys. In consequence of the frequent simultaneous involve-
ment of the peripheral bronchi nodules of pin-head to pea size or
branching masses are found in the lungs.
The most essential symptoms are accelerated respiration with open*-*
ing of the bill, with snoring sounds, also staggering in walking, difficulty
in rising with kicking of the legs toward the head. The depression,
which is present from the start, increases rapidly and the l)irds generally
die within 8 to 10 days, occasionally also earlier and (juite unexpectedly.
The disease may be distinguished from fowl cholera because it occurs
exclusively in geese, ])y the absence of hemorrhages and the presence
of filirinous deposits in the air sacs and by the microscopic detection
of a slender bacillus which does not take a bipolar stain. In croupous
laryngitis of young geese intense dyspnea is present from the start and
the pseudomembranes are found in the larynx.
Since treatment is unpromising the disease can only be mset ^by'
prophylactic measures (see fowl cholera). — (Bugge, Z. L Iniksij'W^','
iii, 470.) j.idiiiym siii io
■ri/Kft 9rfT
ii'i 2. Narrowing of the Large Bronchi. BronchostenoSfe;'^'"''^
Etiology. Stenosis of the larger bronchi may be eau'^ed'
especially by the accidental introduction of foreign bodies, ears
of grain, fir-cones, pieces of bone, cartilage, wood, needles, etc.,'
as they have been f onnd repeatedly in the air passages of horses^,
cattle, swine and carnivora. (Szabo found a mouse in the air
passages of a hog that had suffocated suddenly, which got there
accidentally while the animal had been rooting.) Other canses
are narrowing of the bronchial Inmen by cronpons pseudomehi-'
branes or compression of the bronchi by enlarged or suppurat-
ing bronchial or mediastinal l}anph glands, aneurysms of i}\Q.
a9irta, tumors of the lungs or of the mediastinum,; r ifwri >?iii
f-K} (! : ; 'io nortfi'[.t?,inrmbfi
•■••Symptoms. Narrowing or complete obturatibii ' of '^' lavg^'
bronchus diminishes the exchange of gases in the correspond-
ing portion of the lung or prevents it entirely and causes dif-;
Acuities in respiration, which come on suddenly in the casfe'"'(if
the introduction of a foreign body, but more gradually in ca^^^'
of compression by a tumor. Particularly the former condition
leads to convulsive paroxysms of cough.' Difficulty of respirla-;
tion is generally of a much graver form in consequence of sudi-.
den closure than it is in a stenosis which lias developed gradu-
ally., The stenosis is usually unilateral, it lessens theWcur-
sions of the corresponding half of the thorax and canses a sink-
ing in of the yielding portions of the thoracic wall in inspira^-:
tion. A stenosis sound similar to that heard in laryngeal steno-'
»i& may likewise be observable. ' > ■ =" "iit;» •miT
' The percussion sound remains unchan^M ^'s""roh'^^a^"t'^'erb'
is not a complete olistruction. The vesicular breathing sounds!
are absent over the affected half of the thorax, or "at least'
weakened, and are intensified over the other' portions of the
chest. Over the affected parts are heard occasionally rattling
or whistling sounds.
Asthma Broiichiale. 65
111 stenosis caused by a foreii^n body tlie exhaled air later
on becomes fetid and the temperature rises. In stenosis caused
by compression one occasionally also observes edematous in-
filtration on account of the simultaneous compression of largei-
venous trunks, paralysis of the larynx due to compression of
the inferior laryngeal nerve, disturbances of deglutition due
to compression of the esophagus, and in ruminants clironic
bloating.
Treatment. Since successful treatment is impossible, the
r-:ninals ought to l)e utilized by early slaughtering.
3. Asthma bronchiale.
{Asthma sijasmod'u um, Asthma nervosum. )
Under this name difficulties of respiration are designated in human
medicine which come on periodically in violent attacleondary
infections, particularly to the l)ipolar bacilli of liemorrliagic sei)ticeinia.
Extensive l)roncliial catarrh or bronchopneumonia cause
disturbances of nutrition in consequence of an incr(>ased
(l('('()mj)()siti()n.
Anatomical Changes. These are quite varinbk' according
to tlic i!inii1)er of lung worms, to single or i-epoalcd i]iv;;s:ons, to
Anatomical Changes. 73
the species of the parasites, the duration of the process, etc.
As a rule, airless foci are found in the otherwise normal or em-
physematous and pale lung tissue, preferably in the anterior
and inferior portions of the lungs, from the size of a pea to that
of a walnut. These foci are generally wedge-shaped, with the
base on the pleural surface and the apex directed toward a
larger bronchus. The foci are either sunken in and like meat
(atelectasis) or more or less prominent, doughy, soft to tough,
according to the duration of the process. They are reddish or
grayish red, or even grayish yellow in color (worm-nodules,
bronchopneumonia verminosa lobularis). On section these foci
discharge a thick, reddish fluid which contains epithelia, pus
corpuscles, ova, embryos and fragments of adult worms.
Not uncommonly extensive inflammatory areas are encoun-
tered, especially in certain species of animals (goats, sheep,
(•'lives and field hares), which are confined either to one or excep-
tionally to several lobes (l)roncliopneumonia verminosa lobaris
sive diffusa). The affected portions of lung are like the spleen
in color and consistency and they show on section dark red to
black-red hemorrhagic spots, also dirty gray, crowded, even con-
fluent spots. The expressed juice contains a large number of ova
and w^orm embryos. In acute cases in calves the exudate often
has a fibrinous character. In certain cases, the lungs contain
vesicular nodules (as a rule, situated under the pleura) from
the size of a millet seed to that of a hemp seed, which are found
toward the apices and margins and wdiich are of tough consist-
ency (bronchopneumonia nodularis pseudotuberculosa s. alveo-
litis nodularis verminosa). These nodules are formed around
an isolated, fully developed strongylus capillaris or a strongy-
lus commutatus, or around aspirated ova. The nodules are
light yellow to gray yellow in the presence of Str. capillaris, and
red-brown to violet or blackish in the presence of Str. commu-
tatus. After the death of the worms, the nodules undergo casea-
tion and finally calcification.
In dofJH piiihead-sized, translucent, pearl-like, exceptionally larujer, broncho-
pneumonic foci are formed at the root of the lunjo^s, sometimes also in other places;
they are produced by the ova or embryos of Str. va?orum. In the presence of
Str. pusillus the lungs of the eat show a similar picture; the embolic transportation
of embryos of Ollulanus tricuspis produces nodules similar to miliary tubercles with
a hepatized pulmonary parenchyma in their neighborhood.
The bronchi contain an abundant mucoid or nnicopurulent
secretion, sometimes streaked with blood, in which the sexually
mature worms are found. Under the microscope numerous ova
and embryos are seen. One frequently sees the first worms at
the end of the trachea, i. e., at its bifurcation, and these may
completely obstruct the larger or the medium-sized bronchi,
in dense masses, which sometimes contain only a few or no
worms at all. The mucosa is swollen, reddened and sometimes
streaked with hemorrhages. Bronchiectases of varying sizes
are rareh- missed in the presence of worms.
74 Luugworm Disease.
Inflammation of the deeper layers of the bronchial wall
can be recognized by its thickness, sometimes also by the pres-
ence of small purnlent foci (peribronchitis). In such cases one
finds a proliferation of pulmonary tissue around the bronchi,
and white cicatricial bands are seen radiating from the bronchial
wall into the air-containing tissue.
In hogs particularly pathologic changes are sometimes
found onlj' in the bronchi. These, however, frequently lead to
atelectasis of the neighboring pulmonary parenchyma.
According to the observations of Osier, Blnmberg anfl Eabe, Strongylus
canis bronchialis produce In dogs wart-like nodules up to the size of a bean;
they are arranged like mushrooms on the surface of the trachea and of the larger
bronchi (tracheobronchitis verrucosa verminosa) : these nodules contain worms
which may project from under an uneven surface. In the pulmonary parenchyma
there are many gray subpleural nodules, like granules of sand, and these contain
each one worm. Osier also observed extensive bronchopneunionic inflammatory foci.
The pleura pulmonalis of the affected animals frequently
appears mottled, thickened, but rarely covered with fibrinous
deposits, or adherent to the pleura costalis. According to Kitt,
the Str. commutatus sometimes produces pleuritic abscesses.
In severe cases the other organs present evidences of ane-
mia and cachexia, especially subcutaneous edema and exudates
into the serous cavities. A very intense gastritis is, according
to Schlegel, of frequent occurrence. The bronchial glands are
usually swollen.
Symptoms. The appearance of lung-worm disease is possible
at any time. It occurs, however, preferably in spring and fall
or during the period of pasturing. The climax is generally
reached in fall.
The rei)orts of various authors on the appearance and occurrence of lungworm
disease do not quite agree with each other. According to Eailliet it is observed
mostly during the warm season ; according to Neumann, it occurs all the year
around, especially between March and October; according to Ziirn, in spring and
in fall; according to Friedberger & Frohner generally in fall; according to
Dieckerhoflf in calves toward the end of the pasturing season or even after its
termination. Csokor states that lung-worm disease in lambs appears in summer;
in older animals only in fall. Moussu claims that the disease is prevalent all the
year around, but reaches its climax late in the fall.
The period between the ingestion of the worm brood and
the outbreak of the disease varies considerably according to
the intensity of the invasion and to the individual power of re-
sistance of the infected animal. Six to eight weeks elapse in
the majority of cases till the symptoms become manifest. After
a minor invasion and in strong adult animals the symptoms
of disease come on after several months, while after a severe
invasion, symptoms may be noticeable after some days.
Schlegel saw the disease 12 to 59 days after the infection of
goats, while Kasparek saw, as already mentioned, bronchopneu-
monic foci in infected calves only ly^ to 8 days old.
The disease manifests itself, as a rule, in all species of
Symptoms. 75
susceptible animals as an insidious bronchitis, which increases
in intensity from week to week, and which, in a portion of the
cases, is accompanied by the symptoms of catarrhal pneumonia
which finally leads to cachexia.
In sheep and goats one first observes cough which in the
beginning occurs only in few animals, after long intervals and
preferably during exercise. The cough is short, dry and strong
and spreads gradually to the greater portion of the herd. At
the same time it becomes more frequent, weaker and torment-
ing. In severe cases one observes real paroxysms of cough. The
bronchial secretion is expelled in large lumps through the
mouth and in the former are found the worms, their ova and
embryos; the latter by microscopic examination. The nasal
secretion is usually seromucoid, but it does not usually contain
embryos or ova. Sheep frequently rub their noses on the
ground ; sometimes with such intensity that a loss of substance
occurs.
The respiration becomes more and more difficult, especially
in sheep, so that the animals finally breathe convulsively. A
variety of rales are heard over the thorax and trachea. They
are sometimes so loud that they are audible at a distance of
several steps. Percussion usually shows nothing abnormal ; but
on percussing very attentively one occasionally finds dullness
in circumscrilied or even in more extensive places of the thorax,
and sometimes also tympanic sounds. Bronchial breathing may
likewise be heard. Ben Danon observed albuminuria. In exten-
sive involvement of the lungs the temperature is elevated up to
40.5° to 41° C.
Emaciation and pallor of the mucosa^ occurs in the further
course of the disease, also a diminution in the elasticity of the
skin. The disturbances in nutrition are often intensified by a
complicating diarrhea. The embryos of Str. capillaris are al-
ways found in the feces (Schlegel). Finally edema appears on
the entrance to the larynx, on the eyelids, the lips or on the
whole front of the head ; also on the lower thorax and the ex-
tremities. The animals become very weak and often fall down ;
when attempting to get up, the hind legs appear paralyzed and
the patients succumb in complete prostration.
In cattle, especially in calves, one usually observes cough,
at first strong and occurring at long intervals, but in the further
course it becomes more frequent and more forced ; when cough-
ing the animals protrude the tongue from the mouth and expel
masses of mucus which is sometimes mixed with blood and
always contains worms. In severe cases violent paroxysms with
attacks of suffocation occur several times a day and one of
them may lead to death by asphyxiation. The respiration is
more or less accelerated from the start, later on forced. There
may, however, be rapid variations in the respiratory disturb-
ances, especially during the hot season (Hartenstein). Percus-
sion and auscultation show conditions on the whole similar to
76 Lungworm Disease.
those observed in sheep. A febrile temperature exists only ex-
ceptionally (Seheibel).
After an intense invasion the symptoms may increase in
severity so rapidly that tlie anhnals snccmnb within three to
eight days. The clinical picture, however, develops slowly, as a
rule; tlie cough l)ecomes gradually weaker, the respiration
more and more accelerated, the ingestion of food less. Emacia-
tion, anemia and edematous swelHngs make their ai)pearance.
In hogs, lungworm disease occasionally does not lead to
disturbances of health. However, Str. paradoxus sometimes
causes great losses, probably after an intense invasion, and the
epizootic disease then takes a course similar to that in sheep
(Sequenz, Czokor). In otlier cases the alfected animals show
only disturbances of nutrition.
In horses Hud asses the disease occurs exceptionally and only leads
to a clinical picture, siniilar to that seen in verminous l)ronchitis of
calves. Fatal cases have been observed repeatedly in asses (►Stewart).
Repeated attacks of respiratory difficulties are observed in dogs
infected with Str. vasorum ; these distur])ances may disappear within
a number of days or they may lead to the death of the animal. Ascites
is developed in some cases. The disease occurs rarely, and generally
only sporadically ; however, an enzootic prevalence with numerous fatal
cases has likewise been observed. Rabe observed obstinate cough and
marked dyspnea in the presence of Str. canis bronchialis in the trachea
and bronchi; Osier's Montreal cases occurred almost exclusively in
young dogs and were characterized by fever, lack of appetite, weak-
ness, paralysis of the hind extremities, convulsions, dry, short cough
and vomiting. Railliet believes, however, that the bronchopneumonia
found in these cases on post-mortem examination was due to distemper.
Spiroptera sanguinolenta, which occasionally may get into the
respiratory passages, also produces chronic catarrh.
Lungworm disease of cats produced by the ova and embryos of
Str. pusilhis leads to frcfiuent cough, often accompanied by vomiting,
emaciation, diarrhea, cachexia and a fatal issue after two to three
months. Catarrhal pneumonia may occasionally be produced by the
embryos of Ollulanus tricuspis. Midler & Neumann found Trichosoma
aerophilum in the presence of catarrhal changes in the lungs of cats.
Lungworm disease is very rare in rabbits and in these animals
leads to the same symptoms as in wild hares, where it frequently
prevails to an epizootic extent, viz., accelerated and difficult respiration
with frequent and dry cough and gradually increasing emaciation.
The disease often ends fatally.
Course. The course varies very much, according to tiie in-
tensity of the invasion and the individual species of aninuds.
Tlie hmgworms may frequently live in large numbers in hogs,
but also not unconnnonly in other animals, without disturbing
the condition of health of the infected aiumals. Sheep and
goats generally are atfected most seriously after a more in-
tense invasion, while the symptoms are milder in cattle and par-
ticnhn-ly in hogs. Among infected cattle, only weak calves
Diagnosis. 77
will succumb, while hogs die from the disease only in very
exceptional cases. The course of the affection is influenced by
the occurrence of secondary infections.
The duration of the disease also varies a good deal; in
the great majority of grave, and hence unfavorable, cases, the
duration may be two, three or four months. Deviations in
either direction are, however, frequent. On the other hand, the
disease may last more than four months, even over one year,
particularly in adult strong animals; while on the other hand,
it may take a fatal issue wdthin a few days or w^eeks (mthout
exception only in younger animals, particularly in calves). In
such cases one generally finds a larger bronchus obstructed by
masses of worms, or a rapidly spreading bronchopneumonia.
In its mild form the disease ends in recovery. In cases of me-
dium intensity recovery occurs, usually in hogs, frequently in
calves, after regulation of the diet; wdiile sheep and goats,
everything else being equal, generally succumb, especially
younger, weakened animals, or those which are in the later
stages of pregnancy. The very severe forms usually end fa-
tally. The advent of improvement is marked by a gradual
diminution of the cough and by amelioration of the other symp-
toms.
Recovery is not always complete. Some animals, espe-
cially sheep and goats, still suffer in their nutrition after the
disappearance of the catarrhal symptoms, and there may be a
chronic wasting away with tinai death, unless the animal is
slaughtered in time.
Diagnosis. Neither the symptoms of bronchial catarrh nor
the subsequent cachexia are to be looked upon as characteristic
symptoms of the disease. A diagnosis can only be made after
the detection of the worms or their ova or embryos. The worms
can be recognized with the naked eye in the coughed up sputum ;
if they are absent microscopic examination will detect the ova
or embryos if present. Embryos of lung-^vorms are also found
in the feces of infected animals (Schlegel, Plana, Eichhorn).
Since cattle often swallow sputum which has been coughed up, Andersen
reeoniniends, after an attack of cough, the introduction into the pharynx of a
rod armed at one end with a cotton plug; the secretion obtained on the" plug of
cotton is then examined. Bergeon has used this method with advantage. Hasen-
kanip 's lung-mucus catcher might also be used with advantage. In an emergency
masses of secretion may be removed from the pharynx with the hand.
Symptoms which are more or less similar to those of lung-
worm disease are found in catarrhal pneumonia from other
causes, as well as in enzootic pneumonia of young animals.
These affections, however, lead from the start to more or less
marked disturbances of the general health with fe])rile eleva-
tion of temperature and they do not lead to the formation of
abundant masses of secretion ; both forms of pneumonia usually
occur in very young animals. Differential diagnosis between
cases of lungworm disease associated with bronchopneumonia
78 Limcworm Disease.
and other forms of i)neiimoiiia is only possible upon the detec-
tion of the worms and tlieir broods. The disease is distin-
guished from pleiiropneumonia l)y its iisnally afeljrile course,
by the absence of extensive areas of dulhiess and of pleurisy;
further by the fact that cough remains for a longer time strong
and convulsive. In young animals affected with pulmonary
tul)erculosis, the cough soon becomes weak. In CEstrus disease
s^-mptoms of involvement of the lungs are absent.
Prognosis. This depends upon the severity of the symp-
toms, also upon the age, nutrition and species of the affected
animal. Everything else being equal, the prognosis is most
unfavorable in the case of sheep and goats, most favorable in
lungworm disease of hogs. Fatal cases are always more nu-
merous among young than among adult animals. Sometimes,
however, there may be no difference in this respect (especially
in infection with Str. capillaris or Str. commutatus). In lung-
worm disease of sheep the mortality varies from 10% to 70%.
Treatment. The most serviceable method of removing the
parasites consists in intratracheal injections of antiparasitic
drugs or in treatment with a spray apparatus also supplied
witii antiparasitic drugs. Favorable results have been ob-
tained with these means in some cases. Some authors, how-
ever (Dieckerhoff, Tapken), deny that good results can be ob-
tained with these methods. Oil of turpentine is adapted for
intratracheal application, also tar preparations alone or in com-
bination with the former. The following mixture may be used :
olei therelient. rectif., ol. olivar. (ol. lini, ol. rapae) aa 100.0, creo-
lin purissimi 10.0. Of this mixture sheep receive an injection
of 5.0 cc. ; calves 15 to 20 cc. ; the injection is repeated twice.
Vaeth uses the f ollo^^dng mixture with good results : 01. caryo-
phyll., ol. therebenthin., aa 100, acid, carb., ol. cadini aa 2.0
(calves 10.0 gm.). Wessel and Vaeth obtained favorable results
in cattle, Kronig in lambs with injections of 20.0 or 50.0 of a
1% solution of carbolic acid; Bergeon in calves with creosote
(creosote 20 parts, oleum amygdal. 100 parts, of this mixture
5.0; after four days, 20.0 for several days). Scheil)el likewise
cured cattle with creosote (creosote 1 part, spiritus rectif. and
water aa 50.0). Nielsen used intratracheal injections of 0.1%
solution of potassium picronitricum with good results in calves
(according to the age of the animals from 20-60 in one dose).
Seheibe) uses in the treatment of cattle in place of an injection syringe, a
spraying apparatus -which consists of an elliptically bent tracheal tube 0.4 cm. wide,
with a shield and two eyes, so that the apparatus may be fastened with strings
to the neck. The tube is armed with a trochar, so that it can be pushed into
the trachea of the animal. The trochar is withdrawn and a dichotomously divided
canula is then inserted into the tube. Creosote solution is then sprayed through
the canula into the trachea and bronchi, just as is done when a Frick spray apparatus
is used. The vessel containing the solution must be held lower than the canula,
otherwise the fluid would simply run in without being finely divided. (Zwaenopoel
Prophylaxis. 79
and Coppens). The spray must lie iiiterrupted if an attack of cough sets in. The
tube should be left in the trachea during the whole period in which this treatment
is employed.
Full success can only be secured when the lungs are not
seriously affected. Opinions are still divided as to the special
form in which the drugs are to be used. Some observers prefer
oil emulsions, since these remain longer in the air passages than
the watery solutions. Nielsen, however, considers oil emulsions
improper, since they do not mix with the mucus and do not get
to the worms. The treatment with the spray apparatus as in-
troduced by Scheibel appears most serviceable, since the finely
divided fluid is, during inspiration, aspirated into all bronchi
into which an air current is still entering.
Whether irritating smoke or vapors of similar action are
indicated even in the beginning of the affection is very question-
able. This method consists in burning masses of horn, tar,
stinking oil, etc., on heated iron plates in closed spaces, where
the animals are kept, or in heating turpentine until vapors are
developed, and in compelling the confined animals to inhale the
irritating air so as to produce much cough.
Stimulation and strengthening of the animals is of the
utmost importance because experience hap shown that strong
animals sometimes survive even a severe attack. The animals
should therefore have nutritious food, if possible cereals to
which have been added bitters and preparations of iron. Pas-
turing animals should also receive nutritious food and hay. In
order to prevent repeated invasions the pasture might be
changed or the sick animals might be stabled. Animals which
are very sick and which do not improve in spite of proper
treatment should be slaughtered.
Prophylaxis. Lowly situated, marshy and damp pastures
should be avoided. Care is particularly necessary in continued
rainy weather, and young animals which are especially suscepti-
ble must be protected. In such neighborhoods where the dis-
ease has become permanently endemic, dry feeding offers the
best protection (Schlegel). Preservatives which are praised as
effective are useless, but one might water the animals before
they are driven to the pastures, because this might cause them
to avoid drinking water from pools and marshes. The sputum
coughed up by the sick animals, the feces and the bedding-
straw, the respiratory tract of slaughtered animals or those
dying spontaneously must be destroyed. In a herd which is al-
ready infected, the young animals should be separated from the
adults. Where hogs and cattle are concerned the stables and the
drinking places should be disinfected. In places where the dis-
ease prevails among rabbits the weak and emaciated animals
should be shot (Docter).
Literature. Ben Danou, Journ. vet., 1909, 84.— Csokor, Ger. Tk., 1889, 489.—
Docter, Ein Beitr. z. Kenntnis des verm. Pneum. des Hasen, Diss. Leipzig, 1907
(Lit.).— Joest, Z. f. Infkr., 1908, IV, 201.— Kasparek, A. f. Tk., 1900, XXVI,
80 Syiigamus.
70.— Kitt, rath. Auat., 19()G, II, 284; Bakterienkunde, 1908, 170.— Koch, Eev.
f. Tk., 1883, 17.— Miiller, D. Z. f. Tin., 1889, XV, 137; 1891, XVll, 58.— Xeumann,
Mai. par., 1892, 562.— Nielsen, B. t. W., 1909, 212.— Plana, Clin, vet., 1906, 15.—
Kailliet, Zool. nied., 1895, 424.— Eeynal, Diet., II, 627.— Scheibel, D. t. W., 19o7,
673.— Schlegel, A. f. Tk., 1899, XXV, 137.— Schultz, A. f. Vet.-Wiss., 1901, 1117.—
Strose, B. t. W., 1892, 614.— Tapken, Monh., 1891, II, 241.— Zurn, Tier. Par.,
1882, 264.
5. Animal Parasites in the Air Passages of Fowl,
(a) Syngamus. (Gapes.)
Historical. A disease caused in chickens and turkeys by Syngamus
trachealis was first observed in 1779 by Wiesenthal in Baltimore. It
has since been reported repeatedly and has been studied more care-
fully bv a number of observers (Leuckart, Ehlers, Railliet, ]\Iegnin,
Walker) .
Occurrence. The disease which is produced by syngami
appears to be especially prevalent in America, England, Italy,
France and Germany, and it prevails preferably in enzootic or
epizootic distribution among pheasants bred in larger numbers
in captivity. Syngamus trachealis invades especially pheasants,
chickens, turkeys and peacocks, while Syngamus bronchialis
infects water fowl (geese, ducks) ; however, S. trachealis occa-
sionally affects other domestic birds, especially pigeons (Tossi)
and room birds kept in cages. Syngami have also been found
in partridges, American blue-jays, in cardinals, magpies,
rooks, swallows, wood-peckers, storks, starlings and ravens.
Young birds are generally affected.
Wiesenthal estimated that the loss by syngami in the invailed parts of the
I'nited States amounts to 80Vv of all young chickens; Crisp states that England
loses annually aliout one-half million of chicks. In a large pheasant breeding
establishment of France there was a daily loss of 1,200 pheasants. Klee estimates
the loss in Germany to several hundred pheasants annually.
Etiology. Of the genus Syngamus, belonging to the family
StrongylidcT, the air passages of birds are invaded ])y Synga-
mus trachealis Siebold (Strongylus trachealis, S. primitivus)
and Syngamus bronchialis Miililig. The air passages of water
fowl sometimes contain Monostoma flavum.
Syngamus is a slender, red filiform worm. The head
contains a mouth-opening surrounded by a strong chitinous
ring. The posterior end of the much smaller male ter-
minates in a ribbed bursa which covers two spicula. The
female is three or four times as long as the male; its
posterior end is blunt, the genital pore is situated in the
anterior portion of the body. The male of syngamus
trachealis is 2-6, the female 5-20 mm. long; the male of
syngamus bronchialis 10 mm., the female 25 mm. The oval
ova (Fig. 8) are small, provided with a doulile shell. The
latter contains at either end a roundish opening closed liy
Fig. 8. Ova of Synga- a delicate membrane. They contain a segmented mass or
mus trachealis. a nna may either remain normal
(emphysema pulmonum alveolare acutum) or atrophy may
occur of the interalveolar septa (emphysema pulmonum alveo-
lare genuinum s. substantiale s. essentiale).
(a) Acute Alveolar Emphysema.
{Simple Bloating of iJic Lungs.)
Acute alveolar bloating of the lungs consists in simple
dilatation of the air vesicles without any structural changes
of the pulmonary parenchyma. It is always secondary in nature
Etiology. Symptoms. Diagnosis. 91
and may disappear completely as soon as the primary affection
is relieved. It is therefore of minor clinical importance. Ac-
cording to the primary disease simple bloating of the lungs
may be diffused over both lungs (volnmen auctum pulmonnm,
Krehl) or it may be confined to portions of the lungs (emphy-
sema pulmonnm alveolare vicarians).
Etiology. Diffuse acute bloating of the lungs is a regular
concomitant to diffuse* microbronchitis. It is seen in the course
of pleurodynia (see page 87) ; also in long-lasting convulsive
cough, in long-continued strong inspiration and expiration as
it is seen in certain diseases of the air passages or in a pro-
tracted agonal struggle.
Circumscribed acute bloating of the lungs develops if the
bronchi of a certain territory become narrowed or if certain
parts of the lungs have l)ecome obstructed. In the former
case the corresponding portions become emphysematous ; in the
latter case, neighboring areas.
Diffuse, as well as circumscribed emphysema develops
partly on account of overstretching of the alveoli, partly on
account of the fact that the escape of air out of the alveoli
is more or less interfered with in certain diseases of the air
passages, hence more and more residual air remains in the
alveoli.
Symptoms. Aside from the symptoms of the primary dis-
ease there is in diffuse acute bloating of the lungs, an increased
resonant percussion sound over the lower and posterior pul-
monary margins and a displacement backwards of the posterior
inferior pulmonary border, which may be extensive enough so
that the posterior inferior pulmonary border reaches to the
costal arch (authors' own observation). The percussion sound
is more rarely affected in circumscribed acute bloating of the
lungs, i. e., Avhen a larger lung territory has become affected.
The respiratory sounds vary in both forms, according to the
nature of the primary affection; if larger pulmonary territories
have been obstructed one hears intensified vesicular breathing
over the emphysematous portions.
Bloating of the lungs decreases the expansion of the lungs
in direct proportion to its extent because severe bloating, which
has existed for any length of time, will decrease the elasticity
of the pulmonary tissue. Bloating, however, will disappear
without leaving any trace, if the primary disease leads rapidly
to recovery, but chronic alveolar emphysema with atrophy of
the interalveolar septa will develop when the primary disease
exists for a longer period of time.
Diagnosis. If the percussion sound is changed in the
manner indicated above and if primary diseases as mentioned
92 Chronic Alveolar Bloating-.
are present a diagnosis can be made safely, provided chronic
alveolar pulmonary emphysema can be excluded.
Treatment. This depends entirely upon the primary dis-
ease. Its removal must be sought for because its persistence
entails danger of the develo2:»ment of lasting chronic dilatation
of the alveoli.
(b) Chronic Alveolar Bloating. Emphysema pulmonum alveolare
genuinum.
{Ilcavcs: Emphysema pubn. alv. st(hstanfialr.)
Chronic alveolar bloating of the lungs consists in a per-
manent dilatation of the alveoli accompanied by atrophy of the
interalveolar and the interinfundibular septa and of the vessels
contained in them.
Occurrence. Chronic emphysema of the lungs is found
preferably in horses, more rarely in working oxen, quite fre-
quently in hunting dogs, usually in canines that are somewhat
advanced in age. It is the most common cause of horses being
broken -winded.
Etiology. Chronic emphysema of the lungs develops, as
a rule, after the animals have been used a long time for heavy
work (pulling or running) ; it is more rarely due to continued
inspiratory or expiratory dyspnea in chronic diseases of the
air passages. Since continued inspiratory dyspnea is rare as
long as the air can stream into the lungs, it plays only an
insignificant role in the production of chronic pulmonary em-
physema. A more potent and more frequent cause of the affec-
tion is difficult expiration, which is occasionally simultaneous
with inspiratory dyspnea.
Long-continued and convulsive cough is more dangerous
in this respect than impeded expiration, because a deep inspira-
tion precedes every effort at cough and this produces a liigh
air pressure in the lungs. On account of narrowing of the
bronchial lumen by plugs of mucus or swelling of the mucosa,
the escape of air out of the alveoli is impeded in catarrh of
the finer bronchi. These circumstances sufficiently ex])lain why
chronic bronchial catarrh so frequently leads to emphysema
of the lungs. Ball saw several cases of chronic emphysema
in cats following multiple bronchial adenomata.
The presenee of chionic bioiu-hial catarrh in emphysema of the lungs floes
not ])er se prove that the latter is always eansed by the former, because emphysema
may exist and only subsequently lead to bronchial catarrh.
Emphysema of the genuine or substantial type may arise also from
other causes aside from tliose already enumerated, and a permanent dila-
tation of pulmonary alveoli with atrophy of the pulmonary tissue may
Paflio-.'.H'sis. 93
develop as a vicarious clironiv' (Miipliysciua of the lungs in various chronie
diseases leading to the obstruction of portions of the lungs. This form
is of clinical importance only in so far as it increases still further the
respiratory difficulties caused by the primary disease.
Predisposition. The frequency of the disease increases
with age. It is exceedingly rare in horses younger than five
years, but common in older horses. The frequent occurrence
of the disease in older animals finds its explanation in the
fact that forced respiration continued over longer periods and
due to hard work will produce a detrimental effect; work
horses are moreover frequently exposed to affections of the
respiratory organs and to disturbances of nutrition in con-
sequence of insufficient feeding and of digestive anomalies.
The influence of insufficient nutrition is seen convincingly
in senile atrophy of the lungs, where dilatation of the alveoli
is due exclusively to atrophy and thinning out of the inter-
alveolar septa. The power of resistance of the pulmonary
tissue shows a good deal of individual variability because it
would otherwise be unexplainable why some animals contract
the disease after a comparatively short exposure to harmful
influences and at a comparatively young age, while others
remain well under the same conditions or only develop a mild
form of the affection late in life. A diminished resistance of
the pulmonary tissue may he acquired, congenital or hereditary.
Pathogenesis. A considerable dilatation of the alveoli
occurring again and again innumerable times, perhaps for
years, will decrease the elasticity of the pulmonary tissue of
itself to a certain degree. Much more important, however, is
the circumstance that under the conditions indicated the
alveolar pressure becomes increased during expiration or
coughing and the interalveolar and interinfundibular septa with
their capillaries, are compressed and distorted from both sides.
Frequently recurring narrowing of the pulmonary capillaries
impedes the free flow of the blood more or less and some
capillaries will become impervious, while blood corpuscles are
arrested in them. Since there is then no blood-current in some
capillaries or at least only a current of blood plasma, the nutri-
tion of the pulmonary parenchyma suffers, including that of
the compressed and distorted capillaries. For this reason and
in consequence of the ever increasing alveolar pressure the
capillaries become completely obliterated, the elastic fibers
yield to the increased pressure and the alveolar epithelia
undergo fatty degeneration. Thus the interalveolar and inter-
infundibular' septa gradually become thinner, the interstices
l^etween the yielding elastic fibers become lar-er, until finally
the interalveolar and later also the interinfundibular septa dis-
appear entirely so that neighboring alveoli become confluent
to form a common cavitv.
94 Clin.iiir Alvc.ilar Bloatiii-
If tliis process s'0^« oii iii the lungs it leads to a successive
decrease of elasticity, hence the lungs will increase their size
with difficulty during respiration and also decrease it with
difficulty in expiration, so that a gradual increase in the volume
of the lungs is produced. The obliteration of a portion of the
pulmonary capillaries which bring about the exchange of gases,
leads to a decrease of the respiratory surface, to an increase
in pressure in the pulmonary artery and consequently to a
hypertrophy of the walls of the right side of the heart. The
decrease of elasticity and the diminution of the respiratory
surface cause dyspnea which is particularly manifest in ex-
piration. Deficient ventilation of the air passages, and changes
in the lesser blood circulation predispose the animals to
bronchial catarrh.
Anatomical Changes. The lungs appear larger, softer and
less ehistic (more like an air-cushion) and in consequence of
the diminished blood-supply also paler than normal; their
surfaces frequently show the impressions of the ribs (this is
important from a forensic standpoint). The changes are most
marked toward the inferior and posterior borders. The
diaphragm appears raised posteriorly, the heart is covered by
the lungs to an increased extent. The margins of the lungs
are rounded off, individual air vesicles can be recognized with
the naked eye and between them sometimes larger air spaces,
up to the size of a hazelnut. If cut into, the lung tissue col-
lapses more slowly than under normal conditions and without
crepitation ; the cut surface is pale red and discharges only
a small amount of foamy blood; small droplets of pus, which
appear on pressure, point to the existence of bronchial catarrh.
The enlarged lungs are lighter in weight than those of healthy
animals.
Stommer has investigated the histologic changes and has ascertained that
the diameter of the alveoli is increased from a normal of 0.15 mm. to 1.5 mm.,
while the diameter of the interalveolar septa is decreased from 8 fi to 1-2 /x. The
vessels ai'e more straight, their Inmen is narrowed, partially obliterated. The number
of elastic fibers is decreased, the alveolar epithelia are in a state of fatty degenera-
tion. Rindfleisch found in the lungs of man that new vessels are formed partially
in place of those that have become obliterated; this change is brought about by
a new-formation from branches of the pulmonary artery which enter into anastomosis
with branches from the bronchial artery. The involuntary muscle fibers of the
bronchial wall are increased.
Hypertrophy of the right cardiac ventricle is found in
advanced cases, in the most severe cases also dilatation with
symptoms of general congestion.
Tn senile atrophy of the lungs (atrophia senilis pulm.) the ])icture is similar,
because the alveoli have become enlarged secondarily, ex vacuo, in consequence of
tissue atrojihy. Such lungs are, however, never enlarged. They ai'e, on the contrary,
smaller ami there is no hj^^iertrophy of the right side of the heart.
Symptoms. A¥ith the usual methods no changes can be
demonstrated in the lungs while the disease is in its stage
Anatomical Changes. 95
of development. On close inspection one may reco^-nize a minor
change in the respiratory movements; the expiration is some-
what prolonged and ocenrs with the auxiliary action of the
abdominal muscles. In less well nourished animals one sees
during inspiration a slight sinking in of the intercostal spaces
and of the wall of the thorax in the cardiac region. The fre-
quency of respiration is at first not changed. The animals
are, however, more easily tired during w^ork, and they breathe
then more rapidly; they show in short the symptoms of being
short of wind even at this early stage.
In a more advanced stage the dyspnea, however, becomes
distinct. The ribs are now elevated strongly and moved for-'
ward, and there is strong passive sinking in of the intercostal
spaces of the lower portions of the thoracic wall, also of the
anterior aperture of the chest and of the flanks. Expiration
occurs under very strong auxiliary action of the abdominal
muscles and the formation of a depression along the costal
arches. The expiration is often double and is accompanied by
an upward movement of the lumbar portion of the spinal column
and by a shaking of the whole rump. The inspiration often
also occurs in two stages (see Fig. 10). The respiration is
usually somewhat accelerated.
A lasting dilatation of the thorax progresses in like degree
with the gradual dilatation of the lungs. The more prominentlv
curved ril)s produce a barrel-shaped thorax, a picture which
betrays the character of the disease on first sight.
The percussion sound over the lungs is deeper and markedly
loud. The increase in intensity is particularly marked over
the inferior margins of the lungs, wdiere a higher but duller
sound is heard under normal conditions. The area of cardiac
dullness becomes smaller or may disappear entirely. In severe
cases one can also show by weak percussion that the posterior
boundary of the lungs has been displaced backward and down-
ward. (In healthy horses which are not overly fat one finds
the posterior boundary of the lungs in the iliac line where
it is crossed by the seventeenth rib, in the ischial line by the
fifteenth rib; in the shoulder line by the eleventh rib; and
it passes into the lower horizontal boundary in the seventh
intercostal space ; in emphysema of a high degree, however,
the lungs reach to the eighteenth ril) in the iliac line, to the
seventeenth rib in the ischial line, and to the twelfth or four-
teenth rib in the shoulder line. [See Fig. 9].)
On auscultation one hears weakened vesicular breathing,
often mixed with dry or moist rfdes as an indication of an
existing bronchial catarrh, which then also leads to an intensi-
fication of the vesicular breathing sounds over some portions
of the thorax.
Cough is due to a more marked bronchial catarrh and
usually occurs in a somewhat more advanced stage of the
disease. It is weak in more pronounced cases of emphysema
96
Chronic AIv
Bloatinj
on account of diniinislicd j)iiliiioiiary clasticit}', short, and as
a rule, dull.
The apex beat is fre(iuently somewhat accelerated, the
heart sounds are weakened, the second pulmonary sound is
commonly somewhat accentuated (felt in the median portion
of the left lower thorax in the third intercostal space). Transi-
tory sii>ns of cardiac weakness may come on, particularly after
hard work.
The respiratory difficulties increase markedly during work
aud this reduces the work-value of the animals correspondingly
with the advance of the disease, when the signs of shortness
of breath become verv marked.
Fig. 9. Displacenicnt of the jiosterior, lower l)ouii(lary of Tlie lung in chronic
emphysema. The anterior liner line indicates the normal boundary whicli at C
goes over into cardiac dullness; the heavier line indicates the boundary of the
enlarged lung. Tiie figuri's indicate the numbers of tlie ril)s.
The investigations of Eiclitcr and Schmidt have shown that shortness of breath
produced by chronic alveolar pulmonary emithysema, particularly during exercise,
brings about an elevatioTi of temperature which will return to normal only after
two hours. Half an hour after the exercise the temperature may still be 38.9° C.
Disturbances of nutrition and permanent circulatory dis-
turbances a])pear after the disease has lasted a long time.
Animals which were previously fairly well nourished or even
fat gradually become emaciated; edema appears on the lower
Coui'se. Diagnosis. 97
abdomen, on the lower chest and on the extremities, nntil tlie
animals are ntterly unable to work and have to be killed.
Course. Months, perhaps years, elapse until the disturb-
ances in respiration and circulation point, even at rest, to
material tissue changes. (Holterbach saw severe shortness of
breath appear forty days after a convulsive coug'li; it is not
clear, however, whether this case was one of chronic emphysema
of the lungs.) The course is much influenced by the work
required of the animals, since hard work leads to respiratory
and circulatory disturbances and to a more rapid progress of
the pulmonary changes, to the development of complications,
particularly of obstinate bronchial catarrh and these of course
materially contribute to a further deterioration of the condition
of the animals. This may particularly be observed in horses
which, because of their lessened ability for work are sold to
poorer proprietors, where they have to work still harder and
at the same time receive poorer food, for which reasons they
often succumb rapidly. Recovery or a permanent stationary
condition of the affection appears excluded on account of its
very nature, because the existing pulmonary bloating will pro-
duce respiratory difficulties and these will of necessity further
increase the morbid condition. Transitory, and even marked
and rapid improvement occurs, but this is almost without ex-
ception due to improvement in the complicating bronchial
catarrh. If this occurs, a decrease of the pulmonary dilatation
is at once demonstrable. A sudden deterioration may occur
in consequence of the development of an interstitial emphysema.
Diagnosis. In a more advanced stage the disease can
easily be diagnosticated, if the signs of enlargement of the
lungs, of an increased air content, and a decrease of elasticity
are present. Early in the course of the disease it cannot be
diagnosticated by the aid of physical methods, because the
changes in the pulmonary tissue are of a minor degree ; it may,
however, be suspected if dyspnea of a more or less pronounced
character is present and if reliable data reveal a preceding-
pulmonary aifection, while careful examination of the thoracic
organs for other changes is negative.
Temporary relief from dyspnea is often brought about by horse dealers by
the internal administration of leaves, roots or seeds of plants containing atropine
(Atropa belladonna, Datura stramonium, Hyoseyamus niger). Eaitsits ' experiments
made in the Budapest clinic have shown that these plants do not merely reduce
the frequency of respiration, but also abolish the double period and the forced
character of the respirations, so that it may appear perfectly normal, even in
advanced cases. The effect is produced within fifteen minutes and lasts a whole
day. After the effect has vanished the dyspnea becomes more intense than previously.
During the first hours after the administration of the above-mentioned plants the
buccal mucosa is very dry (to mask this it is usually rubbed with fat). One also
observes dilatation of the pupils which do not respond to light (sometimes also
visual disturbances), and a considerable increase of the pulse rate. Subcutaneous
injections of atropine (0.03-0.05 gm.) have the same effect; this, however, comes
on within a few minutes and lasts only for one to three hours (see Fig. 10),
Vol. 2-7.
98
Chronic Alveolar Bloating.
Vside from its rapid development acute bloating of the
luno- is distinguished by the fact that it either comes on as a
concomitant affection iii acute disease of the lungs, or during
hard work or after a long railroad transport, and that it dis-
appears again after amelioration of the primary disease or
during rest. It must, however, not be forgotten that the factors
mentioned mav also su(klenly increase the s>miptoms of chronic
Time
Fig. 10. Pneumograph of a horse with pramonnry emphysema, a before in. lect ion
of atropine, (marked dyspnea with double expiration) ; b l^ inmvites a ter he m ec-
tionof 0.05 gm. of atropine, (dyspnea has disappeared) ; c VA hours after tlie injec-
tion ; d 17 liours after the injection, (dyspnea ayani very markctt) .
emphysema or that their discontinuation may much improve
the clinical picture of emphysema. Interstitial emphysema is
characterized by a rapidly increasing dyspnea, without the
possibility of demonstrating a displacement of the boundaries
of the lungs, and frequently with the development ot sub-
cutaneous emphysema. Pneumothorax is characti^nzed^ by a
sudden onset, by a metallic percussion sound and by similar
breathing sounds.
Pro,i;nosis. Tceatineiit. Jnterstitial Eiupliyseuia of the Lungs. 99
Prognosis. It is impossible to prevent the progressive
development of the disease; the prognosis therefore is un-
favorable as to complete recovery. Since, however, the develop-
ment goes on very slowly, the animals may occasionally be
serviceable for years for walking and for pulling moderate
loads. The degree of the diminution of the ability to work
must be ascertained by actual tests.
Every complication which appears during the course of
the disease influences the prognosis unfavorably. This is
particularly true of bronchial catarrh which is seen so fre-
quently as a complication ; its complete cure will be much re-
tarded in consequence of the insufficient exchange of gases.
Cardiac weakness is of similar unfavorable prognostic signifi-
cance.
Treatment. Good nutrition and appropriate work may be
relied upon in the absence of any specific curative treatment
to prolong the period of usefulness of the animals. Complica-
tions which may arise, especially bronchial catarrli, must be
properly treated (see page 61).
The systematic administration of arsenic (0.1-0.5 gni. pro
die) is generally indicated in affections of this kind which are
characterized by an asthmatic condition. The beneficial effect
of arsenic depends on its improvement of the nutrition. The
authors have found intratracheal injections of strychnine use-
less. Equally doubtful is the value of vergotinin (in teaspoon
doses), a mixture of veratrin, strychnine, ergotin and glvcerin.
Uhland injected daily 5-10 gm. of a 1% solution of atropine and
obtained only a temporary improvement (see page 97). Cau-
tion is indicated in the use of eserine or chloride of ])arium
in horses with emphysema, since in consequence of contraction
of the muscle fibers of the bronchi these drugs may increase
the dyspnea and even lead to suffocation, as shown by the
experiments of Raitsits.
Literature. Bouley, Diet., 1S7S, V, 484.— Delafond, Eec, 18a7, 243.— Griiter,
Beitr. z. Kenut. d. Broiich. ehroii. des Pferdes, Diss. Ziirich, 1909. Holterbach,
B. t. W., 1905, 425.— Eichter, A. f. Tk., 1905, XXX, 576.— Schmidt, Naturf. Vers.
Dresden, 1907.— Stommer. D. Z. f. Tm., 1887, XIII, 93.
4. Interstitial Emphysema of the Lungs. Emphysema pul-
monum interstitiale.
Interstitial pulmonary emphysema consists in the accumu-
lation of atmospheric air in the intra- and interlobular con-
nective tissue of the lungs after solutions in the continuity
of the alveolar walls.
Etiology. Every considerable increase of the air pressure
in the lungs, particularly if occurring suddenly, may directly
100 liiU'i-stilial Einpliysoiua ui' the Luiij,^s.
lead to rupture of tlie alveolar walls. The advent of the con-
dition is therefore observed frequently after convulsive and
forced attacks of cough. The following diseases may be in-
direct causes of the ati'ection: acute catarrh and croupous in-
flammation of the liner bronchi; foreign bodies accidentally
entering the air passages; improper drenching; pointed
bodies which may directly injure the alveolar walls ; over-
exertion of the abdomiiuil press in pulling a heavy load,
in delivery, in vomiting or in efforts of animals which liave
met with an accident. Rupture of the alveoli may also be
brought a])0ut by continuous bellowing, by forced expiration,
in rapid running, in excitement, in railroad transportation, in
falling or kicking (Arendt saw a case of this kind in a horse),
after traumatic insults to the chest, etc. If the resisting power
of the pulmonary tissue has been lessened, these forces may
more easily lead to a solution of continuity, hence interstitial
emphysema is often seen following alveolar emphysema.
According to Michels, Detmers and others, interstitial eniphysenia
of the lungs occurs to an epizootic extent in some marshy parts of Hol-
land and Belgium among cattle (pneumatosis l)0vum). The cause of the
disease has not yet been ascertained definitely, but it appears to stand m
causal relation with frequent bronchial catarrhs due to exposure to cold.
(Joest thinks that these cases are interstitial emphysema due to lung
strongylosis of cattle, see page 72).
Anatomical Changes. Air bubbles varying in size from a
nut to a fist, exceptionally also as large as a child's head, are
found beneath the pleura and in the pulmonary parenchjana;
the smaller bubbles are often present in large numbers and
densely crowded. Otherwise the pulmonary tissue may be
healthy or it may show the changes of a prhnary basic disease.
The connective tissue of the mediastinum, of the chest aperture,
of the neck and the sul)peritoneal tissue, may occasionally like-
wise contain air bubbles.
Symptoms. The air which has entered into the interstitial
connective tissue soon compresses the neighboring alveoli;
hence the respiratory surface becomes correspondingly dimin-
ished. In some eases the disease therefore sets in suddenly
with dyspnea which progresses so rapidly that the animals
sometimes are cyanotic and threatened by suffocation after a
few hours. The percussion sound either remains normal or
is accompanied l)y t>nnpanitic accessory sounds. In the presence
of large subpleural air bubbles it may be purely tjiiipanitic.
The respiratory sounds, both in expiration and in inspiration,
are occasionally accompanied ])y crepitant and cracking noises.
In some cases, particularly in cattle, subcutaneous emphysema
is developed subsequently and moderate pressure on the tense,
but otherwise healthy, skin elicits crepitation; the percussion
sound is in these places tjmipanitic. The subcutaneous em-
Diagnosis. Treat men t. Croupous Pneumonia. IQl
physema may occasionally increase more and more, so that the
whole body becomes swollen and disfigured. Subperitoneal
emphysema can be felt with the hand introduced into the rectum.
The condition is sometimes rapidly aggravated, so that
the animals suffocate within 1 to 2 days, while in other cases
even an extensive air infiltration disappears and recovery finally
takes place after a considerable period of time.
Diagnosis. The disease may be suspected if dyspnea has
been preceded by the factors enumerated above ; it can, how-
ever, only be diagnosticated beyond doubt when subcutaneous
emphysema develops after the respiratory disturbances, and
when other causes, such as injury to the upper air passages
or to the esophagus, have been excluded. At its onset the
disease may be confounded with hyperemia or edema of the
lungs.
Acute edema of the glottis is differentiated by dyspnea
associated with an inspiratory, whistling stenosis sound.
Treatment. To prevent if possil)le the further escape of
air, complete rest must be enforced and cough, if present, must
be alleviated with narcotics. Subcutaneous emphysema does
not call for any special treatment, because the escaped air
is gradually absorbed spontaneously, provided that the tears
have been closed; slight massage may hasten the absorption.
Puncture must be avoided on account of the danger of infec-
tion. Hasenkamp, however, produced rapid recovery in a sheep
which had become emphysematous all over the body by making
a number of small incisions into the previously cleansed skin.
Literature. Bouley, Diet., 1878, Y, 4S2.— Delafond, Rec, 1832, 243.—
Denieester, Aim., 1859, 342.— Hasenkamp, D. t. W., 1909, 472.— Littinger, Ziindels
Beridit., 1880-1881, 67.
5. Croupous Pneumonia; Pneumonia crouposa.
(Pneumonia fihrinosa; Pneumonia lobaris.)
Croupous pneumonia is an acute febrile disease with a
typical course, associated with the occlusion of the alveoli of
larger continuous parts of the lungs, with an exudate consisting
of fibrin and blood corpuscles.
Etiology. Croupous pneumonia of domestic animals is
caused without exception by an infection, whether occurring
as a primary disease or whether it comes on as a complication
in the course of specific infectious diseases. The infectious
agents may be endowed with pathogenic properties from the
start and may, after invading the animal's body, at once produce
an inflammatory process. Croupous pneumonia of this type
occurs as a localization of certain specific infectious diseases
102 Croui)ous Pneumonia.
(swine plague, horse influenza, contagious pleuropneumonia of
cattle) and it appears more or less widespread according to the
pathogenic characters of the particular causative microorgan-
isms. Microorganisms which are morphologically and cultur-
ally identical with such disease producers are found not uncom-
monly as saprophytes in the air passages or in the environments
of domestic animals without interfering with their health. If,
however, the power of resistance of the organism as a whole or
of the pulmonary tissue alone has been diminished by definite
external influences or by other diseases, such microorganisms
are enabled to penetrate into the organs of the body, to multiply
in the lungs and to produce an inflammatory process in them.
Their virulency may so increase that they are able to invade
healthy animals without the auxiliary effect of external influ-
ences. It cannot be denied, on the other hand, that microorgan-
isms living as saprophytes outside or inside of the animal or-
ganism may become pathogenic under special circumstances,
and may be able to attack an animal the power of resistance of
which has not been previously lessened. Such bacteria which
have become pathogenic may lose their virulency in the dis-
eased animal, or they may, on the contrary, retain it and
spread the disease.
It has been customary for a long time to consider as a
disease sui generis, and to call genuine pneumonia, that form
of croupous inflannnation of the lungs which appears, after
certain external stimuli or without them, as a primary disease
which does not, hoAvever, manifest a distinctly contagious type.
This form has been separated from other types of pneumonia.
Such a separation of diseases, which differ essentially only in the
virulency of the infective agents concerned, does not, however,
appear justified either from a scientific or from a practical
standpoint, particularly since we are unable to determine at
the onset the further behavior of the causative microorganism
as to its virulency. Croupous pneumonia of man furnishes an
analogous example ; it appears sporadically at one time,
endemically at other times, though the causative microorganism
is the same under both conditions. We have no proof based
upon sufficient bacteriologic investigations that there exists a
separate clinical picture of croupous pneumonia occurring in
any other way except by localization of well known infectious
diseases.
Confusion as to the nature of croupous pneumonia has
also been caused since the pathologic anatomical picture has
been made the main basis of consideration, and therefore those
cases have been designated as genuine croupous pneumonia
in which a fibrinous exudate is found in the lungs, and where
the specific infectious character of the disease cannot be
recognized from the external clinical picture. It appears that
the predisposition of the animal organism, to form a fibrinous
exudate in the lungs after certain noxious stimuli, has not been
Etiology. 103
sufficiently considered; this predisposition, however, varies
consideiably according to species, age, nutrition; etc. Foreign
bodies which have penetrated into the lungs, likewise food aspi-
rated into the lungs of cattle, and also of other species of ani-
mals, ma}^ cause a croupous pneumonia ; this, however, depends
directly on the entrance of the foreign body and it does
not lead to a typical clinical picture of croupous pneumonia.
Some authors call all lobar processes croupous pneumonia, dis-
regarding entirely the fact that certain bronchopneumonias may
likewise assume the characteristics of a lobar process.
The occurrence of a genuine croupous pneumonia as a
disease sui generis can therefore not be considered as an
estal)lislied fact. Croupous pneumonia of domestic animals
develops in consequence of the localization of some known
infectious disease in the lungs or in the course of a variety of
internal diseases.
It has been a much contested question whether horses suffer
from any other genuine croupous pneumonia except influenza.
Several "authors (Roll, Friedberger & Frohner, Siedamgrotzky)
believe in the occurrence of a genuine croupous pneumonia
aside from influenza; the former, as a rule, occurs sporadically
in horses and in other species of animals and is usually not
contagious in nature. Other authors (Lustig, Sclmtz, Diecker-
lioff, Cadeac) include all croupous pneumonia in horses under
horse influenza. According to the view of the authors, so-called
genuine croupous pneumonia in horses not infrequently shows
such peculiarities in its appearance and course that the con-
clusion appears justified that these are simply cases of influenza
(see Vol. I). One can observe in all extensive epidemics of
influenza, that while a variable percentage of the horses of a
stable shows typical symptoms of influenza, others, even many
under the same conditions, suffer from a typical croupous
pneumonia. It has also lieen observed a number of times that
a horse, apparently suffering from a croupous pneumonia, may
have infected its neighbor, or even all of the horses of the
stable, with a disease which later on led to the typical picture
of influenza. It is indeed impossible to draw an exact line
between alleged genuine croupous pneumonia and influenza.
The occurrence of sporadic cases of influenza is likewise not
rare.
Croupous pneumonia in horses is seen sometimes as the
sequel of external influences (cold, inunctions in skin diseases,
irritating vapors, smoke, exertions, tying the head high, throw-
ing for operations, contusion of the thorax). These were the
very cases which were cited as proof of the existence of a genu-
ine croupous pneumonia. It must, however, be claimed for the
majority of such cases that the nature of the disease is influenzal,
and that external factors, such as cold, which formerly used
to be considered as the exclusive cause of the disease are only
of importance as predisposing factors. These external in-
104 Croupous Pneumonia.
fluences act l)y lowering the resistance, to the influenza micro-
organism, of the organism as a whole, or of the lungs in partic-
ular. It cannot, however, be denied that these external influ-
ences play a decided role which may he of sucli importance
that the disease would never have occurred without them. These
external causes may, in infected stables, lead to a so-called
croupous pneumonia, while they will simply produce a catarrhal
or interstitial pneumonia in non-infected stables, either after
such external influences or without them ; then there still exists
the possibility that the influenza virus may have lived in the
affected horse as a saprophyte and did not produce any noxious
effect in the absence of a harmful predisposing factor.
Experimenters have not been a])le to produce croupous pneumonia
in domestic animals. Diirck, who succeeded a few times in producing
croupous pneumonia in small laboratory animals by consideral)le ex-
posure to cold, found in all cases bacteria as the direct producers of the
inflammatory process.
Secondary pneumonia is probably likewise due to the
influenza bacillus and is sometimes seen after catarrhal influenza,
epizootic laryngotracheal catarrh, strangles, hemorrhagic sep-
ticemia and purpura hemorrhagica. It does, however, usually
not show the course of a typical pneumonia.
The occurrence of croupous pneumonia independently of
pleuropneumonia in cattle is established beyond doubt; it
develops usually after the invasion of bacillus bovisepticus
(see Vol. I). It is also commonly observed as a foreign body
pneumonia after the entrance of foreign bodies from the air
passages or from the forestomachs, although it does not show
a typical course in these cases and usually takes the course of
a catarrhal pneumonia.
The ol)servation of Jensen, Bucli and Krliger have shown beyond a
doul)t that hemorrhagic septicemia of cattle also occurs sporadically.
Schiitz found "ovoid" bacteria in the affected lungs in croupous pneu-
monia of cattle. Kriiger demonstrated the presence of bipolar bacteria
by inoculation experiments. Coulon and Olivier saw croupous pneu-
monia in cattle in wet valleys ; Cagny in steers which were kept in the
open during cold weather. These affections, however, could not be
transmitted by application of the expressed lung juice to the skin de-
nuded of its epithelium, or by subcutaneous application with a vaccina-
tion lancet. Nevertheless, the negative result does not exclude the possi-
bility of pneumonia being caused by the bipolar bacterium, because
subcutaneous inoculation is not always successful even when lymph of
animals is used which undoubtedly suffer from the pectoral form of
hemorrhagic septicemia.
Hogs suffer from the pneumonic form of swine-jDlague which
often assumes a croupous character (see Vol. I). The eases
of pneumonia observed by Bayer in Hungary probably belong
to this type. Hemorrhagic septicemia whicli sojnetimes spreads
from cattle to hogs may likewise form the basis of a croupous
Etiolc
105
pneumonia if it does not end in death rapidly. Since bipolar
bacilli with the morphologic characteristics of bacillus suisepti-
cus occur in the buccal cavity, pharynx and nose of the hog, tliey
may get into the bronchi with the feed, in greedy feeding or
w4th accidentally inhaled foreign bodies, and may there cause
a foreign body croupous pneumonia. The observations of
Passerini and Wyssmann prove that anthrax in hogs may lead
to a croupous pneumonia; the latter may form the exclusive
localization of the anthrax infection.
The epizootic pneumonia which is rarely croupous in sheep
is caused by bacillus ovisepticus (see Vol. I) ; the infectious
pneumonia of anatolic goats (see Vol. I) is likewise due to
bipolar bacteria ; the cause of infectious pleuropneumonia of
goats is unknown (see Vol. I).
According to older statements (Roll, Trasbot, Boissiere,
Renault) dogs were said to be frequently subjects of croupous
pneumonia. These older statements, however, do not deserve
much credence because the cases referred to were evidently
distemper bronchopneumonias, which not infrequently involve
whole pulmonary lolies. One may claim this with confidence,
since the recent reports concerning croupous pneumonia of
carnivora are very meager and the few cases published refer
only to clinical observations. Distemper bronchopneumonia
leads to only a partial formation of fibrinous exudate.
According to Friedl^erger & Frohner cats suffer not in-
frequently from croupous pneumonia. Whether this disease
is identical with the cat epizootic observed recently by Gartner
in Greifswald, cannot be decided definitely. The latter disease
is, according to Gartner, caused by the bacillus pneumoniae
felis, a microorganism belonging to the group of bipolar
bacteria; the affection consists of an extensive necrotizing
pneumonia, principally of the posterior lobes; it is sometimes
accompanied by a hemorrhagic, fibrinous pleurisy. This bacillus
is probably identical with one described by Marx (bac. pneu-
moniae tigris) and found in a tiger dead from hemorrhagic
pneumonia (Gartner). Typical croupous pneumonia in the
anatomical sense is also found in carnivora ill with glanders
(Kitt).
Rabbits suffer from croupous pneumonia after an attack of
contagious rhinitis (see page 15), or this affection represents
the localization of such an invasion. Siidmersen described a
bacillus of the colon group as the cause of an enzootic pleuro-
pneumonia of rabbits; Selter, one of the bacillus bipolaris
septicus group (compare catarrhal pneumonia).
Croupous pneumonia in fowls is seen in slow cases of fowl cholera.
Jowett saw an epizootic pnenniopericarditis in turkeys, which was caused
by the bacillus bipolaris septicus.
For details as to these affections due to bipolar bacilli
the reader is referred to the first volume, dealing with infectious
diseases,
106 Croupous Pneumonia.
Susceptibility. On account of the great prevalence of
influenza, horses are most connnonly affected with croupous
pneumonia, as far as domestic animals are concerned. It is
not merely relatively but absolutely frequent among horses and
follows in frequency the colicky diseases. Younger, well
nourished horses are most commonly alfected; poorly nourished
and overworked horses are less susceptible ; young foals still
less. Other domestic animals are affected more rarely or not at
all by this form of pneumonia.
Anatomical Changes. Croupous pneumonia begins with an
active hyperemia in a large continuous usuallj^ lower or anterior
portion of one or both lungs (stadium hyperaemiae). The
parts which are situated near the root of the lungs (pulmonia
centralis) or the posterior, or still more rarely the upper por-
tions are not often affected alone. Simultaneously with
hyperemia there appear, not uncommonly, smaller or larger
hemorrhagic foci. Extravasation of blood serum with white
and red blood corpuscles occurs from the vessels into the alveoli
and into the finest bronchioles, where the exudate coagulates
at once, so that the affected pulmonary tissue becomes similar
in consistency to hepatic tissue (stadium hepatisationis). The
affected lung portion appears enlarged at this stage ; its tissue
is peculiarly tough and friable and it sinks in water. The cut
surface, particularly on oblique illumination, appears uniformly
finely granular and not juicy. Its color is at first red or brown-
red (st. hepatisationis rubrae) ; afterward, however, fibrin and
white corpuscles predominate in the exudate over the red blood
corpuscles, the cut surface assumes a reddish-gray (st. hepatisa-
tionis griseo-rubrae), and later on a light gray color (st.
hepatisationis griseae). Still later a yellowish color becomes
more prominent in consequence of fatty degeneration (st.
hepatisationis flavae).
While the inflammation sets in simultaneously in larger t-ections of the
lungs, there are some deviations in the ai)pearance of the cut surface; hence
it frequently appears mottled (like granite), and red, gray and yellowish spots
and streaks are found side by side. This so-called marbled appearance is also seen
in croupous inflammation of cattle. However, the interstitial bands, if widened
at all, are often only gelatinous, dilated lymph clefts not being visible, and the
ground substance of the hepatized ])ortions is much alike in color (see Vol. I).
After the exudate has become liquefied a reddish thick
fluid mixed with fine air bubbles and fat droplets may be scraped
off the cut surface, the consistency of the tissue has become
softer. This stage of resolution leads to recovery after absorp-
tion and expectoration.
Tn the alveoli of the hepatized pulmonary tissue a reticulum may be seen
under the microscope formed of fine threads of fibrin ; its meshes are filled with
white and red blood corjtuscles, desquamated epithelia and granular detritus. Later
on the alveoli contain only detritus and fat granules. The interstitial connective
tissue shows an inflammatory infiltration with round cells and the fibers of the septa
li;i\(' IiecM |iiisli('(l ajiart by an odeniatnus infiltration.
Syuiptuius. 107
The connective tissue septa of the lungs are occasionally
infiltrated, changed into gelatinous strips, several millimeters
wide and dividing the cut surface into islands. Such strips
are uniformly yellow and moist shining and are seen particularly
in the lungs of cattle and hogs. The bronchi usually contain
an abundance of a mucopurulent secretion; their mucosa is in
a condition of catarrhal infiannnation and croupous membranes
are occasionally found in the smallest bronchioles.
Abscesses or necrotic foci are found in the hepatized por-
tions or in those undergoing resolution in a portion of the fatal
cases. The visceral pleura over the affected pulmonary portions
is almost always lusterless, cloudy or rough, and occasionally
infiltrated with small hemorrhages. Not unconnnonly a fibri-
nous or serofibrinous pleurisy is found. The bronchial glands
usually show acute swelling.
The post-mortem examination also shows secondary
changes, such as cloudy swelling and sometimes fatty degenera-
tion of the parenchymatous organs, especially of the myo-
cardium.
Symptoms. Except in very rare cases the disease begins
with the symptoms of a febrile condition with sudden onset.
The appetite, and in ruminants also rumination are diminished ;
the former, however, is only rarely suppressed entirely. The
patients stand listlessly and with drooping heads in front of
the crib, smaller animals like to hide themselves and lie con-
tinually on the floor. Frequently one even o))serves at this
stage cough and an accelerated respiration. The .temperature
rises to 40-41° C. and above within half a day and in some
patients chills and muscular tremors occur. In older and
debilitated animals the temperature does not show a considera-
ble rise, but the other general symptoms reach an intense degree.
If, for some reason or other", the animal already had fever,
the onset of pneumonia is indicated by a sudden aggravation
of the general condition and possibly by an additional rise in
temperature.
After the fever has lasted from one-half to tw^o,_ excep-
tionally also from 3 to 4 days, changes in the percussion and
respiratory sounds become manifest, which can now be watched
in modifications characteristic for the disease.
Percussion gives at first a somewhat dull sound, which
assumes a tympanitic timbre usually on the second or third
day, rarely earlier, and soon becomes purely tympanitic or
it may also become gradually less intense. The change in
sound usually shows "itself at first in the region behind the
elbow and spreads from there backward and upward to an
extent which varies from case to case. As the alveoli become
more and more consolidated, the tympanitic sound gradually
changes into a dull tjnnpanitic and later on into a very weak,
dull sound. The area of dullness varies as to size and boundary
108
Croupuus Pueumuiiia.
line. It usually extends backward from the elbow and readies
to the middle or even to the upper third of the thorax. Usually,
although not always, the upper boundary line describes a curved
line, with tlie convexity above, or descending l)ackwards (see
Fig. 11). It remains unchanged for three to five days, when
the sound again assumes a tympanitic timbre, later on it be-
comes purely t^mipanitic and then gradually changes again into
a normal, loud, non-t^^npanitic percussion sound. The low, dull
sound only rarely changes to the normal without having first
assumed a tjanpanitic timbre.
Deviations from the changes here described are observed.
In affection of the deeper portions of the lungs the percussion
Fig. 11. Arched boundary of area of dullness in croupous pneumonia.
sound may either remain normal or not change until later on
after the inflammation has reached the external strata.
If the consolidation of the upper boundary of the affected
area is confined to the deeper strata, one hears above the
upper boundary of dullness a tjanpanitic sound which may
exist for several days. If the deeper layers are consolidated
in such a manner that they nowhere touch tlie wall of the
thorax, but are separated from the wall by considerable por-
tions of healthy lung tissue, one hears only a tjanpanitic sound
during the whole course of the disease, and this changes into
a normal percussion sound during the stage of resolution.
Deviations as to the seat of the area of dullness also are not
Syinptoiiis.
109
so very uncommon. The original change in sound over the
lower portion of the thorax may gradually extend up to the
vertebral column, or the change in intensity or timbre of the
sound may occur exclusively on the posterior or upper pul-
monary boundary and then may change in a manner already
indicated (see Fig. 12).
During the initial stage of the disease auscultation reveals
intensified and rough vesicular breathing on account of the
swelling of the bronchial mucosa and of the accelerated respira-
tion ; even then high and crepitant rales may, however, be
heard, especially during inspiration, indicating the presence
of a serous, thick exudate in the alveoli and bronchioles. When
Fig. 12. Croupous pneumonia with an aty])i('ai location, a, area of dullness over
the most posterior and upper portions of the lungs; i, area of a high, and c,
area of a low tympanitic sound.
a tympanitic or weak percussion sound is audible, bronchial
respiratory sounds are usually heard, and frequently also
metallic rales. If the area of dullness becomes larger and the
lumen of the smaller bronchi also becomes filled with an exudate
there is usually an absence of all breathing sounds. Even in
these cases, however, one usually hears bronchial breathing at
the boundary of the area of dullness and further upward, be-
cause the hepatization of the lung reaches higher up in the
deeper than in the more superficial portions of the lungs and
bronchial breathing is conducted through the overlying, air-
containing layers and is heard on auscultation, while percussion
makes the air column in the outer strata vibrate; hence there
is no dullness.
no
rroupoiis T*iieuiii()iiia.
A strong, double blowing in tlic nciyiibuihood oi' the heart, heard synchronously
with the heart contractions, is claimed by Cadeac to be a valuable ]irodronial
symptom of pneumonia. The authors have, however, not been aV)le to confirm this
observation.
The statement of Trautmaun that bronchial breathing during he]>atization,
and rales during resolution, are rare, is contradicted by general experience and can
only be explained on the basis of the fact that there are some ei)izootics in which
tlio smaller bronchi are not involveil and l)ronchial breathing is not noted.
The manner in which pneumonic processes develop makes it obvious that
methodical examinations are necessary to ascertain the various modifications of the
respiratory sounds.
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areas of dnHness with the gradnal liquefaction of the exudate
which is always intensified in the neighborhood of the con-
solidated areas.
A rnsty or saffron-colored nasal discharge is seen only
in a minority of cases ; it then comes on almost always before
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stage of resolution.
the beginning of hepatization and persists either only one or
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since it is frequently the only symptom in central pneumonia
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and the nature of the disease.
The respiration shows a normal costo-abdominal type; it
is, however, more or less forced and accelerated, according
to the extent of the consolidation; the acceleration is least
Symptoms.
Ill
marked in horses. Cough is present from the start; it occurs,
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pears painful, hence less violent, even very feeble, but it be-
comes markedly easy and moist with the advent of resolution.
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the disease in those cases which run their course without com-
plications.
The temperature rises on the first day to 39.5° -41° C.
and remains high with slight variations during the next days
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Fig. 14. Fever curve in croupous pneumonia of a horse. Lysis. Gradual increase of
the frequency of the pulse and respiration with the approach of the stage of resolution.
the stage of hepatization, i. e., toward the end of the first week,
the_ temperature either falls rapidly within i/o to li/o days
(crisis — Fig. 13) or gradually, with remissions in the niorning
and exacerbations in the evening, so that the animal is free
from fever only after 2 to 5 days (lysis— Fig. 14). The fall
in temperature is usually preceded by a change of the dull
and low percussion sound into a tympanitic or loud sound.
_ The temperature , which has fallen to normal or which is falling
rapidly, may, in exceptional cases, rise again on the following day;
it remains, however, high only for two days and then again goes down
(perturbatio eritica). Exceptionally the temperature may fall below
"normal, occasionally down to 36° C. ; this occurrence, however, is like-
112 Cruupous Pneumonia.
wise of short duration. The authors have seen intermittent fever in
horses, as a rule, in combination with other severe symptoms.
The heart's action does not go parallel with the fever;
there is, on the contrary, a certain antagonism between the
fever curve and that of the pnlse beat. The latter is only
moderately accelerated in the beginning, in spite of the high
fever (in horses np to 50 per minute) and the pnlse is tense
and full. The contractions of the heart become, how^ever, more
frequent in the latter course of the disease, and at the same
time less strong; the pulse becomes empty and small (Figs. 13
and 14). This cardiac disturbance becomes the more marked
the larger the affected lung territory and the more intense
the infection. In the less severe cases the heart's action be-
comes again normal as soon as the stage of resolution is com-
pleted; on the other hand, there may be arhythmia or
allorhythmia of the heart; it is, how^ever, usually of no signifi-
cance even if it still exists during the stage of convalescence.
The general condition and with it the appetite of the ani-
mals varies a good deal from case to case. In milder cases
the animals may ingest a normal amount of feed, though more
slowdy, during the whole course of the disease ; others may re-
fuse feed entirely during the course of the fever, and may
show a considerable degree of listlessness and prostration.
Most cases sIioav at the onset a more or less marked diminution
of appetite, a sjanptom which will first attract the attention
of the attendants. Sick horses usually remain standing during
the whole course of the disease ; ponies and the smaller domestic
animals lie do^vn a good deal; in the case of unilateral affection
they lie on the diseased side in order to permit the free expan-
sion to the healthy lung.
The amount of urine decreases rapidly during the stage
of hepatization and increases rapidly during resolution. The
specific gravity is high during hepatization and sinks rapidly
during resolution. The quantity of chlorine is diminished
during hepatization ; the amount of phosphoric acid, of sulphuric
acid and of nitrogen is increased. The conditions are reversed
with the advent of resolution (urinary crisis; Siedamgrotzky
& Hoffmeister and also Wissinger have demonstrated these con-
ditions in horses).
Storch demonstrated a considerable increase of nitrogen excretion in pneumonia
of horses; this is explainable by an increased decomposition of nitrogen and nuelein
compounds of the animal body during the course of the disease.
Urticarial eruptions sometimes appear, but do not last
longer than two days. An exanthematous eruption similar to
that caused by distillery mash and extending over all four
extremities, w^as observed by Frohner in a horse. Moderate
perspiration sometimes comes on with the advent of resolution
and with a rapid fall of temperature; strong perspiration is
seen only in severe cases shortly before death.
Symptoms.
113
The blood of horses with pneumonia shows a moderate
hypoleucocytosis at the onset or during the fever; it changes
into a hyperleucocytosis during resohition. The increase in
the number of white blood corpuscles is mainly due to an
increase in neutrophile also in acidophile cells (Sturhan,
Wiendieck, Meier, Franke, Gasse). The number of red blood
corpuscles and the amount of hemoglobin are diminished in
most cases of pneumonia during the course of the disease;
the values are, however, materially influenced by the ingestion
of water and feed. If water is refused for several days and
a loss of water of the organism occurs in consequence, the
number of red blood corpuscles and the amount of liemoglol)in
may be relatively increased, though absolutely decreased
(Wiendieck, Wetzi).
Deviations from the picture of typical and mild cases of
pneumonia are not rare even in the absence of complications,
but in such cases it is not possible to
ascertain the cause of the atypical
course. In stables with many
horses one frequently notices that,
simultaneously with a number of
typical cases of pneumonia, a few
cases occur with a markedly short
duration. There is a sudden f el^rile
attack with more or less severe
general symptoms, but simulta-
neously with an improvement of
the general condition the tempera-
ture goes back to normal on the
second or third day (see Fig. 15).
The thorax presents the signs of
infiltration of the lungs (tym-
panitic, then dull sound, rales,
sometimes indefinite breathing
sounds), but they disappear after
one to two days (pneumonia
ephemera sive abortiva).
There are, on the other hand, cases in which the inflamma-
tory process is confined to the deeper portions of the lungs
which are not accessible to our methods of external examination
(pneumonia centralis). These cases present for several days
a high, continuous fever, although there are no demonstrable
signs on the part of the lungs, and the patient may recover
from an attack which has possibly lasted over a week, physical
examination of the lungs having never furnished any positive
data. However, one may reasonably suspect the presence of
a croupous pneumonia from difficulties in respiration, from
a saffron-colored nasal discharge which may be present, and
from a typical fever curve.
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Fig. 15. Fever curve in croupous
pneumonia of short duration in the
horse.
114 Croujious Pneumonia.
Fairly frequent are those cases in which the inflammatory
infiltration spreads from the j^nhnonary portions that are first
affected to parts situated posteriorly and upward, or to the
other lung- (pn, progrediens). Under these circumstances the
disease extends over a longer period, occasionally over several
weeks, and the involvement of new portions of lung is indicated
by elevations of temperature.
Recurrences occur exceptionally in cases in which the
process has subsided, the fever disappeared and resolution
taken place. In such cases the animal is, after a few days, again
attacked by fever and the signs of pulmonary consolidation
reappear at the place where they were found originally, or
at another portion of the lungs (pn. recidivans).
The s^inptoms of croupous joneumonia vary also according
to different species of animals. Horses present the picture
described above. Elevation of temperature does not occur as
rapidly in cattle as it does in horses ; the acceleration of respira-
tion is, however, more marked in the former than in tlie latter.
Cattle frequently present a weak, painful cough which can
easily be brought on artificially. Saffron-yellow or rust-colored
nasal discharge is absent, but one may observe a whitish mucoid
nasal secretion. Bronchial breathing is heard more rarely than
in horses ; vesicular breathing over the affected portions is
more commonly weak or completely absent. The duration of
the disease is longer; it lasts from one to three weeks, imtil
resolution occurs in cases of favorable termination.
According to Gaertner's observation, during an epizootic
among cats, these animals frequently sneeze and have an
abundant nasal discharge, which is at first seromucoid and be-
comes purulent within two to three days. Masses of pus fill the
nares, they move backward and forward during respiration, dry
into crusts, often close up the nose and compel the animals to
breathe through the mouth. The respiration is forced, often
pumping, accelerated and accompanied by loud sniffing and
snoring. Intense conjunctivitis is always present ; it is at first
serous then purulent. A weak, hollow and painful cough is
heard in all cases. The temperature ranges between 39.5 and
41.6° C. The animals are at first depressed and morose, later
on apathetic.
The affected animals usually die within three to six daj^s,
although exceptionally the disease may be prolonged to three
weeks and more, and may then pass into recovery.
Complications are comparatively frequent in the course of
croupous pneumonia. The degeneration of the myocardium
plays an important role in the prognosis of the disease. A
certain degree of cardiac disturbance forms a part of the typical
clinical picture of pneumonia; these disturbances, however,
assume a threatening character only in case of very grave
infection or in very extensive spreading of tlie inflammatory
Syniptc
115
process. Cardiac weakness manifests itself in a pounding apex
Ijeat and in a weak to filiform pulse which may be increased
to double the normal number or more per minute. There is
then also collapse, cyanosis, the veins are over-distended and
a venous pulse is noted. These circulatory disturbances are
caused partially by the weakening effect of bacterial toxins on
the vessel walls.
Another very dangerous complication is suppuration or
gangrene of the pulmonary tissue, particularly in horses. The
advent of this complication is sometimes announced by a chill
and by elevation of the temperature which may even have been
falling; then there
is continuous or re-
mittent fever to the
end. Disintegra-
tion of pulmonary
tissue is announced
unmistakably by
the onset of signs
of cavity - forma-
tion (tympanitic
sound persisting
long in a circum-
scribed place,
possibly asso-
ciated with metal-
lic sounds and am-
phoric breathing ) ,
and by the appear-
ance of a disagree-
able sweetish smell
of the exhaled air.
The symptoms of
septicemia likewise
become manifest.
Under these condi-
tions improvement
occurs only very
exceptionally. (Abscesses of the lung may break into a bron-
chus and may then heal completely. — Johne.)
Pleurisy is seen comparatively frequently; its occurrence
as a complication is, however, quite variable. Tenderness of
portions of the thoracic wall situated over the affected pul-
monary areas, in connection with considerable acceleration of
the pulse (Fig. 16), sometimes alone suggest the occurrence
of a complicating pleurisy. Friction sounds are heard fre-
quently or an al)undant fluid exudate is formed in the thoracic
cavity. The signs of pneumothorax (metallic sound, splashing,
sudden respiratory difficulties) may occur in gangrene of the
Fig. 16. Fever curve in croupous pneumonia wUhco-
existituj fibrinous pleurisy in a horse. Increased pulse
frequency from tlie beginning of the disease.
116 Croupous Pneumonia.
lungs. Fibrinous or serolibrinous pericarditis is observed more
rarely and still more rarely acute verrucous endocarditis.
Icterus is seen frequently in horses and is usually due
to a sinmltaneous gastro-intestinal catarrh or to a hemo-
globinemia from an influenzal or septic infection. Parencliym-
atous degeneration of the kidneys or acute parenclijanatous
nephritis are very common. They are announced l)y slight
albuminuria which usually disappears with the fever. Acute
diffuse nephritis is rare, it leads to profound albuminuria and
to the appearance of renal tube-casts ; renal epithelia and occa-
sionally also degenerated red blood corpuscles are seen. Al-
buminuria is of grave significance, since it points to grave infec-
tion which is liable to lead to degenerative changes also in other
organs, preferably in the heart.
Rare complications are: acute tendovaginitis and arthritis
of the extremities, laminitis in the horse, iritis, acute meningitis
and encephalitis. In horses pneumonia is sometimes followed
by purpura hemorrhagica.
Course. Croupous pneumonia is one of those diseases
which run a very typical course. The stages of inflammatory
congestion, hepatization and resolution follow each other reg-
ularly. In horses pneumonia usually reaches its climax toward
the end of the first week, i. e., on the fifth to seventh day; then
all morbid symptoms usually disappear rapidly within one day,
sometimes a little more slowly, so that the duration is at the
utmost two weeks in all. The period of convalescence cor-
responds to the intensity of the attack and usually leads to
complete recovery. In other animals the course of pneumonia
varies more or less (see page 114).
Deviations from the normal course occur especialh' in
cattle and swine, although they are not rare in horses. The
sequence of the various stages remains the same, but the whole
course may be of shorter or on the contrary of longer duration.
Pneumonias caused by bacillus bipolaris or by external in-
fluences rarely take a typical course and those caused by the
bacillus named (in cattle, hogs and sheep) may lead, within
a few days, to a fatal termination. Complications which may
develop also produce more or less marked deviations from the
typical course and sometimes stand so much in the foreground
that the clinical picture of pneumonia becomes completely
clouded.
A fatal issue in consequence of suffocation may occur in
very severe cases with extensive consolidation. Another cause
of death may be grave degeneration of the myocardium. Cases
with very severe infection lead to early and rapidly increasing
prostration ; usually toward the end of the stage of hepatization,
the respiration becomes much accelerated and very forced, the
heart is rapid and thumping, the pulse small, filiform, finally
imperceptible; the mucosae become livid; there is finally a
Course. Diagnosis. 1X7
general perspiration and the animals fall to the floor. In the
meantime symptoms of j^nlmonary edema have developed.
Suppnration and gangrene lead to death in other cases, after
pyemic and septicemic symptoms have made their appearance.
An edema of the glottis may sometimes produce death by
suffocation.
A considerable number of cases of pneumonia is followed
by a serous pleurisy; this must be suspected if dullness persists
obstinately or even increases in the lower portions of the thorax
and if more or less remittent fever is present. Severe pleurisy
may cause adhesions of the pleura and this may lead to an
asthmatic condition.
Chronic induration of the lungs not infrequently persists.
This is indicated by a long drawn out stage of resolution, some
difficulties of respiration persist ; there may be moderate fever
and the dullness does not clear ujd completely. A similar
chronic process is sometimes developed in the neighborhood
of a gangrenous focus, which may, even after weeks, produce an
acute inflammation and cause death. A chronic pulmonary
induration following upon acute pneumonic s\Tnptoms appears
in horses and cattle tolerably frequently only in certain years,
while in other years pneumonia rarely leads to this complication.
The physical changes pointing to induration of the lungs dis-
appear anyhow in a considerable number of cases 3 to 4 weeks
after the fever has disappeared and the animals may be con-
sidered completely cured from a clinical standpoint.
In 0.4-2.8% of the cases occurring in the Prussian army
the animals which had recovered presented after a few weeks
the symptoms of paralysis of the larynx (q. v.). (Twenty-four
[77%] of thirty-one thoroughbred horses of a stud, which had
sulfered from pneumonia, subsequently developed paralysis of
the recurrent nerve [Plosz]).
Diagnosis. The typical form of croupous pneumonia can
easily be diagnosticated in all species of animals. The sudden
onset, a fever which is continuous for several days and falls
either rapidly or gradually, the regailar sequence of changes of
the signs elicited by auscultation and percussion, recovery
generally occurring in the second week of the severe affection,
form a clinical picture which cannot easily be confounded with
that of any other disease. None of the enumerated sjanptoms
is of course characteristic by itself alone. Most characteristic
is a rust or saffron-colored nasal discharge; however, this
valuable symptom is often absent, even in horses. In the very
first stage of the disease the cause of the fever is, of course,
not ol)vious unless a similar affection has been observed pre-
viously in other animals. Systematic temperature observa-
tions among the animals in one barn will permit the early
recognition of new cases, because changes in the percussion
sounds will reveal the nature of the disease on the day following
the observation of fever.
118 C'rouiKius I'liciiiiiotiia.
Errors of dia.iiiiosis may occur in pneimionia duriuiJ!: the
stage of hepatization, if a diagnosis has to be made on the
basis of a single examination or if the disease is complicated
by concomitant affections. One must think in this respect of
pleiiritis with effusion. Contrary to what is found in pneumonia,
dullness is, in pleurisy, always in the lowest portions of the
thorax, in horses it is usually on l)otli sides, the upper boundary
is almost without exception a horizontal line; the resistance
in the area of dullness is increased, In'eathing sounds cannot
be heard at all or onlj^ along the upper boundary; the disease
comes on slowly, fever is usually less high, the course of fever
irregular, breathing first of the abdominal type and later on
very forced ; dullness decreases or disappears after animal has
been laid down and vesicular breathing takes its place; in
smaller animals the dullness changes with changes in position in
such a manner that it always appears in the lowest place. When
pleurisy and pneumonia are present simultaneously some diffi-
culty as to differential diagnosis prevails because the con-
solidated lung as well as the pleural exudate l)oth cause dull-
ness, while breathing sounds are often absent over the con-
solidated portions of the lungs. Edematous infiltrations formed
on the lower thorax or lower abdomen may give some clue to
the existence of jileurisy along with pneumonia. In doubtful
cases an exploratory puncture should l)e made with a hypo-
dermic syringe. The procedure is perfectly harmless even in
the presence of an exclusive pneumonia. Only a positive result
of the exploratory puncture can be utilized for diagnosis, be-
cause puncture may be negative even in the presence of
pleuritic effusion.
Catarrhal pneumonia may furnish similar physical findings
as croupous pneumonia if a number of small catarrhal foci
have become confluent and have formed one larger consolidated
area. However, bronchial pneumonia usually follows an ex-
tensive bronchial catarrh; it progresses slowly and lacks a
typical course. One should never forget that adult horses
usually suffer from croupous pneumonia, young foals and dogs
exclusively, or at least preferably, from catarrhal pneumonia.
The differential diagnosis from contagious pleuropneumonia in
cattle is very important. During the stage of hepatization the
findings may be identical in the two diseases ; hence a reliable
diagnosis can theu only be made under consideration of the
course. Contagious pleuropneumonia comes on gradually in
contradistinction to the sudden onset and cyclical course of
pneumonia, and cases with a comparatively rapid course last
several weeks. The possibility that the contagious disease may
be imported nuist always be considered. Inflammatory edema
at the entrance of the larynx or in other parts of the body in
the sanu» or in othei- animals, tlie sinuiltaneous occurrence of
enteritis and the rapid fatal termination, point to a septic origin
of pneumonia.
Prognosis. 119
Foreign body pneumonia may be confounded with croupous
pneumonia. It is, however, usually distinguished by a slower
development. Fever is often absent at the onset or is very
insignificant, bronchial breathing is likewise missed. After the
entrance of foreign bodies from the stomach into the lungs,
changes of the percussion sounds and respiratory sounds are
noticed at first in the region of the diaphragm, and disturbances
of digestion generally precede the affection of the lung.
In animals which are examined only after the fall in tem-
perature, chronic inflammatory process, tumors, etc., must
be excluded on the basis of a polyuria present, or of anamnestic
data, and with the aid of an ol)servation extending over several
days.
In horses tympanitic sounds in the neighl)orhood of the
lower pulmonary boundary may also be referable to the colon ;
this can, however, l)e recognized easily because a tympanitic
sound of the same pitch can be elicited also beyond the pul-
monary boundary over the abdominal wall or even below the
costal arch.
Prognosis. The stronger the animal has been before the
pneumonic attack came on and the more the latter conforms
to the classical type the better is usually the prognosis. The
course of the fever is of the greatest prognostic importance.
If the temperature curve falls rapidly or gradually after a
continuous fever of several days, a typical — that is, a favorable
—course may be expected. Fever that has lasted over a week
and has perhaps risen above 41° C. causes anxiety. A con-
tinuous, though not high fever, during or after the stage of
resolution, points to retarded or incomplete absorption of the
exudate or to the development of a secondary pleurisy.
The behavior of the pulse is of special importance. If,
in the absence of a complicating pleurisy the number of pulse
beats has risen to twice the normal, the pulse being at the
same time weak, the prognosis is fairly unfavorable. It is
also necessary to consider the extent of the inflammatory in-
filtration; the chances for recovery decrease in direct propor-
tion to the size of the consolidated territory. Hence, bilateral
pneumonia is more serious than a unilateral affection. Devia-
tions from the usual localization have a similar unfavorable
prognostic significance. Central pneumonia and the involve-
ment of the upper parts near the vertebral column show a
higher mortality.
The age and nutrition of the sick animals must be con-
sidered. In very old or debilitated animals a slowly developing
pneumonia is observed, with moderate elevation of temperature,
yet with marked prostration (so-called asthenic or adynamic
type), which is always very unfavorable in nature and wdiich
generally takes a fatal issue.
Every complication diminishes the chances for recovery
120 Croupous riieumonia.
more or less ; particular!}' unfavorable are : pleurisy with abun-
dant effusion, pericarditis, diffuse nephritis; to a lesser degree
fibrinous pleurisy or intestinal catarrh. Sjauptoms of gan-
grene or suppuration of the pulmonary tissue point almost with
certainty to an early lethal issue.
It must finally be considered that sequela? may come on
which will materially reduce the value of the animal. Since
the advent of such sequelse cannot be foreseen in the milder
cases, the prognosis must always be guarded until the lung
affection has entirely disappeared.
The mortality varies in horses between 0-20% ; it is usually
between 10-15% ; in milder enzootics much less. In cattle the
mortality varies considerably more; sometimes all cases get
well (Strerath, Coulon & Olivier, Gotteswinter) ; at other times
a mortality of 40% has been observed (Kriiger) and even more
(Guillebeau & Hess).
Treatment. The establishment of the most favorable
hygienic conditions, especially sufficient ventilation of the barn
or sojourn in the open, is of the greatest importance in influ-
encing the course and termination of the disease. AVorking
animals must at once he taken off work, to be kept in a moder-
ately cool, well ventilated place or in the open air during
favorable weather, but they must be protected against rain and
wind. Where there are larger numbers of horses, turning them
out into a yard will influence those that are affected favorably
and prevent the spread of the disease. Weak large animals,
especially horses, should be placed in slings. They should be
permitted to lie down only at intervals and not more than two
hours at a time. Rubbing of the body is beneficial and invig-
orating to the patients.
Since in acute febrile diseases the animals usually eat
only juicy, dainty feed, herlnvora should have fresh green feed,
or if this cannot he had, good fresh hay, bran or flour mash
perhaps mixed with some grains, also roots, beets, carrots, etc.
If sick horses appear to prefer oats they should have them,
mixed however with chopped vegetable roots. Carnivora should
receive fresh milk, finely chopped boiled or roast meat, also
strong meat-soups with one or more eggs. All food should
be given in small but often repeated rations. The animals
should frequently be offered fresh, but not too cold, water,
also during the night, since the animals, and particularly the
horses, are too weak to get to the suspended or otherwise placed
water vessels. It is also advisable to clean the mouths of the
sick animals with pure water before offering them food. They
often take it then even if they appear previously to have no
appetite. Where aspiration is threatening on account of dis-
turbances of deglutition, food and water may be withdrawn,
and moderately or well nourished animals may be made to
fast for a few days. Later on, however, these patients and
Treatment. 121
those wliicli are weak or emaciated must be nourished artificially
(see page 123). The same procedure must be instituted with
patients who entirely refuse to eat. Where water by moutli
has to be withheld completely, water injections per rectum must
be resorted to.
Drugs can be dispensed with in all cases with a typical
course. If the pulse varies only slightly from the normal,
alcohol is indicated in small, often repeated doses (ordinary
spirits), larger animals 25-50 gm., sheep, goats, swine 10-20 gn\.,
carnivora 1-2 gm. ; wine 1/.-1 quart or teaspoon doses, cognac,
carnivora Yi teaspoon. Sulphuric ether (10 gm., 5 gm., or
0.25-1.0 pro dosi) may likewise be administered. If the number
of pulse beats is increased to more than twice the rate, and
also if they are weak, cardio- and vasotonic drugs are indicated.
The most serviceable of these drugs is camphor, as ol. camph.
according to Frohner in tolerably large doses (for large animals
20-50 gm., for smaller animals 4-10 gm., for carnivora, 1-2 sub-
cutaneously in one dose). The same results may be had with
the much cheaper ol. camph. syntheticum (Frohner) used in
similar doses. Caffeine (for large animals 6-8 gm., for small
animals 0.5 to 1 gm., subcutaneously every six hours) is likewise
beneficial. (Gmeiner claims to have shortened the course of
cases of pneumonia by the use of sulicutaneous injections of
caffeine.) Strophantinum purissimum Merck (horses 0.003 gm.)
recommended by Regenbogen by subcutaneous injections in
cardiac affections has not proved beneficial in the authors'
cases. It acts much better by intravenous injection (for horses
up to 0.015 gm. — Dorn, authors' own observation). For the
purpose of sul)cutaneous injection strophantine must be dis-
solved in enough water (6-10 gm.) in order to avoid necrosis
of the skin (Frohner) ; however, even if applied in this dilution,
a painful infiltration at the place of injection, which lasts
several days, cannot be avoided. Such swellings are likewise
frequently seen after injections of caffeine. Digitalis prepara-
tions to be used are: pulverized leaves of digitalis (for large
animals 2-5 gm., for smaller animals 0.5-1.0 gin., for carnivora
0.05-0.3 for three to four days) ; also folia digitalis diah^sata
(for larger animals 5-15 cc. per os) ; further, digitalysatum
Burger (small animals 20-30 drops, sul)cutaneously). Accord-
ing to the investigations of Salvisberg, digitalis preparations
are destroyed in the stomach of ruminants ; hence the proper
preparations must be given subcutaneously or intravenously.
It must not be forgotten that digitalis has a tendency to produce
abortion in pregnant cows. The general use of the excellent
preparation digalen (horses 5-15 cc, cattle 20-30 cc, subcu-
taneously or intravenously) is frequently prohibited by its high
price (Dorn) ; tincture of strophantus has been found unreliable
(Regenbogen, Gmeiner).
In the face of threatening cardiac weakness the proper
preparations of digitalis must be given intravenously because
122 Crouptms J'lieiiiiHiuia.
then only can tliey prodnce tlie desired effect witliin a short
time.
If disturbances of circuhition have been bronftht about
solely on account of a decreased tonicity of the arteries (see
Vol. I) the effect of cardio-tonics may be augmented by intrav-
enous injections of physiologic salt solution or of Ringer's
solution (4-6 quarts for a horse). The intravenous injection of
larger amounts of fluid may become dangerous in the presence
of cardiac weakness and may then lead to fatal edema of the
lungs (authors' own ol^servation).
Fever does not, as a rule, require any special treatment,
except in the presence of hyperpyrexia, when cold sponging, or
irrigation or injections of cold water into the rectum may be
indicated. However, cold douches should not be used during
the cold season nor in very young or very debilitated animals.
Of antipyretics the following may be used: antifebrin (15-30
giu. for large, 1-4 gm. for smaller animals, 0.1 to 1.0 gm, for
carnivora pro dosi) ; phenacetin (the same doses) or antipyrin
(the same doses). Lactophenin, which is much higher in price,
may be given to smaller animals (0.5-1.0 pro dosi). With the
exception of phenacetin or lactophenin these drugs must be
used cautiously, since they may bring about collapse. The
salicylates are indicated much less (acid, salicylicum, sodium
salicylicum, salipyrin, salol, aspirin, dymal) since they often
produce intestinal" disturbances or irritate the kidneys. Tallia-
min (10 cc. intravenously) has not been effective in the treat-
ment of influenza-pneumonia of horses, neither have inhalations
of oxvgen as recommended bv Eberlein and Topper (Pr. VI).
1908,6).
Venesection, which Avas formerly practiced universally, may
bring temporary relief in the beginning; it does not, however,
influence the course of the disease at all, and is l)y no means
void of danger, on account of decrease of the tonicity of the
arteries.
Delayed resorption may be stimulated by Priessnitz' axj-
plications and by diuretic drugs; of the latter we should use
preferably acetate of sodium or potassium (25-30 gin. for large,
3-10 gm. for smaller animals, 0.2-1.0 gm. for carnivora, two to
three times daily) ; diuretin, theozin, theophyllin (for carnivora
daily three tunes 0.2-0.5 gm.) ; iodide of potash (for large
annuals 10-20 gm. pro die per os) iodipin (for large animals
30-50 gm. subcutaneously), fibrolysin (large animals 10 cc.
every third day, dogs 2 cc. of the solution). The resorption
of the exu(Uite may be stimulated in protracted cases by punc-
ture of the infiltrated lung with the hollow needle of an injection
syringe; the procedure is similar to that used in exploratory
puncture of the thoracic cavity.
Tlie repeated inhalation of atomized disinfecting fluids
(solution of corrosive sublimate 1 :2000-4000, 2 to 3% solution
of carbolic acid or creolin) may diminisli putrefactive processes
Artificial Feeding. 123
ill the air passages, but they cannot prevent putrefaction in the
lung tissue itself after puhiionary gangrene has set in. Intra-
tracheal injections of a 1% solution of carbolic acid (for horses
60-100 gm. at one time) or of a creosote or forinol solution (see
page 61) are better adapted for the treatment of pulmonary
gangrene.
When pleuritis is present, it calls for sr»ecial treatment
(q. V.)
Stomatics (rheum, root of calamus, gentian, or their tinc-
tures for smaller animals), artificial Carlsbad salt, hydrochloric
acid with pepsin may be administered to stimulate appetite.
Convalescent animals must be well nourished and not used for
work until they have regained their full strength. Moderate
exercise in the open is beneficial if the weather is favorable.
Since croupous pneumonia is usually a localization of some
acute infectious disease, such prophylactic measures as are rec-
ommended for the particular infection, must be carried out.
Artificial Feeding of Sick Animals. The simplest aud most practical method
of artificial feeding of animals consists in the introduction of food stuffs into the
stomach. It consists in its simplest form in pouring liquid foomipanitic timbre at the boundary
of the area of dullness or in other
places. Small animals sometimes
present the cracked pot sounds.
Auscultation reveals a vari-
ety of catarrhal sounds, sometimes
in circumscribed places, as a rule,
below, at times over, the whole of
the thorax. Sounding (metallic)
rales have a special significance if
they are present. In exceptional
cases, if the lungs have become
consolidated to a larger extent,
while the lumina of the larger
bronchi have remained open, one
hears bronchial breathing in the
area of dullness; as a rule, how-
ever, the breathing sounds are
more or less weakened, because
the bronchi are stretched by the
catarrhal secretion.
The pulse is accelerated, at
first quite strong; later on it be-
comes weakened.
The general condition suffers
materially in most animals, both
on account of the fever, and on
account of the respiratory difficul-
ties and the tormenting attacks of
cough. Small animals usually rest
on the sternum. The appetite is
diminished or entirely suppressed ;
sucking animals do not go to the
mother.
T.
p.
R.
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2
3 1
<•
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6 1
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ITO
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150
63 =
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ly
60 =
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UO
55 -
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120
-
ttro
UO
19-5
100
,'
1J -
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J Lj
-j
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i
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sn
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an
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—
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ies
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id
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rl
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Fig. 18. Fever Curve in catarrhal
pneumonia of the dog with terminal
collapse temperature.
Infectious bronchopneumonia of cattle follows, as stated, after infec-
tious catarrh of the upper respiratory passages (see page 45) (accord-
ing to Schmidt, in 50% of the cases). Three to four days elapse, ac-
cording to Lewek, before catarrhal pneumonia develops; catarrh of the
upper respiratory passages may, however, assume a slow, insidious course
and may bring about pneumonia at any time (Reisinger). If this is
the case the fever comes on suddenly, and dullness and bronchial breath-
ing can soon be demonstrated over the anterior and lower portions of
130 Catarrhal Pneumonia.
the thorax. The fever may, however, disappear again within a short
time; the appetite may improve, yet the signs of pneumonic consolida-
tion persist without influencing the general nutrition or the yield in
milk. In this form the disease lasts about fourteen to eighteen days and
reaches its climax about the tenth day ; then the symptoms decrease and
most animals recover completely (Lewek). Occasionally the course may
be less favorable. In both forms interstitial pulmonary emphysema is
not infrec^uently developed.
Course. Catarrhal pneumonia follows a very variable course,
in accordance with the variety of its causes. It develops very
rapidly in some cases and may have assumed a considerable ex-
tent within a few days ; the development is slower in other cases
and the course may extend over several weeks and even months.
The fever subsides in favorable cases toward the end of the sec-
ond or third week, or often even earlier; the cough becomes
easier, moist, less frequent; the respiration less accelerated and
forced, and complete recovery takes place. Renewed elevations
of temperature may come on during the period of recovery; this
is then due to the formation of new inflammatory foci.
In other cases the disease takes a fatal termination, and the
animals die from suffocation, cardiac paralysis, exhaustion, in-
tercurrent pleuritis or pericarditis, or from profuse diarrhea,
occasionally also from pulmonary gangrene or in consequence
of a general sepsis. Again, in other cases there may remain a
chronic pulmonary induration ; the animals then suffer in their
nutrition and from respiratory difficulties. Young animals are
retarded in development under these circumstances.
Diagnosis. The greatest difficulty is offered by the differ-
ential diagnosis between catarrhal pneumonia and bronchiolitis ;
a careful physical examination, however, often enables us to
come to a definite conclusion. High fever, absence of vesicular
breathing, and particularly dullness on percussion, speak in
favor of catarrhal pneumonia. Catarrh of the bronchioles
rarely exists for any length of time without the advent of ca-
tarrhal pneumonia. Croupous pneumonia can be distinguished
by its much more rapid development, its acute and cyclical
course, by the extensive and strong dullness, the bronchial
breathing which is frequently present over a wide territory and
finally by its often favorable termination. Bronchopneumonia
in cattle can not be differentiated from pulmonary tuberculosis
without any further study when it takes a someAvhat pro-
tracted course. In contradistinction to pulmonary tuberculosis,
bronchopneumonia does not lead to severe emaciation, even
after severe local changes, and the catarrhal sounds remain, as
a rule, confined to the anterior and inferior portions of the
thorax.
Prognosis. The prognosis is the more unfavoral^le the
younger or the older the animal. The poorer the state of nutri-
Pneumonia of Birds. Atelectasis of the Lungs. 131
tion, and the liigher the fever, the slighter are the chances for
complete recovery. The course is particularly unfavorable if
the catarrhal pulmonary infection comes on during an acute in-
fectious disease. Robert observed a mortality of 30% in epi-
zootic bronchopneumonia of dogs ; Deich, 50% ; Schmidt re-
ported 30% mortality in contagious pneumonia of market
cattle.
Treatment. The hygienic environment and diet should be
regulated according to the same principles as were laid down for
croupous pneumonia (see page 120). Sucklings suffering from
lack of appetite must be fed with freshly drawn milk or with
boiled milk cooled down to body temperature ; two to four eggs
may be added ; eggs can also be given raw or mixed with w^arm
wine soups.
To improve the bronchial catarrh inhalations may be prac-
ticed (see page 7 and page 42) ; inhalation of oxygen might
likewise be tried. Narcotics (see page 42) should be used only
in the presence of tormenting, convulsive cough, and even then
very cautiously. The regulation of the heart's action requires
special attention ; the principles are the same as those laid down
for croupous pneumonia (see page 122). Priessnitz' applica-
tions to the thorax may be useful. If a complicating pleuritis,
pericarditis or enteritis is present, they should be treated suit-
ably.
Prophylaxis. If the disease is due to an infection, the ani-
mals which are still healthy should be removed to suitable
quarters, preferably to some distant place; they ought to re-
ceive a change of diet and water and disinfection should be
practiced repeatedly. Newdy bought cattle should be isolated
for one week (Lewek).
Literature. Berger, Z. f. Infkr., 1907, III, 101, 356.— Berstl, T. Z., 1893,
49.— de Blieck & Berger, Vet. Jhb., 1906, 157.— Deieh, S. B., 1903, 82.— Dralle,
A. f. Tk., 1885, XI, 231.— Ducas^e, Vet. Jhb., 1906, 157.— Faller, Pr. Mt., 1870-71,
153.— Habieht, B. t. W., 1906, 504.— Holth Z. f. Infkr., 1907, III, 155.— Lewek,
Beitr. z. Kenntnis d. Erkraiik. d. Liiftwege u. d. Liingen d. Rindes, Diss. Dresden,
1909 (Lit.).— Martens, B. t. W., 1906, 655.— Eeisinger, Monh., 1908, XIX, 193
(Lit.).— Robert, S. B., 1894, 133.— Schmidt, S. B., 1903, 79.— Smith, Vet. Jhb.,
1897, 95.— Siidmersen, Cbl. f. Bakt., 1905, XXXVIII, 343, 595.
Pneumonia of Birds. This is rare with the exception of
pneumonomycosis. According to Ziirn (Gefliigelkrankheiten, 1885,
286), the symptoms are accelerated, short, whistling respiration through
the open bill, tenderness and elevated temperature of the thorax, cough
with the expectoration of tenacious, grayish-white, sometimes, or hem-
orrhagic saffron yellow masses, listlessness, lack of appetite.
The treatment is similar to that for bronchial catarrh or for pneu-
monomycosis.
Atelectasis of the Lungs. This occurs very frequently among
domestic animals. Simader, who studied this affection in the Leipzig
]^32 Atelectasis of the Lungs.
slaughtering house, found 15% of the slauglitered young pigs affected;
50% of sucking pigs; 7% of young goats; sucking calves, 13% ; young
sheep, 16%. Atelectasis may be primary or congenital, or secondary
and acquired. Congenital atelectasis is due to the fact that portions of
the lung do not expand after birth and remain airless during extra-
uterine life. Acquired atelectasis occurs if some bronchi become im-
pervious (obstruction atelectasis) or if portions of the lung become
pressed upon (compression atelectasis). In both cases the air is ab-
sorbed within a few hours and the portions affected become void of air.
As a third form we may mention marantic atelectasis which also is due
to a gradual absorption of the air out of the alveoli. Simader believes
that atelectasis in food animals is a congenital affection.
The cause of congenital and marantic atelectasis is usually an
atrophic condition of the respiratory muscles due to fatty degeneration,
lack of development, or due to various diseases of infancy (dysentery,
polyarthritis, rachitis, rheumatism) ; not uncommonly atelectasis can be
referred to insufficient physical exercise if the animals are kept con-
tinually in the barn. Obstruction atelectasis usually occurs during
bronchial catarrh, more rarely in new-born animals, in consequence of
the obstruction of bronchioles by epithelial plugs, by mucus or by
aspirated meconium. Compression atelectasis is usually caused by an
accumulation of fluids or air in the pleural cavity, more rarely by
voluminous tumors of the lungs or pleura.
Anatomical Changes. The seat of atelectasis is usually in the
upper portions especially the anterior lobes of the lungs. The atelectatic
foci appear browned, sunken in under the surface of the lungs and
wedge-shaped if they are due to a bronchial obstruction. Congenital
atelectasis is characterized by its typical location in the apices, by a
normal appearance of all bronchi, or at least of those in the neighbor-
hood of the atelectatic focus, and also by the fact that the pleural
covering does not appear folded. If a portion of lung has not been
expanded properly, hyperemia occurs and soon a serous infiltration of
the atelectatic focus (splenization) develops; the epithelia then undergo
fatty degeneration and become desquamated; mucoid material collects
in the bronchioles and leucocytes wander into the interstitial connective
tissue (desquamative catarrh). The tissue elements which have under-
gone fatty degeneration are absorbed and this is followed by marked
atrophy which may progress to a degree that the two opposite leaves
of the pleura finally touch (induratio).
There exist no observations concerning the clinical symptoms. It
is, however, proliable that in extensive atelectasis disturbances of respira-
tion and physical changes in the thoracic sounds may be found similar
to those encountered in catarrhal pneumonia. Congenital pulmonary
atelectasis must always be suspected when animals are apparently still-
born. Atelectatic foci of lesser extent do not cause any symptoms at all.
The significance of the lesion depends upon the underlying cause.
Atelectasis is of a certain importance because it might be confounded
with contagious bronchopneumonia of young animals and an inflam-
matory process may be established secondarily in the atelectatic focus
(usually bronchopneumonia, exceptionally croupous pneumonia), due
to the action of non-speciflc microorganisms. Specific microorganisms
may sometimes invade an atelectatic focus. (Hogs develop the pneu-
monic t.ype of hog cholera in this way.)
The treatment of acc|uired atelectasis depends upon the cause.
In congenital atelectasis one must attempt to stimulate respiration by
Enzootic Pneumonia of Youni; Animals. 133
massage of the heart (compression of the cardiac regions from both sides
about fifteen to twenty times per minute), by artificial respiration
(movements of the bent front leg upward and downward and then back-
ward toward the region of the flank), the removal of mucus from the
buccal cavity, rhythmical pulling out of the tongue, friction of the skin,
instillations of vinegar into the nasal cavity, titillation of the nasal mu-
cosa with a straw (Moussu). Hygienic measures, particularly proper
breathing and proper care, are important from the standpoint of
prophylaxis.
Literature. Jiuiack, Z. f. Flhyg., 1906, XVI, 321. — Siniader, Ueber Lungen-
atelectase, etc., B. t. W., 1906, 445 (complete Literature).
7. Enzootic Pneumonia of Young Animals.
(Septic pneumonia of calves, lambs, kids, pigs, foals; enzootic
hronchopneumoma of young animals , pleuropneumonia sep-
tica [PoELs], pneumo-enteritis septica [Galtier] ; Fer-
kelsterbe, Ferkelhusten, Zementhusten, clironische
Schweineseuche [German] ; Broncliopneumonie
infectieuse des veaitx, des agneaux, des
chevreaux [French] ; pneumonite dei
neonati [Italian].)
Enzootic pneumonia of young" animals is an infectious pneu-
monia, or pleuropneumonia, which occurs enzootically, and is
usually catarrhal, not uncommonly catarrhal croupous, or
purely croupous ; it is caused by various bacteria, among them
the bacillus bipolaris septicus and its varieties.
Though some of the forms of pneumonia here enumerated have
already been described in Volume I. as special diseases, the collective
consideration in one chapter of all contagious pneumonias occurring in
young animals cannot be avoided, because only in this manner is it pos-
sible to do justice to the requirements of practice and also to consider
those forms of contagious pneumonias which were not taken up in the
other volume.
Historical. Reports on the occurrence of a contagious pneumonia
in young animals are found since the middle of the last century ; but
they received more particular attention since 1890. In 1886 Poels de-
scribed the disease in cattle in Holland and claimed as its cause a bacillus
similar to the bacillus of swine plague. These findings have subse-
quently been confirmed by Jensen (1890), van den Maogdenbergh and
Lienaux (1892). Perroncito, in 188.5, described a pleuropneumonia of
calves, occurring sometimes sporadically and at other times epizootically.
He claimed as its cause an organism which he called micrococcus ambra-
tus, a bacterium which is different from the bacillus bipolaris septicus.
The exact etiologic position of the disease described by Perroncito has
not yet been cleared up satisfactorily.
Aside from those named, the following have studied the etiology of
contagious pneumonia in young animals: Semmer (1888); Bongratz
(1892) ; Stroese & Heine (1898) ; Grips, Glage & Nieberle (1904) ;
Schreiber (1906) ; Pfeifer (1906) ; Hartl & Reisinger (1907) ; Lignieres
(1907) ; Berger (1907) ; and J. Miiller (1907).
134 Enzootic Pneumonia of Young Animals.
Occurrence. Enzootic pneumonia of young animals occurs
in all countries in wliicli young animals are bred in large num-
bers and it has been ol)served particularly in Holland, Germany,
Denmark, France, Belgium, England, Italy, Switzerland, Eus-
sia, Hungary and America. Most commonly affected are calves,
lambs, young pigs, less commonly kids, and rarely foals. The
animals are, as a rule, affected during the first weeks of their
lives, but even up to the sixth montli and later.
The disease has become of greater economic significance
since it recurs annually again and again in spring and becomes
more extensive as a barn enzootic, causing numerous deaths and
retarding the development of those animals which survive.
Strose & Heine demonstrated contagions pneumonia in 1 to 1%% of all
young hogs slaughtered in the stockyards of Hanover (Simader claims, however,
that the?e were cases of pulmonary atelectasis). Grips, Glage & Nieberle saw
pneumonia in about 50,000 young hogs in Hamburg.
Etiology. There is no uniformity in the etiology of the dis-
ease. The bacillus bipolaris septicus (see Vol. I) or its varie-
ties (bacillus vitulisepticus, ovisepticus, suisepticus, equisep-
ticus) are frequently the cause of the disease. Galtier's pneu-
mobacillus septicus is probably identical with the former or-
ganisms.
Virulency. The experiments of Poels have shown that the inocula-
tion of cultures of bacilkis vitulisepticus into the lungs or the serous
cavities of rabbits kills the animals Avithin fifteen to thirty-five hours;
calves within twenty to sixty-six hours. Intrapulmonary infection is
followed by a serofibrinous pleurisy, occasionally accompanied by lobu-
lar pneumonia. Rabbits, guinea-pigs and mice die from septicemia
after subcutaneous injection or feeding. Hogs, when artificially in-
fected, sicken under symptoms similar to those of swine plague ; other
animals, occasionally even guinea-pigs (Jensen), develop suppuration
at the place of injection. Dogs are resistant. The experiments of Gal-
tier with his pneumobacillus septicus were positive in intrapulmonary,
intratracheal, nasal, intraperitoneal, intraocular and sulicutaneous injec-
tions in calves, lambs, kids and hogs. Semmer, however, did not suc-
ceed in spreading the disease to healthy calves by the nasal, intratracheal
and intrapulmonary injection of pulmonary juice. Bacteria, which
were not fully described, were cultivated from the afiPected lungs, but
did not prove effective in Greve's case; some other animals could not l)e
infected. Similar were the (negative) results of Hartl & Reisinger in
inoculating small laboratory animals with a pleomorphous bacterium
similar to the bacillus bipolaris. After subcutaneous injections of this
bacillus domestic animals susceptible to the disease did not usually
become affected, though rabliits sometimes succumbed to a pneumonia
(Stohr). The same observations have been made with reference to the
bacillus suisepticus (Smith, Kitt) or to the bacillus bovisepticus
(Marek).
Several investigators found other bacteria, aside from the
bacillus bipolaris as the cause of enzootic pneumonia in young
animals. Poels, J. Miiller and Schreiber observed an enzootic
pneumonia in calves and young pigs, caused by a bacterium of
Etiology. 135
the coli group. Poels & Berger described an enzootic pneumonia
in calves and young pigs, caused by streptococcus pyogenes. Ba-
cillus pyogenes may likewise occasionally produce enzootic bron-
chitis and bronchopneumonia in young pigs and calves (Grips,
Glage & Nieberle, Olt, Poels, Berger). The bacillus bronchio-
litidis vitali described by Kitt is probably identical with the
bacillus pyogenes. Poels also ascribes the faculty of producing
enzootic pneumonia in young pigs to a staphylococcus pyogenes
and to a kind of streptothrix, which he has not described more
fully. Finally Berger observed an enzootic pneumonia in
calves which was produced by bacillus pyocyaneus.
The causal relation between enzootic pneumonia and varie-
ties of the bacillus bipolaris septicus is now generally considered
as being well established. Still, many authors do not believe
that the other microorganisms mentioned are at all etiologic
factors in the production of enzootic pneumonia and hold that
they are present only secondarily, having invaded an already
diseased lung. This view appears justilied in those cases in
which bacteriologic examinations were made onlj^ in an ad-
vanced stage. However, other bacteria than the bacillus bipo-
laris have been found in the absence of the latter in very recent
cases (Poels, Berger, J. Muller, Kitt, Grips, Glage & Nieberle,
Olt) and pneumonia has been produced with them in experi-
mental animals by subcutaneous and by intratracheal injection,
as for instance by J. Miiller with a bacillus of the coli group and
by Junack with a staphylococcus or a streptothrix organism.
Several kinds of bacteria appear to be effective in some
cases. Frequently, however, the presence of bacteria different
from the bacillus bipolaris simply represents a secondarj^ infec-
tion, particularly when the disease has run a longer course.
This furnishes the basis for further tissue changes which may
so modify the original pathologic picture that it appears as if
we were dealing with a new disease (Holtli). A secondary in-
fection of the lungs may occur also in other enzootic diseases
(pyosepticemia, dysentery of sucklings, white scours, strangles)
and then give rise to numerous cases of bronchopneumonia (sec-
ondary bronchopneumonia of sucklings).
The Etiological Relation Between Enzootic Pneumonia of Young
Animals of Various Species. Some incontestable clinical observations
furnish the proof that enzootic pneumonia may occasionally be trans-
ferred from the young of one species to that of another. Lambs were
infected from hogs suffering from swine plague (Keleti, Pr. Vb.).
Calves were infected from calves, kids or foals suffering from septic
pneumonia (Perroncito, Saner, Pr. A^b., 1905, ii, 17, Bass, Pfeil) ; Riihm
& Schreiber likewise consider the spreading of swine plague to calves, as
probable or of calf-pneumonia to young pigs. In connection with the pos-
itive inoculation experiments mentioned, and the biologic properties of ba-
cillus bipolaris, these observations permit the conclusion that the different
forms of pneumonia caused by it in calves, pigs, lambs and kids are
intimately related or are produced by varieties of the same bacterium.
The bacillus bipolaris appears to have adapted itself, in the majority
236 Enzootic I'neumoiiia of Young Aiiinials.
of cases, to a certain species, so that only the young of the same species
are susceptible to contagion. If, however, its virulency becomes in-
creased, or if certain environmental conditions become favorable to
microorganisms, it may spread to young animals of another species, and
exceptionally to adult animals of this kind. (Pr. Vb., 1905, ii, 17.)
Young animals may also be infected from adults, as occurs in hem-
orrhagic septicemia of cattle, in swine plague and in hemorrhagic sep-
ticemia of sheep.
The same general rule might apply to pneumonia of the young
caused by other microorganisms, but observations proving this are still
lacking.
The etiology of enzootic pneumonia of sucking foals has not yet
been investigated ; but the occurrence of this disease appears to be very
probably due to some of the bacteria mentioned above. (Kutzbach
observed an enzootic bronchopneumonia similar to that of calves among
foals which had had an attack of strangles a few weeks previously.)
Natural infection occurs by sucking an unclean udder,
through contact with straw, by licking the walls, through inges-
tion of infected food, through inhalation of droplets of secre-
tion, which are coughed up by sick animals, through the stump of
the umbilical cord, through abrasions of the skin. Sick animals
confined to a stable will spread the infection by expectorated
bronchial secretion, by intestinal discharges which may contam-
inate the floor, the straw, the feed remnants, the crib, and which
may remain virulent upon the infected objects for a long time.
The disease has, therefore, a tendency to become stationary in
localities which have once become infected, unless prophylactic
measures are carried ont. Intrauterine infection, as claimed
by Galtier, has not been proved to occur. The importation of
the disease into hitherto free herds is usually brought about by
young or adult animals which have passed through the disease,
yet have not fully recovered. The disease is not rarely spread
to new localities by obviously sick animals or by the attendants.
1+ is spread most easily by sick animals of the same species.
The disease may make its appearance among animals which
were heretofore free from the infection without importation
from outside. If this occurs it must be assumed that the causa-
tive microorganisms have been present as saprophytes and have
for some reason acquired pathogenic properties or that the
power of resistance of the sucklings has for some reason been
diminished by external influences (breeding of thoroughbred
stock).
External influences, such as cold, sojourn in cold, drafty,
poorly ventilated stables, favor the spread of the disease or
cause a more virulent course. Another predisposing cause is
primary intestinal catarrh or diarrhea (Poels) and too much in-
breeding.
Pathogenesis. Some of the pathogenic bacteria mentioned
above, especiall,y bacillus bipolaris, mnlti])ly, in certain cases,
very rapidly in the blood of the infected animals, and thus pro-
duce septicemia. If the latter does not lead to death in a short
Anatomical Changes. 137
time some of the bacteria circulating in the blood become col-
onized in the bronchi and the pulmonary tissues and bronchitis
and pneumonia develop. In the meantime, the bacteria may
have disappeared entirely from the circulating- blood and re-
main only in the organs where pathologic changes are estab-
lished. Other bacteria, and also the l)acillus bipolaris, may
produce pneumonia without a preceding septicemia by gaining
access to the lungs either with the inhaled air or through the
blood-current. The localization of bacteria from the circulating
blood or their dissemination with the lymphatic current may
cause inflammation of the serous membranes of the thorax, par-
ticularly if the bacteria possess a higher degree of virulence.
Since diseased pulmonary tissue forms a good nutritive soil
for various bacteria, saprophytic microorganisms living in the
bronchi of otherwise healthy animals or in their neighborhood
may multiply rapidly (secondary infection) and produce fur-
ther changes.
Anatomical Changes. These vary according to the several
microorganisms and their variable degree of virulence, also ac-
cording to the power of resistance of the affected animals and
to the duration of the disease.
Aside from those cases which run their course as a pure
septicemia and which are not here considered, in its acute form
the disease not uncommonly presents the picture of a septic
pleuropneumonia. A serofibrinous exudate is found in one or
in both pleural cavities, the pleura being covered to an extent of
several millimeters with loose, juicy, fibrin membranes, which
are lusterless and studded with punctiform hemorrhages. The
lung is uniformly dense, void of air, friable in its anterior lower
portion ; frequently also to a greater extent, a reddish-gray
cloudy fluid may be scraped off the dark red-l)rown or grayish-
brown, finely granular cut surface. The interstitial connective
tissue appears uniformly serously infiltrated and forms yellow-
ish, gelatinous, reticulated stripes of varying width on a red-
brown or more grayish-brown background (marbled). Some-
times one sees lymph vessels with coagulated lymph and a
fibrinous exudate in the wider stripes (Lienaux). Of other
changes occasionally met with may be mentioned gelatinous in-
filtration in the neighborhood of the larynx and the pharynx,
hemorrhages into the tissue of the pericardium and peritoneum,
fibrinous pericarditis, acute swelling of the lymph glands, acute
gastro-intestinal catarrh, sometimes ulcers in the abomasum
(Beresow), cloudy swelling of parenchymatous organs, also,
according to Galtier, hemorrhages into, and fatty degeneration
of, the muscles of the rump, the extremities and of the heart.
The anatomical picture in sheep and goats is sometimes similar
to that of septic pleuropneumonia ; in young pigs, however, to
that of typical swine plague (see Vol. I).
Very frequent findings in acute cases are bronchitis or ])ron-
138 Enzootic Pneumonia of Young Animals.
cliopneiiHioiiia with or without a simultaneous pleuritis or peri-
carditis. Individual lobules or occasionally whole lobes (espe-
cially the anterior and median lobes and the anterior angle of
the principal lobes) apjjear brown, jjurple or grayish-red, flesh-
like, dense, non-crepitant when cut into. The interlobular con-
nective tissue appears occasionally somewhat swollen; the
bronchi contain mucoid, gelatinous yellowish masses of secre-
tion. The bronchial and mediastinal glands are markedly
swollen.
The chronic form presents a flabby pneumonic consolida-
tion. Occasionally one finds in the affected pulmonary tissue
purulent or caseous foci from pea to walnut size, in other cases
dry, grayish yellow necrotic foci, sometimes also cavities as
large as a fist. The pleurae present the picture of a chronic
fibrous adhesive inflammation. The bronchial and mediastinal
Ijanpli glands often show considerable chronic swelling and
exceptionally contain dry foci up to the size of a lentil.
Pneumonia assumes the form of bronchopneumonia sup-
purativa if caused by bacillus pyogenes (Olt, Holth) or bacteria
of the coli group (J. Miiller). It is then characterized by a
light 3^ellow suppurative condition of the small bronchi, in the
middle of the hepatized or only atelectatic lobules. A gradual
purulent liquifaction of lobules, inspissation of pus and adhesive
pleurisy radiating from the bronchioles takes place in the
further course of the disease.
Kitt described a caseous broncliopneuniouia iu a young steer which was very
similar to pulmonary tuberculosis, but differed from it in that there were no
caseous foci in the connective tissue between the white yellowish caseous looking
lobules; calcareous changes and cavity formation was likewise absent. The exudate
in the bronchi contained exclusively the bacillus bronchiolitidis vituli (see page 135),
Symptoms. The duration of the period of incubation varies
a good deal according to the type and virulence of the patho-
genic bacteria, and it can be determined only in cases with
an acute course.
According to Schreiber septic pneumonia occasionally appears on the second
day of life ; in other cases on the ninth to seventeenth day after infection. In
contagious catarrhal pneumonia of young pigs Grave observed a period of incubation
of ten to fourteen, rarely up to twenty-four days.
The clinical picture itself varies a good deal. One can
distinguish, generally speaking, an acute and a chronic form
of the disease.
The acute form is usually observed in very young animals
a few weeks old at the utmost; it is initiated by a decrease
in the lively behavior and in appetite, and by a fel)rile ele-
vation of temperature up to 41° to 42° C. The respiration
is accelerated from the start and becomes more and more fre-
quent, so that after a few days the number of respiratory move-
ments may be 40-60 even 100 per minute. At the same time
the respiration becomes forced, the animals spread their front
legs, stretch their heads and neck; calves and foals also dilate
their nostrils. Cough occurs soon after the onset of the dis-
Diagnosis. 139
ease ; at first it comes on during exercise ; later on also during
rest and it becomes more frequent and more tormenting.
Mucopurulent nasal discharge occurs in some cases.
Percussion and auscultation of the chest reveal the same
changes as are usually found in bronchopneumonia (see page
129). In some cases there are found in addition the signs of
acute fibrinous or serous pleurisy or pericarditis. Exceptionally
the disease may present itself exclusively under the clinical
picture of acute pleurisy or pericarditis (Immelmann).
The physical weakness increases rapidly during the course
of the disease; the animals become unable to stand up and
they succumb between the second, fourth, sixth day of the
disease; often profuse and fetid diarrhea has set in. If, as
occurs rarely, the animal remains alive the symptoms of the
chronic form of the disease are developed.
The chronic form is seen in somewhat older animals or
in somewhat milder outbreaks; cough being the first obvious
sjanptom of this form of the disease. It is at first infrequent
and comes on only on rising or lying down or during exercise.
Later on it becomes more frequent and weaker. In the mean-
time, the respiration becomes more frequent and more or less
forced. Rales and whizzing sounds, also purring are heard
over the chest and in addition often the changes on percussion
and auscultation as in the acute form. Fever is often present;
but only of moderate degree. The general condition and the
appetite may remain undisturbed, particularly in hogs ; however,
the appetite is, as a rule, diminished and the sensorium more
or less depressed.
Gradual emaciation becomes manifest in the further course.
In this manner a chronic marasmus is established, which may
terminate fatally in three to six weeks or only after one to
two months. In the milder cases the condition gradually im-
proves, the cough becomes less frequent, the nutrition better,
and all symptoms entirely disappear, often however, only after
several months.
In some cases, apparently in those due primarily or secondarily to the bacillus
pyogenes, itching and scabby eczemata, appear on tlie neck along the back, on the root
of the tail, also swellings and abscesses in various parts of the body, which are,
according to Schimmelpfennig, of unfavorable prognostic significance.
Diagnosis. The exclusive affection of young animals and
the enzootic occurrence of the disease are generally sufficient
to lead to a correct diagnosis, and there is frequently besides
the additional chance to make a post-mortem examination on
one of the earliest fatal cases. The exclusive affection of calves,
lambs or kids distinguishes the disease from pleuropneumonia
in cattle and from hemorrhagic septicemia of sheep and goats.
The same is true of the differential diagnosis between con-
tagious pneumonia of young pigs and t^q^ical swine plague
which is caused by bacillus suisepticus alone, while in hog
cholera the clinical and anatomic pictures are usually charac-
140 Enzootic Pneumonia of Young Animals,
teristic. A favorable course also speaks against swine plague.
In clou])tful cases the epizootical factors have to be considered.
Contagious pleuropneumonia can usually be easily distinguished
from pneumonia of calves according to the principles laid down
in Volume I. An enzootic occurrence permits the exclusion
of sporadic bronchopneumonia. Lungworm disease is usually
seen in somewhat older animals after pasturing. The detection
of worms, their embryos and ova in the coughed up sputum,
or on post-mortem examination in the bronchi, establishes the
diagnosis beyond doubt. Atelectasis of the lung must also be
considered in the anatomical diagnosis (see page ]31). The
fact that calves and lambs hold their bodies stiff might lead
to a confusion with tetanus; a more exact examination will,
however, exclude such aii error.
The detection of the causative microorganism should be
attempted in all cases by post-mortem examination and by
bacteriologic tests of recent cases.
Prognosis. It is usually quite unfavorable; however, con-
siderable variations occur in various enzootics as to the morbid-
ity and mortality, according to age, species and environ-
mental conditions of the animals. Most of the animals which
are affected during the first weeks of life perish and even
those that remain alive are stunted in their development, and
their raising does not pay. A complication of dysentery is par-
ticularly unfavorable. The disease very often terminates fa-
vorably in young pigs over one month old (Greve, authors' own
observation), and also not uncommonly in other animals; the
recovery may, however, l)e apparent only and extensive indura-
tions may persist in the lungs.
Treatment. Medicinal treatment is not at all promising
and its carrying out meets with great difficulties. Dietetic and
hygienic regulations may, on the contrary, influence the course
of the disease favorably (see page 120). vSerum treatment may
be indicated in those forms of pneumonia which are caused
by the bacillus bipolaris, by bacteria of the colon group and by
streptococci.
Prophylaxis. Prophylactic measures carried out energeti-
cally permit the successful struggle against enzootic pneumonia
of young animals ; hence our main efforts must be spent in
this direction. To prevent the importation of the disease, it
is advisable not to introduce too young animals for breeding
purposes and to subject newly bought stock to an isolation
of two weeks and then to keep them together with other young
animals only provided they are healthy and have not shown
any suspicious symptoms (cough!). The stables must be kept
clean and must be properly ventilated; during favorable
weather the animals must be kept in the open and inbreeding-
must be avoided. The floors of stables and pig pens should
be warm; cement or stone floors are not desirable and if they
Protective Inoculation. 141
are present, they sliould be covered with lumber, which can
easily be removed and cleaned.
If, in spite of jDrecautions, the disease has made its ap-
pearance, healthy animals should be separated from the sick
and suspicious ones. The removal of the healthy animals and
their mothers to another stable or another farm, etc., wdiere
there are no young ones is very desirable. Those animals
which are to be transferred sliould be cleaned, especially on
their extremities. The isolated animals should have separate
attendants. If the disease has made its appearance to a limited
extent, it is best to slaughter the sick and suspicious animals,
otherwise they may be kept alive and isolated until they either
recover or until their slaughter becomes necessary. Recovered
animals should only be used for breeding purposes with every
possible precaution, since they may become instrumental in
spreading the disease.
Stables, pens and runs must be disinfected thoroughly
after the removal and burning of loose woodwork. Manure
must be made innocuous by the use of chloride of lime. Stables
for breeding animals, which have been visited repeatedly by
the disease, must be disinfected before the young ones are born
(the procedure after parturition has been indicated in Vol. I).
These measures usually make it possible to stop the spread
of the disease and to prevent its occurrence.
Protective Inoculation. Protective inoculation against
pneumonia of lambs has recently been practiced with good
results (Proske, Goldmann, Beckhard, Becker) with a poly-
valent immune serum of Ostertag & Wassermann (Pr. Vb.) or
with septizidin or with septizidin B. (Goldberger, Evers,
Schreiber). Dysentery serum has been used in other cases.
Streptococcus serum is indicated in streptococcus infections.
It appears advisable to vaccinate animals shortly after birth
and to repeat the vaccination after a few weeks.
It is impossible at present to make a definite statement on
the prophylactic efficiency of protective inoculation; it must,
however, be stated that unfavorable results have also been
reported. This may, of course, be explained by the fact that
enzootic pneumonia of young animals is caused by a variety of
bacteria, and that the virulency of the bacillus bipolaris is
subject to a great deal of variability.
Literature. Becher, B. t. W., 1906, 696.— Beckhard, Ibid., 1906, 681.—
Berger, Z. f. Infkr., 1907, III, 356.— Goldberger, B. t. W., 1906, 507.— Goldmann,
Ibid., 1906, 322.— Gotteswinter, Ibid., 1891, 384.— Greve, D. t. W., 1902, 491.—
Grips, Glage & Nieberle, Die Schweineseuchen, Berlin, 1904.^Hartl & Eeisinger,
B. t. W., 1907, 197.— Holth, Z. f. Infkr., 1907, III, 155.— Immelmann, Pr. Mt.,
1883, 46.— Jensen, Monh., 1891, II, 1.— Kitt, Monh., 1890, T, 145.— Kutzbach,
Pr. Mt., 1859, 159.— Lignieres, Bull., 1907, 45.— Miiller, Kitts Bakterienkunde,
1908, 254,— Olt, D. t. W., 1904, 325.— Pfeiffer, Vet. Jhb., 1906, 101.— Poels, Hdll.
B., 1887, 159; Z. f. Flhyg., 1905, XV, 278.— Pr. Vb., 1903 ii. 1904., II.— Proske,
B. t. W., 1906, 506.— Eiihm, W. f. Tk., 1906, 702.— Schimmelpfennie, Pr. Vb., 1904,
II, 22.— Sc-hleg, S. B., 1893, 124.— Schreiber, Monh., 1907, XVIII, 299 (with
literature on tlie septic pneumonia of calves, lambs and kids). — Strose & Heine,
D. t. W., 1898, 813.— Wittlinger, Pr. Vb., 1902, II, 23.
142 Mycotic Pneumonia.
8. Mycotic Pneumonia. Pneumonomycosis.
{Pneumonomycosis asperglUbia.)
Etiology. Moulds in the air passages are found most
frequently in places where the temperature is somewhat lower
and where fungi can remain permanently in contact with the
air. They also form larger colonies in the presence of more
ahnndant masses of secretion or decomposition products. One
finds colonies of moulds in bronchiectasias, pulmonary cavities,
exceptionally in bronchial catarrh. In all of these cases, how-
ever, moulds live in the interior of the air passages onh" as
saprophytes without attacking the living tissues and without
producing pathologic changes in them (secondary mycosis).
Only rarely can disease of the air passages be referred
directly to a pathogenic effect of moulds (primary or true
mycosis). This appears to be the case after the inhalation
of very great amounts of moulds. Moulds may display a
pathogenic effect preferably in weakened individuals and in
the presence of a catarrhal affection of the lungs. Schultz
produced the disease artificially in birds by inhalation. Accord-
ing to Folger, mould spores may also get into the lungs by
embolic transport.
Most common of the pathogenic moulds are species of
aspergillus, especially aspergillus fumigatus and aspergilhis
nigrescens. The former still grows well at a temperature
of 37°-40° C. ; the latter at 37° C. ; hence aspergillus fumigatus
is considerably more dangerous (Schultz, Lucet). Aspergillus
glaucus does not grow at body temperature and only forms
larger colonies perhaps in the larger air passages, but it can-
not penetrate into the tissues. Some species of mucor grow
at 40° C. and also in the interior of animal tissues.
Tlie species of aspergillus form a colorless mycelium, from which arise straight,
11011- branehiug hyphae; these end free in a globular swelling, the columella, which
carries numerous radially arranged sterigma^, from which a single row of conidia
is formed by constriction, which, in combination with the sterigmaj and the columella
form the fruit -headlet {Fig. 19). The following species are pathogenic:
Aspergillus fumigatus forms at the beginning bluish-green, later on ashy-gray
colonies. The diameter of the semispherical or club-shaped columella is 8 to 20 ^u;
of the conidia 2 to 3 ytt. The sterigmge rise more or less upward.
Aspergillus nigrescens (asp. iiiger.) columella spherical and carries pure
ra. Xasal discharge in pulmonary gangrene of the horse, a, elastic fibers from
pulmonary tissue; b, pus corpuscles; c, bacilli; d, cocci.
yellowish brown; they consist, either at the periphery, or
throughout their entire extent, of a mushy mass of very dis-
agreeable, sweetish, foul smell. Liquefied or soft masses, which
have a similar smell and are likewise discolored, are found also
in the bronchi, the mucosa of which is dirty red or slate-gray
in color. In the neighborhood of the gangrenous foci and be-
tween them, the pulmonary tissue shows the picture of a ca-
tarrlial or croupous pneumonia. The internal surface of the
cavities that are formed is ragged, eaten out, and is covered
with a friable, smeary, stinking, mushy mass. In the rarer
more chronic cases one finds in the neighborhood of the cavities
a yellowish, or yellowish-gray, purulent, infiltrated zone or a
cicatricial grav shell of connective tissue.
150 Pulmonary Gangrene.
Fo<^i situated near the pleura frequently lead to a purulent
or putrid pleurisy, or pneumothorax develops after the focus
breaks through. The internal organs present the signs usually
found in grave general infection, such as parench^anatous and
fatty degeneration, occasionally also hemorrhages and metas-
tatic foci.
Symptoms. The earliest s>Tnptom of pulmonary gangrene
is usually a peculiar, sweetish, foul, very disagreeable smell of
the exhaled air. Stinking gases are developed in consequence
of the putrefactive processes ; these escape with the exhaled air
and are at first noticeable only in the immediate neighborhood
of the nose of the animals ; later on they pervade the air of the
neighborhood and can be smelled at once upon entering the place
Avliere the patient is kept. This smell may, however, be absent
in pulmonary gangrene, if the focus has remained closed and has
no communication with the outside world through the air pas-
sages.
As soon as gangrenous foci have broken into bronchi, there
appears a dirty-grayish red, eventually ])rown-red or greenish
tenacious nasal discharge, which becomes verj^ abundant after
coughing or after lowering of the head and which always dis-
seminates the disgusting smell. Microscopically, the nasal dis-
charge (Fig. 23) shows granular tissue, detritus, fat droplets,
needle-shaped fat crystals, l^rown or black masses of pigment,
sometimes pus corpuscles, red blood corpuscles, numerous varie-
ties of bacteria, and elastic fibers, occasionally in alveolar ar-
rangement. (Elastic fibers can easily be demonstrated after
boiling the exudate in 10% solution of caustic potash, followed
by centrifuging.)
Corresponding to the extent of the inflammatory process,
the respiration is difficult and accelerated ; this becomes par-
ticularly marked after a general septic infection of the organ-
ism has taken place.
The percussion sounds remain unchanged if central por-
tions of the lung are affected exclusively. Frequently, however,
we hear dullness, and occasionally also tympanitic sounds in
the anterior and inferior pulmonary portions. The formation
of cavities may sometimes be diagnosticated if elastic t^nnpanic,
or metallic sound, or cracked pot sounds are found in a circum-
scribed place of the thorax, associated with metallic rfdes and
bronchial breathing; these correspond in pitch with the tym-
panitic percussion sound. Splashing and similar noises are
also characteristic of the existence of pulmonary cavities.
Pulmonary gangrene is almost always accompanied by
fever. Its intensity varies from case to case, but it usually
reaches above 40° C. and shows a remittent type (see Fig. 24) ;
an insignificant fever is often seen at first for several days in
aspiration pneumonia. The pulse becomes accelerated, small,
Course. Diagnosis. 151
and soon thready. Chills and sweats come on from time to
time. There is great prostration and dullness of the sensorium,
the appetite is suppressed and profuse diarrhea not uncom-
monly comes on toward the end of the disease.
Pleurisy frequently develops during the course of the dis-
ease; pneumothorax only exceptionally. Pulmonary hem-
orrhage from the rupture of a blood vessel by coughing or by
ulcerative processes of the vessel walls is rare.
Course. If pulmonary gangrene follows upon some form of
pneumonia, it is preceded by the symptoms of this disease. If
gangrene occurs in the course of croupous pneumonia,
it usually occurs toward the terminal stage of hepa-
tization; the non-appearance of improvement or resolu-
tion, or a new elevation of the temperature which had
been falling, then point to an aggravation of the con-
dition. It is also possible that the symptoms of pul-
monary gangrene become manifest only after the beginning
of the stage of resolution ; a putrid inflammation of parts situ-
ated more centrally may at first not become manifest and may
only be suspected after the fetid odor of the exhaled air and of
the nasal discharge have been observed. In all cases, however,
after once being established, the gangrene progresses rapidly
to a fatal termination, and the animals die between the second
and fourth, or in any event before the end of the eighth day.
Pulmonary gangrene arising after other diseases than croupous
pneumonia, usually takes a similar course, except that some-
times weeks may elapse before a more considerable portion of
the lung has become affected. The symptoms are then at first
mild and only gradually increase in severity. A gangrenous
pulmonary focus may, in exceptional cases, become encapsu-
lated and recovery take place.
Diagnosis. The only pathognomonic sign of pulmonary
gangrene is the presence of shreds of pulmonary tissue or of
elastic fibers in alveolar arrangement found in "the nasal dis-
charge or in the sputum expelled by coughing. Without the
detection of these elements, the diagnosis depends upon the pe-
culiar smell and upon the detection of signs pointing to cavity
formation in the lung. In other cases, a diagnosis can be made
only with some degree of probability; it becomes, however,
fairly certain as soon as the peculiar disagreeable smell becomes
manifest in the course of acute pneumonia, or if the symptoms
of pneumonia come on after a disease wdiich points to the aspira-
tion of particles of food, masses of secretion, etc. Signs of sep-
sis are also of importance and always accompany pulmonary
gangrene of any extent.
The disease might be confounded most easily with putrid
bronchial catarrh ; if primary, this does not lead to any consid-
152
PiiliiK)iiai-y Gangrene.
erable elevation of temperature, or to pulmonary consolidation ;
it is, however, always present as a concomitant factor in pul-
monary o-angrene. The differential diagnosis becomes partic-
ularly difficult if putrid bronchial catarrh is present in connec-
tion with bronchiectasis ; the constancy of abnormal percussion
c= rc:-
sounds and rather insignificant disturbances of the general
condition speak in favor of l)ronchiectasis. In gangrenous
inflannnation of the upper respiratory passages, especially of
tlie pliarynx, the nose and its accessory cavities, one finds, aside
from the putrid smell of the exhaled air, other symptoms point-
Prognosis. Treatment. Chronic Interstitial Pneumonia. 153
ing to the organ affected in particular, and the grave symptoms
of affection of the kings are absent; one can sometimes ascer-
tain that only the air exhaled from one nostril has a putrid
smell.
Prognosis. While a gangrenous process in a circumscribed
territory of the lung may, in rare cases, come to a standstill, be
encapsulated, and end in permanent recovery (if occurring at
all, most commonly in cattle and swine), the process is, as a rule,
progressive in character; sepsis develops and a fatal termina-
tion occurs. The prognosis is therefore, in general, unfavor-
able, and the more so when gangrene is established in a pre-
viously inflamed lung or as a complication in a grave general
infection.
Treatment. One might try inhalations of finely atomized dis-
infectant solutions, or intratracheal injections, the latter after
a preliminary tracheotomy; it may exert a favorable influence
upon the upper respiratory passages and may diminish the fetid
smell (see page 61). A circumscribed gangrenous focus may
possiblv be removed bv pneumotomy (Pansini, 0. M., 1907,
289).
Further therapeutic measures consist in strengthening and
nourishing the patient, in the regulation of the cardiac action,
combating hyperpyrexia, and ameliorating cough and diarrhea.
As a matter of prophylaxis, cases where it is advisable to
guard against the development of gangrene, where the exhaled
air becomes fetid, should receive inhalation-sprays, or still bet-
ter, intratracheal injections of some disinfectant solution (see
page 61). One must always guard against aspiration in the
administration of medicine, and therefore one should entirely
avoid drenching if disturbances of deglutition exist.
11. Chronic Interstitial Pneumonia. Pneumonia interstitialis
chronica.
{Pneumonia inchirativa, Sclerosis piilnwnnin, Cirrhosis pul-
monum.)
Etiology. Chronic interstitial pneumonia occurs very
rarely in horses and cattle as a primary disease. Among these
must" be mentioned particularly what has been described by
Dieckerhoff, and later by Bang, as lardaceous pneumonia in
older horses; it appears to develop after an infection. (Bang
expressly states that the disease has nothing to do with tuber-
culosis, but Rabe claims to have found tubercle bacilli in a case
of this kind.) A disease, in some respects quite similar to that
mentioned, has been described by Gruter, a pneumonia devel-
oped in connection with bronchitis scleroticans in horses. A
154 Chronic Interstitial Pneumonia.
further cause of chronic pneumonia may be the inhalation of
dusthke bodies (fragments of plants, silicon-, lime- or coal-
dust), which are absorbed from the bronchi into the interstitial
pulmonary tissue, and there produce a usually circumscribed,
occasionally, however, a more extensive, chronic inflammatory
process. (Pneumoconiosis.) Larger foreign bodies which
have penetrated into the lungs from the air passages or from
the fore-stomach may exceptionally produce chronic intersti-
tial pneumonia. Schmidt observed a traumatic inflammation
of the stomach, diaphragm and lungs in a horse with bronchi-
ectasis.
Vansteeiiborglie & Grisez claim, on the basis of their animal experiments, that
pulmonary anthraeosis is not caused by the inhalation of dust-like foreign bodies,
but by the absorption of dust-like bodies, which are swallowed and only secondarily
brought from the intestines into the pulmonary vessels. Numerous experiments
which Avere stimulated by the above statement have, however, proved that the
dust-like foreign bodies in natural affection do get into the lungs by inhalation;
anthraeosis of intestinal origin is observed only exceptionally and then it does
not reach a high degree (Liittschwager).
As a rule, the disease is a secondary affection, seen par-
ticularly after bronchial catarrh. When existing for a long
time, this leads to the new formation of connective tissue in
the bronchial wall and finally spreads to the neighboring inter-
lobular connective tissue. Purulent catarrh of the bronchi, giv-
ing rise to chronic pneumonia, occurs frequently in cattle, hogs
and sheep. Polyadenomatous proliferations in sheep (Prosch)
and cats (Ball) may have a similar origin, but they are rather
to be looked upon as true tumors (q. v.). The process arises
not uncommonly from atelectatic foci (see page 131). In pro-
tracted cases of acute pneumonia a progressing inflammation
in the connective tissue is also seen, surrounding the affected
lobules. This termination is observed particularly after ca-
tarrhal pneumonia, more rarely after croupous pneumonia,
where, if seen at all, it occurs usually in old debilitated animals.
An inflammatory new formation of connective tissue also oc-
curs in the neiglil)orhood of encapsulated abscesses, putrid or
caseous foci, parasites, tumors, etc. Chronic pneumonia also
occurs in the course of chronic pleuritis. Certain chronic in-
fectious diseases also always finally lead, in their localization
in the lungs, to chronic connective tissue inflammation.
Anatomical Changes. The affected pulmonary portion
a])pears firmer, touglier, more tenacious, it contains less air,
the cut surface shows a few cicatrices or cicatrixlike stripes
between the air-containing lobules, or a whole portion of lung
may be changed into an almost homogenous, firm, airless tis-
sue, in which one can see only here and there an air-containing
lobule. The shrunken portions of lung sometimes contain case-
ous foci and abscesses.
In lardaceous pneumonia of horses the upper portions of
Anatomical Changes. Symptoms. 155
the lungs appear uniformly grayisli-wliite or yellowisli-gray
and lardaceous. They contain little air and are, consequently,
firm. The lower and inferior portions usually show only a few
nodules and are otherwise similar. Microscopically, we find
proliferation of alveolar epithelia, much new formation of con-
nective tissue, compression of the alveoli ; the histologic picture
has some similarity to that of carcinoma. There is, on the
other hand, some similarity between lardaceous pneumonia of
horses and multiple adenoma of sheep (see tumors of the
lungs), and also between focal chronic pneumonia following
bronchitis scleroticans of the horse. However, in this form
of chronic pneumonia, inflammatory new formation of tissue is
found, particularly in the peribronchial tissue, along the blood
vessels and in the interalveolar tissue (l)ronchopneunionia
fibroplastica, Griiter). In this latter disease lardaceous-look-
ing foci are also generally seen which, however, grow at most
up to the size of a fist.
In pneumoconiosis one sees in the lungs either fibrous-
calcareous nodules or streaky cicatricial l)ands, or on the con-
trary, the picture of a fibrous bronchopneumonia ; after coal-
dust inhalation slate-black spots are also oliserved. The ana-
tomical picture usually includes the signs of chronic bronchial
catarrh and chronic pleurisy.
Symptoms. The respiratory surface of the lungs becomes
diminished and the expansion on inspiration is impeded in
consequence of the new formation and subsequent contraction
of the connective tissue. Hence, difficult resx)iration is noted
in cases of a somewhat more extensive affection; it is partic-
ularly noticeable during work and leads to rapid tiring out of
the animal. The signs of chronic In-onchial catarrh are also
usually present, such as a dull, weak cough, scanty, usually
sharp (dry) rales, or purring or whistling sounds, etc. They
are often noticeable only after deep inspiration, after exercise,
after coughing, or after one has previously closed the nostrils
of the animal. Disturl)ances of nutrition l)ecome marked
later on.
On careful percussion, particularly on corresponding places
of the two sides of the thorax, one can usually make out a more
or less distinct dullness, occasionally tympanitic sounds over
the anterior and inferior portion, as a rule behind or below the
scapula. The vesicular breathing is weakened in the area of
dullness or is entirely alisent ; in other cases one may have, on
the contrary, bronchial breathing, or intensified, drawn respira-
tory sounds. In extensive shrinking of the pulmonary tissue
many pulmonary capillaries become obliterated; consequently
the second pulmonary sound is intensified.
The disease runs its course without fever, and this is im-
portant as a point of differential diagnosis with reference to
acute pulmonary consolidation. However, bronchial catarrh,
156 Chronic Interstitial Pneumonia.
which is scarcely ever absent, occasionally leads to a transi-
tory elevation of temperature.
Lardaceous pneumonia of horses at first leads to diminished appe-
tite, listlessness, cough, emaciation, and to gradually increasing acceler-
ation and dit^iculty of respiration, with the characteristics of broken-
Avinded trouble. Only after several weeks does percussion reveal, par-
ticularly in the upper portions of the thorax, more or less distinct dull-
ness and diminution or absence of the vesicular breathing sounds, and
the presence of rales. Bang l)elieves that a chronic alveolar pulmonary
emphysema is probably always formed. Fever and acceleration of the
pulse come on only after the disease has lasted a long time or after very
severe service. The course of the affection is insidious and slow and
difficulties in respiration only after one-half to one year, reach such
a high degree that the animals can not be used for work.
In lironchopneumonia filiroplastica of horses Griiter observed fre-
quent, strong cough, scanty nasal discharge, accelerated respiration with-
out special use of the muscles of the flanks, unchanged percussion sounds,
normal boundaries of the heart and of the lungs.
Diagnosis. When dealing with a very slowly progressing
pulmonary affection, one must ahvays think of chronic inter-
stitial pneumonia ; however, it can only comparatively rarely
be diagnosticated definitely. The greatest difhcnlties in differ-
ential diagnosis are offered by echinococcns diseases of the
lungs and by pulmonary tumors. The diagnosis is compara-
tively easiest if the chronic pnlmonar^^ disease comes on after
the sjanptoms of acute croupous or catarrhal pneumonia or
acute pleurisy have passed off. In cattle and also in other
animals it is important to exclude tuberculosis ; this can, of
course, usually be done hj a tuberculin test.
Treatment is absolutely non-promising, hence all efforts
must l)e directed toward sparing the animal and promoting a good
nutrition, which may retard the further development of the path-
ologic process. The improvement of the bronchitis will improve
the condition of the patient. One might try fil)rolysin (for
large animals every second to fourth day, one gm., dogs 0.2
gm. ; or 10 cc. and 2 cc. respectively of the prepared solution
subcutaneously). Animals whose meat is used for human con-
sumption should be slaughtered as soon as their nutritive con-
dition has improved.
Literature. Bang, Maandsskr., 1894, V, 218.— Berger, Z. f. Infkr., 1007,
III, 356.— Dieckerhofif, W. f. Tk., 1884, 3.57. Spez. Pathol., 1904, I, 854.— Gnieter,
Beitr. ?.. Kenntii. d. Bronchitis chronica des Pferdes, Diss. Ziierich, 1909 (Lit.). —
Lnlienau, Arch. f. Hyg., 1907, LXTII, 391.— Liittschwager, D. t. W., ' 190.S. 1
(Lit. on Pulmonary Anthracosis). — Olkers, Leipzig. Ber., 1906. — Prosch, Loipyig.
Hor., 1906, F.— Vansteenberghe & Grysez, A. P., 1905, 787.— Bull., 1906, 695.
12. Echinococcus in the Lungs. Echinococcosis pulmonum.
Occurrence. Echinococcosis in general, and pulmonary
echinococcosis in particular, occurs everywhere. Its fre-
quency, however, varies within wide limits in different parts.
Etiology. Auatoniical Symptoms. 157
Most commonly aflVctcMl are ruminants and hogs; a few cysts
are sometimes fonnd in the hmgs of horses. (For more details
on the frequency of echinococcosis, see the chapter on echino-
coccosis of the liver.)
Etiology. Echinococci are the cysticerci of the dog par-
asite Taenia echinococcns, the oncospheres of which are prob-
ably carried by the blood current from the intestines into the
lungs; they change into cysts in the pulmonary tissues; these
cysts grow very slowly in size. Infection occurs by swallow-
ing the ova of Taenia echinococcns with food or water (on the
developmental history and the various forms of echinococcns,
see echinococcosis of the liver).
Anatomical Changes. In some cases, the lungs contain
only a few echinococcns cysts, in others these occur in so great
numbers that they cannot be counted, so that the weight of the
organ may have become increased considerably^ (in a case re-
ported byFindeisen, the lungs of a steer weighed seventy-eight
pounds). The surface of the lungs then becomes uneven, nodu-
lar, and the palpating hand feels the cysticerci in their interior,
surrounded by a connective tissue capsule and containing a
clear serous fluid. These cysts may be felt as firm, tense,
globular nodules, up to the size of a fist. If the cysts are cut
into they discharge a serous fluid, and the elastic membrane
forming the interior surface can then be peeled off easily from
the external capsule. The cysts are sometimes provided with
scolices, or they maj^ frequently be sterile, or exceptionally
also contain daughter cysts. Small, dry, caseous nodules or
mortarlike masses are also often present in foci, Avhich look
similar to caseous tubercles, but in which the microscope shows
sometimes folded parts of the chitinous membrane, occasionally
also booklets. The pulmonary tissue in the immediate neigh-
borhood of the cysts appears compressed, flaccid, either entirely
void of air, or containing very little of it. Echinococcns
multilocularis has once been found in the lung of a steer. Other
cysticerci are usually found in the other organs, particularly
in the liver.
Symptoms. Only if the invasion is considerable, does the
disease manifest itself by difficult respiration, which develops
very insidiously, and which, therefore, remains unnoticed for a
long time and very rarely takes on a threatening character.
With such difficulties of respiration, a cough appears ; it is fre-
quently heard after short intervals, usually weak, dull, some-
times even hardly audible. Difficulties of respiration and
cough may suddenly increase without any apparent cause (rup-
ture of a cyst into a bronchus or into the pleural cavity).
Sometimes exhaustion and overheating bring about an aggra-
vation of the condition. In case of rupture of a cyst, a watery
fluid is sometimes discharged through the nose, in which shreds
158 Chronie Interstitial Pneumonia.
of the chitinoiis membrane of tlie ruptured ecliinococcus can
be seen (Bolz).
The percussion sound remains normal if onlj' small cysts
are present or if the cysts are limited to the more central pul-
monary portion. If they are more numerous and larger, cir-
cumscribed areas of dullness are found in various portions of
the thorax. The percussion sound is more rarely tympanitic
and the cracked-pot sound may be heard in animals with a
more yielding- thorax, because cysts may be crowding each
other or may be situated near the pulmonary surface. Metallic
sounds may possibly be heard over cysts which have become
empty. The areas of dullness exhibit diminution or absence
of vesicular breathing sounds. Also whistling, purring and
other noises. A peculiar noise called "quurksen" by Harms
is characteristic for the disease, which noise is claimed to be
identical with the sound elicited on rolling and pressing a lung
containing echinococcus cysts. Since it is impossible that a
noise arises in the cyst synchronously with respiration, such
noises must arise in the bronchi. They are simply catarrhal
noises and cannot be characteristic of echinococcus of the
lung.
The general condition of nutrition of the animals remains
satisfactory for a long time. However, when the disease of
the lungs reaches a high degree, and when it is associated with
ecliinococcus of the liver, the animals suffer later on in their
nutrition. The affection takes an afebrile course.
Diagnosis. Only severe cases can be diagnosticated with
more or less probability, especially in cattle. One of the most
important points to be observed is the presence of severe res-
piratory difficulties, while the general nutritive condition of
the animals shows only very insignificant disturbances. A con-
comitant increase in the size of the liver must direct suspicion
toward echinococcus infection. In special cases one might
make use of the complement-fixation test which has been found
reliable in animals by Weinberg and Yieillard ; in man by Putzu.
Cough is more powerful, frequent and convulsive — at least in
the beginning of pulmonary tuberculosis; the temperature is
elevated. There are also s>anptoms of a more or less extensive
bronchial catarrh and the nutrition of the animals suffers at a
comparatively early stage. Pulmonary tuberculosis is distin-
guished by a more extensive dullness, by bronchial breathing
and by a more rapid development which is accompanied by
fever.
Treatment. There is no successful treatment of the dis-
ease ; hence early slaughter of the animals is advisalile, because
otherwise their value is decreased in consequence of emacia-
tion which will come on.
Literature. Bolz, W. f. Tk., 1907, 28.— Martin, Rev. vet., 1907, 734 (Lit.).
(Also see literature on echinococcus of the liver.)
Plate I. Enlargement of tuberculous nieiliastinal glands in a dog. ((.
Mediastinal lymph-gland which takes up almost the whole portion of the
thorax situated above and behind the heart, with the exception of a small
strip (c) ; h. trachea with its main branches; c. and d. pulmonary
tissue filled with air; e. heart; /. apex of the diaphragm with the liver
(indistinct on account of respiratory movements) ; g. humerus and be-
hind it the shadow of the muscles (Eontgenograph).
Other Parasites in the Lungs. Neoplasms of the Lungs. 159
Other Parasites in the Lungs.
Distomatosis of the lungs is frequently seen in cattle, rarely in
sheep, exceptionally only in hogs, buffaloes, horses, asses and drome-
daries. The invasion of the lungs is brought about in such a manner
that hepatic distomas get into the hepatic and from there into the pul-
monary vessels. Globular cysts from walnut to apple size are then
formed in the pulmonary tissue, preferably in the posterior cutaneous
lobe, which have a fibrous, sometimes calcified capsule, and may, in
sheep or young cattle, be surrounded by hemorrhagically infiltrated
tissue. In the yellowish or olive green contents of the cysts the ova of
distoma are foiind and occasionally one, oxceptionally two of the liver
flukes.
Lung distomatosis usually does not lead to any clinical symptoms ;
occasionally there may be cough, possibly also a circumscribed dullness
on percussion, also rales. Emaciation occasionally occurs, but it is then
probably due to a simultaneous distomatosis of the liver.
Lung pentastomosis caused by Pentiistomum denticulatum or
Linguatula denticulata has been observed in a few cases, viz., in the goat
(Gerlach, v. Ratz) ; in the roe (v. Ratz), and in cattle (Hermann, Lung-
witz). The larvge of pentastomum burrow canals into the pulmonary
tissue and frequently also into the pleura? ; numerous hemorrhagic foci
are formed thereby and the animals may die from cachexia (v. Ratz).
Worm-nodules and cysticerci, sometimes seen in the lungs of horses
and cattle, are without clinical significance (see liver cysticercosis con-
cerning the occurrence of Cysticercus tenuicollis).
Literature. Lungwitz, Z. f. Flhyg., 1S93, III, 218. — Neumann, Mai. paras.,
1892, .560.— V. Eatz, Cbl. f. Bakt., 1893, XII, 329.— Regnier, Rev. gen., 1908, XI, 131.
13. Neoplasms of the Lungs. Tumores pulmonum.
Tumors of the lungs are not very rare ; they are, however, less im-
portant from a clinical standpoint, because it is very difficult to diag-
nosticate them. Most frequent are carcinomata and adenocarcinomata
(especially in dogs), then sarcomata and melanosarcomata (in horses)
as a rule as metastatic neoplasms. Fibromata, chondromata, lipomata,
osteomata, dermoid cysts are occasionally encountered. Botryomyco-
mata are sometimes found in horses.
The symptoms which might be detected in the living animals are
on the whole very indefinite in nature, because usually they refer only
to a diminution of the respiratory surface; possibly also to an infiltra-
tion of parts of the pulmonary parenchyma with bronchial catarrh ; the
clinical picture then may be similar to chronic interstitial pneumonia.
Sometimes tumors may press upon the heart or upon the larger blood-
vessels and may thus bring about congestion in the territory of the
jugular vein with hydropic symptoms (see compression of the heart, Vol.
I), or there may be compression of a larger bronchus. Very gradually
increasing dullness, eventually in combination with bronchial breathing
sounds, confined to a certain portion of the thorax, may be observed
and may give some information concerning an existing dyspnea. Intra-
thoracic tumors in smaller animals may be recognized easily in the
160 Neoplasms of the Lungs.
Roentgenogram anpanitic sound in
smaller animals is furnished in a comparatively considerable
diminution of the sounding column of air enclosed in the thorax.
Auscultation show^s absence of friction sounds in the area
of dullness; further upward they are, however, commonly
heard later on. The other respirator}^ sounds are likewise
much diminished or absent in the area of dullness, and along
the upper boundary indefinite or bronchial breathing is lieard
in many cases. If, however, the lung has become adherent at
the onset of the disease or previously, bronchial l)reathing is
heard also in the area of dullness. The vesicular breathing is
intensified above the area of dullness and on the healthy side.
The apex beat is weakened on the diseased side and the
heart sounds are duller and weaker. Toward the termination
of severe cases the sjanptoms of cardiac weakness appear.
The temperature (Figs. 27 and 28) does not give a typical
curve. Great variations of temperature are usually seen in
the later course of the disease. Remittent or continuous fever
in less acute cases is occasionally interrupted by fever-free in-
tervals. Very high fever is usually seen in purulent or ichor-
ous pleuritis.
Continuous standing during the course of the disease is
frequently observed in horses. If the animals lie down ex-
ceptionally they rest on the sternum or on the healthy side, as
do other animals in the beginning stage of pleurisy, in order to
protect the tender portions of the thorax against pressure ; after
an exudate has been formed they lie on the diseased side, so
that the healthy portions of lung have a chance to expand. If
animals in this stage are, during examination, placed upon the
healthy side, the dyspnea is at once markedly increased and the
animals may even suffocate, because the healthy parts of the
lungs are compressed l)y the body weight, and the affected por-
tions by the exudate.
The appetite is capricious and only becomes normal after
recovery has set in. If the disease lasts for a long time the
animals become markedly emaciated.
The amount of urine is diminished in the beginning; the
amount of chloride of sodium diminishes markedly as the exu-
date forms, while its absorption leads to an increase of urine
and of its chloride of sodium contents (urinary crisis). Al-
Complications.
169
biiminuria is not uncommonly present durinj
disease.
Complications are fre-
quent, even if the primary
diseases followed by a sec-
ondary pleurisy are left out
of consideration. Very im-
portant, as a complication,
is pericarditis, because it may
lead to complete cardiac ex-
haustion. Delacroix found
embolism in the puhnonary
arteries in a horse which died
suddenly during recovery from
pleuritis; the origin of the
embolism was found in a
thrombotic, bent posterior
vena cava. An abscess is
sometimes found in the wall
of the thorax in purulent and
ichorous pleuritis ; the abscess
breaks outside, or it opens into
one of the thoracic organs,
into the lungs, or through a
cavity of the latter into a larger
pharynx, mediastinum, etc.
the course of the
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pneumonia) .
According to Guittarcl, pleuropneumonia of fowl at first leads to
listlessness, cbminished appetite, retarded digestion, and after several
days to great prostration, the comb becomes pale and the respiration
170 Inflaniniatiou of the Pleura.
forced. In the further course of the disease the animals die quickly
after diarrhea has set in. An exact diagnosis can only be made on post-
mortem examination.
In the beginning and often during its whole course, chronic
pleuritis does not lead to very prominent sj^nptoms, which be-
come marked especially during exercise. If there are extensive
adhesions, the vesicular breathing is less marked, but the percus-
sion sounds remain normal. In the presence of serous or more
purulent exudates in the thoracic cavity, after certain occur-
rences, for instance after hard work or after a cold, one ob-
serves acute exacerbations which, in addition to already exist-
ing areas of dullness and diminution or absence of breathing
sounds, lead to tenderness of the thoracic wall, marked dysp-
nea, dry, rough cough and moderate elevation of temperature.
Displacement of the heart by the exudate leads to change of the
apex beat and in the intensity of the different heart sounds in
various places of the cardiac region; disturbances of circula-
tion may also be present (stronger filling of the veins, presysto-
lic venous pulse, edematous infiltrations). (See compression of
the heart, Vol. I.)
Disturbances of nutrition appear sooner or later. The
hair becomes lusterless and ruffled, the skin dry and less elastic;
emaciation gradually reaches a high degree, the production of
milk diminishes, the symptoms of cardiac weakness come on
and the animals die exhausted and emaciated.
Course. Very mild cases of fibrinous pleurisy sometimes
run a very rapid course, occasionally one of a few hours only.
The symptoms may be of a very minor character, very insig-
nificant tenderness, soft friction sounds ; otherwise nothing ab-
normal can be detected in the chest. These symptoms may en-
tirely escape notice, as is proved l)y the well-known fact that
thickening of the pleura and adhesions are not infrequently
found in animals wdio have always been under observation and
who never showed symptoms of pleurisy.
The fonnation of an abundant fluid exudate often requires
a long period of time; sometimes, however, the pleural cavity
may become filled within a few days to over one-half of its
space. The increase of the exudate usually occurs periodically
and is accompanied by elevation of temperature. Occasionally
the exudate only increases to such an extent that life is not en-
dangered for several months.
Pleurisy with exudate may end in complete recovery, espe-
cially when the exudate is not very fibrinous or is purely
serous. In the majority of cases chronic tissue changes, such
as thickening and adhesions, remain as permanent residua.
Whenever the quantity of the exudate is considerable, its ab-
sorption requires several weeks and is interrupted by tem-
porary relapses. Adhesions which have been formed may sub-
Diagnosis. 171
sequently interfere with the proper movements of the lungs.
Most dangerous in this respect are adhesions at the lower pos-
terior thirds of the lungs, or the lower posterior margins. An-
imals with adhesions in these parts usually suffer for the rest
of their lives from shortness of breath, even if their general
state of nutrition is good. Adhesions of the lungs may also
bring it about that the portion which is fixed in an abnormal
place is unable to return to its normal place after the exudate
is absorbed. The neighboring portions must then expand more
extensively, the heart may be displaced toward the affected
side and the thoracic wall may eventually be depressed.
Chronic pleurisy does not terminate in complete recovery,
particularly since the compressed pulmonary tissue becomes
permanently solid, on account of the collapse of the alveolar
walls, and on account of the connective tissue proliferation.
Such animals are easily tired out when worked, their nutrition
is not good, they cough periodically, breathe with difficulty and
the presence of an exudate in the lower portion of the thorax
can be demonstrated objectively.
Chronic pleurisy sometimes develops as such from the start and
only reaches a high degree after months. According to Rigot and
Cruzel, this form is particularly common in cattle, and as Lafosse and
Trasbot state, particularly after milder, but fre(|iiently recurring, colds.
A fatal termination of pleurisy occurs in acute cases usu-
ally after two to three weeks, in consequence of suffocation or
exhaustion. Before death the sick animals show great dyspnea,
the nostrils are convulsively dilated in each inspiratory act,
the ribs are extensively elevated with a simultaneous elevation
of the spinal column and the mucous meml)ranes are cyanotic.
The animals finally fall down, try several times to get up again,
kick around the floor and die in convulsions. Death sometimes
comes on quite unexpectedly with the symptoms of cardiac
weakness during an attack of suffocation. In some chronic cases
the animals succumb completely prostrated.
Diagnosis. The only pathognomonic sign of pure fibrinous
pleuritis is the friction sound heard synchronously with the
respiratory movements. If, however, in the course of a dis-
ease which is usually followed by pleurisy, tenderness of the
intercostal spaces come on, one is justified in thinking of the
probability of a beginning pleurisy. Rheumatism of the inter-
costal spaces (pleurodynia) is very rare and can be distin-
guished from pleurisy, even in the absence of friction sounds,
on account of marked general disturbances which are present
in pleurisy, by the accelerated and weak pulse, acceleration of
the superficial, so-to-say trembling, respiratory movements.
Affections of the ril)s (fracture, periostitis, caries) are charac-
terized ])y swelling and tenderness confined to the ribs, as well
as by the absence of general symptoms.
172 Inflammation of the Pleura.
Pleuritis with fluid exudate is characterized by the following
clinical picture : marked horizontal dullness, often on both sides,
strong increase of resistance and the absence of respiratory
sounds in the area of dullness. Exploratory puncture may be
necessary to clear up a doubtful case. Croupous pneumonia is
differentiated by the presence of an area of dullness which is
bounded upward by a curved line or which rises or falls pos-
teriorly, and by bronchial breathing which is audible at least
from time to time. The initial symptoms are also very different.
The onset of pneumonia is characterized by a reddish yellow
discoloration of the mucosae, eventually by a rust-colored nasal
discharge, by deep and difficult respiration and by a strong
pulse; in the beginning of pleurisy the respiration is much
accelerated, superficial, almost trembling ; the pulse is hard and
small and the hand placed on the chest wall can detect a mus-
cular tremor. The fever curves of the two diseases differ mate-
rially. The course of the fever in pleurisy is similar to that in
catarrhal pneumonia ; however, a continuous area of dullness
is either absent or it is shaped as in croupous pneumonia.
The difficulties increase, however, when it must be decided
whether pneumonia and pleurisy exist simultaneously^ The
shape of the area of dullness is then not decisive, because
fluid below and infiltrated lung floating on it above may give
a curved boundary line of the area of dullness. One also hears
bronchial breathing sounds in the floating lung especially near
the upper boundary of the area of dullness, as it is often found
in croupous pneumonia. The behavior of the apex beat and
of the heart sounds often is decisive; a diminution in their
intensity points to pleurisy. Important also is the presence of
edema on the inferior thorax, which does not occur in pneu-
monia.
The differential diagnosis between pleurisy and pleuro-
pneumonia in cattle may be difficult when pneumonia consoli-
dation exists simultaneously with pleurisy. The concomitant
circumstances, such as the possibility of importation of the con-
tagion must then be considered. A suspicion of the existence
of pleuropneumonia appears justified where subacute or chronic
pleuritis or pleuropneumonia are found and where the possi-
bility of a contagion cannot be excluded.
Pleuritis may be distinguished from pericarditis by the
fact that in the former case the apex beat is not as much inten-
sified and as rhythmic as in the latter case ; the friction sounds
in pleuritis are usually heard on one side only, they are influ-
enced by the respiratory movements, and friction sounds and
tenderness of intercostal spaces are usually found in other areas
aside from that of the heart. Apex lieat and heart sounds are
almost absent in pericarditis with effusion; this is contrary to
what is found in pleurisy.
Anamestic data and the eventual simultaneous presence
Diagnosis. Prognosis. 173
of other patliologic processes deserve full consideration in es-
tablishing the particular nature of existing- pleurisy, which may
depend upon a lourulent inHamniation of neigh))oring or more
distant organs ; purulent or ichorous pleurisy sometimes occurs
after penetrating wounds of the thorax. Pleurisy accompanying
chronic affections of the lungs (tuberculosis, glanders, actinomy-
cosis, hmgworm disease) is usually filirinous or serofibrinous.
In tuberculosis and in cachectic processes in general it may
also be hemorrhagic. Assistance in the diagnosis may be af-
forded in cattle and also in dogs by a tuberculin test. The char-
acter of the exudate is best ascertained by an exploratory punc-
ture, which is perfectly void of danger and which should be
performed in all doubtful cases.
^-^C
Fig. 29. Sediment of an exudate in serofibrinous pleurisy of a horse, a, polynuclear
leucocytes ; h, red blood-corpuscles ; c, endothelial cells in a condition of fatty degen-
eration.
The exploratory puncture is best made with a hypodermic syringe; its needle
is pushed into the area of dullness, into the pleural cavity, best in the sixth or
seventh intercostal spaces. In withdrawing the piston of the syringe, fluid often
enters even if the needle has been pushed into masses of fibrin. The end of the
needle may touch the lung and in this manner we may eventually gain some informa-
tion about the consistency of the lungs; if the needle has been pushed into the
lung parenchyma, we get pure blood or, in the presence of pneumonia, a bloody
stained fluid. The fluid obtained by puncture may be used for bacterioscopic
examination and for animal inoculation.
The prognosis depends upon the etiologic factors, the char-
acter of the exudate, the species and the age of the animals
affected. Pure fibrinous pleurisy following croupous pneumonia,
is not of very grave significance, but the accumulation of a fluid
exudate under these and other circumstances is usually an un-
174 Inllaiumation cf the Pleiwa.
favorti))le syniptoiii. Cases with lii,i;li fever, cliills and great
prostration, witli rapid increase of the exudate, usually take
an unfavorable course. A guarded prognosis is, however, indi-
cated even in less tempestuous cases, liecause relapses are com-
mon and may lead to a fatal issue. Speedy death must be ex-
pected in purulent and ichorous pleurisy. The formation of a
jiemorrhagic exudate into the pleura under marked acute s;saup-
toms also has an unfavoralile significance.
In considering the prognosis one must also think of the
sequelae which may materially decrease the value of the animal.
Adhesions usually remain after a pleurisy which has lasted
three to four weeks ; relapses and the formation of an area of
permanent dullness exclude the possil)ility of complete recovery.
Treatment. The most important measures are the estab-
lishment of favorable hygienic conditions, regulation of diet
and nutrition of the animal following the same principles as
laid down for the treatment of croupous pneumonia (see page
120). Energetic antiphlogistic treatment is indicated in the
beginning of pleurisy when friction sounds are still present.
To this end the thoracic wall should he irrigated with cold
water, or snow or ice should be applied to the tender region.
This must be continued until the sensitiveness, the friction
sound, and the high fever has subsided. Good results may be
obtained in the beginning with these applications. Inunctions
with irritating or acrid substances, based upon the principle
of counter-irritation, appear less indicated, although they were
formerly much practiced.
Freneh veterinarians even today extensively employ the socalled revulsive
treatment by irritating' inunctions applied to the thorax from the start and alleged
to stop the inflammation. Venesection is practiced for the same reason. Trasbot
recommends the following treatment in acute cases; in the very beginning vene-
section, with the removal of an amount of blood in proportion to the existing
plethora of the animal, then energetic treatment with preparations of mercury,
salicylates and digitalis.
In the further course, beginning on the second or third day,
moist, warm applications may be made. Energetic inunctions
may be serviceable in delayed absorption, viz., spirits of mus-
tard, 6-10%, chloroform liniment (chloroform 10.0, liniment
volatile 40.0). These are to be applied twice or thrice daily
over the area of dullness, while more intensely acting drugs,
such as cantharidin, croton oil, euphorbium ointment, etc.,
should rather be left alone. Priessnitz' applications may be
employed two to three hours after the inunctions.
Note. — In human medicine applications of green soap have proved very efficient
means of stimulating delayed absorption of pleuritic exudates (see Report from
the Winyah Sanatorium, Drs. K. and S. von Euck, Asheville, N. C., 1911, page 4).
This should prove of value in animals also. The green soap is applied by friction
over the affected side after the skin has been washed with ordinary soap and hot
water. As a rule the application is made at bed time, is allowed to remain over
night and repeated daily, or less frequently, depending upon the tolerance of
Treatment. 175
the skin. When hyperemia occurs as an effect of irritation, this is allowed to
subside before the application is repeated. In many cases the skin is tolerant
enough to permit daily applications; in others marked hyperemia follows after its
first use in which event the soap must be diluted (Transl.).
Narcotics are to be employed in severe tenderness of the
thoracic wall and against tormenting cough. Fever requires
interference only when it is very high and when the affection
has set in in a very tempestuous manner ; then the drugs recom-
mended elsewhere (see page 122) are to be considered.
Diuretics are indicated in the presence of a diminished
excretion of urine ; powerfully acting drugs should however be
avoided. Aside from those medicines which were recommended
for croupous pneumonia (see page 122) the following are to be
recommended: digitalis (daily 3-7 gm. or to dogs as an infusion
1 : 100 in tablespoon doses, not to be continued longer than one
week; liq. potassii acetici (100-180.0 or 5-10.0 per diem, also in
combination with digitalis) ; oil of turpentine (10-15.0 or 1-2.0) ;
calomel (2-4.0 or 0.03-0.05) must be discontinued at once after
diarrhea has set in; common salt. To increase absorption the
following drugs are serviceable: pilocarpine (0.1-0.2 and for
small animals 0.005-0.01 gm. subcutaneously) ; arecoline (0.08
gm. for horses subcutaneously) and the laxatives, especially the
salts. Animals vntli cardiac weakness should not receive pilo-
carpine or arecoline.
The most reliable procedure to diminish the amount of the
exudate is puncture of the thorax (thoracocentesis), an interfer-
ence absolutely void of danger if performed with aseptic and
general precautions. Thoracocentesis is indicated especially
when there is immediate danger of suffocation and in purulent
and ichorous pleurisy. There exist, on the other hand,
numerous observations (Alniy, Lienaux, Frohner, Marek), which
show that puncture made repeatedly and immediately after the
exudate has formed may bring about a speedy amelioration even
if only a small amount of fluid has been removed. The often
observed favorable influence, even after the removal of a small
amount of exudate, may be explained by a diminution of the
pressure exerted upon the blood and lymph vessels of the pleura.
(There is hope for the absorption of the exudate then only if
the molecular concentration of the latter is not greater than that
of the blood plasma. This has been demonstrated in the case
of man by Ketli and Torday.) The primary affections, of
course, influence materially the possibility of successful treat-
ment in secondary pleurisy. Frohner is inclined to believe that
only those cases offer hope in which the exudate is free from
bacteria. A favorable result does not occur after puncture in
cases where the lungs have lost the power to expand.
The puncture is best made in the seventh intercostal space but on the right
side it may be made in the sixth space ; in larger animals 3 to 5 cm. above the costal
cartilages. The instrument may be simply a hollow needle provided with a long,
slender rubber tube, the free-end of which should dip into sterile water. A trochar
(Billroth 's trochar is particularly serviceable) is still better adapted which has
the canula provided with a stop-cock which should be closed after the withdrawal
1 76 Dropsy of the Thoracic Cavity.
of the stiletto; then a rubber tube can be fastened to the trochar. This simple proced-
ure does, however, not always lead to success, because the exudate rarely stands under
sufficient pressure to force the fluid out of the rubber tube. It is therefore frequently
necessary to enijiloy the aspirators of Dieulafoy or Potain, which will permit the
aspiration of fluid out of the thorax and ofi'er the additional ailvantage of preventing
the entrance of air into tiie thoracic cavity. The entrance of bacteria into the
thorax during puncture must by all means be prevented because this would lead
to a more serious and more malignant inflammation.
The evacuation of the exudate must always he brought about gradually and
slowly in order to avoid sudden changes of the intrathoracic pressure, as these
might lead to extensive cajiillary hemorrhages and paralysis of the heart. The
puncture must be intorrupteanp-
toms are usually absent, although in more severe cases there
may be a formation of crusts on the skin, general emaciation,
and a bad smell from the mouth.
Lienanx noticed in a row salivation, grating of teeth and diarrhea in addition
to the symptoms above described. Post-mortem examination showed erosions and
loss of substance along the whole gastro-intestinal tract similar to those in the
mouth. Artificial inoculation was not successful in contradistinction to what occurs
in contagious jiapulous inflammation. Hess mentions the occurrence of very small
vesicles in the center of nodules which burst soon and attain the size of a millet
seed to that of a pea.
Diagnosis. The presence of the peculiar flat, nodule-like
formations on the buccal mucosa, and occasionally on the muz-
zle, without disturbance of the general health and without in-
volvement of the feet, the slight extension of the lesions, their
eaten-out appearance, with only superficial loss of substance
suflficiently characterize the disease. It may be distinguished
from vesicular stomatitis by the absence of vesicles in the mouth,
and by the presence of the characteristic nodules in the neigh-
borhood of the existing erosions; besides there is increased se-
cretion of saliva in vesicular stomatitis. The same differential
features also distingiiish the affection from foot-and-mouth dis-
ease in which large vesicles are often seen on the back of the
tongue or on the feet. In aphthous stomatitis of sucklings,
pseudomembranous deposits are developed on the usually red-
dened tongue and the disease affects only sucklings and young
animals which have just been weaned.
Other Diseases Similar to Stomatitis.
193
Treatment. This is similar to that employed in vesicular
stomatitis. Considering the contagions nature of the disease,
sick animals should be separated from the healthy ones.
Literature. Degive, Ann., 1884, 369.— Deppe, A. f. Tk., 1899, XXV, 199.—
Haag, W. f. Tk., 1907, 906.— Hess, Kongr. Bern., 1899, 382.— Ostertag & Bugge,
Z. f. Infkr., 1905, I, 3.— Tiarks, Pr. \h., 1904, II, 72. (Compare also the literature
on Pseudostomatitis ; Pseudomaulseuehe.)
Other Diseases Similar to Stomatitis. Aside from aphthous
stomatitis of sucklings and from contagious papulous stomatitis, diseases
have been observed in cattle and exceptionally in sheep which, on the
basis of pathologic-anatomical changes, are best classified with aphthous
stomatitis. Among them are to be mentioned the following: sporadic
stomatitis (Maul- _
seuche, Utz), affec-
tions similar to foot-
and-mouth disease
(Bang, Stribolt, An-
dersen, Kern), pseu-
do mouth-disease or
stomatitis erosiva
(Pusch), thrush of
cattle (Hajnal), epi-
zootic inflammation
of the mouth of
sheep (Vigadi),
stomatitis ulcerosa
in cattle (Bedel),
p s e u d o foot-and-
mouth disease (Kan-
torowicz), stomatitis
mycotica ( Mohler ) ,
stomatitis pseudo-
aphthosa (Cadeac).
Concerning their
etiology, these af-
fections may be di-
vided into three
groups. The first
group comprises
those diseases w4iich
are contagious and
which consequently must be due to an infectious agency,
which in part of these cases may be the bacillus necrophorus (see Necro-
bacillosis). In the affections of the second group (Utz, Bruemmer,
Bang, Stribolt, Andersen, Kantorowicz) injurious food appears to be
the exciting cause. The appearance of such diseases has followed upon
feeding with green clover. They are not contagious. In the other non-
contagious diseases of this kind, nothing positive is known as to their
cause. Pusch believes that they may be due to some noxious agent which
becomes a disease producer only when the resistance of the organism has
been lowered by overexertion (as in railroad transit), irregular care or
Pscudu-Aplithoiis Liflamniation in Cattle
(According to Kern) .
194 Otlu'i- Diseases Similar lo Stomatitis.
sudden cluiiif^e in feed. Fungi and moulds linve Ix-en accused as the
causative factors. Iiut notliing has been proven in tliis respect.
It is not impossible that some of the forms here enumerated belong to the
contagious papulous form of stomatitis (see page 190).
As to tlie clinical picture, the aphthouslike diseases may, for con-
venience sake, l)e divided into two groups. In one group the buccal
mucosa only or possibly also the integument of the muzzle is involved.
The mucosa of the hard palate, the gums, more rarely the sides and the
tip of the tongue, the inner surface of the lips and of the cheeks, present
grayish-white to grayish-brown pseudomendiranous deposits on a more
or less reddened surface, or in other cases, round, intensely red erosions
up to the size of a silver quarter, the base of which is partly covered with
a grayish-red, or yellowish, thin, flaky or thicker deposit. In some
cases one also sees numerous pinhead hemorrhages in the papillae of the
mucosa. In some animals the muzzle shows lenticular prominences and
erosions of the epithelial covering (Fig. 30). Only exceptionally does
the disease assume a febrile course and lead to salivation and disturb-
ances in the ingestion of food.
The clinical picture of the second group is characterized by the
simultaneous affection of the buccal mucosa, of the integument of the
muzzle, of the integument of the extremities, and of the udder. With an
elevation of temperature, the appetite is diminished or entirely lacking.
Profuse salivation appears and smacking noises are heard just as in
foot-and-mouth disease. The mucosa of the mouth is intensely reddened
and covered with corrugated, diffuse, pseudomembranous deposits, espe-
cially on the hard palate, the gums, the inner surfaces of the lips. The
pseudomembranes come off in shreds and the erosions heal in a few
days. Lenticular yellowish-red or grayish nodules or crusts with a cen-
tral depression appear on the muzzle and exceptionally on the nasal
mucosa. Similar nodules sometimes appear on the mucosa of the mouth.
The lower extremities show evidences of a dermatitis which is similar
to that seen in clover diseases (see under this heading) ; on the skin
of the udder, nodules of the size of a lentil with several vesicles and
subse(|uent crust formation were seen by Kantorowicz.
Tlie disease always takes a favorable course either within a week,
or in the variety last described within two to three weeks, slight emacia-
tion having become manifest in the meanwhile.
The differential diagnosis has to consider foot-and-mouth disease.
It is distinguished by the simultaneous vesicular eruption at the ends of
the extremities and on the ])uccal mucosa, the involvement of the back
of the tongue and the absence of the peculiar pseudomembranes on the
mucous membranes of the mouth. In the forms of stomatitis here de-
scribed, the contagious character is usually absent, also the involvement
of the extremities and of the udder.
Treatment becomes necessary only in the more severe forms with
dermatitis at the extremities. The principles of the treatment are the
same as those in catarrhal stomatitis (see page 185). Most cases end in
recovery without any treatment at all.
Literature. Andersen, Maanedsskr., 1901, XTII, 182. — Bang, Maanedsskr.,
1899, XT, 1.57.— Bedel, Bull., 1904, .545.— Cadeae, J. vet., 1906, 556.— Hajnal, Vet.,
1900, 71.— Kantorowicz, Z. f. Tnfkr., 1906, TT, 550.— Kern, A. L., 1907, 387.—
Mohler, Eec, 1905, 112.— Pusch, D. t. W., 1906, l.-^.S.— Stribolt, Maanedsskr., 1901,
XI 11, 130.— TTtz., B. Mt., 1890, XXVI, 135.— Vigadi, A. L., 1905, 345; 1906, 423.
Thrush.
195
4. Thrush. Stomatitis oidica.
{Soorkranhlieit, Scliwaeuimchcn [GornianJ ; MiKjuct [French].)
The term thrush designates patches formed on the mucous
membrane of the mouth and pharynx by the mycelium of oidium
albicans or monilia Candida.
Historical. The disease has heretofore only been found positively
in fowls, especially in pigeons (Eberth, Martin). Its occurrence in
other animals is at present doubtful. (Gravitz has produced it experi-
mentally in a dog.) Ziirn described under the same name a disease
of foals and calves, but he has not demonstrated the typical fungus and
his description of spots and vesicles suggests that he was dealing with a
more severe form of stomatitis vesiculosa or stomatitis aphthosa.
Hajnal observed a contagious disease in young cattle which
he believed to l)e thrush, but he did not demonstrate the
fungus (see page 193). The fungus of thrush was discovered
in 1840 by Berg and Gruby, and studied more minutely by
Gravitz, and particularly by Plant (1887). The latter author demon-
strated the identity of oidium albicans and monilia Candida and the
transmissibility of thrush in fowls. (It is also found in man, almost
exclusively in infants or young children. [Translator].)
Etiology. Oidium albicans (saccharomyces albicans, mo-
nilia Candida) is probably only a stage in the development of
one of the liigher
hyphomycetes ^ ^ m
(Plant) with mnl- ^
tiple - branched
filaments wliicli
possess rounded
ends, while the
spores are oval,
elongated and
sharply circum-
scribed" (Fig. 31).
On solid media
the colonies con-
sist of roundish
cells only, Avliile in
fluid media tliey
become elongated
into extensive fila-
ments. The or-
ganism grows well
on decaying wood,
on fresh cowdung and in curdled, but not in fresh, milk (Plant).
It invades particularly the mouth of debihtated and young
animals, and the sojourn in damp, dark, poorly ventilated places
favors the appearance of the infection.
Fig. 31. Oidium ulhicans. From the mycotically de-
generated eye of an inoculated rabbit; hyphte, spores
and a number of leucocytes in groups. (From Plaut.)
196 Phlegmonous Inflammation of the Mouth.
Martin and Klce claim to have observed the transmission of thrush
from sick cattle to chickens and to one turkey.
Symptoms. The characteristics of thrush are grayish-
white or yellowish, later on brownish points, spots or even
larger psendomembranes adhering to the underlying tissue,
which does, however, not show any signs of inflammation. Dur-
ing the course of the disease, the most superficial epithelial
layer perishes and the colonies of fungi now are seen on the sur-
face. However, this occurrence does not loosen the intimate
connection of the fungi with the tissues. Similar psendomem-
branes are found in the pharynx and in the crop; when this
occurs, the birds are listless and perish in spite of good appe-
tite. (See catarrh of the crop.)
Under the microscope one sees in the scraped off masses, besides desquamated
epithelia, some round cells and numerous curved and straight filaments and between
the latter spores.
Diagnosis. Thrush is distinguished from aphthous and
other inflammatory forms of stomatitis by the absence of an in-
flammatory reaction in the neighborhood of the lesions. It is
necessary to demonstrate the typical fungi microscopically be-
fore an absolute diagnosis can be made.
Treatment. The mouth must be kept clean and it may be
painted with a 2.5% solution of borax, or, according to Klee,
with a solution of bichloride of mercury (1:1000). If the lat-
ter solution is employed, great care is required. If the crop
is involved, it should be irrigated with a 2% boracic acid solu-
tion. (See catarrh of the crop.)
The places where the fowls are kept should be washed with
bisulphate of calcium ; the feeding vessels should be disinfected
by scalding. In this manner a spread of the disease may be
prevented.
Literature. Klee, Gefliigelkrkh., 1905, 81.— Martin, M. Jb., 1882-83, 125. —
Voigt, Hb., f. p. M., 1903, I, 575 (Lit.).— Zurn, Pfl. Parasiten, 1874, 188;
Gefliigelkrkh., 1882, 130.
5, Phlegmonous Inflammation of the Mouth. Stomatitis phleg-
monosa.
{Stomatitis erysipelatosa, S. erosiva.)
Etiology. After the ingestion of large masses of food con-
taminated with rust and other fungi, a severe inflammation of
the buccal mucosa is occasionally seen in horses and exception-
ally ill sheep, complicated by suppuration and necrosis of the
submucous connective tissue. De Hahn & Hoogkammer saw
in East Indian horses an inflammation of the skin of the
Etiology. Symptoms. 197
face, complicated with erysipelatous stomatitis, caused by fungi
(liypliomycosis destruens equi). (See Vol. I.) Food wliicli
contains many caterpillars or tlieir hairs (porthesia chrysor-
rhea, bombyx processionalis) may act likewise. Liithens and
Koster have shown experimentally that otherwise good food,
but mixed with procession caterpillars or their hairs spread on
oak leaves, was able to produce a severe stomatitis in horses.
Irritants, such as lye, acids, carbolic acid, croton oil, and
scalding of the mouth, are likewise able to produce severe stom-
atitis. Traumatic lesions of the mucosa may give rise to in-
flammatory processes of the deeper tissues.
The disease may appear secondarily after purulent or
gangrenous processes of neighboring organs (purulent inflam-
mation of the entrance of the esophagus) or in connection with
infectious diseases, such as strangles, cattle plague, anthrax,
hog cholera, morbus maculosus (purpura hemorrhagica), ma-
lignant catarrhal fever, diphtheria of fowl or calves, dog
typhus. Erysipelatous inflammation of the tongue forms part
of the picture of the disease known as blue-tongue of sheep in
South Africa. (See Vol. I.)
Symptoms. The disease sets in with distinctly inflamma-
tory phenomena, great tenderness, intense reddening and swell-
ing of the mucosa ; these are generally accompanied by an ele-
vation of temperature. The swelling later on increases still
more, and external inspection shows particularly swelling of
the lips and of the neighboring portions of the cheeks. The
swollen lower lip has fallen and a profuse saliva drips in long
tlireads from the corners of the mouth. The mucous membrane
on the inner side of the lips and cheeks is very tense, bluish-red,
and forms thick folds back of the teeth, on the floor of the buccal
cavity, but especially on both sides of the lingual ligament.
The swelling of the tongue is sometimes so extensive that its
tip protrudes between the incisors and the organ shows on its
lateral margins the impressions of the molars, and on the tip
the impressions of the incisors ; it is, at the same time, tense and
hard.
In the further course, symptoms of pharyngitis make their
appearance, and interference with the ingestion of food and
water may become complete. The nasal mucosa may also be-
come involved and then a mucous yellowish-brown nasal dis-
charge appears. The submaxillary and the peripharyngeal
IjTuphatics become swollen, hard and painful.
At this stage, the disease has, in most cases, reached its
height and recovery sets in slowly. In the severe cases, how-
ever, pale yellowish, mushy deposits and pustules appear on
the swollen mucosa up to the size of a pea (observed by
Bertsche in sheep) and these again lead to the formation of ir-
regular, angry-looking ulcers. Occasionally abscess formation
occurs with ichorous, dirty, ill-smelling pus, mixed with frag-
198 Ulcerative lullaiuniatioii of the Buccal Cavity.
nients of necrotic tissue and parts of food stuffs. In these cases
there is fever, listlessness, and indican appears in the urine.
Course and Prognosis. The primary form of phlegmonous
stomatitis generally takes a favorable course. If there is no
necrosis of tissue and no abscess formation, complete recovery
usually takes place within two or three weeks; even in the
severest cases recovery may occur under the proper surgical
treatment. Exceptionally, however, the inflammatory process
spreads to the larynx, the posterior wall of the pharynx and
along the trachea, which then usually leads to an unfavoral)le
termination. The latter also occurs in secondary stomatitis,
especially if it occurs in connection with anthrax, hemorrhagic
septicemia or with other malignant affections.
Treatment. If the inflammation has been caused by nox-
ious food, a change of the latter and of pasture must be in-
stituted. Besides, irrigations and mouth washes, as generally
used in stomatitis, are indicated; purulent and ichorous inflam-
mation requires proper surgical interference.
Literature. Berndt, A. f. Tk., 1887, XTTI, 364.— Bertst-he, B. Mt., 1890,
137. — Klimnier, Veterinarhygieue, 1908, 20-4, 230 (Lit.)-— Koster, Pr. Mil. Vb.,
1889, 84.— Zurn, Pfl. Parasiten, 1874, 187.
Stomatitis Gangraenosa Agnorum. Gangrenous Stomatitis of
Lambs. Riolta repeatedly has observed a severe epizootic disease of
young lam])S characterized l)y the appearance of vesicles up to the size
of a copper cent, with thickened margins. Most of the sick animals die
within a few days, and the post-mortem exaniination, aside from the
lesions of the month, always showed tnbercledike foci in the liver. In
these foci was found the bacterium subtile agnorum which produced
ulcers on the mucosa on being inoculated into the buccal cavity of
healthy animals. (Rivolta, Giorn. di Anat. fisiol. e pathol. 1883-78.)
6. Ulcerative Inflammation of the Buccal Cavity. Stomatitis
ulcerosa.
{Mundfaeule [German] ; Stomacace.)
Ulcerative stomatitis is especially a disease of carnivora,
consisting in an acute inflammation of the g-ums, which soon
leads to necrosis and ulcerative destruction.
Severe forms of stomatitis of herbivora caused by spoiled food, in-
cluding aphthous stomatitis, are included in this affection by some
authors (Friedberger & Frohner, Gips, Cadeac). But their clinical pic-
ture is so different from that of stomatitis ulcerosa, that such a classifi-
cation does not appear justified.
Etiology. The disease generally occurs among highly
bred pet dogs and cats, especially among weakly and anemic
Etiology. Syniploins. 199
animals, after distemper or in the course of rachitis, etc. Older
dogs with tartar and caries of the teeth are affected most fre-
quently, particularly if they have been nourished insufficiently.
The direct causes of tlie inflammation and of tlic subsecjuent tissue
necrosis are not known. The character of the morbid process points
to an infection as does likewise the experience that a simihir disease in
man frequently assumes an epidemic character. Tartar on the teeth
predisposes to infection in consequence of the loosening of the gums ;
anemia and cachexia act by diminishing the resistance of the tissues.
It is possible that patliojicnic bacteria, wliieh are normally found in the saliva
may have part in the causation of the disease. Fiocea has demonstrated a bacillus
salivarius septicus and the staphylococcus pyogenes aureus in tlie saliva of dogs
and the l)acinus coli communis in the mouth of sucking eats. One also must think
of the presence of the bacillus necrophorus. However, inoculation of material
from sick into healthy animals has not been successful in transferring this disease
(Cadeac).
Exceptionally a stomatitis which is primarily benign may
pass over into an ulcerative inflammation in consequence of
secondary specific infection. The disease also appears as a
part of the clinical picture of the infrequent scorbutus in dogs
and swine and of chronic hog erysipelas. (See Vol. I.)
The disease is similar in its symptoms to inflammation of
the mouth seen in connection with mercurial poisoning after re-
peated inunctions with gray ointment or after excessive injec-
tions of corrosive sublimate (stomatitis mercurialis). (Accord-
ing to Cadeac 's experimental investigations, the real cause of
this affection is claimed to be the bacillus necrophorus.) Some-
times other agencies like lead, copper or phosphorus may have
a similar effect.
Symptoms. The inflammation l)egins almost without ex-
ception at the margins of the gums, around the neck of the in-
cisors of canines, especially in the spaces between the individ-
ual teeth. The gums of the molars usually become aifected la-
ter. The gums at the affected places appear dark or sometimes
bluish-red, swollen, very painful, and on being touched l)leed l)ut
slightly. After one or two days, the free margins of the gums
become changed into a pale yellowish or dirty-greenish smeary,
mushy mass, which can easily be removed; the live tissue in
their neighborhood looks bluish-red and swollen. After the ex-
pulsion of the mushy masses, one sees, around the neck of the
teeth, ulcers with margins and bases covered by necrotic, dis-
colored detritus. The erstwhile round ulcers become confluent
forming an ulcerated discolored surface; the necks of the teeth
are left uncovered. After the process has spread into the
alveoli, the teeth become loosened and can be extracted easily,
or they may fall out spontaneously.
In the further course similar ulcers are formed on the mu-
cosa of the lips and cheeks ; these ulcers are found opposite the
200 Ulcerative Inflammation of the Buccal Cavity.
primary ones on the gums and tliey are probably due to contact
infection. Tiie lips and the cheeks become swollen. In very
severe cases the inflammation may extend into the maxillae and
cause necrosis of portions of the bone.
Sometimes, however, the process may begin on the lips or
at the angle of the lips and may extend toward the neighbor-
ing portions of the integument (Noma) while the giims remain
intact. (Friedberger & Frohner.)
There is always an extremely disagreeable, repulsive,
sweetish, cadaverous smell present, emanating from the buccal
cavity (foetor ex ore), which pervades the whole space in which
the sick animal is kept. There are also s^^llptoms of acute ca-
tarrh of the mouth, especially profuse salivation. The saliva
is fetid, mixed with necrotic shreds and also with blood. The
submaxillary and the cervical glands are acutely swollen and
the inflammation extends also to the salivary glands. The in-
creased tenderness disturbs mastication, and the animals either
take only fluid food or they swallow soft pieces of meat without
chewing.
Later on the s^^nptoms of septic infection develop, such as
febrile elevation of temperature, rapid small pulse, diarrhea,
prostration ; the rapidly emaciating animals soon succumb.
Course. The disease takes a favorable course under favor-
able h3^gienic conditions, with the proper treatment and if the
patients are still in good condition of nutrition. The inflamma-
tory and necrotic processes become limited, the necrotic por-
tions are shed and healthy granulations form from the margins
and from the base of the ulcers. The disease ends then in com-
plete recovery within one to two weeks. If the cases are neg-
lected, the animals become much emaciated and a general infec-
tion or exceptionally an aspiration pneumonia with pulmonary
gangrene develops. (Miiller has observed this course in a dog,
the authors a similar case in a lion.)
Diagnosis. Since ulcerating stomatitis may form an ac-
companying sjanptom of scurvy, the other symptoms of this dis-
ease must be looked for; the absence of hemorrhage indicates
that the stomatitis occurs independently. In young pigs
chronic erysipelas must be excluded; only the history and the
accompanying conditions can usually give information as to
whether the ulceration is due to poisoning.
Treatment. Next to washing and irrigation of the buccal
cavity with solutions already mentioned (page 185), careful
cauterization of the ulcers with nitrate of silver is indicated.
Crusts form on the cauterized places and, after the shedding
of the former, clean granulating surfaces appear. Painting
with the following solutions also gives favorable results:
1-2% solution of nitrate of silver, 2-3% solution of
Other Diphtheritic Inflammations of the Mouth. 201
chloride of zinc, pure turpentine, 5-10% solution of tannic acid,
glycerine, 3% solution of creolin; deodorizing solutions may be
used in addition, such as 0.3% solution of potassium perman-
ganate. After the ulcers have become clean, mild disinfectant
and astringent solutions are indicated.
During treatment, the animals have to be fed suitably with
liquid, juicy nourishment (milk, meat). The teeth whicli have
already become loosened must be removed, a procedure which
in the beginning of the disease occasionally leads to a rapid
termination of the pathologic process.
Literature. Cadeac, J. vet., 1907, 484.— Hebrant, Ann., 1903, 11.
Other Diphtheritic Inflammations of the Mucosa of the Mouth.
Aside from hog cholera and diphtheria of calves and older cattle, other
distinct diphtheritic inflammations occur occasionally on the mucosa of
the mouth. Bang and Lanritsen saw diphtheritic pseudomembranes in
hogs, (Lauritsen in very young sucking pigs), on the mucosa of the
lips and the buccal cavity in connection with a painful swelling of the
skin in the neighborhood of the snout, occasionally with diphtheritic
necrosis of the mucosa of the septum of the nose. This was associated
with very rapid emaciation. Stallmann saw a similar disease in goats
Avith salivation, disturbed deglutition, lack of appetite, and high fever;
most of the animals died. In the case of young pigs, curetting of the
necrotic tissue followed by astringent irrigations gave good results.
(Lauritsen, Maanedsskr. 1903, XV. 121.— Stallmann, Pr. Mt. 1880, VI.
51. See also Necrobacillosis.)
Section II.
DISEASES OF THE SALIVARY GLANDS.
1. Salivation. Ptyalism.
{Speichelfuss [German] ; Salivatlo, Sialorrhoe.)
Etiology. Salivation is almost without exception a purely
secondary symptom, seen most frequently in inflammation of
the mucosa of the mouth and pharynx and due to a reflex irrita-
tion of the nerves which regulate the activity of the salivary
glands. It is also a frequent, though not constant, symptom of
parenchymatous inflammation of the salivary glands. Certain
chemicals, especially mercury, pilocarpine, arecoline, nux vom-
ica, more rarely arsenic, iodine, lead and copper likewise in-
crease the secretion of saliva; also acrid substances and food
contaminated with rust and other fungi. Disturbances of deglu-
tition also are accompanied by salivation ; this is especially seen
in pharyngitis, in spasm and paralysis of the larynx, and in
diseases of the esophagus. Diseases of the gastric mucosa (ul-
cer, catarrh, inflammation) may cause salivation by reflex irri-
tation. Whether certain diseases of the sexual organs stand
in a causal relation to salivation is a point not yet settled in
veteriliary literature. Anacker reports the interesting obser-
vation that a horse always showed salivation when taken to the
knacker's yard.
Symptoms. Saliva flows abundantly out of the mouth,
particularly at the corners, either as foam or in long strings,
and contaminates tlie food and other nearby objects. Long-con-
tinued salivation finally leads to emaciation. Aside from these
symptoms, the primary cause can generally l)e recognized.
Treatment. Apparently, primary cases of salivation may
be treated by the subcutaneous injection of atropine (for large
animals, 0.05-0.1 gm. ; for small ones, 0.005-0.02 gm.) or scopo-
lamine (0.01 or 0.002 gm.). This leads, however, usually only to
temporary relief. In a case of Dieckerhoff's, continued treat-
ment with arsenic (horses, 0.05-0.8 gm.) led to permanent im-
provement, while Ziindel was successful in the treatment of a
cow with iodide of potash. In most cases, the treatment must
202
Iiiflanimatiou of the Parotid Gland. 203
be directed against the underlying primary condition and no
direct treatment of the salivation is required. Diem obtained
recovery in a case due to swelling of the parotid gland by re-
peated injections of pilocarpine, followed by inunctions with
an iodine-iodide of potash ointment.
2. Inflammation of the Parotid Gland. Parotitis.
Etiology. Parotitis occurs, as a primary affection, with
comparative frequency among domestic animals, after trau-
matic injury of the parotid region. It occurs rarely in epi-
zootic form as a specific infection among cattle, horses, dogs,
cats and goats. The cause of this form of the disease is prob-
ably an infective agent gaining entrance into the glandular tis-
sue either through the salivary duct or through the general
blood circulation. The analogous disease of man known as
mumps or parotitis epidemica is beyond doubt due to an infec-
tion; according to Korsutschewsky, its cause is a micrococcus.
Bissauge has repeatedly seen parotitis as an epizootic among cattle
in the neighborhood of Orleans in France and always simultaneously
with mumps among children. In a dog a case occurred likewise during
a mumps epidemic among children, and the affection spread to another
dog. A diplococciis was obtained in pure culture from Stenon's duct
(Busquet & Boudeaud). The infection of a dog from sick children was
demonstrated beyond doubt by Prietsch.
Aruch saw inflanunation of the parotid and of the submaxillary
glands on one side among seventy horses, within one year and a half; as
a rule there was suppuration. He repeatedly found lieards of oats and
of hordeum sylvaticum in Stenon's duct and in the pus; in one case 100
l)eards were in Steuon "s duct. Sometimes the inflammation is caused by
bromus maximus (Renault, Meyer) or by vicia tenuifolia (Labat) and
it is probable that these plants simply play a role as carriers of patho-
genic bacteria.
Parotitis is frequently secondary in nature, particularly
after inflammation of the pharynx. In this case the process
probably extends along the connective tissues, but the inflam-
mation may also spread from the pharynx along Stenon's duct.
Salivary calculi may also cause inflammation in this long duct
with secondary involvement of the glandular tissue.
As a part of the clinical picture in infectious diseases, par-
otitis occurs in strangles in the horse, also as a metastatic pro-
cess in dog distemper and in influenza of the horse.
Chronic parotitis develops after repeated traumatic inju-
ries (particularly in race horses) in the presence of salivary
calculi, and in cattle in connection with actinomycosis.
Anatomical Changes. Acute parotitis leads to swelling and
intense reddening of the glandular tissue and to interstitial
serous infiltration of the interlobular connective tissue (paro-
204 Anatomical Changes. Symptoms. Diagnosis.
titis parenclijaiiatosa ) ; at other times it leads to tlie formation
of small purulent foci between the lolmles; these may subse-
quently become confluent and form larger abscesses (parotitis
apostematosa s. abscedens). Chronic inflammation leads to
an increase of the interlobular connective tissue, partial atrophy
of the lobuli and induration of the whole gland (parotitis chron-
ica indurativa).
Symptoms. Acute inflammation exhibits primarily a dif-
fuse or on the contrary a more circumscribed swelling of the
parotid region, which may extend into the neighborhood as a
collateral edema. The edematous infiltration in the neighbor-
hood leads, especially in cattle, to laryngeal stenosis and dis-
turbances of deglutition. The gland itself is painful, and as in
inflammation of the throat, the head is stretched, or in uni-
lateral affections of the gland, held obliquely. The animals
chew with care, and they do not ingest large morsels, because
every depression of the lower jaw compresses the tender parotid
gland. The secretion of saliva is usually increased (Miiller),
but it may also remain normal (Friedberger & Frohner). Some-
times the disease is preceded by symptoms of stomatitis and
pharyngitis, complicated with immobilization of the swollen
tongue and intense swelling of the gums (Arucli).
Purulent inflammation always leads to inflammatory edema
of the neighboring connective tissue, consequently the individ-
ual lobules cannot be distinguished; the swelling is usually of
a high degree and continues down toward the neck and into the
larynx. Later on the swollen tissues exhibit fluctuation in one
place and pus finally breaks through in one or more places.
Every form of parotitis generally takes a favorable course.
During the course of parenchymatous inflannnation, the swell-
ing goes down gradually and disappears rapidly after pus has
been discharged spontaneously or evacuated surgically. The
wound usually closes rapidly; frequently, however, a salivary
fistula remains, which closes up finally under the proper treat-
ment. Exceptionally the facial nerve of the same side may be-
come paralyzed in consequence of compression by the swollen
gland or of an extension of the inflammation along the nerve
trunk.
Epizootic parotitis is accompanied by high fever ; it may be
unilateral or bilateral, and never results in suppuration. In
cows it is sometimes accompanied by a mild catarrhal mastitis
(Bissauge).
The chronic inflammation presents a firm, tough swelling
of the parotid which is not painful. In making a diagnosis it is
necessary to exclude swellings of a different nature (true tu-
mors, etc.) which may occur in this region.
Diagnosis. Acute parotitis may be confounded with an in-
flammation of the neighboring connective tissue or of the re-
Treatment. 205
gional lymph glands. However, the swelling in these cases is
more diffuse and does not reach up to the ear. The differential
diagnosis may become very difficult since parotitis sometimes
spreads to the neighboring connective tissue and may also be
complicated by an affection of the lymph glands. Acute tulier-
culosis of lymphatic glands of the parotid region occurs in cat-
tle and frequently also in hogs, and this fact must be considered
in diagnosis. Pure cases of parotitis may be distinguished
from pharyngitis hj the absence of cough and nasal discharge
and usually also of' disturbances of deglutition; further, by the
superficial" character of the swelling in the parotid region. In
catarrh of the guttural pouch there is a nasal discharge, while
the parotid remains normal in size and consistency.
Treatment. To counteract the inflammatory swelling,
Priessnitz' applications are indicated, possibly with carbolized
instead of with ordinary cold water. Ointments favoring ab-
sorption, such as iodoform-, iodinevasogen-, camphor- or mer-
cury-salves, are beneficial. Abscesses must be opened, the
sooner the better. Chronic swellings may be treated by strong
inunctions, injections of tincture of iodine, or of Lugol's solu-
tion; iodide of potash may be given mternally. (Iodine treat-
ment is particularly successful in actinomycosis.)
Literature. Bissauge, Eec, 1897, 289.— Busquet & Boudeaiul, Vet. Jhb., 1903,
129.— Labat, Rev. vet., 1891, 57.— Meyer, O., Vj., 1855, 87.— Prietsch, S. B., 1905,
81.— Renault, Eec, 1830, 305.
Inflammation of the submaxillary gland, almost without exception,
follows upon the penetration of foreign bodies, especially parts of food
in straw feeding (Albrecht) into Wharton's duct. More rarely does it
follow upon parotitis or stomatitis (authors' case).
The disease is most common among cattle, less among horses and
least among dogs. One can feel the swollen, painful submaxillary gland
upon the inner side of the angle of the maxilla. The margins of the
meatus of Wharton's duct are often reddened and swollen; upon pres-
sure on the duct, pus is frequently discharged. On the side and under
the tongue a fluctuating or purely edematous and painful swelling may
be recognized (Ranula Inflammatoria). More or less profuse salivation
and disturbances of mastication likewise exist. The inflammation often
leads to suppuration and more rarely to partial necrosis of the glandular
tissue. Pus, usually fetid in character, breaks ordinarily into the buccal
cavity, more rarely towards the outside ; the disease then ends in recov-
ery in one to two weeks.
The treatment is similar to that recommended for parotitis.
Literature. Albrecht, W. f. Tk., 1890, 317.
Sectiox hi.
DISEASES OF THE PHARYNX.
1. Pharyngitis.
{Baclienf'ittz^tendmifi, Hcdseufzuendung , Sclilundhopfentzuen-
dung, Halshrduue [German]; Angina.)
As pharyngitis are designated all inflammations, which are
partly catarrhal, partly deeper seated and penetrating even
into the snbmncons tissne of the pharyngeal mucosa, including
the soft palate and the tonsils. Such inflammations produce in
man a constricting sensation of the pharynx during deglutition
and they are therefore also called angina or synanche.
Occurrence. Pharyngitis is observed most frequently in
horses and hogs, more rarely in cattle and still more rarely
in sheep or carnivora. Among the first mentioned animals
it occurs quite often enzootically, among the latter more rarely.
Angina among chickens has ])een observed by Albrecht.
Etiology. Of external causes of acute pharyngitis, must
be mentioned mechanical injuries by swallowing rough, pointed
particles of food or other foreign bodies which penetrate the
wall of the pharynx during deglutition or which injure the mu-
cosa, and so form a portal of entrance for pyogenic bacteria.
Hot feed or hot drinks, acrid, caustic materials may likewise
produce an inflammation of the phar^aigeal mucosa. This may
also be produced by the inhalation of gases, hot air, or hot
smoke during a conflagration. Sometimes gastrophilus larvje
produce pharyngitis either by direct mechanical irritation or by
forming a portal of entrance for infecting bacteria. (Gastro-
philus larvae may also be an accidental finding in pharyngitis,
as shown by the observations of Lichmann & Buffington.)
Colds sometimes play an important role. This is suggested
by the frequency of the affection during the cold season when
the animals are frequently exposed to the influence of sudden
changes of temperature. Pharyngitis may appear, particularly
in horses, a few days after exposure of heated animals to cold
rain or sharp wind, or when cold air has come directly in con-
tact with the pharynx. The ingestion of very cold, hoar-frosted
206
Etiology. 207
or frozen feed, or of very cold water may have a similar influ-
ence. These influences are particularly potent in cattle when,
during winter, they are kept in warm barns and are taken out
to drink very cold water.
Infection undoubtedly often plays an important role. Even
in those cases when the disease follows immediately upon a
cold, the latter very probably only forms the predisposing
cause. Suggestive for an infection as the cause is the fact of
the enzootic appearance of the disease in certain localities with
a tendency to progress from animal to animal. The bacteria
concerned may be those which occur in the buccal cavity and
pharynx of otherwise healthy animals (streptococci, bacillus
necrophorus, bipolar bacteria) and which may only occasionally
exert a morbid effect after the resistance of the mucosa has
been lessened by noxious external influences.
The bacillus necrophorus deserves first consideration as it has
repeatedly caused enzootics of angina in hogs (Johne & Meyfarth, Kitt,
Schleg) and also appears to have played a role in diphtheritic pharyn-
gitis in cattle as observed by Mayr, Strebel, Prietsch. Similar anginas
have been observed in sheep (Roche-Lubin, Diem) and in dogs or cats
(Robertson, Gray, Symes).
Young dogs sometimes develop an enzootic pharyngitis during the
first weeks, which may pass into pyemia (Friedlierger & Frohner). In
a case of croupous pharyngitis of a dog, Ball demonstrated streptococci
which he believed to be the cause of the disease.
Secondary pharyngitis, as a part of the clinical picture of
specific infectious diseases, frequently appears either sporadical-
ly or enzootieally. Such diseases are strangles, influenza of the
horse, buffalo plague, hemorrhagic septicemia of cattle and of
swine, fowl cholera, anthrax, diphtheria, purpura hemorrhagica,
variola, etc. Pharyngitis due to the bacillus suisepticus (septi-
cemic angina) occasionally appears in enzootic form (Graffun-
der & Schreiber, Pr. Vb.)".
Inflammatory processes of neighboring tissues such as the
nasal and buccal cavities, the larynx, the air sac, the esophagus,
and of the bones of the face not infrequently extend to the
mucosa of the pharynx.
Chronic pharyngitis is quite common. It is, however, of
no great importance from a clinical standpoint, since it does
not lead to important pathologic disturbances. It generally
develops after an acute phar^aigitis or after repeated, long-con-
tinued irritation.
Susceptibility. Horses and swine are most prone to de-
velop disease of the pharynx. The marked difference in the
predisposition of various groups of animals partially depends,
perhaps, upon the fact that the tonsils of horses and swine pos-
sess several foramina coeca, those of other animals only single
ones. Hence, it appears that the tonsils of horses and swine
208 Pharyngitis.
may more easily be invaded by pyogenic and other microorgan-
isms than those of other animals.
Anatomical Changes. Catarrhal inflammation (pharyn-
gitis catarrhalis) affects the mucosa only; this appears red-
dened diffusely or in spots, swollen, covered with a tenacious
mucus; the lymph follicles and the mucous glands are swollen
and the submucosa tissue may be in a condition of edematous
infiltration.
In severe cases the highly swollen mucosa may become ul-
cerated and the submucous tissue then presents a thickened,
gelatinous mass, containing streaky extravasations of blood, or
purulent infiltrations (ph. purulenta s. phlegmonosa). Sub-
mucous abscesses may be formed in certain places, particularly
in the retropharyngeal region (al)scessus retro- or peripharyn-
geales). These then protrude into the pharyngeal cavity, en-
croach upon it, or may even obliterate it completely. After the
opening of the abscess into the pharynx or towards the outside,
there may exceptionally remain a pharjnigeal fistula. After in-
jury of the pharynx or after malignant infection, the abscess
frequently contains fetid, ichorous masses, sometimes mixed
with remnants of food. Eetropharyngeal abscesses may also
be formed in consequence of suppuration of the post-pharyngeal
lymphatic glands. Such abscesses are formed in the horse in
strangles or influenza. In the dog, retropharyngeal abscess
often appears simultaneously with purulent parotitis.
In some cases pseudomembranes form on the mucosa ; they
may consist of a deposit of exudate (ph. membranacea s. croup-
osa) or they may contain necrotic tissue (ph. diphtheritica).
The tonsils are always more or less swollen, their crypts
filled with a thick purulent caseous, ill-smelling material. The
soft palate is likewise swollen ; the connective tissue between the
bundles of muscle fibers is infiltrated edematously.
In pharyngitis in hogs due to the bacillus necrophorus the tonsils are much
swollen, dirty grayish-yellow; the crypts are filled with dry caseous material, the
lymph follicles in the neighborhood and in the mucosa of the pharynx in general
are necrotic, the surfaces coated everywhere with masses of fibrin. The necrosis
sometimes spreads to the surface of the tongue, while the submucous tissue of this
organ and of the pharynx, and likewise the muscles become infiltrated edematously.
The neighboring lymph glands show acute swelling.
In chronic pharyngitis, the mucosa is thickened, particu-
larly on the posterior wall, and is bluish-red ; the h^llpll follicles
and mucous glands form nodules of the size of a lentil (ph.
granulosa). The muscles of the pharynx become atrophic and
the connective tissue proliferated (Trasbot). In horses the
tonsils may increase in size to form purplish masses of the size
of a finger (Kitt).
Symptoms. In acute pharyngitis the ingestion of food oc-
curs slowly and carefully and there is difficulty in deglutition.
Symptoms. 209
The food is masticated slowly and the head and neck are
stretched out in swallowing. The animals are sometimes rest-
less and dogs and hogs occasionally cry ont. Sometimes food
is expelled after repeated unsuccessful attempts at swallow-
ing, to be again taken up later. Finally, the animals do not touch
their food any more, and rather starve than be again and again
exposed to the pain of swallowing. The ingestion of fluid, while
easier, also causes pain, so that the patients may even refuse to
drink, but only irrigate or wash out their mouth in water that
is held before them. The patients sometimes make swallowing
movements, probably in consequence of the inflammatory irri-
tation and of the masses of mucus which are collecting. Vomit-
ing is brought about similarly, particularly in dogs and swine.
In a large number of cases, however, usually only in horses,
ingested water is partly expelled through the nasal cavities
(regurgitation). The cause of this symptom lies in the edema-
tous infiltration which, in the severer inflammations, develops
in the submucous connective tissue of the soft palate, the lower
portion of the pharynx and between the muscles of the roof of
the tongue. This interferes mechanically with deglutition and
with the proper contraction of the muscles.
Nasal discharge occurs during the acute course of the dis-
ease, and the mucous secretions usually mixed with particles of
food appear in large amounts at the anterior nares. A low posi-
tion of the head in horses sometimes increases the nasal dis-
charge. More or less salivation is likewise present. Increased
tenderness of the pharynx is manifest in a stiff, stretched posi-
tion of the head and, on moving, the animals hold the head and
neck in this stiff position. They try to escape palpation and
even a careful touching of the region of the larynx excites mani-
festations of pain and often leads to a convulsive cough, accom-
panied by a peculiar, snorting sound. The pharyngeal region
frequently appears swollen, tender and hot. The swelling is
particularly noticeable in hogs and the mucosa is purplish.
The submaxillary and upper salivary glands are swollen, al-
though they may not be palpable, in consequence of edematous
infiltration. Sometimes swelling of the salivary glands is no-
ticeable. In calves, sheep, dogs, cats and fowls, direct inspec-
tion of the pharynx shows the swollen and intensely reddened
mucosa, covered w^itli pseudomembranes. These conditions are
particularly noticeable on the soft palate and on the pillars of
the fauces. The tonsils are likewise swollen and they may have
become so much approximated to each other that there is only
a slender cleft left between them. The pharyngeal wall is cov-
ered with a profuse mucoid, or muco-purulent secretion.
Cough is present in all cases, either after deglutition or in
regular attacks. The animals then cough up a large amount
of secretion, which is often mixed with particles of food.
Laryngitis, wdiich really is the cause of the cough, may become
dangerous in consequence of edema of the epigio-ttis or of the
210
Pliarynij'itis.
arytenoid cartilages. In sueli eases respiration becomes difficult.
Deep inspiration after each congii, and later on every inspira-
tory etl^'ort, is accompanied by a snorting or whistling sound.
The animal has attacks of dyspnea and the latter may become
fatal. These respiratory disturbances are particularly well
marked and common in the hog. Elevation of the temperature
exists in the majority of cases. In pharyngitis following a cold
or an infection, fever is usuall}' present from the start and the
latter mav precede the other s^anptoms for one to two days
(Fig. 32)."
Pharyngitis from traumatic or chemical causes usually be-
gins without an elevation of temperature, and fever only ap-
pears later after ulceration or pus formation has occurred.
An elevation of temperature recurring during the later course
of the disease points to a penetration of the process into the
32. Fever curve in a case of pliaryngitis in a horse.
deeper tissues. In these cases the fever then generally per-
sists until the shedding of the necrotic tissues or until the spon-
taneous or artificial opening of an abscess, when the tempera-
ture usually goes down within one to two days.
The appetite may be permanently retained in those cases
which are not accompanied by fever at all or only by a mod-
erate elevation of temperature ; but even in these cases the nutri-
tion usually suffers in consequence of the difficult deglutition.
The urine, in insufficient nutrition assumes an acid reaction,
even in herbivora, and it may be quite thin for days. In-
dican is increased in ichorous necrosis of tissues. Meyer dem-
onstrated an increase in the number of leucocytes of the blood
in acute pharjmgitis.
The sjauptoms of chronic pharyngitis are in nature similar
to those descril)ed above; they are, however, milder in char-
acter. Deglutition is difficult but not impossible; the pharyn-
Course. Diagnosis. 211
region is swollen moderately or not at all; it is not very
tender; the ingestion of food is frecjuently interrnpted by at-
tacks of congli and the anterior nares discharge a tenacious
mucoid or mucopurulent secretion.
Course. Primary acute pharyngitis usually takes a favor-
able course, except in hogs, where the disease usually leads to a
fatal issue. The symptoms appear in rapid succession, so that
they are fully developed in two to three days ; they then remain
at their height for an equal period of time and recede gradually,
so that at the end of the first, or during the second week, coni-
jDlete recovery occurs.
The course is more protracted when ulceration or suppura-
tion of the deeper tissues occurs. In these cases all symptoms
persist for a longer time or even increase in intensity. The
fever goes up, remains stationary or becomes remittent until
the shedding of the necrotic tissue occurs or the abscess opens
into the pharynx or into the outer w^orld. After opening of
the abscess and the discharge of pus, the condition of the patient
rapidly ameliorates and recovery takes place. A pharyngeal
fistula, which may have formed, generally closes only after a
long period of time. Occasionally a thickening in the pharyn-
geal wall may be formed, which may permanently disturb
deglutition and respiration, particularly during work (Wetzl).
A catarrh of the guttural pouch may occur in horses ; in hogs,
a tough, not painful, swelling may be formed after the opening
of a number of small subcutaneous abscesses, which permanently
interferes with deglutition and respiration. Paralysis of the
pharynx may also occur, but may again disappear after a pro-
longed period.
A fatal issue is generally due to complications. Edema of
the larynx, in the absence of proper aid, may lead to suffoca-
tion. An occurrence, which is not infrequent in horses, is as-
piration pneumonia due to swallowing or inspiration of pus of
an abscess breaking into the pharynx. Inflammation may also
spread into the loose connective tissue in the mediastinum, and
then a pleuritis or pericarditis closes the chapter (Cadeac).
In phlegmonous pharyngitis septic material may be absorbed
from ulcerations and lead to general sepsis or a fatal hem-
orrhage may occur at the base of an open ulcer (Wakefield, De
Jong, Monod).
Diagnosis. The clinical picture of pharyngitis is, as a rule,
quite characteristic, so that diagnosis offers no difficulties. For-
eign bodies which have become wedged in the pharynx, gener-
ally in carnivora and cattle (Fiebiger has seen two such cases
in horses), can liest l)e detected by inspection and internal man-
ual palpation. Tumors of the pharynx are usually not painful,
the signs of an acute affection are missing and internal palpa-
tion reveals the tumor. In paralysis of the pharynx there is no
212 Pharyngitis.
tenderness and the pecnliar position of the head is absent.
Diseases of the central nervons s^'stem will lead to other paraly-
sis besides that of the pharynx; and in cases of meningitis
there are mental distnrbanees. In ol)strnction of the esoph-
agus no changes are found in the pharynx and regurgitation
during the act of deglutition occurs later ; a sound will find the
obstruction in the esophagus. Parotitis does, generally, not
lead to regurgitation, and is not accompanied by nasal dis-
charge. If jiressure is made on the lower wall of the pharynx
(base of the tongue), pain is not elicited. Catarrh of the gut-
tural pouch generally causes a unilateral swelling in the upper
portion of the parotid region; pressure on the latter usually
causes nasal discharge ; pressure on the lower pharyngeal wall
does not elicit pain. Since pharyngitis may be a part of the pic-
ture of a general infectious disease, one must, in the beginning,
think of this possibility. In horses one must think of strangles ;
in cattle and swine, of hemorrhagic septicemia, hog cholera,
or anthrax.
The determination of the nature of pharyngitis is usually
very difficult, except in smaller animals where inspection per-
mits a good survey of the anatomical changes. It may be
said, in general, that high fever persisting during the course of
the disease, intense and increasing swellings of the pharynx,
speak for a deeply penetrating inflammation. Gangrene of the
mucosa, phlegmonous or diphtheritic inflammations, aside from
their local manifestations, are characterized by a fetid smell
of the saliva and the expired air. Coughed up masses of filn-in
point to croupous pharyngitis. In proper cases one may use
in liorses the rhinolaryngoscope of Polansky & Schindelka,
which occasionally makes it possible to recognize swellings of
the mucosa, hemorrhages, small abscesses, etc. In difficult res-
piration this instrument cannot be used.
Prognosis. The prognosis of primary uncomplicated
pharyngitis is favorable ; however, it becomes the more unfavor-
able the more the symptoms point to phlegmonous, diphtheritic
or purulent inflannnation. Even affections which are mild at
the start, may in their further course assume a malignant char-
acter, particularly in horses, Avliere aspiration may easily occur;
hence a guarded prognosis is advisable during the early stages.
Treatment. Considering the increasing tenderness of the
mucosa and the difficulties in deglutition, the food must be soft,
mushy or fluid in consistency. In herbivora, the best nourish-
ment is green feed, well wetted hay, flour or bran mashes thin
in consistency, wiiile hogs and carnivora are best fed with milk.
Horses suifering from intense difficulty in deglutition should
at first not lie fed even with entirely fluid feed and water; thirst
can be alleviated by repeated injections of lukewarm water into
the rectum. The patient should fast from one to two days and
Treatment. 213
artificial feeding may then be instituted (see page 123). This
is best accomplished by the introduction of liquid food into
the stomach through the stomach tube. Most patients permit
the introduction of this instrument without any difficultv. If
stenosis of the larynx exists at the same time, a preliminary
tracheotomy must be performed. The authors have in this
manner fed many horses for days and even for weeks and have
thus prevented inanition and aspiration pneumonia. Cribs and
utensils soiled with pathologic secretions must be cleansed at
short intervals.
The local treatment consists in the application of astringent
and disinfectant solutions, such as 2% nitrate of silver, 3 parts
of tincture of iodine Avith 25" parts of glycerin, 10% alum-
glycerin; peroxide of hydrogen, 15% creolin-vasogen. These
medicated solutions are used to paint the pharyngeal mucosa;
however this procedure can be employed only in short headed
animals. If the animals so treated show too much excitement,
it is better to desist from this form of treatment, likewise in
larger animals when the difficulty in deglutition is not too great ;
in such cases disinfectants may simply be added to the drinking
water, such as chlorate of potash (horses 40-50 gm. for each
bucket of water, dogs a 2% solution in tablespoon doses), or
salicylate of sodium (80-100 gm. or a 0.5% solution). Inhala-
tions of the vapors of pure water, or of a 2% carbolic acid
solution, or a finely divided spray of astringent or disinfectant
solutions (1-2% carbolic acid, creolin, alum, or tannic acid,
possibly corrosive sublimate 1:1000) may also be used. It
appears best to introduce these solutions with a Frick or a
Bayer-Kieselbach spraying apparatus. In horses which are
not particularly restless these astringent and disinfectant
drugs may also be applied in the fonn of ointments. This
can be done with the aid of a long, metallic sound. Its dull
end is wrapped in cotton, saturated with the ointment (accord-
ing to Bringard eucalyptol and vaselin 1:15); the sound is
introduced below the inferior turbinate into the pharynx, and
the ointment is rubbed over the dorsal surface of the soft palate
and over the mucosa of the naso-pharynx. Intrapharyngeal
injections from the trachea as recommended by Dieckerhoff
are not always devoid of danger ; the same is true of the intra-
nasal injection of fluids through a hard rubber tube or a
urethral catheter. The injection of larger amounts of fluids
may, in difficult deglutition, give rise to the aspiration of fluids.
External applications in the region of the pharynx are always
beneficial. In the earlier stages cold applications are indicated,
later on Priessnitz' applications, with disinfectant solutions.
Warm applications (with oat, barley or linseed meal, etc.) may
be used in case of continued swelling to hasten the ripening of
the abscess. Ointments favoring resorption (gray mercurial
ointment, camphor or iodoform ointment 1:10) niay likewise
be useful. . If the swelling shows no tendency to go down, inunc-
214 Paralysis phai-yngis.
tioiis may sometimes give relief in combination with Priessnitz'
applications (oil of mustard in 6 to 8% alcoholic solution, red
biniodide of mercury ointment 1:4).
Abscesses should, if possible, be opened early; it is some-
times possible in cattle to open an abscess, previously located
in the pharynx by palpation, with a knife introduced into the
mouth (Macgillivray, Cunningham). A pharyngeal fistula
which has eventually formed may be made to heal within a
few weeks by repeated disinfection. Tracheotomy must not
be delayed in the presence of intense dyspnea or edema of the
larynx. The use of internal medicines usually appears super-
fluous and may even be dangerous. Should it however become
necessary, such medicines should be used by rectal or by sub-
cutaneous injections.
Chronic pharyngitis in small animals may be treated with
local applications of tincture of iodine (Tinct. lodi., Tinct.
Gallarum aa), chloride of iron (1:6), iodine or tannic-acid-
glycerine, insufflations of boracic acid or tannic acid with sugar
(aa). In large animals treatment must be limited to irritant
inunctions and Priessnitz' application.
Literature. Albreeht, M. t. W., lf)09, 26.— Ball, J. vet., 1906, 449.— Buffington,
Am. V. R., 1905, 37.— Cuiiniiigliam, Vet. Jhb., 1906, 161.— Diem, W. f. Tk., 1897,
339.— Fiebiger, Z. f. Tm., 1902, VI, 443.— Graffuiider & Schreiber, D. t. W., 1902,
471.— de Jong, D. Z. f. Tm., 1S92, XA^ITI, 306.— Kitt, Miiiieh., Jhb., 1893-94, 81.—
Lichmaun, O. M., 1893, 169.— Lovy, Vet., 1892, 443.— Meyer, Z. f. Tm., 1906.—
X, 1.— Nikolski, Vet. Jhb., 1886, 81.— Preisz, Z. f. Tm., 1898, II, 62.— Pr. Vb.,
1900, II, 9.— Sequens, Vet., 1894, 504.— Soiiin, Vet. Jhb., 1888, 81.— Wetzl, A. L.,
1907, 18. (See also literature on epizootic laryngo-pharyngeal catarrh.)
2. Paralysis pharyngis.
{Paralysis of the Pharynx, Schlundhopflaehmung [German].)
Etiology. Paralysis of the pharynx is especially seen as
a part of the clinical picture of bulbar paralysis in disease
of the central nervous system (meningitis, meningitis cerebro-
spinalis enzootica, progressive bulbar paralysis, tumors), in the
course of certain infectious diseases (rabies, acute infectious
bulbar paralysis) and intoxications (botulism) and also, as is
claimed, after poisoning with some fungi.
Occasionally it develops secondarily after acute pharyngitis
(Bongartz) probably due to secondary affection of the glosso-
pharyngeal nerves or of the branches of the pneumogastric
nerve which supply the muscles of the phar^mx. (Zschokke
saw a case of paralysis of the pharynx caused by a perineuritis
after infection of the guttural pouch of a horse with hyphomy-
cetes.) Tumors compressing the pneumogastric nerve may ex-
ceptionally produce paralysis of the pharynx. Somethnes the
latter may appear as a primary condition.
Symptoms. Paralysis of the pharynx makes deglutition
impossible, coiiseciuently food and water taken up are again
Diagnosis. Treatment. Enzootic Paralysis of llie Pharynx in Cattle. 215
voided by tlie mouth, or expelled tlirougli the nose. The morsels
of food cannot descend into the esophagus, though attempts
at deglutition occur accompanied by loud sounds. Sali-
vation is always profuse, because the saliva cannot be swal-
lowed and hence collects in the buccal cavity. Portions of food
or whole mouthfuls may become wedged in the pharynx; parts
may get into the larynx and trachea and cause gangrene of the
lung. Introducing the hand into the pharynx of larger animals
does not produce any contraction of the pharyngeal muscles
(Ziirn). Whistling and snorting noises accompany the move-
ments of the animals and may even be heard during rest; the
disturbances of regurgitation diminish the capacity for work.
Straub and Friedberger have seen horses unable to swallow water
but able to swallow dry food in a perfectly normal manner. In these
cases, the causes of which could not be ascertained, the remedy consisted
in mixing the dry feed with water so that the system received a sufficient
amount of fluid.
Diagnosis. A careful examination must exclude all other
diseases of the pharynx (wedged foreign bodies, tumors, retro-
pharyngeal abscess), occlusion or compression.
Treatment. Paralysis due to local inflammation sometimes
subsides without any treatment at all (Dieckerhoff). The
animals must, however, in all cases be fed artificially (see page
123). Irritant inunctions and nerve tonics by subcutaneous
injection are frequently used. Recovery in horses was seen by
Bongert after daily injections of 0.05-0.06 gm. strychnia ; Langer,
0.03 strychnia; Sonnenberg after one injection of 0.025 gm.
arecoline. Sometimes, however, it is necessary to slaughter
the animals in order to recover part of their value.
Literature. Besnoit, Hex. vet., 1903, 10.— Boiigartz, A. f. Tk., 1881, VII,
48.5.— Dexler, Nervenkrkh. d. Pferdes, 1899, 30.— Lauger, Z. f. Vk., 1890, 417.—
Sonnenberg, B. t. W., 1906, 858.— Straub, Eep., 1858, 26.— Zschokke, Sehw., A.,
1907, XLIX, 313.— Zurn, D. t. W., 1905, 62.
Enzootic Paralysis of the Pharynx in Cattle. This name was given
by Dieckerhoff to a disease of cattle originally called meningitis boum
enzootica by several authors (Vogel, Utz, Mayer, Zipperlen and others).
Dieckerhoff believed that the disease is caused by an infectious sub-
stance contained in the food, because this assumption would explain its
enzootic nature. It is not spread to neighboring farms. The disease
has been noticed particularly in Germany, although Andersen and Berg
have seen it frequently in Denmark. Its nature and its relation to
enzootic cerebrospinal meningitis are not definitely known.
To this group may also belong an enzootic ] analysis of the pharynx frequently
seen in cattle, less frequently in ^sheep ami lioises, and believed to l>e due to the
ingestion of food much contaminated with rust fungi (Johne, Herele, Adam,
Brandt and others).
216 Animal Parasites in the Pharynx.
Symptoms. Mastication is slow and the mouth can be pried open
easily. Soon inability to swallow develops, food is either thrown out of
the inouth, or placed beside the molars. From the third day there is
inability to swallow water. Salivation is intense. The animals move
restlessly on their legs, and weakness of the hind legs develops in two to
three days; the animals then lie down continually and turn the head to
the side or toward the back. This position of the head may have been
noted from the start. Constipation, and tenesmus in defecation and
urination are often ol)served. Other symptoms are absent except in the
Avorst cases when respiration and pulse l)ecoine accelerated.
In places where rabies is common, dumb rabies must be excluded,
because its symptoms may be absolutely the same as those described.
The course is unfavorable in complete paralysis of the pharynx.
The animals rapidly become emaciated and succumb within three to
five days, more rarely within ten to twelve days. Less severe cases and
those having lasted longer than five days generally end slowly in
recovery.
The treatment is the same as in other forms of paralysis of the
pharynx. Considering the possibility of contagiousness, the barn must
be disinfected.
Literature. Adam, W. f. Tk., 1874, 377; 1876, 362.— Andersen, Maanedsskr.,
1908, XX (Lit.).— Berg, ibid., 1909, XX (Lit.).— Brandt, W. f. Tk., 1880, 79.—
Biirc'hner, ibid., 1905, 23.— Dieckerhoff, Spez. Path., 1892, II, 22.5.— Faiistle, W.
f. Tk., 1906, 554.— Herele, ibid., 1874, 377; 1876, 362; 1878, 233.— Schraiiber,
ibid., 1906, 386.— Schwarz, ibid., 1876, 373.— Steger, ibid., 1900, 369; 1905, 23.
3. Animal Parasites in the Pharynx.
Larvae of gastrophilus (Gastrophilus haemorrhoidalis and G. equi)
are found sometimes on the posterior wall of the pharynx of horses, also
on the velum, and if present in larger numbers they produce an intense
inflannnation of the pharyngeal mucosa ; on penetrating into the larynx
they cause sudden attacks of apnea.
In some wild living animals (roes, deer) larvae of certain flies,
pharyngomya, are found in the pharynx and here cause inflammation.
They frecjuently get into the larynx, are aspirated into the bronchi and
may cause edema of the glottis and purulent bronchitis (Kitt). These
larvae can be removed by the hand introduced into the pharynx. Oil is
also recommended internally, or removal with a rod supplied with a
cotton plug which is saturated with oil or with eucalvptus ointment
(1:15).
Hungarian flies (Simulia columbacsensis), when attacking cattle
in larger numbers, are liable to wander through the mouth and nose
into the pharynx, w^here they cause a profound inflammation leading to
suffocation.
Horse-leeches (Ha'mopis sanguisuga), in southern countries, some-
times get with the drinking water into the pharynx of horses and mules ;
more rarely of cattle; they suck the blood from the mucosa and pro-
duce inflammation. Their presence is indicated by a considerable hem-
orrhage from the mouth or nose. If present in larger numbers, they
may lead to profound anemia or even fatal hemorrhage (Baise saw in
two cases 185 and 192 leeches).
Prophylactic measures in southern countries consist in filtration of
the drinking water. The treatment of the affected animal consists in
Tumors of the Pharynx. 217
irrigation with solutions containing common salt, vinegar or ammonia
or in the inhalation of turpentine vapors.
Tokishige found filiform worms in the pharynx of a horse dead
from pharyngitis, which he thought to be Dispharagus reticulatus.
4. Tumors of the Pharynx. Tumores intra- et peripharyngeales.
Occurrence. Tumors of the pharynx and its neighborhood
are rare in domestic animals. Least frequently seen are such
true neoplasms as papilloma, sarcoma, carcinoma, lipoma, also
retention cysts; connective tissue hypertrophy of the mucosa
of the pharynx is seen after an acute pharyngitis (Wetzl).
Actinomycomata or tuberculous growths are seen more com-
monly in cattle.
According to Zimmer's statistics seventy-three cases of tumors of the pharynx
in cattle were divided as follows: Fifty-four cases of actinomycosis, five cases of
tuberculous growths, seven cases of dermoid cysts, four eases of fibroma, two cases
of colloid cysts, one case of melanoma. Out of 4,708 cases of profound tuberculosis
Easmussen found retropharyngeal lymph glands in a condition of tuberculous
degeneration in 3,245 eases (68.937r); the gland below the parotid in 228 cases
(4.84%); and the tonsils only in fifty-two cases (1.1%).
As has been shown by the fundamental work of Morkeberg, acti-
nomycosis usually develops in the upper, posterior parts, more rarely
in the lateral walls of the pharynx, that is either in its mucosa or in the
neighboring tissues. These actinomycotic masses then show a tendency
to project polyplike into the pharynx. Tuberculous tumors, on the con-
trary, arise outside of the pharynx and only make its wall protrude in
a tumorlike manner. The root of the tongue is usually the seat of
retention cysts, also the anterior surface of the epiglottis or a place be-
tween the latter and the root of the tongue. True tumors usually arise
in the upper posterior portion of the pharynx.
Intrapharyngeal tumors usually become pediculated in consequence
of traction made in deglutition.
Symptoms. The sessile tumors produce increasing diffi-
culty in swallowing, but without pain; later dyspnea and rat-
tling, whisthng and snorting noises are heard, when the tumor
encroaches upon the posterior nares and the larynx. Difficulty
in deglutition and respiration is increased when the head is bent
forward or sideways. Stenosis of the posterior nares causes
labial breathing in all animals (bulging of the cheeks during
expiration) which disappears when the mouth is opened.
Smaller, pediculated tumors cause difficulty in deglutition
or respiration as well as rattling sounds only occasionally,
namely, when they become displaced into the pharynx, larynx
or towards the choanse, in deglutition, strong inspiration and
in certain positions of the head, until they are again expelled
by a strong expiration or a movement of the head. It may,
however, occur occasionally that such an attack brings about
suffocation of the animal. As the tumor grows the attacks
218 Tumors of the Pharynx.
become more frequent and lead linally to permanent difficulty
in deglutition and respiration.
Discharges from the nose are only observed in part of the
cases, such discharges are sometimes fetid and mixed with
fragments of tissues. Epistaxis occasionally occurs; dogs
sometimes vomit and the tumor may then be visible in the
buccal cavity.
With the exception of those on the posterior surface of
the soft palate, tumors of the pharynx in smaller animals can
be seen on inspection; in horses, however, only with the aid
of the rhinolaryngoscope. With the hand introduced into the
pharynx even those tumors can be palpated which arise in
the neighborhood of the posterior nares.
Peripharyngeal tumors when present produce visible
changes in the pharynx.
Swelling of the submaxillary, also occasionally of the
peripharyngeal lymphatic glands, occurs in malignant tumors
and tuberculosis of the pharynx.
Diagnosis. The described disturbances of deglutition and
respiration, if developing slowly, strongly suggest the presence
of pharyngeal tumors ; a definite diagnosis can however be made
only after local inspection. When the examination of the
pharynx is negative, tumors of the larynx may be discovered
by laryngoscopy and it may perhaps be necessary to make an
exploratory laryngotomy. — Tumors of the larynx may also be
distinguished by the fact that compression of the larynx in-
creases the dyspnea; this is not the case in tumors of the
pharynx. However, exploratory tracheotomy may be necessary
to settle the point. — Nasal stenosis can easily be excluded by
a local inspection. — Retro- and peripharyngeal abscesses furnish
a similar clinical picture during a protracted course, but local
examination and the history of the case permit a correct
ditferential diagnosis. In making the latter the following other
conditions have to be considered: Chronic disease of the
pharynx, and of the guttural pouch, spasm of the glottis, steno-
sis of the bronchi, and in the case of dogs cardiac dyspnea in
uncompensated valvular disease of the heart, which likewise
leads to attacks of rattling respiration.
The determination of the nature of the tumor requires
a careful examination of the pharynx and its neighborhood.
Prognosis. This depends upon the seat and the nature
of the tumor. If the latter can be removed, the animal can
be saved; if its removal is impossible the animals die from
suffocation, pneumonia or marasmus. Even tuberculous tumors
may be removed and complete recovery may follow the opera-
tion if the process has l)een purely local. Tuberculous and
actinomycotic tumors sometimes become smaller and shrink
after the evacuation of their contents.
Treatment. 219
Treatment. Pecliculated tumors and those not having a
broad base may be crushed or cut off after ligation of the
pedicle with instruments introduced through the mouth. A
preliminary tracheotomy is however usually necessary. Iodide
of potash often proves of no value in the treatment of actinomy-
cotic tumors of the pharynx. (Details about the operative
treatment of pharyngeal tumors may be found in the publica-
tions of Morkeberg.)
Literature. Morkelierg, Z. f. Tni., 1907, XT, 153 (Lit.)- — Easmussen, B. t. W.,
1906, 848.— Wetzl, A. L., 1907, 3.— Zimmer, B. t. W., 1891, 376.
Section IV.
DISEASES OF THE ESOPHAGUS.
1. Inflammation of the Esophagus. Oesophagitis.
{EntzUendimg des Schlundes [German].)
Etiology. Irritating, caustic substances or rough, pointed
bodies, which are ingested with food or water, or improperly
selected medicines, may get into the gullet and cause catarrh
or a rather penetrating inflammation of the esophagus. Their
injurious influence here becomes more rarely manifest than in
the buccal cavity or pharynx, because the esophageal mucosa
is less sensitive and better protected by a thicker epithelial
covering, and also because irritating matters very rapidly pass
through the gullet. These morbid conditions are met witli after
the ingestion of very hot distillers' slop, after the administra-
tion of ammonia, tartar emetic, after poisoning with acids or
alkalies or after greedy swallowing of rough fodder, fragments
of bones mixed with meat, foreign bodies which become wedged
in the gullet, or after injury by the esophageal sound. Finally,
there are traumatic influences acting from without which may
become the cause of the inflammatory process.
The disease may be secondary to inflammatory processes
of the pharynx or the stomach, especially if these are due to
a general infection (foot-and-mouth disease, variola, diph-
theria, rinderpest, etc.).
Anatomical Changes. In superficial inflammations the
epithelial covering is missing either in irregular patches or
sometimes to a larger extent, or even along the whole length
of the esophagus (Bertheol). The mucosa appears dark red
on the uncovered portions, occasionally hemorrhages are seen
here; in the other portions the epithelial layers are loosened
and can be removed easily; the submucous connective tissue
exhibits a more or less intense edematous infiltration. In severe
cases the wall of the esophagus is thickened, swollen and the
subcutaneous and intramuscular tissue is the seat of a gelatinous
or even purulent infiltration. Cattle have developed croupous
inflammations after the instillation of spirits of ammonia
(Lemaire).
220
Symptoms. Course. Treatment. 221
Chronic catarrh leads to a marked thickening of the
epithelial layers, occasionally also to papilliferous prolifera-
tions.
Symptoms. A very superficial catarrh of the esophagus
usually escapes notice. In somewhat more intense cases the
food is swallowed with a great deal of effort. The animals
move the head restlessly from side to side in swallowing, stretch-
ing and bending the neck, horses paw with their front feet and
their faces express anxiety. Sometimes one may observe how
a morsel becomes wedged in the esophagus, occasionally directly
below the pharynx. Such morsels then become dislodged toward
the pharynx l)y antiperistalsis and are expelled through the
mouth or nose. Deeply penetrating inflammations lead to a
mucous secretion or to a bloody discharge from the mouth
or nose independently of the ingestion of food. In such cases
food is refused. Tubular croupous masses are sometimes ex-
pelled in croupous inflammation. Increased tenderness of the
esophagus is shown by the animals when pressure is made
over the left jugular depression. One may sometimes see here
spontaneous undulating motions followed by the expulsion of
mucus or food from the mouth. In more intense inflammation
of the esophagus, particularly in carnivora, vomiting occurs.
Difficulty in deglutition greatly interferes with the nutrition
of the animals and the inflammatory process may cause an
elevation of temperature.
Course. Simple catarrh ends in recovery after one to two
weeks, while deeply penetrating inflammations lead to cicatricial
contractions of the esophagus or to a purulent infiltration in
the surrounding connective tissue. The infiltration spreads
along the large vessels towards the thoracic cavity and leads
to the formation of abscesses. Exceptionally a perforation of
the esophagus occurs. All these complications are indicated
by an inflammatory swelling in the region of the left jugular
vein. If perforation occurs in the thoracic portion of the
esophagus pleurisy follows.
Treatment. One should attempt to ameliorate the inflam-
matory process by the administration of small pieces of ice,
by cold water, cold milk, mucilaginous or astringent fluids
(1/^ to 1% tannic acid in linseed infusion). Cold applications
on the region of the esophagus should also be made. If the
inflammation is due to corrosive poisons, antidotes like weak
acids or alkalies in mucilaginous milk should be administered.
When the pain is intense narcotics are indicated (morphine
subcutaneously, chloral hydrate, tincture of opium in the drink-
ing water). If the animals still persist in refusing to take
food, artificial feeding per rectum becomes necessary.
Literature. Eichenberger, D. Z. f. Tm., 1885, XT, 111.— Guilniot, Ann., 1854,
341._Dohne, S. B., 1879, 4(5.— Koch, B. t. W., 1889, 229.— Lebel, Eec, 1864, 355.—
Lemaire, Ann., 1860, 544.— Renault, Eec, 1834, 561.
222 Spasm of llie Esophagus.
2. Spasm of the Esophagus. Oesophagismus.
{Krampf des Schlundes [German].)
'Spasm of the esophagus consists in a morhid contraction
of its musck^s, which occurs in paroxysms, without organic dis-
ease or obstruction. These latter conditions also lead to spasm
of the muscularis of the esophagus. Esophagism, as a disease
]:>er se, is rare among domestic animals.
Etiology. Primary disease of this kind is verj^ rare, and
it then occurs upon a neuropathologic basis. It has been ob-
served without any special cause only a few times in nervous
horses of quick temper. Such animals may have an attack
upon drinking cold water or upon pressure upon the esophagus.
Nothing definite is known whether in these cases disease of the
pneumogastric nerve or transitory malposition of the esophagus
may play a role.
Horses sometimes exhibit esophagism after the injection of
morphine or after chloral hydrate or chloroform narcosis
(Frohner, Vennehrolm). In a case of this kind Plosz could
demonstrate the obliteration of the esophagus by a morsel of
food. A similar morbid condition occurs very rarely in adult
cattle (Ries) and somewhat more frequently in calves (Trous-
sier). Esophagism occurs secondarily in the course of epi-
lepsy, tetanus and rabies.
Symptoms. When the spasm begins, the animal suddenly
becomes very restless and betrays great anxiety ; if it happens
to be feeding when the spasm comes on, the ingestion of food
ceases, yet empty mastication continues, and a foamy saliva col-
lects in the mouth. The animal stretches its feet out and tries
to swallow^ the saliva while the head is strongly stretched or
bent. At the same time, the undulatory motions of the esoph-
agus become visilde in the left jugular region. However, swal-
lowing of the saliva can take place only incompletely, and it is
expelled through the mouth and nose by antiperistaltic move-
ments. If the spasm occurs during the ingestion of food, the
saliva is at first mixed with food particles, later on it becomes
pure and does not give an acid reaction like expelled gastric
contents. Along the left jugular depression the cordlike gullet
can be felt distinctly, pressure upon it excites pain. Sometimes
a moderate enlargement, filled with air, saliva and mucus, is
formed above the spasmodically closed section (Friedberger).
The attack may last from a few minutes to several hours ;
it may or may not recur. In a case reported by Cadeac, the
sick horse had several such attacks every week for a year and
a half, and these could be produced at will by feeding short cut
dry feed or by the administration of cold water. Roy, on the
Diagnosis. Treatment. Paralysis of the Est)pliagus. 223
other hand, saw five attacks in five years; they always histed
five hours and were followed by respiratory difficnlties lasting
for twenty-four hours. The disease always ends in recovery.
Diagnosis. On account of the disturbances of deglutition
and the subsequent vomiting, esophagism may be confounded
with inflammation, stenosis or obstruction of the esophagus.
However, the sudden appearance, the likewise rapid disappear-
ance of the attack, the perfectly normal condition of the animal
between the attacks furnish enough data to distinguish this
affection from stenosis or inflammation. Primary esophagism
may l)e distinguished from mild cases of obstruction of the gul-
let in the thoracic portion, which disappear spontaneously after
a short time, by the use of the sound (perhaps after the pre-
liminary application of narcotics). If no impediment is found
and if the attacks still persist, the diagnosis is, of course, pri-
mary esophagism. It is also possible that during very greedy
feeding, a morsel may become lodged in the caudal portion of
the esophagus, this subsequently may pass on, yet the described
s^anptoms may persist a while, and a veterinarian not knowing
the history of the case may think of primary spasm of the esoph-
agus (Cagny, Johne). Indeed, esophagism is, as a rule, due
to a temporary obstruction or to a superficial injury.
Treatment. The disturbed condition of the nerves calls
for the use of narcotics, such as morphine subcutaneously (0.04-
0.6 gm. for horses; 0.01-0.1 gm. for smaller animals); chloral
hydrate per rectum (25-50 gm. for large animals; 0.05-0.5 gm.
for smaller animals) ; during the intervals between the attacks
bromide of potash internally (for horses, in daily doses of 20
gm.). This treatment is usually successful.
Literature. Bournay, Eev. vet., 1898, 204.— Cadeae, J. vet., 1888, 618.—
Friedberger, Miinch., Jhb!, 1890-01, 60.— Frohiier, Monh., 1S97, YJII, 484, 1898,
IX, 345.— Johne, S. B., 1879, 45.— Eies, Eee., 1897, 228.— Eoy, Rev. vet., 1898, 286.—
Winkel, Holl. Z., 1905, XXXII, 56.
3. Paralyis of the Esophagus. Paralysis oesophagi.
{Laehmmifi des SchJundes [German].)
Etiology. Paralysis of the esophagus occurs usually to-
gether with paralysis of the pharynx, and is due to the same
causes as the latter (see page 214). There have, however, been
described a few cases of primary paralysis of the esophagus in
horses, the nature of which has not been cleared up. Moeller
saw this affection a few times after resection of the arytenoid
cartilages, sometimes as a temporary, sometimes as a permanent
condition. He found marked proliferation of connective tissue
around the larynx in one case and thinks it may be possible that
224 Obstruction of the Esophagus.
in other cases likewise inflammatory swelling in tlie first por-
tion of the esophagus might have been the cause of the disturbed
deglutition. In a case of Brissot, a fall upon the left side, and
in a case of Graf, a kick on the neck were the causes of paralysis
of the esophagus. (In these two cases a traumatic lesion of the
esophageal wall itself cannot be entirely excluded, also in the
case of a horse of the Prussian army.) In this case a gelatinous
bloody infiltration was found behind a portion of the gullet
filled with particles of food. Puschmann and Schneider were
unable to discover a cause in their cases.
Oceasionally liistologic changes may be discovered in the pneumogastric or
recurrent nerves.
Symptoms. In primary paralysis of the esophagus the
food is always masticated without trouble ; but masses of fodder
accumulate in the gullet. In this manner the esophagus forms
a thick, firm or more soft, non-painful, cylindrical prominent
mass in the left jugular depression. Deglutition becomes im-
possible and regurgitation occurs. These disturbances appear
suddenly.
Disturbances in deglutition coming on after arytenectomy
may disappear after a few weeks. In the above mentioned case
of Brissot recovery occurred in two days, but the affection may
lead to death in consequence of impeded nutrition or of foreign
body aspiration pneumonia.
Diagnosis. A diagnosis of paralysis of the esophagus can
be made after the exclusion of paralysis of the pharynx, ob-
struction of the esophagus, stenosis or dilation of the esophagus,
contusion of the esophagais.
Treatment. Attempts must be made to push the accumu-
lated, wedgedrin masses of food down with the esophageal
sound. The animals should then receive juicy or liquid feed
only. The employment of nerve tonics (strychnine, veratrine)
or of electricity, is not promising.
Literature. Graf, Z. f. W., 1802, 211.— Moller, Chirurgie, 1891, 190.—
Schneider, W. f. Tk., 1905, 39.
4. Obstruction of the Esophagus. Obstructio oesophagi.
{Foyelgn Bodies in the Esophagus; Occlusio Oesophagi.)
By ol)struction of the esophagus is meant a sudden closure
of its lumen by morsels of food or foreign bodies.
Etiology. Obstruction of the esophagus is seen most com-
monly in cattle and is caused by large, solid constituents of the
food (potatoes, beets, apples) or exceptionally by entirely for-
Etiology. Pathosienesis. 225
eign bodies (see foreign bodies in the stomach). Sometimes
iiniisually hirge morsels of rongli fodder may remain wedged in
the gullet. Sometimes also an esophageal sound which has
been introduced with insufficient dexterity may be swallowed
and may remain wedged in the gullet. Only exceptionally hair
balls or other foreign bodies of this kind may be displaced from
the rumen into the esophagus during rumination. In sheep the
esophagus may be obstructed by firm parts of food (beets) or
by large morsels.
In horses obstruction occurs by coarse and dry feed or
by large morsels, if they feed greedily and do not masticate the
fodder properly and mix it with saliva, or when the reflex irri-
tability of the esophageal nerves has been diminished by a
previous narcosis. More rarely the esophagus of horses be-
comes obstructed by foreign bodies, such as eggs, pills, broken-
off pill sticks, sounds, swallowed milk teeth, etc.
In swine, the affection occurs quite often and the obstruc-
tion is caused by pieces of potatoes, fruit, leaves, etc.
The esophagus of dogs may l)econie ol)structed l)y parts of
the food (bones, cartilages, large pieces of meat or sinews, fish-
bones) or by foreign bodies mixed with the food, or by objects
swallowed in play.
Exceptionally a foreign body that has been swallowed may
get into the esophagus in vomiting and may become wedged in
its wall (Zietschmann).
In horses, foreign bodies are usually found in the thoracic
portion of the esophagus, in other animals most frequently di-
rectly behind the pharynx or in front of the thoracic aperture.
Pathogenesis. When parts of the food or foreign bodies
become wedged in the esophagus, they usually cause a complete
obstruction of its lumen, in very exceptional cases a thin
wedged-in foreign body may cause a more or less incomplete
stenosis of the lumen. Total obstruction prevents deglutition
and the expulsion of the gastric contents (as in rumination,
eructation, vomiting). After partial obstruction by thin bodies,
fluid, gaseous, or thin mushy matters may still be transported
in either direction. Whenever a foreign body becomes lodged
in the esophagus, it causes convulsive contractions of the eso-
phageal muscularis and pain while the spasm lasts. The animal
experiments of Kahn and Meltzer have shown that the convul-
sive muscular contractions are the more frequent and the more
energetic and of longer duration, the nearer to the cardia tlie
obstruction is situated. In this manner lodgment of a foreign
body in the most caudal portion of the esophagus causes a con-
stant muscular spasm, while obstruction in the first portion of
the esophagus leads to less intense muscular contractions, or
they may be entirely absent, while sharp and pointed foreign
bodies produce continuous pains in consequence of trauma to
the wall. Stretching of the wall of the esophagus by the for-
226 Obstructiou of the Esophagus.
eign body itself or by the swallowed material subsequently
causes antiperistaltic movements.
Pressure of the foreign body ujion the neighboring organs
disturbs their function, more or less, while the compressed or
directly injured mucosa of the esophagus may get into an in-
flammatory condition which may lead to necrosis. Inflamma-
tory changes frequently are also produced in front of the ob-
struction in consequence of accumulating, decomposing mate-
rials. This diminishes the resistance of the esophageal wall
and makes an acute dilation of the esophagais possible.
Symptoms. Pain and the peculiar sensation produced by
the lodgment of the foreign body cause the animal to make
strong efforts at deglutition, and to become quite restless. The
animal suddenly ceases to feed, becomes restless, lowers and
stretches its head and makes strong attempts at deglutition,
now and then it opens its mouth, from which saliva flows abun-
chmtly; the expression of the face betrays great anxiety, the
tongue protrudes from the mouth, and a convulsive cough is
heard from time to time. The symptoms eventually become
less marked, but are lial)le to recur now and then. The inges-
tion of food and drink is entirely abolished or the patients at-
tempt to swallow food and water after becoming more quieted
and on feeling hungry. But these are soon thrown out of the
mouth and nose, although in incomplete obstruction water may
get into the stomach. These attempts give us some informa-
tion about the site of the obstruction. If it is located in the an-
terior portion, morsels of food and water at once return after
an attempt at deglutition ; if the obstruction is at the caudal end
we may see how the swallowed material passes along the esopli-
agns as indicated in the left jugailar depression. The expul-
sion occurs the later the nearer to the caudal end the obstruction
is located. The patients sometimes keep on swallowing in
spite of the obstruction, until the esophagus is filled completely,
even up into the pharynx; then the ingestion of food usually
ceases, but the animals continue to masticate on an empty mouth
and to make convulsive attempts at deglutition. In such cases
the gullet can be felt as a firm or more or less soft cylindrical
mass on the left side of the neck. Kneading of the mass may
eventually excite gagging. From time to time masses of mas-
ticated food mixed with saliva are expelled from the mouth
and nose; during these attacks the animals are quite restless,
and the mass expelled is undigested and does not contain any
free HCl. After ol)struction has lasted some time, dilation of
the esophagus sometimes occurs (see page 235).
The cause and site of the obstruction may be ascertained in
a number of cases. Pieces lodged in the anterior portion of the
esophagus may be seen in the well illuminated pharynx of the
dog and cat or they may be palpated with the finger; in cattle
they may be felt after the mouth has been opened, and the whole
hand introduced.
Symptoms. Course and Prognosis. 227
If a foreign body lias lodged in the cervical portion of the
esophagus, the jugular depression is only bulging at a circum-
scribed space, either at the left or at both sides; in the latter
case the bulging is more marked on the left than on the other
side. By palpation one may occasionally be able to determine
the consistency and shape of the body; this manipulation usu-
ally causes gagging or the expulsion of a foamy fluid.
The location of an obstruction in the thoracic portion can
only be ascertained by the use of the esophageal sound or by
a careful analysis of the disturbances of deglutition. Foreign
bodies of a high specific gravity (especially metals), may be
made visible in all animals by the aid of the Roentgen (X) rays.
In cattle and in ruminants in general, meteorism is pro-
duced the more rapidly, the more complete the obstruction and
the more fermentable the previously ingested food has been.
Gases can, however, be expelled partially in incomplete obstruc-
tion of the esophagus, hence meteorism is only moderate. Un-
der these conditions the animal may begin to feed and then pro-
duce a complete obstruction by the swallowed morsels which
fail to pass down.
If the obstruction lasts for any length of time in hogs, they
may become moderately bloated; in such cases they stand
quietly, with their head bent down, their mouth open ; they are
salivated, gagging occurs as if they wanted to vomit. They do
not lie down, or if they do at all, for a short time only. Thirst
is increased, the animals try repeatedly to drink, but the water
returns to, and runs out of the mouth. If the foreign body is
near the pharynx, the animals produce a yelping sound instead
of a grunt.
Course and Prognosis. Foreign bodies lodged in the esoph-
agus are frequently and often expelled within a short time in
consequence of repeated gagging, or they are transported into
the stomach or rumen by continuous strong contractions of the
muscles of the esophagus. In this manner the animals recover
spontaneously. This happens the more easily, the smaller,
smoother and softer the foreign body is and the nearer it lias
become wedged to either the anterior or posterior extremity
of the esophagus. However, if the efforts of the patients are
futile and if they are left to themselves, there occurs a progres-
sive deterioration of their condition. Cattle may die from suf-
focation within a few hours after the obstruction occurred, in
consequence of the rapidly developing bloating, followed by
disturbances of respiration and circulation. A rapidly fatal
issue may also take place in some cases in consequence of com-
pression of the trachea or of the nerves running along the esoph-
agus, or of obstruction of the larynx by particles of food
(Sequens).
In other cases, the animals may suffer from an obstruc-
tion for some time, even for several days, but in such cases pro-
228 Obstruction of the Esopliaj,nis.
gressive and rapid emaciation becomes noticeahle and tlie wall
of the esophagns which is compressed by the foreign Ixxly be-
comes necrotic. If the necrotic portion of the wall breaks into
the surrounding tissues, the clinical picture terminates by a
purulent or ichorous inflammation of the cervical connective
tissue or, if the thoracic portion of the esophagus is involved,
by a pleuritis. Inflannnation and gangrene of the esophageal
wall develops rapidly if the wall has been injured and a channel
for infection has been opened up. Injuries produced by the
introduction of the esophageal sound and in attempts at remov-
ing the foreign body may have the same effect.
Obstruction caused by morsels of food may, without veter-
inary interference, be recovered from speedily, i. e., if the mor-
sel becomes softened and if it can then be removed. If, on the
other hand, the morsel dries and becomes harder, it may pro-
duce dilatation or perforation with grave consequences. A
fatal issue may, however, occur occasionally after removal of
the foreign body into the stomach, if artificial feeding has been
neglected (Drouin) or if an intense inflammation of the esoph-
agus has occurred and now of itself causes intense difficulty in
deglutition (Johne). Difficulties in deglutition and vomiting
may, especially in the horse, lead to pulmonary gangrene from
the start. In greedy horses, obstruction of the esophagus by
too large morsels may recur repeatedly within a short time.
(Small, pointed bodies frequently perforate the wall of the esoph-
agus and become encapsulated in the neighboring tissues witliout pro-
ducing any marked disturbances [Bruckmiiller, Kitt].)
Diagnosis. In obstruction of the esophagus by lodgment
of a foreign body we can usually get a proper clinical history
and we have the sudden appearance of the grave disturbances
of deglutition. If the obstruction has occurred in the cervical
portion of the esophagus, a reliable diagnosis can be made by
palpation from the outside or from the pharynx. In other
cases, particularly if the obstruction is in the thoracic portion,
the diagnosis may meet with considerable difficulties. Spasm
of the esophagus can be distinguished from the milder rapidly
recovering cases of obstruction by the use of the sound, which
must sometimes be preceded by the administration of narcotics
(see page 223).
Stenosis or dilation of the esophagus may be excluded from
the clinical history and from the observation, that soft feed and,
still more, fluids will pass the giillet without difficulty some
time after feeding. In paralysis of the esophagiis, forced at-
tempts at deglutition and gagging are absent.
In ruminants, acute meteorism, due to some other cause,
might erroneously be referred to obstruction of the esophagus ;
but if not due to the latter condition, there is no disturbance
and no regurgitation, and the sound meets no impediment in
Treatment. 229
the esophagus, except in ruminants; masses vomited from the
stomach, smell sour, contain free HCl, and true vomiting occurs
within a certain interval after feeding and with participation
of the abdominal muscles. In dogs the possibility of rabies
must be considered, since disturbances of deglutition'^are so com-
mon in this disease.
Treatment. Removal of a foreign body wedged in the first
portion of the esophagus is best accomplished by the hand or
by a suitable instrument introduced into the buccal cavity.
For this purpose the head of cattle is stretched forward, the mouth is opened
by the aid of the mouth gag or simply by drawing the tongue out and to the
side, next the right hand is introduced into the pharynx and the foreign body is
withdrawn by the fingers of the operator. Since attempts at deglutition are fre-
quently caused by this manipulation, and since the former might move the foreign
body towards the stomach, it is best to have an assistant fix the latter from the
outside. The removal of the foreign body may also be brought about in such a
manner that the fingers introduced into the esophagus are spread out, the assistant
pushes the obstruction towards the buccal cavity and lowers the head of the animal
at the same time. In this manner the foreign body usually slides between the
fingers into the palm of the hand of the operator "(Eolfes). The procedure is
usually applied to the standing animal; it becomes necessary only exceptionally
to have the animal lie down; in such a case it should lie on the right side; horses
must be thrown. Foreign bodies in the first portion of the esophagus of smaller
animals are best removed by appropriate forceps.
Since the animals get excited during this manipulation and since the hand
introduced into the pharynx interferes with respiration, it is necesi-ary to act
quickly. Tf the procedure has not been successful, it is advisable not to prolong
the attempt but to wait for some time and then try again. Such repeated attempts
are however not without danger and Deneubourg has seen an inflammatory cervical
edema follow them, which disappeared only after one month.
When the foreign body is located in the cervical portion of
the esophagus, one should always attempt to dislocate it to-
wards the buccal cavity unless there is danger of suffocation.
For this inirpose the operator grasps the neck of the animal at the sides
from above with both arms, and approaches both hands immediately behind the
foreign body. He tries to move it forward by alternate pressure, made best with
the thumbs. Tf the procedure appears to be successful, it is continued until the
foreign body has been pushed in front of the larynx. It must then be fixed in this
position by an assistant, to be removed through the pharynx as described above.
This is sometimes not necei-sary, because the animal begins to gag and expels the
foreign body through the mouth without any further aid. To assist in the removal
of the foreign body, it is advisable to press it and the larynx forward and down-
ward and to lower the head and approach it to the thorax before the hand is
introduced into the mouth. This causes a depression of the root of the tongue,
and an enlargement of the space between it and the soft palate so that the foreign
body can fall out more easily (Martin). It is also well to oi)en the mouth as
much as possible (Favreau). Chapellier uses two devices similar to hoof -forceps;
with one he compresses the jugular gutters behind the foreign liody to prevent its
sliding backward ; with the other he presses upon the postei'ior end of the
foreign body and pushes it upward. The two forceps are alternately moved forward
until the foreign body has been brought into the pharynx. T'liminger removes
foreign bodies in the most anterior portions of the esophagrs by introducing
a small trochar into their center from the left side of the neck; with this he then
moves them up gradually.
Opinions differ as to how the head of the animal should be held during
the operation. When the head is stretched and helil high the esophagus forms
an almost completely straight line with the pharyngeal and buccal cavity; but
this also sti'etches and narrows the esophagus. In view of this fact it appears
more advantageous to bend the head downward and backAvard ; this certainly is
230 Obstruction of the Esophagus.
always indicated if the foreign body has already been pushed to the pharynx
and is to be pressed into the pharynx or mouth. If the hand is to be introduced
into the mouth, the head must be elevated. Moeller maintains that the head of
the animal should not be held at all.
Some cases can be treated successfully hy the subcutaneous
injection of certain medicines. Hogs and dogs may receive an
emetic subcutaneously (liogs, 0.02-0.03 gm. veratrine or 0.05
gm. liydrocblorate of apomorpliine [Moulis], dogs, 0.01-0.02 .gm.
apomorpbine). Tbese emetics sometimes cause tbe expulsion
of tbe foreign body after a few minutes. In otber ani-
mals likewise, tbe following subcutaneous injections may ac-
complisb tbe oliject, even after unsuccessful attempts at extrac-
tion, by causing energetic muscular contractions and powerful
attempts at deglutition wliicli move tbe foreign body into tbe
stomacb, viz: Strychnine (Maury), eserine (Clerc), veratrine
(Micbalski), arecoline (Frobner).
In eases where he did not succeed in removing the foreign body, Schaak
proceeded as follows : He pouied one quart of mucilaginous fluid into the animal
and then made it run uphill; in this manner horses and cattle often swallowed the
foreign body.
If tbe methods described are unsuccessful, tbe further pro-
cedure depends upon the nature of the wedged-in body. Fruit,
bulbs, morsels of food, etc., in tbe course of time become soft-
ened in the esophagus and are finally swallowed. Since obstruc-
tion of tbe esophagus in cattle soon leads to bloating, one may
leave tbe foreign body undisturbed only if meteorism has been
relieved in the meantime. It is therefore necessary to per-
forate the rumen and it is best to leave the shield of the trocbar
in the wound, closing its outer opening with a cork, and to open
it from time to time in order to let out the accumulating gases.
It is also necessary, in the further course of the disease, to at-
tend to the artificial feeding of the patient per rectum.
If the wedged-in body is too bard, or if its nature is un-
known, if one wants to accomplish removal when other means
have failed, displacement towards the stomach may be attempted
by the aid of an esophageal sound, a catheter, and in an emer-
gency, with a carefully wrapped elastic stick (stick of a whip,
piece of rattan), or a piece of moistened and oiled rope with a
knot at one end. The foreign body must, however, be pushed
without much force and very gradually. The extraction of for-
eign bodies with special armed extraction forceps or the crush-
ing of the foreign body is not to be recommended.
The propulsion of the foreign body towards the stomach succeeds rapidly,
although in some cases this procedure requires great care and dexterity. Tf the
sound is introduced without care or with sudden force, injuries and tearing of
the esophageal wall and even lacerations of the neighboring vessel occur easily,
particularly in restless animals. Such cases are particularly frequent if the operation
is performed by non-professional attendants who are often too ready to step in.
If the removal of tbe foreign body in the cervical portion
of tbe esophagus is impossible by any method above described.
Narrowing of the Esophagus. 231
or if these methods are unpromising from the start on account
of the nature of obstruction, the division of the foreign body
with the aid of a tenotome may be attempted in the following
manner: The foreign body is pushed to the left side, an in-
cision is made into it with a fine-pointed tenotome, next a dull-
pointed tenotome is introduced and the division of the body is
attempted (Imminger). In some cases, however, esophagotomy
cannot be avoided. Porcher and Morey removed a foreign body
(teaspoon) from the caudal extremity of the esophagus of a dog
by a laparo-gastrotomy.
Literature. Chapellier, Bull, 1904, 483.— Droiiiu, Bull., 1904, 854.— Eber,
S. B., 1896, 30.— Fabretti, Vet. Jhb., 1896, 161.— Imminger, W. f. Tk., 1906, 221.—
Johne, S. B., 1879, 4.5. — Kahu, Eugelmanns Arch. f. Physiol., 1906, 355. — Maury,
Rev. vet., 1899, 159.— Meltzer, Ztbl. f. Physiol, 1906, 993.— Porcher & Morey
Bull, 1898, 707.— Pr. Mil Vb., 1903, 114.— Rolfes, Vet., 1894, 128.— Schafer!
A. f. Tk., 1896, XII, 280.— SufEran, Eev. vet., 1906, 652.— Zietschmann, S. B
1903, 262.
5. Narrowing of the Esophagus. Stenosis oesophagi.
{Yerengeniug des Schlundes [German].)
Etiology. Stenosis of a shorter or longer section of the
esophagus may be brought about by cicatricial contraction of
the mucosa (strictura oesophagi), caused by deeply penetrating
inflammations or injuries, crushing by pointed or rough foreign
bodies, destruction of tissues by corroding poisons. Thickening
of the mucosa or of the muscularis of the esophagus produces
a similar effect, likewise an abscess or a neoplasm or other
swellings, such as carcinoma, actinomycosis, papilloma, nodules
due to spiroptera sanguinolenta. In the case of a cow seen by
Joest, a pediculated, nodular, spindle-celled sarcoma of the
lower end of the esophagus always receded like a ball valve
during deglutition, to be again pressed into the esophagus upon
the filling of the rumen. In the case of a horse reported by
Schimmel a single gastrus larva, which had penetrated into
the esophageal wall, produced stenosis.
Stenosis of the efsophagus in the liorse may l)e due to continuous
and often repeated spasm of the cardia. The occurrence of muscular
hypertrophy with dilation of the esophagus, but in the absence of any
obstruction (Kitt, Frohner and others) to which one could refer the
hypertrophy and the subsequent dilatation of the esophagns, permit the
conclusion that stenosis may he due to the causes given above. This is
also shown by an observation of Woodruff who failed to find any-
thing abnormal in the esophagus at the post-mortem examination of a
horse which, during life, had presented the sj^nptoms of esophageal
stenosis and which, after the introduction of the finger into the cardia,
had always shown strong antiperistaltic movements. Petit and Ger-
main are, however, inclined to look upon muscular hypertrophy at the
caudal end of the esophagus as depending upon chronic dilatation of the
stomach, due to abnormal gas formation.
232 Narrowing of the Esoi^liagus.
Compression of the esophagus is frequently due to neo-
plasms (melanoma, struma, lymphoma, myoma) exostoses,
tuberculous masses in cattle, but also in dogs, tuberculous
mediastinal glands, purulent or tuberculous peribronchial
glands; sometimes also to arteries with an abnormal course
(Labat). All these formations may cause lateral or annular
compression and diminution of its lumen (Compressio oesoph-
agi).
Cases of stenosis in a circumscribed place due to anomalies
of development are very rare (Casparini and Serres saw such
a case each in a foal. Smith in a one-month-old dog).
Pathogenesis. With the exception of the congenital
stenosis or of cases due to spasm of the cardia, all other fonns
develop very slowly and the symptoms therefore rarely appear
suddenly or immediately after birth, or after the weaning of the
young when these are fed with vegetable food; but they make
their appearance very gradually. Since inhibition of the pas-
sage of morsels of food stands in direct relation to the degree of
obstruction, it may happen that a larger or firmer mass of food
becomes caught accidentally in front of the obstruction. As
long as arrested it will cause the symptoms of obstruction
of the esophagus l)y a foreign body (see page 226). The con-
vulsive contractions of the muscles of the esophagus, caused
by the arrested morsel, press the latter through the narrowed
place after a shorter or longer time, and deglutition is then
again possible. Repeated and strong efforts at deglutition made
voluntarily by the animal also assist in pressing the morsel
through the stenosed portion.
Symptoms. The symptoms consist from the start in dis-
turbances of deglutition. The animals begin to feed greedily,
they masticate and swallow, and the mouthful first passes down
perfectly normally, then, however, there are strong efforts at
deglutition ; the morsel may finally pass into the stomach. The
efforts are repeated later at each act of swallowing or at each
meal again and again, according to the degree of stenosis and
to the nature of the feed, until the animal, half fed but tired
out, desists from feeding. During the forced attempts at degluT
tition, saliva, or saliva mixed with masticated food is from time
to time transported outwards through the mouth or nose in con-
sequence of antiperistalsis. Deglutition of fluids, however, is at
this time not at all or very little disturbed, Init if the stenosis is
quite marked, fluids will also cause disturbance. In some cases,
there is only a retarded ingestion of food accompanied for some
time by more or less regurgitation.
If the stenosis increases the clinical picture of complete
esophageal occlusion, or more often that of dilation, gradually
develops.
A considerable stenosis in ruminants leads to chronic
Symptoms. Diagnosis. 233
bloating, since belching is prevented. Bloating is frequently
the first sj^nptom in cattle (Johne) and is in certain cases,
as claimed by Hamoir, not due to an obstructing impediment
in the esophagus, but to pressure upon the pneumogastric
nerve by tuberculous mediastinal glands. (Gruetzner, however,
saw bloating of the stomach in rats only after severing the
cervical portion of the pneumogastric nerve ; cutting in a more
caudal region had no effect.)
Some information as to the seat of a stenosis may be gained
from a careful observation of the animal during feeding;
energetic efforts at deglutition or a discharge of saliva mixed
with particles of food from the mouth or nose appears the
longer after swallowing of a morsel the nearer to the stomach
a stenosis is situated. The advance of the morsel may be con-
trolled by placing the hand upon the esophagus. The best re-
sults may be obtained by the use of the esophageal sound, but
the use of this instrument is not always without danger. A
sound of proper thickness, on being introduced into the esoph-
agus, meets the impediment and its seat can be ascertained
from the length of the part introduced. If now successively
smaller and smaller sounds are introduced, the thinnest one,
which finally passes into the stomach, gives the degree of the
stenosis.
The introduction of the esophageal sound requires great care and some
practice; it can, however, be easily accomplished on all animals, particularly in
the horse in a standing position. The anterior end of the sound is moistened
with oil, glycerine, fat or vaseline, the head of the patient is elevated and so
stretched that it forms one line with the neck; the mouth is opened with a mouth
gag, or if nothing better is at hand with a piece of wood or cork placed Ijetween
the molars, the tongue is then depressed with the left hand which is introduced
into the mouth, then the sound is grasped with the right hand, like a penholder
with the anterior end somewhat raised, introduced into the mouth and pushed
carefully over the left hand into the esophagus until it meets an impediment. The
sound is then in place, held for a little while, is withdrawn somewhat, and again
pushed forward under even, very moderate pressure. Care must be taken not
to produce a perforation of the esophagus. If the sound again meets the impedi-
ment at the same place, a stenosis at this site may be diagnosticated.
In ruminants the sound is to be intro
countries (El)er). Energetic contractions of the rnnien may
also be produced by freely soaking the flanks with cold water,
or by driving the animals into a river (the latter method is to
be recommended if numerous cases of the affection occur simul-
taneously in sheep).
The effect of massage of the rumen is materially assisted
by such measures as will cause belching or vomiting. A very
simple and frequently effective method consists in irritating the
velum and the pillars of the fauces of the animal with a dull,
flexible rod (the blunt end of a whip wrapped with cloth) ; while
this is being done the mouth must be forced open and the tongue
drawn out. This frequently causes a good deal of belching with
the expulsion of very large amounts of gas, sometimes mixed
with food particles. It is advisable to stand on the side of the
head of the animal, so that the very fetid gases do not get
directly into the face of the practitioner. It is less satis-
factory to merely pull out the tongue of the animal, moving
it up and down in the mouth with a rope provided with knots or
made of straw, or to apply a straw rope soaked in tar or other
nauseating substances to the mouth of the animal.
The removal of the gases in the rumen through an arti-
ficial opening is only indicated if the condition of the patient
becomes worse in spite of all other means, if suffocation is
threatening, or when the animals are on the floor, so that the
common methods of treatment have become impossible. The
introduction of the stomach tu])e is not a very dangerous pro-
cedure ; but it is usually not successful in primary bloating, since
the inner opening of the esophagus lies behind the masses of
food, so that the tube will immediately become obstructed by
food particles. This defect may be remedied by an elevation of
the foreparts of the animal; however, when this is done, mas-
sage is usually sufficient and makes the use of the stomach tube
superfluous (Eber). If the dyspnea is severe, the introduction
of the stomach tube may be injurious and may lead to fatal
asphyxiation.
Monroe's stomach tube consists of a spiral wire covered with leather, or
of vulcanized rubber or guttapercha, and terminates at one end in a blunt knob
with several openings. It is introduced in a manner previously described (see
page 233), and after its internal end has entered tlie rumen the expulsion of
gases may be supported by pressure upon tlie left flank. — Sendrail recently
recommended a tube formed by a spiral metal 1)and which is said to be much
more durable than the old style. The stomach tube for horses is perhaps most
serviceable, because its wide lumen and smooth wall may permit the expulsion of
particles of food more easily than the older instruments.
If immediate danger has been removed by one of the meth-
ods recommended, the animals must be kept under further ob-
servation so that a repeated accumulation of gases can be met
by proper means.
Puncture of the rumen must be reserved for cases of pri-
mary meteorism after the other methods have failed and when
Treatment. 261
there is immediate danger of death. In some cases puncture of
the rumen, particularly if performed l)y laymen, may cause a
more or less extensive peritonitis or the adhesion of the rumen
to the abdominal wall, which will subsequently endanger the
health of the animal, more or less.
Puncture of the rumen is performed with a loiiy troehar held in the closed
hand; it is jnished (contained in its protecting tube) into the most prominent
point of the left flank or into the center of a line which connects the external
angle of the ileum with the middle portion of the last rib. An incision into the
skin may have been made previously. The point of the trochar is directed towards
the right elbow. After penetration the stiletto is withdrawn and it or a thin
rod is used to remove particles of food which may collect in the tube of the trochar.
In order to prevent too sudden congestion of the abdominal vessels or rupture of
vessels, or anemia of the brain, it is advisable to let the gases escape gradually.
The tube of the trochar should then be closed with a cork and left in place for
several hours, safely secured by a bandage wound around the rump of the animal.
In an emergency, puncture of the rumen may be ])erformed with a strong
pointed knife. The latter, first carefully cleaned, is held with its blade towards
the front and is pushed 8 to 10 cm. deep into the rumen; it is then rotated at
a right angle in order to produce a gaping wound.
The punctured wound usually heals rapidly, Init a wounmiptoms generally precede, but occasionally follow,
those of intestinal catarrh.
Diagnosis. The diagnosis meets wdth difficulties only in
the absence of diarrhea, but a correct diagnosis is suggested by
lively intestinal sounds, in connection Avith symptoms of colic,
possibly with icterus, and by the fact that the general disturb-
ances and those of the pulse are usually not considerable. In-
flammation of the intestines usually leads to grave disturbance
of the general condition from the start, weak and frequent pulse,
330 Acute Intestinal Catarrh.
obstinate lack of appetite, and the impossibility of inflnencing
the disease favorably by treatment.
Since intestinal catarrh may be dne to acute infectious dis-
eases and to intestinal parasites, these conditions must be con-
sidered in the diagnosis.
Prognosis. Primarily uncomplicated intestinal catarrh is
dangerous only in very young or very old animals; in these it
may occasionally lead to death; as a rule the disease ends in re-
covery and rarely leads to chronic catarrh. Of unfavorable
prognostic significance are elevation of temperature, very severe
pains, marked prostration, obstinate diarrhea ; these symptoms
point to secondary inflammation of the intestines.
Infectious gastro-intestinal catarrh of hogs usually disap-
pears, under purely dietetic measures witliin one to four days,
sometimes only towards the end of the first week. Fatalities
do not occur as a rule ; Aronsohn, however, reported a mortality
of 1 to 2%.
Treatment. The main points in the treatment of acute in-
testinal catarrh are the establishment of favorable hygienic con-
ditions and the proper regulation of diet. The sick animals
should, above all, be kept quiet in a warm, dry place where they
can, if necessary, be protected against loss of heat by being cov-
ered with blankets. The selection of such a place is particularly
important in young and small animals, including rabbits and
fowls. The feeding ought to be done in the most cleanly man-
ner and the feeding vessels should be cleansed scrupulously be-
fore each meal. The parts of the body which may become soiled
in defecation must be cleansed, the feces must be removed
promptly and frequently from the neighborhood of the sick
animals, and an admixture of feces with feed must be strictly
prevented. The buccal cavity of the animals should be mped
out several times each day with pure or somewhat acidulated
water.
The regulation of the diet should protect the inflamed mu-
cous membranes against further irritation and should attempt
to furnish as little culture-material as possible to the microor-
ganisms which rapidly increase in the abnormal intestinal con-
tents. Animals sliould, therefore, receive a starvation diet for
one or two days, if they come under treatment at the first stage
and if their state of nutrition permits of the withdrawal of food.
All irritating, acrid, undigestible food must be avoided and food
must in general be given only in small doses for each meal.
Herbivora may receive aromatic, but not fresh, hay (perhaps
scalded), grains softened in warm water, crushed oats or bar-
ley (best mixed with water and salts), flour or bran mash and,
in case the diarrhea is severe, mucilaginous soups of oats, bar-
ley, linseed cakes; for ruminants in addition boiled beets and
potatoes. Raw feed cannot, as a rule, be withheld entirely, since
Treatment. 331
the animals will then refuse all food. Diarrhea occurring in
cattle after feeding green sugar beet leaves- can be stopped rap-
idly by giving rough feed, particularly hay in the morning as an
alternating meal. Sick swine must be fed with flour, rice flour,
germinated malt, linseed, bread soups, roasted oat or barley
flour, roasted chestnuts, rice, sago, boiled oatmeal with fat, meat
broth with the yolk of eggs or a variety of artificial foods (see
page 291). After the diarrhea has been stopped, finely chopped
meat or fowl meat may be added to the enumerated food stuffs
or the patients may receive a mash of crushed barley, rice, etc.,
to which has been added some fat and salt. Rabbits should re-
ceive roasted oats, young twigs of oaks or willow, also burnt
flour soup, thick flour paste with roasted rye bread. The follow-
ing are adapted for fowl: millet, rice, corn and other grains,
boiled or worked into a mash with the addition of powdered
chalk; also roasted and finely crushed barley, and infusion of
half an ounce of oatmeal boiled in one quart of water, or one part
of linseed boiled in twenty parts of water; parrots do well on
clioeolate or on bread moistened with claret. The ingestion of
water must be limited and the animals must not receive it cold,
but water which has been standing for some time.
Since acute intestinal catarrh generally follows errors of
diet, the removal of the gastro-intestinal contents is indi-
cated ; this diminishes the amount of the irritating material al-
ready in the gastro-intestinal tract, removes a culture soil for
excessively multiplying intestinal bacteria and to a certain ex-
tent brings about a disinfection of the intestines. If the noxious
material is prol)al)]y still in the stomach then lavage of the latter
or the use of emetics may be indicated. The treatment of dis-
turbances of gastric functions, if at all present, must follow the
principles laid down above (see page 291). To remove the nox-
ious or abnormally fermenting contents of the intestines mild
laxatives should be emploved ; the best drug is probably castor
oil 250-500 gm. to horses;^ 500-1000 gm. to cattle; 50-200 gm. to
calves, foals, sheep and goats ; 50-100 gm. to hogs ; 15-50 gm. to
dogs ; 5-20 gm. to cats ; to rabbits and birds 5-15 gm. To horses
and cattle castor oil is administered with the double dose of hot
water or with the same or the double dose of a bland oil (oil of
sesame, oil of poppies, etc.) ; to the dose for horses may also be
added 50-70 grams of ether; this makes the oil light-fluid; for
dogs and cats the oil may be emulsified with one-fifth gum arabic
and five to ten parts of water or with aqua menthae, tinctura
aurantii, succus citri, etc., or in gelatin capsules (3-10 at 5 grams
each) ; to the hog in the form of an electuary with licorice or
honey ; for fowls a mixture with equal parts of water should be
injected directly into the esophagus with a syringe armed at its
tip with a flexible tube ; or small pieces of stale bread soaked in
castor oil are introduced into the pharynx of fowls (Schlampp).
According to the experiments of F. Miiller calomel has a laxative
effect only in dogs (0.3-0.4 gm.), cats (0.1-0.15 gm.), rabbits (0.2
332 Acute lutestiual Catarrh.
gm.) and birds (0.2 for chickens, 0.05 for pigeons). Like castor
oil, calomel must be given in one full dose. Neutral salts (sul-
phate of magnesium and sodium) are also serviceable (horses
250-500 gm. as an electuary, cattle 500-1000 gm, as an infusion;
sheep and goats 50-100 gm. as an infusion, hogs 25-50 gm. as an
electuary, dogs 10-25 gm. in solution ; cats, rabbits, fowl, 1-5 gm.
in solution). Stronger purgatives should be avoided. The con-
tents of the posterior portion of the intestinal tract are re-
moved more properly by infusions, into the rectum, with luke-
warm water allowed to run in under moderate pressure.
Other therapeutic methods are indicated comparatively
rarely, viz., when the diarrhea persists in spite of the regulation
of diet and of elimination. It would, however, be an error to use
anti-diarrheal drugs at once upon the appearance of diarrhea. If
diarrhea persists narcotics like opium are indicated (for horses
5-20 gm., cattle 10-25 gm., calves, foals, sheep and goats 1-3 gm.,
dogs 0.1.0.5 g-m., cats 0.05-0.2 gm., rabbits and birds 0.05-0,1 gm.),
tincture of opium about 10 times the above doses of opium (pow-
dered) ; both may be used in the form of suppositories or clys-
mata. When the symptoms are particularly violent the subcu-
taneous use of morphia may be indicated, although only in
horses (0.3-0.6 gm.) and dogs (0.02-0.15 gm.). Of the numerous
astringents the following are most commonly used : oak bark (25-
50 gm. for horses and cattle, 5-10 gin. for foals, calves, sheep and
goats, 5-10 gm. for dogs and cats, 0.5-1,0 gm. for rabbits and birds
in the shape of a decoction, and electuary or as pills; tannin
(horses 5-15 gm., cattle 10-25 gm., calves, foals, sheep and goats
2-5 gm., hogs 1-2 gm., dogs 0.1-0.5 gm., cats and rabbits 0.05-0.2
gm., fowls 0.01-0.05 gm.); further, tannalbumin veterinarium
(6-30 gm. for large, 2-5 gm. for medium-sized, and 0.1-0,5-2 gm.
for smaller animals) ; tannoform (the same doses), tannigen (the
same doses), tannalbuminate-salicylate (the same doses). These
preparations are all expensive, hence they can be employed
usually only in small animals. Other astringents which might
be mentioned are Cortex Chinae (for dogs 2-5 gm. as a decoc-
tion), bismuthum subnitricum (for horses 5-15 gm., cattle 10-25
gm., hogs 2-5 gm., dogs 0.5-1 gm.), bismuthum subgallicum
(dermatol, the same doses), bismuthum tribromphenylicum
(xeroform, the same doses), tannismut or bismuthum bitan-
nicum (according to Gottschalk, for horses and cattle 15-30 gm.,
for dogs 2-6 gm.).
The action of disinfecting means appears prol)lematical,
especially in the long intestinal tract of herbivora and hogs.
The best disinfection of the gastro-intestinal tract is accom-
plished by a thorough evacuation of the contents of stomach and
intestines. The following drugs, however, are much used: res-
orcin (10-15.0 gm.,or for small animals 0.5-1.0 gm.),lysol (10-20.0
or 1-2.0 gm,), creolin (the same doses), creosote (5,0-10 gm. or
0,1-0.2 gm.), napththalin (10-15,0 or 0.05-0,2 gm.). Especially
good results have been reported with the use of creolin.
Treatment. Acute Gastro-Iutestinal Catarrh in Young Animals. 333
111 catarrh of the rectum, particularly in carnivora, the in-
ternal treatment indicated should be combined with rectal infec-
tions with disinfectants and astringent drugs ^ (argentum
nitricum 1-5:1000, alum, tannic acid, sulphate of iron in 1 to
2% solutions, also starch in water, perhaps with some tincture
of opium, or with the use of suppositories.
Rectal injections are given with a thick-walled rubber tuhe, connected with a
funnel or an rrigator. The fluid should be lukewarm and it should be introduced
under a low pressure so that the intestine is not made to contmct. In this manner
arge amounts of tiuid may be introduced into the rectum. Before giving an in-
jection, the feces should be removed if possible. In fowls a syringe with a dull
nozzle may be used.
Moderate and even heat is also beneficial and reduces the
peristaltic movements and in this manner acts against abdom-
inal pain Hence warm fomentations on the abdominal wall are
indicated; also warm infusions given internally. Fowls are
often influenced very favorably by hot sand baths (bO-7U C.)
(Klee). . . 1 ^.
To counteract the severe weakness which often comes on in
young animals rubbing, warm packs, sul)cutaneous injections ot
caffeine and camphor are beneficial. Most reliable, however tor
this purpose is the intravenous, subcutaneous or intrarectal in-
jection of physiologic salt solution. This latter is best brought
to body temperature, after having previously been sterilized,
and is "injected with aseptic precautions under the skm or into
a vein. If injected in this manner, one might also add to the
solution 2 to 3% of grape sugar. The intravenous or subcu-
taneous dose for large animals is 4-5 quarts, 2 quarts for me-
dium-sized animals, 1/4-1/2-1 qnart for smaller animals.
Literature. Aronsohn, B. t. W., 1898, 110.— Braun, Kaninchenkrkh., 1907, 25.--.
Esser A f Tk , 1901, XXVII, 306.— Gottschalk, D. t. W., 1909, 497.— Haag, W f.
Tk 1907, 906.— Hentrich, Z. f. Vk., 1905, 59.— Klee, Geililgelkrkh., 190o, oO —
Vet Jhb 1906, 350.— Kramell, Z. f. Vk., 1899, 319.— Muller, Kim Unters, uber
Wei-'t und Wirkung des Kalomels. Diss. Giessen, 1908.— Schlampp, Therap. Technik,
1907, II, 1. Halfte.— Uebele, Therap. Handlexikon, 1910.
14. Acute Gastro-Intestinal Catarrh in Young Animals.
Occurrence. The disease occurs most frequently in calves
and lambs, more rarely in foals and still less frequently in other
domestic animals.
Etiology. The gastro-intestinal organs of young, particu-
larly of sucking animals, are very sensitive and become affected
even after slight errors in diet. Saliva is secreted only to a
small extent; the epithelial covering of the gastro-intestinal
tract is tender and very sensitive, the muscularis is unable to
make any greater efforts ; the basal cells of the gastric glands
are poorly developed, the gastric juice contains comparatively
little pepsin, while the pancreas does not secrete any amylolytic
334 Acute Gastro-Intestinal Catarrli in Young Animals.
enz^ine for some time after birtli. All these conditions fully
explain the sensitiveness of the gastro-intestinal tract of suck-
lings to noxious influences. In ruminants there is the further
cause that the fore-stomachs are not 3'et functioning and the
fluid food enters the ahomasum without any preliminary prepa-
ration. This fact becomes particularly important in young rum-
inants which have been weaned too early.
Since sucklings, as a rule, receive only milk, an improper
composition of the latter is generally the cause of the atfection.
The character of milk is rarely influenced unfavorably by a too
abundant feeding of the mother animals with green feed or
clover hay. Much more dangerous is the milk after insufficient
feeding with watery, non-nutritious, spoiled feed. Certain com-
ponent parts of the feed, poisonous, oily resinous plants, and cer-
tain drugs, particularly laxatives, find their way into the milk
and exert a disease-producing effect upon the digestive organs
of the sucklings. The milk of cows which receive an abundance
of distillery slop or oil cakes may produce gastro-intestinal ca-
tarrh in calves.
Certain diseases of the mother animals produce changes in
the functions of the mammary glands. Most dangerous in this re-
spect are the acute infectious diseases and still more the inflam-
matory diseases of the udder. In the course of acute infectious
diseases the milk, which is also changed in its composition, fre-
quently contains toxins, and in mastitis certain pathogenic bac-
teria may coagulate the milk in the udder, or this may
have undergone slimy or other changes. Hence sucklings al-
most invariably become sick if the mother animal suffers from
acute parenchymatous or any other form of mastitis, from foot-
and-mouth disease, smallpox, epizootic aphtha, or tuberculosis
of the udder. Excessive exertion of the mother animal likewise
disturbs the proper secretion of milk.
Disease of 3'oung animals is frequently seen in artificial
feeding with milk, when the attendants lack in proper cleanli-
ness. Milk is a favorable soil for a variety of bacteria and mil
easily decompose, the organic acids then formed causing ca-
tarrhal processes in the gastro-intestinal tract of young ani-
mals. It must also be considered that boiling destroys certain
ferments contained in the milk which assist the functions of the
gastro-intestinal tract; still more dangerous are milk substi-
tutes; these contain flour almost without exception and are
easily decomposed ; unsatisfactory is likewise skimmed milk to
which flour, bread, etc., have been added.
The ingestion of too large amounts of otherwise unobjec-
tionable milk often produces digestive disturbances. A mistake
is sometimes made in allowing young animals to suck only at
long intervals, for instance morning and evening; under these
conditions the stomach is not able to work up properly the ex-
cessive amount of ingested milk. On the other hand, a mistake
may be made in the other direction, the young animals may be
Etiology. Auatouiieal Changes. Syiiiptoins. 335
permitted to suck too often and tliey may overload tlieir stom-
ach in this manner.
Finally gastro-intestinal disturbances may be brought about
because the young animals have not been permitted to suck the
colostrum which removes the meconium from the newborn.
Frequently a catarrhal affection of the gastro-intestinal mucosa
is due to marked cooling of the body in consequence of staying
in cold, damp, drafty barns, or in consequence of sucking from
a cold udder, or staying in the open air during cold weather or
during rain.
Improper weaning may also produce the affection if only
dry feed is given at once to the weaned young. The gastric
mucosa is excessively irritated by the coarse feed and at this
period the fore-stomachs do not yet function properly in rumi-
nants.
In weaned animals the disease may also be due to the same
factors which cause it in adults (see pages 285 and 325).
Bacteria probably also play a role in the prodiietion of the disease; these micro-
organisms are normally present in the intestinal tract and they may be enabled to
display pathogenic properties in consequence of errors of diet, or bacteria, which are
pathogenic from the start, may be ingested with the food stuffs. The bacillus
coli communis appears able occasionally to attain pathogenic properties, (See vol. I.)
Sometimes intestinal parasites may produce a catarrhal in-
flammation of the gastro-intestinal mucosa.
Anatomical Changes. Post-mortem examination frequently
shows rather insignificant changes such as hyperemia, a mod-
erate amount of swelling of the gastro-intestinal mucosa; in
other cases there may be small hemorrhages, swelling of the
follicles, sometimes also superficial ulcerations.
Symptoms. The disease usually begins with a diminution
of appetite and with a certain degree of lassitude after which
febrile symptoms come on. The sucklings do not hunt up their
mothers; if they are taken to her they suck little and without
relish; weaned animals take little food or none at all. Some-
times vomiting occurs and a marked improvement is then notice-
able.
After a short time diarrhea comes on and this remains the
prominent feature of the clinical picture and it may even be
the very first symptom. In the beginning the feces are of nor-
mal color, but somewhat soft, later on they become thinner and
thinner, finally perfectly thin-fluid and are sometimes voided in
a stream at short intervals, under tenesmus. At this time the
feces are yellowish or yellowish-gray, distinctly acid in reaction
and of a disagreeable, penetrating, sour smell; they contain
white or gray flocculi, lumps (fat-droplets, fat-crystals and bac-
teria), sometimes bloody streaks, or they are even uniformly
reddish. The animals lie curled up on the floor or stand up with
their back curved; the legs are drawn under the abdomen and
the patients exhibit manifestations of abdominal pain which is
generally severe.
336 Acute Gastro-Iutestinal Catarrh in Young Animals.
The thin-fluid feces soil the iieigliborhood of the anus ; as a
consequence the hairs fall out and eczema and intertrigo develop.
The abdomen appears eitlier drawn in and sunken in at the
flanks or it is, on the contrary, bloated moderately; the latter
condition is seen particularly in ruminants. The intestinal
sounds are sometimes exceptionally loud and rumbling. Palpa-
tion in the region of the stomach elicits tenderness rarely if at
all (the abomasum in ruminants).
If diarrhea is obstinate debility and emaciation rapidly ap-
pear. The appetite is now entirely lacking, while thirst may be
intense; the eyes sink in, the fur becomes scrubby, the skin is
dry or covered with a clammy sweat, the whole body emits a dis-
agreeable nauseating odor. Finally the animals are hardly
able to stand on their feet; they lie apathetically on the floor,
the peripheral portions of the body become as cold as ice, in-
voluntary movements of the bowels occur and death takes place
in syncope or wdth convulsions.
Course. In a majority of cases the disease ends in re-
covery. The diarrhea stops after a certain time, occasionally
after a few hours ; the appetite improves, the animals become
more lively and generally recover rapidly, even in those cases
where the affection has lasted for some time. Grave cases lead
to death in three to five days, occasionally, however, they drag
along for several weeks and a catarrhal pneumonia is then usu-
ally the terminal affection. Aphthous stomatitis is a frequent
complication in lambs.
Diagnosis. The disease may be confounded with dysentery
of sucklings; the latter, however, always attacks the animals
immediately after birth or at the utmost during the first few-
days of life ; it takes a much more unfavorable course and be-
trays clearly its infectious character, wdiile simple gastro-intes-
tinal catarrh appears sporadically, and even if there are a num-
ber of cases, one is al)le to demonstrate the common external
factor in its production.
Prognosis. The younger the sick animals, the longer the
disease lasts and the less favorable is the prognosis. The latter
also depends upon whether it is possible to remove the noxious
causative factors.
Treatment. The first attempt at treatment must be the reg-
ulation of the diet of the sick animals ; if they are sucklings, the
diet of the mother animal must likewise be attended to and
errors of diet or external unfavorable conditions have to be cor-
rected speedily. In case the young animals have to be brought
up by hand, it is advisable to feed them with pasteurized milk,
formalin milk (1 to 25.000) or perhydrase milk. The detrimen-
tal effect of feeding milk may be diminished by the addition of
Catarrhal Intestinal Colic. 337
lime water (a teaspoonful to a quart of milk) ; its often markedly
bloating effect may be removed by the addition of boiled oatmeal.
Lafitte saw unfavorable results from the exclusive use of fresh
whey. Sucklings should be allowed to feed three or four times
per day and if necessary should be fed by a healthy foster-
mother. The diet of weaned animals must be regulated in the
same manner as is recommended in intestinal catarrh of adult
animals (see page 330). The barn should be kept uniformly
warm and the place where the young animals are must be
cleansed very thoroughly. The teats of the mother animals
should also be cleaned before the young are allowed to suck.
The medicinal treatment is similar to that used in dysentery
of the newborn (see Vol. I) or to that used in gastro-intestinal
catarrh of adult animals (see page 331).
In calves favorable results have been obtained by the admin-
istration of salicylic acid with tannic acid aa 1-2 gm. three times
a day in camomile tea). Sehwarzmeier recommends for foals
tincture of opium (up to 5. gin. pro dosi) with tannic acid in
whiskey; Schley, for calves, a i/o% solution of nitrate of silver.
Sometimes washing out of the rumen (see page 274) may be-
come necessary (Imminger). Eber has brought about a cure
in two calves, after collapse had occurred, by the sub-
cutaneous injection of two quarts of physiologic salt solution
(Na CI 0.8% carbonate of sodium 0.25%). The absorption
of this solution goes on very rapidly, especially if aided by mas-
sage. Kronacher had similar favorable results with the rectal
application of physiologic salt solution.
Literature. Albrecht, W. f. T., 1888, 335.— Eber, D. t. W., 1909, 107.—
Kronacher, B. t. W., 1909, 575. — Imminger, W. f. T., 1907, 1. — Lafitte, D. t. W.,
1905, 357 (Review).— Leydendecker, B. Mt., 1891, 164.— Sehwarzmeier, O. M., 1889,'
15. Catarrhal Intestinal Colic. Enteralgia Catarrhalis.
{Einfaclie Reiz-, Krampf-, rlienmafische or Erhdltungskolik
[German].)
What is generally called rheumatic or convulsive colic is a
mild, short attack of acute intestinal catarrh with colicky pains.
If a special chapter is here devoted to this affection, this is done be-
cause the afiPection is frequently treated separately in veterinary litera-
ture as a form of colic. The French writers include the disease in the
great group of ''congestions intestinal es," to which also belong the dis-
turbances due to thrombosis of the mesenteric arteries. The term "con-
vulsive colic," " Krampf kolik" (German), appears objectionable be-
cause all genuine colicky pains are due to convulsive contractions of
the intestines.
338 Catarrhal Intestinal Colic.
Occurrence. Symptoms of colic in the liorse iindonbtedly
are due most commonly to a transitory acute intestinal catarrh.
Thirty-five per cent of the colic affections seen in the Budapest
clinic are due to this affection and it is the most frequent type of
colic among- breedins^ and cavalry horses. Cattle and hogs are
likewise sometimes subject to this disease.
Etiology. The causative factors are the same as in acute
intestinal catarrh (see page 325). In a certain proportion of
cases external or internal cooling of the body plays a role;
(drenching, standing- in cold weather in the open air when
heated, the ingestion of excessively cold water or of cold frosted
feed). Catarrh from these causes is, however, rarer than ca-
tarrh due to errors of diet. The loud intestinal sounds which
are considered characteristic for the disease, the socalled
"cramp sounds," clearly point to lively fermentative pro-
cesses in the intestinal tract with an increased formation of
gas; the disease occurs just as frequently during the warm
season, when the animals are less exposed, as during cold
weather. Cavalry horses, which, as a rule, receive little rough
feed and which in consequence often feed upon the bedding
straw, frequently suffer from the disease after the ingestion of
mouldy straw ( Pr. Mil. Vb. ) . In cattle, particularly in working
oxen, catarrhal intestinal cramps are often caused by the inges-
tion of large amounts of water (see page 326).
Pathogenesis. The irritating substances (gases, fatty
acids) or too much cold water cause convulsive contractions in
various portions of an irritable intestinal wall, which vary in
duration. These convulsive contractions then cause the colicky
pains (Bauchzwicken, Bauchgrimmen [German]). After the
abnormal intestinal contents have been voided, the convulsive
contractions cease, but the peristalsis for some time remains
more lively because the intestinal mucosa is in a catarrhal con-
dition.
Symptoms. Horses are subject to symptoms of colic which
are usually violent ; the individual attack lasts from five to fif-
teen minutes and the animals appear well during the intervals.
The intestinal sounds are usually intensified and more frequent,
sometimes continuous and occasionally audible, not merely over
the caecum but likewise over the remainder of the intestines.
Defecation may be perfectly normal, that is, if only the small
intestines are affected, or it occurs more frequently and the feces
are soft and contain undigested particles of feed; sometimes
there are short attacks of diarrhea. In cattle severe attacks of
colic come on suddenly, the abdomen is occasionally somewhat
enlarged and the left flank depression is somewhat filled out,
although bloating is absent. After half an hour diarrhea sets
in and with it a gradual diminution of the pains; the animals
usually appear perfectly recovered after a few hours.
Course. Diagnosis. Treatment. 339
Hogs become very restless in consequence of catarrhal in-
testinal pains ; they lie down frequently, roll, groan, sigh, or cry
out aloud. After the expulsion of flatus and after several defe-
cations they become quiet.
Course. In the course of mild cases the attacks of pain last
only a few quarters of an hour ; the affection rarely extends over
six hours, but even after the symptoms of pain and restlessness
have disappeared, the intestinal sounds persist for some time.
The very mild character of the catarrhal affection of the intes-
tinal wall fully explains the rapid recovery after the irritating
substances have been carried off or the causative factors have
been favorably influenced. The course is favorable almost with-
out exception ; only very rarely do excessively strong intestinal
contractions lead to volvulus.
Diagnosis. The appearance of abdominal pain in par-
oxysms, the absence of an increase of the abdominal circumfer-
ence in the horse, usually also in cattle and swine, in connection
with a lively peristalsis with commonly more frequent defeca-
tion, the absence of general disturbances, the negative result of
an exploration per rectum are characteristic for the affection
under discussion. Embolism of smaller intestinal arteries oc-
casionally also causes abdominal pain. A differential diagnosis
is only possible, and then not always, if the history shows peri-
odic attacks of abdominal pain without any external cause, with
a normal character of the feces, and when rectal exploration
demonstrates throml)osis of the mesenteric artery, in which case
one may, of course, assume an embolic closure of some small in-
testinal vessels. — Abdominal pains due to uterine contractions,
which in mares come on towards the end of gestation and are
due to energetic fetal movements, do not lead to an intensifica-
tion of the intestinal sounds and the fetal movements can easily
be perceived. — Strangulation or invagination in cattle can
be excluded from the history and the findings.
Treatment. Warm applications upon the abdomen and rec-
tal injections with warm water have a tendency to stop the
cramps of the intestines. Warm applications may be made in
such a manner that two sacks are sewed together, dipped in
water of 40° C, placed upon the abdomen and covered with a dry
blanket. The application must be renew^ed every ten minutes.
If in horses the abdominal pain is very intense morphine (0.3-0.5
gm.) may be given subcutaneously or chloral hydrate per rec-
tum. To expel the decomposing intestinal contents rapidly mild
laxatives may be given which are not liable to lead to cramps,
neutral salts, castor oil, combined with ether for horses) ; the
diet should be regulated as in acute intestinal catarrh (see page
331).
340 Abdominal Pain in Uterine Contractions. Chronic Intestinal Catarrh.
Abdominal Pain in Uterine Contractions. Highly bred mares
frequently show symptoms of colic in the advanced stages of gestation,
especially al)0ut the 8th month of pregnancy and during the last weeks
before parturition, these depend upon a mechanical irritation of the
uterus by the moving embryo and upon uterine contractions caused
by it. Predisposing causes are changes in position of the embryo,
external dull force to the abdomen, overheating followed by the inges-
tion of cold water, the ingestion of spoiled feed.
The symptoms are similar to those of catarrhal intestinal cramps,
but the hand placed upon the abdomen may feel the kicks of the embryo
and they may become visible on the abdominal wall. The affection
lasts from 1 to 3 hours and then disappears suddenly; in some mares
the painful attacks recur within short intervals, sometimes every second
day, even every 6 to 8 hours, especiallv shortlv before parturition ;
(Schleiifer Vet. 1894, 229).
For treatment subcutaneous injections of morphine, also the inter-
nal administration of camomile tea are indicated.
16. Chronic Intestinal Catarrh. Catarrhus intestinalis chron-
icus.
{Enteritis catarrhalis chronica.)
Etiology. Primary chronic intestinal catarrh, whicli is com-
paratively rare, usually arises from an acute intestinal catarrh
if the latter has lasted for some time or if the inflannnatory in-
fluences have acted for a considerable period upon the intestinal
mucosa. The causative factors are the same as those of acute
intestinal catarrh (see page 325), the most common cause, how-
ever, is improper feeding- and the continued ingestion of im-
proper or spoiled food.
According fo the statements of Dieckerhoff, there occurs in foals,
also in cattle, sheep, swine and goats, during the first two years of life,
a chronic disturbance of the function of the intestinal mucosa, which
leads to progressive emaciation and frequently to death. Dieckerhoff
has named this disease ''Darrsucht" (German) or Tabes intestinalis
(intestinal wasting away) and has separated it from the disease Tabes
mesaraica. (See Vol. I.) The etiology of the disease is unknown, its
causes are probably various emaciating internal diseases. According
to Glage, this Tabes intestinalis in foals is in reality an infectious sclero-
stomiasis (q. v.).
Dawson has described a disease observed in the United States under
the name of Infectious Asthenia in chickens two to six months old, which
is caused by a bacterium of the colon group (bacterium asthenije) and
characterized by a profound duodenal catarrh. The same disease has
occasionally been observed in Germany by Kitt.
Some of the cases described by Dieckerhoff and Harms as chronic
gastric catarrh of cattle, and a disease described in France as "diarrhee
chronique, " "boyau tendre, " "dysenteric," should more properly be
classified as "enteritis paratuberculosa (Bang). (See Vol. I.)
More commonly chronic intestinal catarrh is a secondary
affection. Such secondary chronic intestinal catarrhs are seen
Anatomical Changes. Symptoms. 341
in chronic passive congestion of the intestines due to chronic
diseases of the heart and liver, very rarely in certain cases of
thrombosis of the mesenteric artery, in chronic infectious dis-
eases (tuberculosis, pyobacillosis [Grips, Glage & Nieberle]),
chronic hog erysipelas (Eisenmann) and in chronic constitu-
tional diseases. Intestinal worms likewise frequently produce
the picture of this disease.
Anatomical Changes. The intestinal mucosa usually ap-
pears dark purplish to brown red, sometimes slate colored, in
consequence of the presence of numerous blackish points, and
thickened, while the glands of the propria are enlarged, tough,
or changed into cysts. Sometimes, however, the mucosa is thin,
pale, and shows depressions in the place of the solitary and
agminated follicles (socalled areolation). Occasionally there
are formed round, thick but shallow, later on deeper or con-
fluent irregular ulcerations with undermined and tough margins.
After healing, these ulcers leave radiating cicatrices. After per-
foration of such ulcers purulent ichorous peritonitis occurs in
their neighborhood, and the affected loop of intestine becomes
adherent to neighboring loops, to other abdominal organs or to
the abdominal wall.
In asthenia of chickens the intestinal contents appear to be
only mucus, the duodenal mucosa is reddened at its prominent
points and the cadaver is much emaciated.
Symptoms. When chronic intestinal catarrh has existed
for some time, the nutrition of the animals suffers to a high
degree. They are listless and their ability to work is much dimin-
ished; later on their condition becomes very poor, the skin is
dry and non-elastic, the fur rough and lusterless, the mucosae
are pale. The appetite is variable, sometimes the animals eat
an enormous amount, sometimes they refuse food for days.
The abdomen is drawn in although a moderate chronic bloating
occurs occasionally, particularly in cattle. Defecation occurs
at irregular intervals, constipation lasting for several days
alternates with violent diarrhea; sometimes the feces are dry
and they are dropped after considerable intervals, at other times
they are thin mushy or fluid, containing poorly digested par-
ticles of food, shreds of mucus, lumps of pus, and they are
sometimes streaked with blood; they are often very fetid.
Occasionally masses of mucus without any feces are voided.
From time to time, particularly when bloating is present,
large amounts of intestinal gases are expelled from the rectum.
Peristalsis is absent during constipation, very lively during
diarrhea. Colicky pains are rare, when they occur, they usually
precede diarrhea or appear while it lasts. During lack of appe-
tite in herbivora the urine often becomes acid ; but Friedberger
& Frohner as well as Albrecht usually found an alkaline reaction
342 Chronic Intestinal Catarrh.
of the urine under tliese conditions. Bauer found an increase
in indican.
According to Dieekerhoff, the symptoms of intestinal tahes of young
animals, are diminution of appetite, partial constipation, occasionally
diarrhea. (Kronig), emaciation progressing to the point of cachexia, and
leading in three to six months to death unless something can be done by
a proper change of diet.
In infectious asthenia of chickens one sees listlessness, depression,
progressive emaciation in spite of greedy feeding, pale discoloration of
the comb and of the wattles, of the throat and ears, and slight consti-
pation. In the further course of the disease the appetite becomes vari-
able. Finally, the cachectic animals succumb after the disease has
lasted about three months.
Course. Chronic intestinal catarrh may last for months or
even years and it may lead to complete exhaustion of the sick
animals, after an edema has developed on the extremities and
in the lower abdominal region. Death takes place from mar-
asmus. The disease usually takes this course in old, poorly
nourished, hard worked animals.
Diagnosis. Progressive emaciation, occasional attacks of
diarrhea, wdiicli rarely last continuously for w^eeks and months,
the presence of undigested particles of feed in the feces are
signs upon wdiich the diagnosis rests. As to the localization of
the affections the same rules hold good as are laid down for
acute intestinal catarrh (see page 329). Lumps of pus in the
feces point "with great probability to ulcerations.
Considering the fact that chronic catarrh of the intestines
is usually a secondary affection, one should always carefully
examine all organs and look into the method of feeding in order
to find out the primary disease. As such, one must think of
chronic infectious diseases, metabolic diseases, helminthiasis,
chronic disease of the liver, chronic uremia, and in horses dis-
turbances of mastication in consequence of anomalies of teeth.
The disease called "Darrsucht, " according to Dieekerhoff, may be
recognized from the fact that the improperly fed young animals of one
herd or flock all become more or less sick and emaciate progressively.
Tuberculosis has sometimes to be excluded by a properly conducted tu-
berculin test.
A diagnosis of infectious asthenia of chickens is suggested by the fact
that the sick animals are all two to six months old. that cachexia de-
velops progressively in spite of a good appetite, that the course is (|uite
chronic and that there are no pronounced anatomical changes. The
differential diagnosis must always consider the possibility of helminthi-
asis.
Prognosis. Chronic intestinal catarrh, whether primary
or secondary, must always be looked upon as a serious affection
wdiich wall often resist the most careful treatment for a long
Prognosis. Treatment, 343
time or even permanently. The prognosis is particularly un-
favorable in old animals and when a proper regulation of the
diet is impossible. The prognosis of secondary chronic intes-
tinal catarrh depends upon the primary underlying disease.
There is no hope of recovery in ''Darrsucht" after cachexia is
once present; young animals three to four months old gener-
ally succumb to this disease. Chickens affected by infectious
astenia generally die.
Treatment. A rational diet (see pages 295 and 330) offers
the best means of preventing the development or to stop the
progress of chronic intestinal catarrh. The sick animals should
be taken out daily and should be used for work only moderately.
Animals attacked by ''Darrsucht" may recover in one to two
month if they are pastured, provided that the disease has not
progressed too far.
To regulate defecation, castor oil and the neutral salts are
indicated, among the latter particularly Carlsbad salt (for dos-
age, etc., see page 331). The desired effect can, however, only be
attained if the salts are administered to the animals one-half to
one hour before feeding, and in moderate doses (130-500 gm. pro
dosi, or of the 5% solution, tablespoonful doses). This course
must be continued for a long time and kept up for some time
after recovery. With the salts may be combined bitters (gen-
tiana, calamus, rheum, oak bark). Constipation must be counter-
acted by mild laxatives, diarrhea by astringents and mucilagin-
ous medicines (see page 332). Good results have been brought
about in horses by the systematic administration of creolin.
A good result may as a rule be expected only in primary
catarrh and while the general condition is still fairly good. The
authors again point out the possibility that intestinal worms
may be the cause of the trouble ; cases which have been treated
for a long time without any success at all, have jdelded in a
short time, after an antihelmintic treatment was instituted.
Against infectious asthenia of chickens, Klee recommends the ad-
ministration of castor oil (in teaspoon doses) or of calomel (0.01-0.05
gm. ) until a marked laxative effect becomes manifest. The birds ought to
rec(}ive further, daily twice per head, 1-2 gm. of the following mixture :
Fennel, anise seed, coriander, bark of quinia, each 4 gm.; powdered root
of gentian and ginger, each 7.5 gm. ; sulphate of iron 2.0. As drinking
water the fowls should have a watery solution of sulphate of iron and
sulphuric acid (1000:2:2). The healthy animals must be separated and
the coops must be disinfected.
Literature. Bachstadt, Z. f. Vk., 1908, 159.— Dawson, Anim. Ind., 1898, 329.—
Dieckerhoflf, Spez. Path., 1892, II, 313, 1904, 1, 638.— Eisenmann, Monh., 1906,
XVII, 97.— Glage, Z. f. Infkr., 1905, 1. 341.— Grips, Glage & Nieberle, Die Sehweine-
seuche, 1904.— Klee, Vet. Jhb., 1901, 245; Gefliigelkrkh, 1905, 26.— Kramell, Z.
f. Vk., 1899, 319.— Krbning, Z. f. Vk., 1906, 202.
344 Membranous Enteritis.
17. Membranous Enteritis. Enteritis membranacea.
(Socalled "DarmJirupp" [German] or Croupous enteritis; en-
terite coueneuse, ou pseuclomemhraueuse ou muco-
memhranense [Cadeac] [French].)
Membranous enteritis is characterized by a peculiar, gener-
ally superficial, inflammatory process of the intestinal mucosa,
with the formation of pseudomembranes, which are composed
almost exclusively of mucus.
Occurrence. This rather rare affection is observed most
frequently in cattle, according to Keilgaard quite frequently
in horses, rarely in sheep (Clavel, Lafosse). Among cattle,
young, well nourished and pregnant animals are affected prefer-
ably if after winter feeding they are pastured during cool
weather on luxuriant meadows.
Etiology. The nature of the affection suggests infectious
material as its cause, while external influences, such as the in-
gestion of too cold water or the feed supply play a role as pre-
disposing factors. Nothing definite can be said as to the nature
of the supposed infectious agent. The disease has been observed
frequently after the ingestion of rotten potatoes or beets or of
absolutely fresh feed.
Whether an occlusion of the intestines or the lack of peristalsis, due to intes-
tinal bacteria, may cause an accumulation of mucus cannot at present be decided.
It is, however, a fact that abundant thick masses of mucus collect in the rectum
of horses, similar to croupous membranes, if an internal occlusion, situated between
rectum and stomach, prevents peristalsis of the rectum.
Anatomical Changes. As a rule the jejunum, cecum and
colon are uniformly changed; however, the small intestine or
on the other hand the large intestine alone may be the seat of
pathological changes. The intestinal contents are thin fluid and
dirty discolored, mixed with blood in grave cases and very fetid,
floating in it are found yellowish to brown, tough, elastic mem-
brane-like or tubular, cylindrical masses. Similar masses are
found adhering to the mucosa. The tubular or cylindrical de-
posits are usually from 1.5 to 3.5 feet long, but they may excep-
tionally be as long as 35 feet (Arnal). They are composed of
several layers, the membranous substance alternating with lay-
ers of darkly stained fecal matter. The intestinal mucosa shows
reddening in grave cases, also hemorrhages, it is somewhat
swollen. In the horse one usually finds changes only in short
portions of the large intestine and the pseudomembranes are
characterized by their small dimensions.
The microscopic examination of the pseudomembranous deposits show the pres-
ence of numerous granules in an exceedingly fine reticulum (Gurlt). Weigert's fibrin
Anatomical Changes. Symptoms. 345
stain never shows any fibrin in the eases examinetl, and the proper stains demon-
strated the presence of mucin (Johne). Chemical tests made by Lassaigne showed
that the pseudomembranes consist almost exclusively of condensed mucus; the same
results were obtained by Clement who investigated membranous enteritis in horses.
All investigations made have failed to furnish any proof that mem-
branous enteritis is a genuine diphtheritic inflammation of the intestinal
mucosa, but they have rather shown that we are dealing with a peculiar
purely catarrhal process with an overproduction of mucus, analogous to
the membranous catarrh of the stomach of man (Nothnagel). One
could not reconcile the usually mild course of the infection with a grave
croupous inflammation. The preferably catarrhal character of the pro-
cess does, of course, not exclude an occasional deeply penetrating
inflammation.
For these reasons it appears proper to consider here this form of
enteritis and to separate it from true croupous inflammation. This will
be considered among the gastro-intestinal inflammations (q. v.).
Symptoms. The disease usually begins with disturbances
of digestion and mild attacks of colic. The animals do not eat
much, they are depressed and ruminate irregularly. One also
observes muscular tremor, reddening of the conjunctivas and an
acceleration of pulse and respiration. The secretion of milk is
suppressed. The mild attacks of colic last only 12 to 15 hours and
then cease for several days. The feces are at first dry ; they are
dropped less frequently and with increased abdominal pressure.
After five or six days, rarely somewhat later, colicky pains re-
cur, the animals Aval'k around restlessly, turn their heads to look
towards the abdomen, kick with their feet and drop feces with
signs of tenesmus. These are thin fluid and fetid, mixed with
gray or yellowish-white membranous, tubular or cylindrical
masses of variable, sometimes of considerable length. The solid
cylinders or the tubular pieces are either empty or filled with
feces and may at first sight be mistaken for pieces of intestines.
However, their homogeneous structure and the absence of
mesentery and blood vessels prevent such a mistake. After one
to two days the symptoms suddenly disappear; however, the
feces remain fetid for several days and are mixed with mucus ;
then the animals recover completely.
Deviations from this clinical picture occur in two direc-
tions. In very mild cases animals previously apparently quite
healthy, very unexpectedly drop such membranes as described,
perhaps with symptoms of a little restlessness, then thin fluid
feces, mixed with mucus, then they soon get well again (Lafore,
Reynal, Combe). There are, however, on the other hand, cases
which run from the start a course with the symptoms of a grave
enteritis or these symptoms may develop later on and profuse
hemorrhages may occur in the further course of the disease. In
cases of this kind there is great prostration, complete lack of
appetite, high fever, the pulse cannot be felt, the peripheral
parts of the body feel cold as ice and the fluid and fetid feces are
more or less hemorrhagic.
346 Membranous Enteritis. Enteritis Pseudomembranacea of Cats.
In horses, the disease likewise usually begins with restlessness; this
soon disappears and the animals then stand apathetically and stagger on
standing and walking. In other cases colicky symptoms are at first ab-
sent, the disease begins with a diminution of the appetite which soon
disappears completely. There is often fever (39.5°-41° C.) and always
an acceleration of the pulse. In the further course of the disease, colic
appears and the feces are profusely covered with mucus ; grayish-white,
or white opaque, structureless or curled-up long strands or membranes
of mucus may also be present free in the intestines or they may be
voided with the feces. The disease always ends in the recovery of the
animals after a few or several days.
Course. The whole course usually lasts from 8 to 12 days, it
may be somewhat shorter or on the contrary longer ; in the lat-
ter case, exacerbations occur during the voiding of the pseudo-
membranes and remissions at other times. The disease usually
ends in recovery; a fatal issue occurs in only such cases as
are complicated with grave intestinal inflammation or intestinal
hemorrhages ; in these the animals may succumb after four or
five days. Very exceptionally there may be a fatal obstruction
of the intestines by the accumulated pseudomembranes.
Diagnosis. The true character of the disease can be recog-
nized only after the appearance of the pseudomembranes ; before
this occurs it cannot be distinguished from other inflammatory
processes of the intestinal tract. The pseudomembranes have
a typical appearance and can easily be distinguished from pieces
of tendons that are accidentally taken up with the feed, from
tapeworms, loops of intestines and other objects.
Treatment. The expulsion of the pseudomembranes and
of fetid feces may be hastened by the administration of alkalies,
especially the laxative salts (see page 331) ; later on mucilagin-
ous mixtures and astringents are indicated, similar to those
recommended in other forms of intestinal inflammation (see
page 331). The regidation of the diet must follow the same prin-
ciples as are laid down in the treatment of acute intestinal
catarrh (see page 330).
Literature. Clavel, J. du Midi, 1860, 361.— Combe, Pr. vet., 1900, 157.—
Delafond, Eec, 1842, 217.— Graziadei, Clin, vet., 1901, 592.— Gnrlt, Mag., 1847, 80.—
Imminger, W. f. T., 1904, 55. — Keilgaard, Maanedsskr., 1907, XIX, 81.— Nothnagel,
Die Kiankh. d. Darmes, 1898, 139.— Eeynal, Diet., 1860, 87.
Enteritis Pseudomembranacea of Cats (croupous enteritis of cats).
This is a disease evidently peculiar to cats. According to Zschokke, who
first described it, it is most common among young cats and appears epi-
zootically during winter and spring. Cases of enteritis pseudomem-
branacea have l)een observed also by Kitt, and more recently by Schmul,
who studied the histologic changes of the disease.
Zschokke believes that the probable cause of the disease is a virulent
Tariety of the colon bacillus. This variety, when fed to a young cat,
Inflammation of the Stomach and Intestines. 347
produced a transitory intestinal catarrh and twitching of the muscles;
In another cat it led to a fatal intestinal catarrh. Schmul believes that
several kinds of bacteria are concerned in the causation of the disease.
The most important anatomical changes consist in an increase in
thickness, diminished elasticity and a greater transparency of the wall
of the small intestines ; in about one-half of the cases there are deposits
on the mucosa; the latter, however, is almost always reddened and
swollen. The contents of the small intestines are of a milky turbidity,
while the contents of the large intestines are frequently mixed with
blood.
The histologic examination shows that the intestinal villi are markedly con-
tracted, the tissues of the intestinal wall are edematous, there is frequently necrosis
of the villi, aud this may extend even into the serosa. There is also a moderate
leucocytic infiltration and likewise moderate hemorrhagic extravasation.
The pseudomembranes are, according to Zschokke, composed of a mixture of
epithelia, leucocytes and fibrin threads, but according to Schmul, they are mostly
made up of bacteria and do not give either a distinct mucin or a fibrin reaction.
The mesenteric lymph glands usually show acute swelling ; the liver
and the kidneys are congested.
The symptoms of the disease consist in vomiting and diarrhea and
these usually lead to death in one to three days, so that a suspicion of
poisoning is frequently created.
Treatment is unpromising, according to past experiences.
Literature. Kitt, Pathol. Anat., 1906, II, 61.— Schmul, A. f. Tk., 1907,
XXXIII, 44.5.— Zschokke, Schw. A., 1900, XLII, 20.
18. Inflammation of the Stomach and Intestines. Gastro-
enteritis.
{Septic, typhoid, mycotic enteritis, intestinal mycosis, intestinal
typhoid, dysentery of adidt animals, Magenruhrseuche
[German], Fungus and meat-poisoning, croupous or
diphtheritic enteritis. Mycosis sea sepsis intesti-
nalis, g astro-enter it e, gastro-enterite dysen-
terique [French], pseudo-typhoid).
Under the name of gastro-enteritis are comprised all of
those inflammatory processes Avhieh affect either the stomach or
the intestines, hut usually both of them simultaneously, and
which are quite intense in character, leading to hemorrhage, sup-
puration or to the formation of true croupous membranes due to
necrosis. These conditions do not constitute one specific entity,
but they have to be treated collectively under a common liead,
since the necessary investigations are lacking to separate them
properly into several specific types.
Severe inflammatory processes in the stomach and intestines may
develop upon the basis of a variety of causes, hence the clinical picture
varies a good deal. In certain cases the symptoms are quite charac-
teristic for particular uniform types and therefore justify a separate
consideration under a special head (see foreign bodies in the stomach,
membranous enteritis, coccidial dysentery). A separate consideration
is also indicated for inflammations produced in the course of poisoning
348 Inflammation of the Stomach and Intestines.
(by acids, alkalies, phosphorus, arsenic, lead, mercury, croton oil, car-
bolic acid, cantharides, lupinai and other plants containing acrid sub-
stances. Consult text-books on Toxicology.)- Those forms of gastro-
enteritis will not be considered here, which occur in the course of acute
infectious diseases (anthrax, all forms of hemorrliagic septicemia, hog
cholera, rinderpest, influenza, distemper, dog typhoid, etc.).
Etiology. In some cases gastro-enteritis develops after a
simple catarrh of the stomach or intestines or it is brought
about by the same factors which cause the latter. Liidecke saw
a hemorrhagic enteritis in cattle after the feeding of green sugar
beet leaves which contained sodium saltpeter. Similar cases
have been observed in horses which had died in collapse before
diarrhea had set in. AVith the exception of these types the most
frequent causes of gastro-enteritis are spoiled feed (socalled
mould poisoning, gastro-enteritis mycotica, mycosis intesti-
nalis).
Herbivora sicken frequently after the ingestion of large
amounts of spoiled and mouldy feed. As such may be men-
tioned rotten and fermenting beets or cuttings of beets, po-
tatoes, to a lesser extent mouldy, moist grain or rough feed,
particularly if much contaminated with rust-fungi (see page
183). Marek has produced hemorrhagic enteritis in rablnts with
the uredospores of Puccinia graminis ; Push in the same animals
w^ith another fungus (Tilletia caries) ; other authors, however,
were not able to demonstrate experimentally the poisonous
nature of these moulds. The ingestion of bedding straw^ and
manure is sometimes also dangerous. Water from wells in the
neighborhood of cesspools, or water contaminated with animal
offal has repeatedly caused numerous affections.
Carnivora very frequently develop a gastro-enteritis (meat
poisoning) after the ingestion of infected or spoiled meat. Meat
derived from animals which have suffered from certain infec-
tious diseases may exert its disease-producing influence by bac-
teria contained therein, by their toxins, or by ptomains subse-
quently formed, or by the combination of all three factors. Most
important in this respect are the pyogenic bacteria or rather
the diseases produced by such as septicemia and pyemia (puer-
peral fever, the various forms of wound fevers, purulent arth-
ritis, purulent inflammations of serous membranes, streptococci-
mastitis, enteritis, etc.). In carnivora the bacteria of meat
poisoning (see there) are of importance. Sometimes meat be-
comes dangerous on account of specific septicemic diseases such
as anthrax. In all septicemic diseases the circulating bacteria
and their toxins are found with the blood in the muscles and in
the internal organs. The dangerous nature of the meat may in-
crease after slaughter because the pathogenic bacteria may in-
crease further.
In 1895 numerous fatal cases of gastro-enteritis were observe('i, in tlie southern
parts of Hungary, in dogs which had fed upon the meat of s-svine sick with hog
Etiology. 349
cholera. It could not be decided in these oases whether the affection of the dogs
was due to the microorganisms of hog cholera, to its toxins or to other bacteria.
Berger saw hemorrhagic gastro-enteritis in the dogs of a village after these animals
had fed upon parts of chickens that had been sick with fowl cholera.
Meat or meat preparations coming from healthy animals
may subsequently become poisonous in consequence of contami-
nation with bacteria Avhich may form organic poisons or which
may themselves l)e of a pathogenic nature. Postmortem putre-
faction of albumen does not, however, appear to have a particu-
larly deleterious effect (M. Mtiller).
It is quite possi])le that bacteria which are important in this re-
spect for meat may come from the feces or from the insufficiently cleaned
intestinal wall. This would explain the often very dangerous nature of
sausages, because they offer a chance for the chopped-up meat, etc., to
become infected from an insufficiently cleaned intestinal wall. Some of
the bacteria in question are common inhabitants of the intestines, such
as some species related to the bacillus coli communis which have been,
demonstrated repeatedly in cases of meat poisoning.
Putrefaction of albumen leads to the formation of poisonous substances which
may ly^doubtedly occasionally lead to meat poisoning characterized by paralysis of
nerves. The most important of these are :
Neurin, a strong poison formed in putrefying meat after .^ or 6 days, probably
in consequence of bacterial activity. Symptoms of neurin-intoxication are difficulty
in respiration, weak heart, salivation, increased peristalsis, diarrhea, convulsions, finally
collapse.
Muscarin is identical with the poison contained in the poisonous fly toadstool;
it leads to similar symptoms.
Methylguanidin, another not well determined ptomain, is formed in putrefying
horse flesh; it causes convulsions and paralysis of the heart.
Less poisonous are cadaverin and putrescin which cause local inflammations
and death only in larger doses, cholin (poisonous only in very large doses) and finally
a ptomain isolated by Garcia from putrefying horse flesh.
Pathogenic bacteria differing from those already mentioned
and generally not yet well known may get into the intestinal
tract with feed that is otherwise perfectly unobjectionable. Such
bacteria probably cause dysentery of cattle, which sometimes
occurs enzootically among barn fed cattle, rarely on the pasture.
The disease attacks almost without exception adult animals.
There is also the possibility that inflammations may be caused
by the normal intestinal bacteria in animals debilitated by insuffi-
cient feed. It is probable, on the other hand, that dysentery
in adult cattle and sheep not due to coccidia is frequently in fact
a form of hemorrhagic septicemia (see Vol. I).
Under the name of dysentery are comprised in veterinary medicine a variety of
deeper inflammatory processes of the gastro-intestinal tract, while in human medi-
cine (aside from tropical amebic dysentery) dysentery designates a specific endemic,
diphtheritic intestinal inflammation caused by the Bacillus dysenteriaj of Shiga-
Kruse. It is possible that a specific, enzootic dysentery may occur in animals,
especially in cattle; however it cannot at this time be separated from other forma
of gastro-enteritis nor can its relation to human dysentery be determined.*
*It lias however been shown that there are various types of human bacillary dysenteries
caused by a variety of bacilli all belonging more or less to the colon group; such bacilli
acting as" the cause" of dysentery, and not quite identical with the Shiga-Kruse bacillus h^ve
been isolated by Flexner'and others. (Translators' notice.)
350 Inflaiimiatioii of the Stcmacli and Inteslines.
Piorkowski and Jess have observed an enzootic enteritis on
two large farms, which was dne to a bacilhis coli, and which
led to perforation of the intestinal wall. Mohler and Buckley
observed an epizootic among cows of one barn and were able to
isolate a bacillus of the enteritidis group. Glaesser claims that
the bacillus suij^estifer alone may cause spontaneous epizootics
of inflammation of the rectum in young pigs, with infiltration of
the rectal mucosa, and with the formation of diphtheritic or
caseous, non-concentric sedimented plates, which upon shedding
leave ulcers and cicatrices ; these are complicated with caseous
degeneration of intestinal glands and caseous pneumonia. Simi-
lar morbid changes have been described as due to the bacillus
paratyphi suis. Kitt observed in a calf, morbid changes of the
intestines similar to those found in hog cholera, namely liand-
like prominent diphtheritic pseudomembranes, concentrically
arranged and button-like formations.
The authors have repeatedly seen in dogs of all ages sporadic cases
of hemorrhagic-gastroenteritis Avhich, both clinically and anatomically,
were similar to the disease known as dog typhoid ("Stuttgarter Hun-
deseuclie") ; when the disease had lasted several days it even led to a
superficial loss of substance in the mucosa of the cheeks. (For details,
see Vol. I.)
Chausse saw a peculiar form of hemorrhagic gastro-enteritis affecting
several animals in a large herd. It showed the usual symptoms of
gastro-enteritis, bloody feces mixed with blood coagula and an anemic
discoloration of the visible mucous membranes. Except in one case, all
of the animals died, either after two to five days, or more frequently
after one to two weeks, after there had been some apparent improve-
ment.
Post-mortem examination showed the changes of hemorrhagic en-
teritis with intestinal ulcers, and profuse hemorrhages into the intestinal
wall, extending into the peritoneum. The intestinal loops were matted
together by blood. The mesentery and the pararenal adipose tissue
showed gelatinous infiltration and the kidneys sometimes large hema-
tomata.
Intestinal bacteria may occasionally become pathogenic for
unknown reasons. In the large intestines of the hog a croupous
diphtheritic inflammation in the form of irregular patches is
found independently of hog cholera, which is due to the bacillus
necrophorus. Kitt saw a similar diphtheritic inflammation in
the small intestines of horses, which was caused likewise by the
same l^acillus. Bang and Berg found the identical microorgan-
ism as the cause of an enzootic enteritis of calves. Injury or
loss of substance of the gastric or intestinal mucosa, due to
foreign bodies, intestinal parasites or to an accumulation of the
gastro-intestinal contents, or catarrhal affections may enable
intestinal bacteria to display a pathogenic effect. Croupous-
diphtheritic inflammation of the large intestines has been ob-
served by the authors following grave phlegmonous or diphther-
itic pharyngitis. Keilgaard saw the same affection following
Etiology. Pathogenesis. Anatomical Changes. 351
pneumonia. If gastro-intestinal catarrh comes on after exces-
sive efforts (long rides, particularly during great heat, long
lasting railroad transportation) one may assume that a lower-
ing of the resistance of the organism as a whole had led to a
lowering of the resistance of the intestinal wall and had
exposed it to the detrimental effect of intestinal bacteria.
The intestinal aifection coming on within twenty-four hours
after excessive work ("Distanzrittkrankheit" [German] of
Heuss) has generally a hemorrhagic character and usually ends
fatally.
Larger masses of sand which have found their way into the
gastro-intestinal canal sometimes cause gastro-enteritis in
horses (Mazulewitsch, Wenderniikow and others) and in hogs,
(authors' observation) owing to mechanical irritation and to
small injuries which open up portals for the invasion by bac-
teria. In this manner hogs often become affected when they are
transported in railway cars the floor of which has been covered
with sand.
Pathog"enesis. Every gastro-enteritis is really due to
microorganisms or their toxins; their effect is not confined to
the intestinal wall but extends to the entire organism. Bac-
teria and their metabolic products are readily absorbed in the
inflamed intestine and then easily lead to general intoxication
or infection. This may occur the more easily since such intes-
tinal inflammations spread to the submucous tissue which is
quite rich in lymph channels. (Some bacteria can, even in a
healthy intestine, travel into the mesenteric gland and into more
distant organs as shown by the investigations of Porcher,
Desoubry, and more recently by Bogozinsky, Wrzosek & Ficker).
Hence gastro-enteritis is complicated from the start by more
serious general disturbances or by affection of more distant
organs.
Anatomical Changes. The gastro-intestinal mucosa is af-
fected to a variable extent from case to case, sometimes more
uniformly, sometimes in patches, especially on the thick rugae
which are of a lively red color, either light or dark with punctate
or streaked hemorrhages ; there may also be more extensive suf-
fusions of blood. In the cases of gastro-enteritis of dogs which
the authors have observed, they found sometimes the mucosa of
the stomach, at other times that of the intestines, diffusely dis-
colored dark red and moderately swollen. The gastro-intestinal
contents are sometimes hemorrhagic, usually quite fetid. The
small hemorrhages in the stomach lead to the formation of
small, round, sharply defined erosions (erosiones haemorrhagi-
cae). The mucosa and submucosa are edematous, the submucosa
of the stomach sometimes sIioavs purulent infiltration (gastritis
purulenta sive phlegmonosa). The abdominal serosa is hyper-
emic (arterial injection).
352 Iiiflamuiation of the Stomach and Intestines.
The solitary and agininated follicles are considerably
swollen and the necrotic epithelial cells form a hoar-frosted,
ashy or bran-like covering. Necrosis may penetrate more deeply
whereupon the various layers of the mucosa become changed
into dirty gray, opaque-yellow pseudomembranes; after these
are shed sinuous ulcers remain behind, round or large and ir-
regular, bounded by undermined margins, the base covered by
necrotic tissue shreds. The bacillus necrophorus leads to the
formation of flat ulcers of the size of half a dollar or a dollar
piece, dirty yellowish or pale yellowish, covered by a soft or
firm cheese-like mass which can easily be removed. Such places
become confluent and form irregular spots, the intestinal wall
becomes thickened and loses in elasticity.
The mesenteric glands are always swollen. Acute swelling
of the spleen, parenchymatous degeneration and inflammation
of internal organs and occasionally the presence of metastatic
abscesses indicate more or less that a general infection has
taken place.
Symptoms. Gastro-enteritis sometimes begins with the
symptoms of acute gastric catarrh and gradually passes over
into the picture of inflammation ; generally, however, the animals
sicken suddenly under grave symptoms. The ingestion of feed
and, in ruminants, rumination cease, thirst is sometimes much
increased, often the animals exhibit manifestations of abdominal
pains, which are generally dull, less frequently sharp and severe
so that they lead to maniacal attacks, Carnivora and hogs vomit
frequently, and the expelled matter occasionally is bloody;
vomiting is sometimes seen in herbivora, and more frequently
repeated retching and gagging.
All animals except the horse usually show tenderness on
pressure of the region of the stomach or abomasum or even of
the whole abdomen. In ruminants there is generally also moder-
ate bloating with moderate increase of the circumference of the
abdomen; this is, however, also in other animals, seen in the
beginning of the disease. In the further course of the disease
the dimensions of the abdomen usually decrease in consequence
of diarrhea, and the abdomen is drawn in.
Whenever the stomach is affected particularly, the intestinal
sounds are less frequent or entirely absent and there is consti-
pation. If enteritis is already present the intestinal sounds are
intensified or continuous and diarrhea sets in, the animals void
large masses of fetid matter with painful efforts; these are
sometimes mixed with shreds of tissue or blood ; dogs sometimes
void pure blood ; relaxation of the rectal sphincter muscle finally
leads to involuntary defecation. If diarrhea has existed for
some time and if the intestinal contents have consequently been
diminished materially, the intestinal sounds, depending both
upon peristalsis and the presence of fluids and gases, may be
absent; simultaneously with the absence of intestinal sounds
Symptoms.
353
there occurs a decrease of the droppings and there may be com-
plete constipation. However, tenesmus of the rectum is even
then often observed.
In hemorrhagic gastro-enteritis of dogs loss ot substance is
seen frequently in the mucosa of the cheeks and on the gums, but
this is rarelv the case in dysentery of cattle.
The urine contains albumen, also occasionally formed ele-
ments such as casts, sometimes also blood, and it shows an acid
reaction even in herbivora.
The symptoms de-
scribed are accompa-
nied by great prostra-
tion and grave gen-
eral symptoms. An
elevated temperature
(Fig. 38) sets in from
the start, but the
height of the fever
varies considerably in
different cases. The
elevation may occur
gradually or the dis-
ease may set in with
a high fevef. In hem-
orrhagic gastro-enter-
itis of dogs the tem-
perature soon goes
down or it may be sub-
normal from the start.
The pulse is acceler-
ated from the begin-
ning and it becomes
small and soft. The heat distribution on the periphery is un-
equal, the extremities feel cold, the skin is covered with per-
spiration and later on the eyes sink in.
Finally the animals lie on the floor stupefied and motion-
less, or they show convulsive motions, dizziness, muscular con-
tractions, or their behavior is like that of dumb staggers. Hemor-
rhages into the skin, into the mucosae or into the retina are
sometimes observed (Schindelka).
Croupous diphtheritic enteritis in the horse occurs in three different
types. The most frequent type begins with great dullness and weakness
of the patient, the gait is markedly staggering, the temperature rises to
40-41° C. or even higher, the conjunctiva^ appear icteric, dirty discol-
ored, injected. There is a lack of appetite, diarrhea sets in only after
four to five days (see Fig. 38), the feces are at first mashy, then entirely
fluid and fetid ; they may contain pieces of pseudomembranes ; before
diarrhea has set in, dry feces may in rare cases he covered with shreds
of croupous membranes. After diarrhea has appeared, a fatal issue
generally soon occurs. The second type, according to Keilgaard, gen-
Fig. 38. Fever curve in diphtheritic enteritis in a
horse.
354 Inflammation of the Stomach and Intestines.
erally commences Avitli not very severe symptoms of diarrhea ; elfevation
of temperature may be absent and a moderate elevation of temperature
may be noted only on the last day of the disease. However, the pulse
is accelerated from the start. The general condition of the animals is
greatly disturbed and a marked emaciation soon occurs. During the
slower course of the disease, pseudomembranes are shed more frequently
than in the first type. The third type, according to Folger, commences
with the symptoms of sleepy staggers ; the dull animals show a staggering,
waddling gait ; they lean forward, press against the wall, but do not show
any symptoms on the part of the intestines. The disease usually ends
fatally.
Course and Prognosis. In very grave cases the disease
usually terminates fatally within the first two clays, even within
the first tw^enty-four hours, while in ordinary cases it lasts from
one to two w^eeks before death comes on from exhaustion, or a
fatal issue may also occur after an apparent improvement. Re-
coveries are as a rule rare and convalescence is of very long
duration.
The more rapidly the symptoms become worse, the less
chance is there for recovery. Important unfavorable sigiis are
a considerable acceleration of the pulse, profuse and bloody
diarrhea or obstinate constipation. There are, however, cases,
particularly among lierbivora with a long intestinal canal, where
there may be a mild course of gastro-intestinal catarrh extend-
ing over one to two weeks, which may suddenly become worse
and end in death in one or two days. Enteritis in hogs, due to
the bacillus necrophorus, not uncommonly takes a less virulent
course.
Diagnosis. A generally sudden onset, a rapid deterioration
with abdominal pains, obstinate diarrhea following constipation,
weakness of pulse as a rule are characteristic enough to lead to
a correct diagnosis and a differentiation from other milder and
more local gastro-intestinal affections. However, since gastro-
enteritis may be part of the picture of infectious diseases (see
page 347), or of poisoning, one must in all cases be on the look-
out for signs of the latter (on the skin, in the buccal cavity, in
the respiratory tract, in the eyes), and one must also consider
whether the affection appears sporadically or widely dissemi-
nated. In horses the possibility of intestinal tuberculosis must
be considered; it also manifests itself by the symptoms of en-
teritis.
The cause of the affection cannot usually be recognized
from the clinical picture but must be looked for in the history
of the case, environmental circumstances, examination of the
feed, etc. Secondary gastro-enteritis due to other disturbances
of the stomach and intestines (accumulation of feces, coprolitlis,
helminthiasis) is usually characterized by the fact that digestive
Diagnosis. Treatment. 355
disturbances have for some time preceded the onset of grave
enteric symptoms.
Frohner gives tlie following differential diagnosis of disturbances
due to various fungi :
1. Moulds ("Schimmelpilze, " German). Lack of appetite, colic,
constipation, diarrhea with bloody, slimy, occasionally very fetid feces,
polyuria, dizziness, stupor, sleepy staggers, paralysis of the extremities
and the tongue, amaurosis, profuse perspiration.
2. Blight-fungi (Ustilagin^, "Brandpilze," German). Saliva-
tion, continued masticatory motions, tottering, staggering, general motor
and sensory paralysis ; in other cases, symptoms of gastritis.
3. Rust-fungi (tFredinje, "Rostpilze," German). Dermatitis on
the head (lips, cheeks, eyelids), conjunctivitis, urticaria, stomatitis,
pharyngitis, glossitis, colic, bloody diarrhea, hematuria, paralysis, som-
nolence.
4. Yeasts (Saccharomyces, "Hefepilze," German). Intense cere-
bral excitement, followed by stupor and paralysis.
Treatment. If gastro-enteritis is due to the ingestion of
spoiled feed, the early removal of the gastro-intestinal contents
is the first indication. Emetics by the mouth or by subcutaneous
injection may be used in hogs and in carnivora ; but much better
is lavage of the stomach (see page 306) ; in other animals efforts
must be confined to the administration of mild laxatives such as
castor oil, salts, calomel; (see page 331). Subcutaneous injec-
tions of drugs stimulating peristalsis, (eserine, arecoline, etc.)
are less advisable, although they may be indicated in such cases
where abdominal pains are absent. If there is reason to accuse
noxious microorganisms introduced with the feed as the cause
of the disturbance, one should attempt to prevent their multi-
plication in the intestinal tract by the administration of disin-
fectants such as resorcin, naphthalin, creolin, salicylic acid (see
page 332). However, a good effect from these drugs can be ex-
pected only in gastritis, because they cannot accomplish much
in the intestinal tract, and they may occasionally do more harm
than good. Mucilaginous drugs and astringents (see page 332)
may likewise be used advantageously. In hemorrhagic gastro-
enteritis adrenalin or suprarenin in 0.1 % solution, thirty drops
every three hours for dogs (Uebele) are indicated as styptics.
In cases of poisoning antidotes have to be administered; how-
ever, even in such cases washing out of the stomach and the
administration of mild laxatives must be practiced.
If abdominal pains are severe they must be alleviated by
opium or morphine (see page 332) ; prostration and stupor
should be treated by cold douches and friction ; however, douches
must not be employed if the temperature is subnormal, when
warm packs are indicated. A weak pulse calls for the adminis-
tration of stimulants such as wine, whiskey, black coffee, tea in-
ternally; ether, oil of camphor, caffeine subcutaneously — in
weakness and collapse. The infusion of warm physiologic salt
solution into a vein or under the skin may be very beneficial,
particularly if some adrenalin, suprarenin, or grape sugar has
356 Inflammation of the Stomach and Intesthies.
l)eeii added (sec page 333) ; such iniusioiis may be repeated sev-
eral times.
If the sick animals are still in a fair state of nutrition, they
should be starved several days; the tormenting thirst must,
however, be alleviated by lukewarm water. Dogs should also
receive tea with some cognac. If there is great debility muci-
laginous food should be given, such as soups of linseed, oat-
meal, rice, sago with the addition of alcohol and eggs or wine,
soups with the yellow of eggs, if the condition of the stomach
permits feeding by mouth at all. If this is impossible, artificial
feeding must be instituted (see page 333) ; this may he accom-
plished by rectal feeding or, if the rectum is likewise affected,
by subcutaneous or perhaps by intravenous injections.
Literature. Albrecht, W. f. Tk., 1881, 1. — Bang, Maanedsskr., 1890, 235.—
Berg, Maanedsskr., 1896, VIII, 236.— Berger, T. Z., 1905, 81.— Chaiisse, Kec, 1905,
788.— Ficker, Z. f. Flhyg., 1906, XVI, 361 (Kev.).— Frohner, Monh., 1892, III, 49.—
Galtier, J. vet., 1887, 142.— Gerlach, Rinderpest, 1867, 61.— Glage, Monh., 1901,
XIII, 550; XIV, 25.— Glasser, D. t. W., 1909, 513.— Heuss, Z. f. Vk., 1908, 201.—
Keilgaard, Maanedsskr., 1907, XIX, 81.— Mohler & Buckley, Anim. ind., 1902, 297.—
Miiller, S. B., 1893, 21.— Oemler, A. f. Tk., 1.SS2, VIII, 241.— Piorkowsky & Jesa,
B. t. W., 1901, 45.— Pusch, D. Z. f. Tm., 1893, XIX, 38.— Eeynal, Diet., 1860, V,
149.— Schiel, B. t. W., 1906, 361.— Sehindelka, O. Z. f. Vk., 1891, 90.— Szanto, A. L.,
1908, 12.— Wedernikow, Vet. Jhb., 1893, 70.— Wrzosek, V. A., CLXXVIII, 82.—
Wyssmann, Schw., A. 1907, XLIX, 129.
Enteritis in Fowls. Aside from secondary enteritis which occurs
in the course of fowl cholera, hemorrhagic septicemia of chickens and
other fowl-septicemias, in fowl diphtheria, in poisoning by acrid sub-
stances and finally in the presence of intestinal parasites (coccidia-en-
teritis, helminthiasis), primary cronpous-diphtheritic processes are met
with in the intestines of chickens, geese, ducks, turkeys and peacocks
(Roll, Johne, Kitt, Guittard). Such affections may appear sporadically
in animals of one species only or in animals of several species.
The cause of cronpous-diphtheritic enteritis in fowl is not well
known ; however there is no doubt that one must look for infectious
agents as their cause.
Fumagalli has seen an enzootic croupous enteritis in chickens caused by asper-
gillus.
Post-mortem examination shows, either in the small intestines
(Roll, Kitt) or only in the cecum (Guittard), soft cylindrical cronpous-
diphtheritic masses as long as a finger, filling the intestines more or less
completely ; the mucosa is intensely reddened, swollen and hemorrhagic.
In other cases the intestines contain a smeary-purulent, rice-waterlike or
light reddish-gray discolored fluid ; while the mucosa is either in a con-
dition of serous infiltration and partial softening (Roll) or is covered by
a veil of fibrin coagula, or it shows sharply contoured, blackish or green-
ish-gray places, elevated 3-4 mm. above the surface; still other evi-
dences of inflammation may likewise be seen.
The symptoms of the disease are lack of appetite, depression, slug-
gish motion due to stiffness of the muscles, brown discoloration of the
integument of the lower abdomen, violent diarrhea with yellowish drop-
pings.
Meat Poisoning and Botulism in Man. 357
The disease usually takes a rapid course and the animals die often
within a few hours (Roll) or after the disease has lasted from twenty-four
to thirty-six hours ; if the eeca alone are affected, death may follow in only
seven to eight days.
The treatment is unpromising. Guittard recommends as a pro-
phylactic the administration of a decoction of radix althefe, and the
addition of syrup, honey and naphthol to the feed; the latter should
previously be softened in a weak solution of carbolic acid or salol.
Literature. Fumagalli, D. t. W., 1907, 38.3 (Eev.).— Guittard, Pr. vet., 1907, 1.—
Johne, S. B, 1880, 39.— Kitt, Pathol. Anat., 1906, II, 61.— Eoll, Spec. Path. 1885, 401.
Meat Poisoning and Botulism in Man. Meat poisoning in man
generally occurs after the eating of meat of cattle, calves, cows, some-
times also hogs and even horses which have become sick with septic or
pyemic inflammatory processes (puerperal fever, purulent mastitis, puru-
lent inflammation of serous membranes or joints, enteritis) and have been
slaughtered while suffering from these affections. Particularly in sum-
mer, more or less extensive epidemics have been observed, variable as to
the severity of the clinical picture and presenting sometimes solely the
symptoms of uncomplicated gastro-intestinal catarrh, and at other times
those of a gastro-enteritis or even typhoid affection with muscular weak-
ness and ataxia. Fre(iuent]y the picture is complicated by albuminuria,
catarrhal pneumonia, circumscribed cutaneous erythema, urticaria or
hemorrhages into the skin. The mortality is rarely more than 2-5%.
Bacteria concerned in meat poisoning of man may be divided into
three main groups.
Type I. Bacillus enteritis: Bacillus of Frankenhausen (Gartner),
B. of Moorseele (v. Emmergem), B. of Gent (v. Emmergem), B. of
Brugge, Brussels, Willebroek (De Nobele), B. of Rumflett, Haustedt
(Fischer), B. of Cotta (Neelsen, Johne & Gartner).
Type II. Bacillus Aertryck (belongs to the group of para- typhoid
or of hog cholera bacilli) : Bacillus of Gaustadt (Hoist), B. of Breslau
(Fluegge-Kaeuscher), B. of Posen (Giinther), B. of Hatton, Chadder-
ton (Durham), B. of Sirault (Hermann & v. Emmergem), B. of Calm-
phout (v. Emmergem), B. of Aertryck, Meirelbeck (De Nobele) ; to
this group also belongs the bacillus morbificans Rosenau which occurs in
septic processes in cattle and which, like the bacillus enteritis, causes
purulent and necrotic foci in the liver and spleen of inoculated animals.
Similar to the latter is the bacillus of Rotterdam of Pols & Dhont.
Type HI. Bad rium coli, bacillus proteus, etc. The bacteria of
the third group get into the meat products after slaughtering and do
not very often become the cause of meat poisoning if compared with the
other two groups.
Sausage poisoning (botulism, allantiasis) has been noticed after
the ingestion of sausage, corned or smoked beef, canned beef, conserved
meat, venison, etc. Sometimes similar symptoms have been observed
after the ingestion of salted fish (ichthyosism).
The cause of sausage poisoning are the toxic products (botulism
toxin) of the anaerobic bacillus botulinus of Van Emmergem, Avhich is
found in meat preparations and taken with them into the gastro-intes-
tinal tract of man. This toxin produces cloudy swelling and fatty de-
generation in the cells of the parenchymatous organs and the lining
endothelia of the blood vessels, also changes in the ganglion cells of
the anterior roots of the spinal cord and in the bulbar nuclei.
358 Bloating of the Intestines.
Hence we observe in botulism symmetric motor paralysis, particu-
larly in the region of the cerebral nerves (paralj^sis of accommodation,
mydriasis, ptosis, aphonia, dysphagia), while gastro-intestinal disturb-
ances are not infrequently absent or are only very insignificant. There
is, however, obstinate constipation and suppression of urine.
The toxin of bacillus botulinus is not very resistant towards various reagents
such as particularly alkalies; it is made innocuous when heated to 80° 0. for one
half hour.
Botulism is, therefore, an intoxication, while genuine meat poison-
ing is produced originally by pathogenic ])acteria or by such that have
become pathogenic ; however the toxins of these bacteria, and ptomainesn
which have been formed, do likewise play a role in the disease-producing I
process. '
Literature. Gutzeit, Fortschr, d. Vet. Hyg. 1906, III, 12.5 (Lit.) t. Emmer-
gem, Hb. d. p. M., 1903, II, 6.37 (Lit.).— Miiller, D. t. W., 1909, .377.— Fhlenhuth &
V. Leuthold, Gedenkschrift, 1906.- — Wiemann, Die Parakolibazillosis d. Kalber and
ihre Beziehungen zu d. Fleischvergift, usw.. Diss. Bern, 1909 (Lit.). — Zschokke &
Feuereissen, D. t. W., 1909, 105.
19. Bloating of the Intestines. Meteorismus Intestinalis.
{Darmaufhldlmng , Windkolik [German] ; Colica flatulenta; In-
digestion intestinale gazeuse [French].)
Bloating of the intestines or meteorism consists in an exces-
sive dilatation of the intestines in consequence of the rapid
formation of gas.
Occurrence. The prevalence of primary meteorism is in-
timately connected with the methods and conditions of feeding
the animals. These conditions vary a good deal in different
countries and parts of countries, hence the affection is not uni-
formly prevalent every^vhere. In the Budapest Clinic it repre-
sents 12 to 15% of the colicky affections of horses; the lower
percentages, however, are observed only rarely. Occasionally
the affection occurs in hogs, dogs and rabbits. In ruminants the
same causes lead to bloating of the rumen.
Etiology. Primary bloating of the intestines is due to the
ingestion of bloating feed. Particularly dangerous are in this
respect withered or heated fresh green feed (clover, alfalfa,
esparsette, fresh grass), also beets and potatoes, rarely seeds
of leguminoscT, more frequently crushed corn or liarley. Mouldy
feed may likewise be dangerous (Hendrick) . Bloating in rabbits
is not infrequently caused by fresh cabbage, kale, beets, raps,
vetches, buckwheat. The ingestion of water in large amounts
increases the danger from these foods materially, particularly
leguminosae and crushed grains may do harm under these con-
ditions. Sometimes an unobjectionable feed, like oats and hay
may cause bloating in horses if these animals feed greedily and
Etiology. Pathogenesis. Anatomical Changes. 359
rapidly or are overworked shortly after feeding. Dogs are
sometimes bloated after the abmidant ingestion of starchy food.
Abundant stuffing of parts of the intestines with thick mashy
feces favors the collection of gases in the parts nearest to the
stomach.
It sometimes happens that cribbling horses swallow enough air on
feeding to produce bloating, and it is claimed that this may also occur
if these animals move rapidly towards the wind. While the first mode
of formation of moderate bloating may be conceded, the second one can
hardly be accepted as probable.
Secondary bloating occurs in various forms of closure of the
intestines in grave thrombotic-embolic disease of the intestine;
and in the course of diffuse acute peritonitis, in internal strangu-
lation, volvulus and thrombosis of the mesenteric vessels, bloat-
ing appears early after a few hours in the affected loops of in-
testines, while anteriorly to the obstruction, as in other cases
of secondary bloating, this condition develops slowly and only
rarely reaches a high degree during the life of the animal.
Pathogenesis. A portion of the feed swallowed ])y horses
gets from the stomach into the small intestines even during
feeding and from there soon into the large gut. According
to Scheuner and Grimmer corn gets into the large intestines
two hours after ingestion, hence fermentable feed can form
gases, very shortly after ingestion, along the whole intes-
tinal tract with the exception of the rectum and also to a mod-
erate extent in the stomach. In consequence of stretching and
by chemical influences (carbon-dioxide, methane, fatty acids)
the muscularis of the stomach and intestines is irritated
to frequently recurring convulsive contractions which in their
turn produce colicky pains. The strong contractions and
the absorption of the gases by the blood at first prevent great
stretching of the intestines, but these means are insufficient to
absorb all of the rapidly forming gas. Loops of intestines, there-
fore, become more and more dilated; these, as Avell as the whole
intestinal tract, suffer in contractility while compression of
blood vessels occurs likewise, further preventing the absorption
of gases. The dilated intestines also press the diaphragm to-
ward the thorax and the negative intrathoracic pressure is
diminished, the cardiac diastole becomes interfered with and
the blood pressure in the arteries is lowered.
In hogs and dogs bloating is developed similarly though
generally somewhat later after food ingestion.
Anatomical Changes. On postmortem examination the ab-
domen is occasionally dilated and very tense, the more so since
fermentation and the formation of gases continue after death.
The dilated and tense loops of intestines are pressed out with
great force after opening up the abdominal cavity. If rupture
360 Bloating of the Intestines.
lias occurred gastric and abdominal contents are found free in
the abdominal cavity. The condition of the margins of the tear
show whether the latter occurred during life or postmortem. In
the former case the margins show bloody sugillation and pos-
sibly also swelling, and the muscularis may be retracted behind
the mucosa. The thoracic organs show a high degree of passive
congestion.
(The formation of gas, produced postinortein in not perfectly fresh cadavers of
horses also causes a general dilatation of the intestines, signs of suffocation are
however absent.)
Symptoms. In horses sjTiiptoms of primary bloating usual-
ly appears shortly after the ingestion of food and are similar
to those of acute dilatation of the stomach (see page 299). As
a rule the clinical picture is initiated by violent, frequently re-
curring attacks of colic. Since genuine colicky pains, due to
convulsive contraction of the intestinal muscularis are not inten-
sified by pressure, the patients throw themselves recklessly on
the floor and roll about in a manner attracting attention; later
on they sit down on their haunches (dog position).
Simultaneously with the spuptoms of colic, the abdominal
circumference increases rapidly, the space between the costal
arches becomes greater, the abdominal wall protrudes in barrel
shape ; most marked is the increase of the abdomen in the flanks,
particularly on the right side. Animals who even normally
possess a tense and less yielding abdominal wall, will not show
a very well marked enlargement of the abdomen, in spite of
severe disease.
The percussion sounds are deep and resonant, more or less
all over the entire abdomen, but particularly in the flanks; the
sound becomes, however, somewhat higher and weaker in grave
cases on account of the great tension of the intestines and of
the abdominal wall. Sometimes the sound is metallic and not
only over the cecum, where a similar sound is heard under
normal conditions, but also over the other portions of the intes-
tines.
The intestinal sounds are sometimes continuous at the be-
ginning of the affection; in the further course of grave cases
they become less frequent and may cease entirely ; they are often
liigii in pitch and metallic.
Rectal examination shows a high degree of dilatation of all
accessible intestines with the exception of the rectum. Their
walls feel tense and elastic. Bloating of the colon displaces its
pelvic flexure deep down into the pelvis or towards the right
side and in the latter case the tense longitudinal bands of the
left lower portion run from the right towards the left and some-
times in a spiral arrangement. The left lower portion is now
much dilated and reaches up to the left kidney; it is either be-
side or below it and the much thinner, but likewise bloated left
upper portion of the colon is displaced by the raised lower
Symptoms. Course.
861
portion, either towards the median line or towards the h't't al)-
dominal wall (Fig. 39).
Defecation at first occnrs more frequently but soon becomes
delayed or suppressed. In the beginning, and in the less severe
cases until termination of the affection, there is a good deal of
flatus.
The respiration becomes increasingly more difficult; the
pulse rapidly becomes accelerated, so that when the bloating
of the posterior abdomen has become quite noticeable the
pulse will soon be 60 per minute; the more rapid it becomes
the weaker it will be. The mu-
cons membranes are at first dark ,^-"
red, soon, however, they become
cyanotic, the visible veins are
strongly filled. ^^MKK^I
The body of the patient is 0«Mi^mm..l
loathed in perspiration. If the
stomach is likewise bloated there
is also often belching, more rare- / i |
ly retching, occasionally^ vomit- v ^ I
ing.
Wohner saw a case of bloating in a foal
with subcutaneous empliyseina on the back and
shoulders. The case ended in recovery.
Secondary bloating leads to
variable symptoms aside from
the increase in abdominal circum-
ference; these depend largely
upon the nature of the under-
lying condition.
In hogs, dogs and rabbits, the
clinical picture varies somewhat
from that in the horse ; the for-
mer animals either do not suffer
abdominal pains or they only be-
tray them by repeated attacks of
crying out, frequent changes of
position or groaning. Belching,
retching and vomiting on the other hand are seen more fre-
quently.
Course. The accumulation of gas may reach such a de-
gree, occasionally within four to five hours, and in smaller ani-
mals earlier, even if the animals have apparently quieted down,
that suffocation comes on. (Goldbeck saw a horse, in which
bloating came on after eating fresh clover, succumb after the
illness had lasted only 16 to 20 minutes.) Ruptures are some-
times seen ; they occur in those cases of primary bloating where
the accumulation of gas is not uniform and where some por-
tions of the gastro-intestinal tract become excessively dilated.
Fig. 39. Bloating of the intestines.
Position of the left loops of the colon
and course of the longitudinal bands of
the left lower portion in extensive
bloating of the horse.
362 Bloating of the Intestines.
(Rupture is more frequently seen in the stomach. The dia-
phragm tears occasionally.) If rupture has occurred, the ani-
mals become suddenly quiet ; however, the general condition de-
teriorates and collapse occurs rapidly (see page 301).
The affection not infrequently ends spontaneously in recov-
ery; in the majority of cases recovery can, however, only be
expected upon proper treatment. The course is always of short
duration and usually it becomes olivious after twelve hours
whether death will occur or whether improvement may be ex-
pected ; if the latter is the case the symptoms of acute intestinal
catarrh generally set in.
Diagnosis. The most important symptoms of primary in-
testinal meteorism are the following: rapidly increasing signs
of colic after the ingestion of usually bloating feed, rapid in-
crease in the size of the abdomen, loud sounds on percussion,
and uniform, extensive dilatation and tension of all of the intes-
tines (general intestinal meteorism). Simultaneously bloating
of the stomach may be recognized by belching and vomiting.
Secondary bloating (see torsion or strangulation of the in-
testines; accumulation of feces, thrombosis of intestinal arter-
ies, intestinal obturation, enteritis, peritonitis), which must be
judged and treated differently, may be initiated with similar
symptoms and must be excluded upon the basis of the history
and upon the result of a rectal examination which should be
made in every case of meteorism. Except in the case of peri-
tonitis, secondary bloating is always confined to individual por-
tions of the intestines (circumscribed, intestinal meteorism),
and there are often symptoms which clearly point to the causa-
tive affection. Bloating occurring in consequence of an inflam-
matory condition is accompanied from the start by fever and
the restlessness is not so marked. Torsion of the stomach in
carnivora may be excluded when belching occurs and when the
abdominal wall is not tender to pressure.
Treatment. In not too severe cases of primary meteorism
one should attempt to stimulate intestinal contractions in order
to remove the gases per vias naturales. Cold packs of the ab-
dominal wall, cold douches to tlie latter, and cold water injected
under some pressure into the rectum, favor the expulsion of
gases in the horse by reflex irritation. One may also employ
ether in w^ater (15:400), salt solution, soap suds or much diluted
turpentine. Massage of the abdomen or internal massage of the
colon and cecum, applied with care through the rectum, are also
beneficial; how^ever, if the intestines are very tense one must
not use this method, because rupture might be caused by it. Hum-
merich produced an extensive evacuation of the intestines by
rolling the previously restrained horse on the back 15 to 20
times and then after an interval of time 8 to 10 times; this
procedure may have to be repeated three or four times. Laxa-
tives are also administered (salts with aloe, 150-200 gm. to 15-20
Treatment. 363
gm.) ; disinfectants are added to these to reduce fermentation
(lysol or creolin, 15-20.0 gn\. naplitliol, naplithalin, 10-15 gm.).
As long as the contractility of the intestinal loops is not abol-
ished, as long as evacuation by it has not become impossible, and
as long as intestinal gases are expelled from time to time,
eserine (0.08-0.10 gm.) or arecoline (0.06-0.08 gm.) may be used
subcutaneously. If, however, parts of the intestine have already
lost their contractility (in very severe cases), these drugs are
no longer beneficial and may be dangerous (see page 303). Since
bloating of the stomach is frequently present simultaneously, the
stomach tube should be used.
If, in spite of these applications, the condition of the patient
becomes worse, or if the excessive dilatation of the abdomen
bring about great dyspnea, puncture of the intestines must no
longer be delayed. This removes the danger of suffocation and
reestablishes contractility of the punctured portion of the in-
testines and the parts situated between the puncture and stom-
ach. In secondary bloating intestinal puncture alone promis.es
relief. Puncture of the cecum is usually practiced ; if necessary,
however, the colon or the small intestines must he punctured.
Intestinal puncture is best practiced with a slender trochar 10x15 cm. long.
The skin is first properly cleansed, then an incision is made. The trochar is now-
introduced into the center of the depression of the right flank with the point directed
towards the left elbow. After the escape of gas ceases, the tube is removed or, better
still, left in place and closed with a cork, when it may be opened later on to let out
more gas which might have again accumulated. If in spite of this puncture the
symptoms of bloating persist or if the left flank has been distended more promi-
nently from the start, the left flank is punctured. If this is done one must pre-
viously ascertain by rectal exploration at which point of the left side the bloated
colon is situated, so that one does not puncture the rectum or some loops of small
intestines or enter into the free abdominal cavity, in which ease the puncture is
without any result whatsoever.
Puncture of the colon from the rectum (Imminger, Foringer, Jensen, Eeinhardt)
appears indicated only in those rare cases, when the left portion of the colon is
not lying close to the abdominal wall and when puncture of the cecum does not bring
relief. Such a puncture may be made with a large exploratory trochar or an Elsch-
ner trochar with a curved canula 40 cm. long or a Eaitsits trochar which is short
and can be introduced into the rectum as far as one can reach, and may in this
manner reach anterior portions of the intestines. To permit the escape of the gases
the short trochar must be connected with a rubber tube. If the free end of the
tube is placed below water the evacuation of gas can be easily controlled.
Intestinal puncture, whether practiced from the flanks or from the rectum, is
never harmful in primary bloating, if we use a slender trochar and proceed under
aseptic precautions, or at least as cleanly as possible, and if in puncture from the
rectum one follows the trochar with the guard. Before puncture from the rectum,
the latter should be irrigated several times with disinfectant solutions. In secondary
bloating, when the elasticity of the intestinal wall has suifered in consequence of
serous or hemorrhagic extravasation, it may occur exceptionally that some intestinal
contents get into the abdominal cavity.
Great restlessness must be counteracted by morphine in-
jections (0.3-0.5 gm.) or by rectal injections of chloral hydrate,
because reckless rolling may bring about rupture.
In hogs, dogs and rabbits, kneading or massage of the ab-
dominal cavity may be beneficial ; • also chasing the patients
around, also repeated cold douches. If the stomach is bloated
simultaneously, emetics (see page 291) may be used. If suffoca-
364 Accumulation ot Feces in the Intestines.
tion threatens, these animals likewise require intestinal punc-
ture. The latter is practiced in the middle of the left or on the
right side of the abdomen.
Literature. Berg, Maanedsskr, 1896, VIII, 332.— Braun, Kaninchenkrkh, 1907,
9.— Foringer, W. f. Tk., 1880, 71.— Goldbeck, D. t. W., 1907, 335.— Hendrickx, Ann.,
1907, 545.— Hunmierich, Z. f. Vk., 1908, 444.— Imniinger, W. f. Tk., 1890, 369.—
Jensen, Tidsskr., 1S91, 103.— Noaek, S. B., 1896, 142.— Rexiliiis Z. f. Vk., 1896, 216.
— Scheunert & (Jrinimer, Dresd., Jhb., 1906. — Schlampp, Then Techuik, 1907, 11,
249.— Wohner, W. f. Tk., 1905, 825.
20. Accumulation of Feces in the Intestines. Impaction.
Obstipatio.
(Kotansdioppung im Darm, Verstopfung, Hartleibigkeit [Ger-
man]; Indigestion intestinale par surcharge [French].)
Obstipation or impaction consists in an accumulation and
drying of masses of feces in the intestines with subsequent
progressive enlargement of some portions of the intestinal tract,
which condition may finally lead to a complete closure of the
intestinal lumen.
The disease defined as above has a definite clinical and pathologic-
anatomical picture and may he differentiated from other forms of fecal
accumulations accompanying displacements, circumscril)ed paralysis,
obturation of the gut, also acute peritonitis and acute diseases of the
stomach.
The symptoms of obstipation or impaction vary so much
according to different animals, that it is necessary to treat them
separately for each species.
(a) Obstipation in the Intestines of the Horse.
{AnschoppungskoUk [German] ; Collca stercoracea; Iiidigesfion
'intestinale par surcharge [French].)
Occurrence. The frequency of primary obstipation is
largely determined by the type of feed and hence the disease
varies very much as to occurrence in various parts of the world.
Ill the Budapest Clinic oljstipation varies in ditferent years from
6 to 20% of the cases of colic observed.
As the frequency of obstipation varies, i-o its localization to individual parts
of the intestinal tract is varia])]e. Of 287 cases of primary obstipation seen in the
Budapest Clinic during tlie years 1906 to 1909, there were 210 cases of colon obsti-
pation, 23 cases of colon-cecum obstipation, 27 cases of ileum obstipation, 3 cases
of duodenal obstipation, 17 cases of cecum obstipation. In the Berlin Clinic the
Btatistics for 449 fatal cases of obstipation observed during the years 1897 to 1907,
show: 224 involvement of the colon, 106 times ileum, cecum 89 times, duodenum 17
times, rectum 11 times, jejunum twice.
Etiology. The long continued ingestion of feed rich in cel-
lulose and wood fibers frequently plays a role in the production
Etiology. Pathogenesis. 365
of obstipation in horses, because feed of this type has to be
taken in very much larger amounts than more nutritious food
and it furnishes feces of much denser consistency, which are
more difficult to move along. Sucli food stuffs are straw, par-
ticularly if cut into short chaff, or if it is taken up from the
bedding straw (socalled straw feeders), corn stalks, hard-fibrous
clover, alfalfa, etc. Constipation is, on the other hand, fre-
quently produced by feeding materials rich in the salts of the
earthy metals such as bran, crushed corn and barley, marshy
hay, and also upon the ingestion of sand. All the aliove men-
tioned food stuffs act particularly unfavorably in sudden change
of feed and with insufficient exercise.
Retarded movement of the large intestines may cause obsti-
pation of the gut, even on proper feeding. This is seen in old,
enfeebled horses, in fat animals which do not exercise much,
usually also in horses of a listless temper. Insufficient peristal-
tic motion may also be consecutive to chronic intestinal catarrh,
and the latter may have developed upon a thrombotic or embolic
basis.
The cause of the disease is sometimes a disturbance of mas-
tication (bad teeth), liecause then the feed is not sufficiently
broken up before it gets into the gastro-intestinal tract. Insuffi-
cient peristalsis and frequent anomalies of teeth in old horses
explain the frequency of obstipation in advanced years.
The combined use of morphine and atropine against shoulder lameness causes
many cases of obstipation with subsequent bloating or rupture of the stomach, be-
cause atropine diminishes the intestinal secretion and morphine suppresses peri-
stalsis.
Secondary obstipation is seen after intestinal stenosis, after
intestinal o])turation existing for some time, in combined paraly-
sis of the tail and sphincter, and exceptionally following throm-
bo-embolic processes of intestinal vessels if these have lasted at
least for several days.
Pathogenesis. Retardation of peristalsis and a firmer con-
sistency of the intestinal contents bring about, even under nor-
mal circumstances, a gradual accumulation of feces, particular-
ly in the narrower portions of the intestines, where the removal
of the contents is slow, even under physiologic conditions. An
accumulation of feces occurs most frequently in the stomach-
like dilatation of the colon, in front of the first portion of the
small colon and it may spread from here to other portions of
the colon and even to the cecum. Sometimes obstipation de-
velops in the pelvic flexure and at other times again in the cecum
in front of the comparatively narrow opening of the colon ; also
fairly frequently in front of the ileo-cecal valve, rarely, how-
ever, exclusively in the rectum, in the region of the second
flexure of the duodenum and only exceptionally in the jejunum.
The accumulation takes place in either one of two modes.
The above mentioned portions of the small intestines, most fre-
366 Accumulation (^f Feces iu the Intestines.
quently the end piece of the ileum during- or after one meal, rap-
idly become filled with coarse fibrous, dry feed (generally chaff).
Since the gastric contents in horses enter the small intestines
partly unchanged (Ellenberger), the feed mash, if insufficiently
broken up or if in a rather dry condition meets an impediment
at the ileo-cecal valve, occasionally^ even in front of second cur-
vature of the duodenum or in front of any curvature of the
jejunum. The development of obstipation in the large intestine
which is much wider, occurs, however, much more slowly.^ The
retardation of peristalsis, the firmer consistenc}^ of the intes-
tinal contents, the greater mass of the intestinal contents, cause
an increasing delay of their transport and they become more
and more desiccated. The appetite of the animals has not suf-
fered in the mean time, and larger and larger masses accumu-
late in the affected portions of the large intestines.
Sudden or rapidly occurring closure of the small intes-
tines, with subsequent* stretching of the intestinal wall by the
accumulated masses of feces, stimulate the occluded portion and
those anterior to it to convulsive contractions which produce
colicky pains. The contractility of the muscularis of the large
intestine, however, diminishes from the start only very grad-
ually since the accumulation and the closure are brought about
very gradually, in the course of several daj^s. Convulsive con-
tractions and colicky pains, therefore, do not occur or only very
moderately, and they are generally localized at a point in front
of the obstipation. The dilatation of the filled portion of intes-
tines, however, produces a disagreeable feeling of tension or
fullness in the abdomen, which in combination with the absorp-
tion of intestinal poisons causes an intoxication which in its
turn produces dullness of the sensorium. An exception is pre-
sented by those rare cases where obstipation in combination
with a change of feed will produce lively gas formation in front
of the closed portion, especially in the cecum. Then the irri-
tating gases will produce strong convulsive contractions of the
muscularis.
According to whether the transportation of accumulated
feces is stopped suddenly or within a short time, or whether as
in obstipation of the large intestines, the cessation occurs very
gradually, contractions of intestines behind the obstructed por-
tion cease after a few hours or only after several days, then
the periodical filling of the rectum likewise ceases. An excep-
tion to this rule sometimes occurs in obstipation of the cecum
in those cases where the desiccated fecal masses do not reach
up to the cecal-colonic juncture and where the contents of the
head of the cecum can be pressed partially into the colon.
The dried masses of feces may subsequently cause ne-
crosis of the epithelial covering of the mucosa, and may in
this manner lead to enteritis, or even to rupture of the wall of
the gut. The decomposition of the thin-fluid feces accumulat-
ing in front of the point of obstruction in the course of time
Anatomical Changes. Symptoms. 367
causes moderate bloating, possibly even enteritis ; since there is
no fermentation in the obstructed portions of the intestines,
bloating- will not occur there. However, in obstipation of the
small intestine and not infrequently in oJjstipation of the large
intestine, secondary dilatation of the stomach is seen frequently.
Enteritis and the other complications cause general symptoms,
which, however, come on only after several days in obstipation
of the large intestines.
Anatomical Changes. The obstructed parts of intestines
are dilated, their surface may be smooth or nodular, their
abundant contents appear more or less desiccated, mortar-like ;
the contents of the large intestines may even show the contours
of the pouches. The mucosa shows blood extravasation ; it looks
as if covered with bran in consequence of epithelial necrosis,
and sometimes shows larger patches of necrotic tissue. In more
prolonged obstipation of the cecum one sees hypertrophy of the
muscularis and considerable chronic dilatation of the intestines.
Sometimes a rupture is found at the place of the obstruction
or immediately in front of it ; if there has been dilatation of the
stomach there may be rupture of the stomach.
Symptoms. In the most common type of obstipation of the
large intestine one sees in the beginning retarded defecation
which may last for several days, then there is complete absence
of it in spite of repeated efforts. Obstipation of the cecum
offers an exception because there may be defecation, though per-
haps deficient, which only ceases in the further course of the
affection. With the absence of defecation symptoms of colic
appear, at first of a mild type and at long intervals, often lasting
for hours. Restlessness later on becomes somewdiat more con-
tinuous and intense, but does not reach a high degree. The
animals lie fairly quietly on the floor, only occasionally turning
their heads toward the abdomen (rolling is rarely observed) ;
they paw from time to time with their front feet and move their
tails. Squatting on the haunches may occur in any form of
obstipation. Not infrequently the patients place their feet like
male horses in urination, so that the front legs are placed much
towards the front and the hind legs much backwards, while the
back is stretched out.
The abdominal circumference remains unchanged for some
time, and occasionally until the disease has run its course, par-
ticularly if the horse has a tense abdominal wall. The percus-
sion sound is usually dull over the colon, and the dullness may
extend over the cecum ; often, however, percussion may not re-
veal anything abnormal in spite of extensive accumulation of
feces, because the loops of intestines filled with firm fecal masses
may not be in touch with the abdominal wall. The intestinal
sounds always occur less frequently and they may be suppressed
entirely in the further course of the disease.
368 Acciuiiulatidn ot' Feces in the Intestines.
Kectal examination reveals dilated, semi-solid, soft or en-
tirely firm loops of intestines. If there is an accunmlation of feces
in the colon, which is qnite frequent, one finds the whole left
half of the abdominal cavity filled with the left portions of the
colon, the lower one being characterized by longitudinal bands
and pockets and being felt towards the median line, the smooth
upper portion becoming larger towards the thorax, and the two
other portions in the entrance of the pelvis leading to the
smooth pelvic flexure. The latter frequently becomes displaced
entirely into the pelvis or slides towards the right side. If this
is the case one can feel the longitudinal bands running from
left to right, possibly with a spiral twist. Not infrequently the
left upper portion of the colon is displaced to the right or to
the left, beside or even below the dilated lower portion, but
without the production of a true torsion. The enlarged stom-
ach-like dilatation of the rectum may also be palpated in horses
unless they are large; it can be felt in front of the cecum, a
little to the right of the median line, and it has the shape of a
large semi-spherical, tough body, moving synchronously with
the respiration, possibly covered by the anterior mesenteric
root. The beginning of the small colon may be felt under the
anterior pole of the left kidney, as a sausage-like body of the
thickness of an arm, running obliquely from right to left. The
cecum, filled with feces, is detected when the hand is directed to
the right flank; it is recognized by its form and by the course
of its two longitudinal bands; it may be as firm as the colon
under similar conditions or its contents may even be almost as
hard as a rock. The head of the cecum and the small intestines
are frequently bloated in cecal obstipation. Loops of the small
colon in which feces have accumulated are felt, by the hand in-
troduced into the rectum as sausage-like loops, at the entrance
of the pelvis and particularly to the left, externally or internally
to the left portion of the large colon ; they are provided with one
longitudinal band and filled with balls of fecal matter.
The pulse and respiration remain normal for a long time,
even for days, or if abnormal at all they present only slight
changes from the normal. The appetite may be good in the be-
ginning of the affection or for several days, even after the first
symptoms of colic, the animals ingest some feed and this ag-
gravates their condition and the restlessness after each meal.
Later, however, the appetite becomes permanently abolished.
In a more advanced stage, usually only after several da^^s,
there is elevation of temperature, with debility and accelerated
pulse, indicating the advent of complications (enteritis, peri-
tonitis, meteorism, dilatation of the stomach).
E. Bauer has made interesting observations concerning indican in
the urine in obstipation. In all cases examined an increase of indican
was found; in obstruction of the cecum three to four times the normal
amount, while in obstruction of the colon a rather moderate increase
was usually found. If the accumulation of feces could be removed from
Symptoms. 369
the entire intestinal tract, the amount of indiean became diminished be-
low normal, but it remained high if the cecum could not be evacuated,
even if diarrhea had been produced.
The symptoms of obstipation in the small intestines vary
from those in obstipation of the large intestines since they come
on suddenly, within a few hours after food ingestion, or directly
after the latter, if the duodenum is involved. The symptoms of
colic are decidedly more marked, sometimes quite severe, and
a stretched position of the animals, as in urinating of male
horses, is observed. Defecation ceases within a few hours. Rec-
tal examination reveals the extended ileum as a smooth cylin-
drical mass the size of an arm, situated in the plane of the pos-
terior pole of the left kidney and to the right of the vertebral
column running from al)Ove obliquely downward and backward
and to the right, or on the contrary from below on the left up-
wards and to the right towards the base of the cecum and con-
tinuous with the latter. The obstructed duodenum can likewise
be felt as a cylindrical smooth body, the size of an arm, extend-
ing immediately behind the anterior root of the mesentery in a
curved direction from the right to the left and adherent to the
mesentery only by a short band.
In contradistinction to what happens in obstipation of the
large gut, acceleration of the pulse and respiration appear one-
half day or sooner after the occurrence of obstipation of the
small intestine. This is olmously due to a secondary dilatation
of the stomach or to early inflammatory changes of the mucosa,
the pulse in particular rising to sixty and more per minute
even on the first day of the disease. The appetite is completely
suppressed.
Complications are not at all rare in either form, but are
more common in obstipation of the small intestine. In the latter,
that is, in one-third to one-half of the cases, secondary dilata-
tion of the stomach (see page 297) occurs, although this condi-
tion is not at all rare in obstipation of the large intestine. Dila-
tation of the stomach may lead to rupture of the stomach. Rup-
ture of the intestines, which is toleral)ly common in obstinate
and unyielding intestinal obstipation and which always occurs
in very extensive fecal accumulation in the cecum, like rupture
of the stomach, leads to collapse (see page 301), or if the tear
is not very large and the shock has not been too great, it will
subsequently be followed by general acute peritonitis. A not
infrequent complication in obstipation of the small intestines is
enteritis.
Course. Obstipation of the large gut develops, as stated,
very gradually; restlessness sets in only after a few days and
the condition becomes worse by and l)y. The patients, however,
are more or less dull during the whole course of the disease.
Cases are seen occasionally where, after several days, the dis-
370 Accuinulatiou of Feces in the Intestines.
ease ends in recovery without having led to s}^nptonls of colic.
Fecal accnmulation in the small intestine causes sudden attacks
of colic and usually lasts one to two days. Obstipation of the
large intestine always lasts several days, even two to three
weeks (especially obstipation of the cecum), unless it is relieved
earlier by proper treatment.
A recurrence of the attacks of colic is not infrequently ob-
served, either because errors of diet have not been corrected or
because the intestinal niuscularis has been weakened while the
obstipation lasted, or because the accumulated feces have not
been removed completely. The two latter circumstances are
particularly effective on account of anatomical conditions in
obstipation of the cecum ; and this form of fecal accumulation is
seen not infrequently in the form of recurring attacks (socalled
habitual chronic or periodic colic).
Diagnosis. Retardation followed by cessation of defeca-
tion, the history of the case, and the usually mild attacks of
colic occurring at long intervals, the absence of general symp-
toms make a diagnosis of obstipation in the large intestine quite
probable ; however, only rectal examination can make the diag-
nosis absolute ; its differentiation from similar affections, and its
exact localization depend upon rectal exploration. Feces contain-
ing sand point to obstipation due to this (socalled sand colic),
and in this type the general symptoms usually come on sooner.
Valuable assistance in the diagnosis and prognosis may be ob-
tained by the quantitative determination of indican as proposed
by Bauer. It is absolutely impossible to determine the seat of
the obstipation from the behavior of the animals as suggested
by Klemm.
The size and the firm consistency of the affected parts of
the intestines, which can be ascertained by rectal examination,
distingaiish the disease from various other forms of intestinal
occlusion, with the exception of stenosis or obturation of long
duration, or of paralysis of the rectum ; these can be differen-
tiated by the different nature of their onset and by the fact that
the site of the stenosis or of the obturating foreign body can be
felt from the rectum. In affections of the stomach and in ob-
struction of the small intestine, the contents of the large intes-
tines likewise become desiccated if the disease has lasted for
any length of time ; however, the large intestines are not dilated
by the desiccated feces but are diminished in diameter.
Prognosis. If proper treatment is instituted in good time,
the great majority of cases end in recovery. The longer the
disease has lasted the firmer the stagnating intestinal contents
are, and the more dilated the obstipated intestines the less hope
there is to remove the obstruction. One also must always con-
sider the exact site of the obstipation, because if it is in the
small intestines or cecum, a fatal issue is comparatively fre-
Prognosis. Treatment. 371
quent, and recurrences often occur. In obstipation of the cecum
the reappearance of defecation does not always indicate im-
provement, because masses of desiccated feces may remain be-
hind in the cecum. If complications have already occurred there
is no hope for recovery, except in secondary dilatation of the
stomach, which can be treated successfully.
In the Budapest Clinic the mortalitv for different years ranges between 3 to
10%.
Treatment. To remove accumulated masses of feces from
the large gut, those which can be reached manually from the
rectum should be evacuated, then a rectal injection of a large
amount (30-40 qts.) of lukewarm water should be given, being
allowed to run in under a low pressure. The injected water is
partly soon expelled, but Dammann and Marek have shown
experimentally that in horses without ol)stipation the fluid may
travel up to the middle or even to the beginning of the colon,
and that it may therefore be expected to produce softening of
the feces in obstipation. Cold water is not well adapted for this
purpose because it stimulates the intestines to contract and to
prevent the progress of the fluid inward. The injection of a few
quarts is of no avail, because the fluid will then irrigate only the
posterior portion of the rectum. Accumulations of feces in the
cecum or in the small intestines cannot be influenced even by
very large quantities of water. The injections (which are not
usually successful by themselves) must be repeated several
times.
In order to soften the masses of feces which are situated
more towards the stomach and to stimulate peristalsis, neutral
salts in large doses should be administered (250-500 gm.), or
aloes (30-40 gm.), according to Hohne, even 50 gm., or castor oil
(300-500.0 gm.) with one-half to one quart of neutral oil, or with
50-70 gm. of ether. In cases w^hich are not very grave, abundant
defecation and speedy recovery are usually observed after
the administration of these drugs. In grave cases, how-
ever, the rectal injections and the administrations of the above
drugs must be supported by medicines which stimulate the in-
testinal muscularis to strong contractions. Not earlier than
half a day after the rectal injection, or after the salts or castor
oil have been given (in obstipation of the ileum, however, after a
few hours), one should administer subcutaneously eserine (0.06-
0.08 gm.), with pilocarpine (0.15-0.25 gm.) or with arecoline
(0.05-0.08 gm.). These applications do not only stimulate the
intestinal muscularis but they increase the intestinal secretions
and make the mucosa more slippery for the expulsion of the
masses of feces. Without such preliminary softening, the above
named drastic means may produce rupture ; this might particu-
larly occur if eserine alone is used in somewhat large doses.
It is necessary to watch the animals carefully after the use of
the above drastics because they intensify abdominal pains, and
the horses must be prevented from reckless throwing and roll-
372 Aeeiiniulatioii of Feces in the Intestines.
ing in order to prevent the oeeurreiiee of ititestinal rupture. It
is usually necessary to repeat the administration of the above
drastic medicines. In obstipation of the cecum Hohne repeatedly
gives 50 gin. of aloes at intervals of three days, the treatment
to be continued, if necessary, for two weeks; good results are
claimed for this treatment.
The elTect of different forms of treatment is assisted by
massage or kneading of the masses of accumulated feces from
the rectum (Sobelsolm), this further causes the intestines to con-
tract and the fecal masses which can be reached may be broken
up or moulded. Massage alone is usually not successful, except
in obstipation of the small intestines if the jejunum can easily
be reached by the hand introduced into the rectum. Hummericli
and Kalcher obtained good results in obstipation of the large
intestine by rolling the animals on their backs (see page 362).
In very severe obstipation of the ileum which does not yield to any of the forms
of treatment described, one might try laparotomy to remove the desiccated contents
through the left sided lai)arotomy wound, either l)y propelling them by hand or by
taking them out after enterotomy. In obstipation of the large intestine, laparotomy
does not appear indicated, becaiise one cannot remove the great masses of desiccated
feces completely and the sutures would not keep after partial removal, being torn
by the masses which have remained behind. The cases of Gaullet and Hobday prove
conclusively the danger of laparotomy in obstipation of the large intestine. Deg-
hilage has massaged intestinal loops through an incision made into the upper vaginal
wall of a mare and has in this manner brought about recovery.
Secondary dilatation of the stomach can only be treated by
the use of the stomach tube (see page 304). This instrument
should always be used in obstipation of the small intestines,
even before symptoms indicate dilatation of the stomach. If
the gastric tube is used repeatedly under these conditions, rup-
ture of the stomach can usually be prevented.
Obstipation in the large intestine also calls for dietetic
treatment. Instead of rough feed or grain, which horses with
obstipation of the large intestine .take by preference for some
time or after a temporary improvement, but which will surely
lead to an aggravation of the affection, the animals should re-
ceive juicy food stuffs, like bran or flour gruels, beets, bullions
plants, green soft feed, always in small amounts and at in-
tervals. The animals should be prevented from eating bedding
straw by the use of a muzzle or otherwise. Pasturing the ani-
mals is very good. However, they should not be fed on any
bloating green feed, particularly not in obstipation of the cecum.
Prophylaxis. Animals inclined to sulTer from obstipation
should be fed with fresh hay and green feed or molasses, or they
should be pastured at certain times; if this cannot be carried
out, the systematic administration of salts with the feed may
properly be substituted to a certain degree. Faulty teeth must
be repaired. The predisposed animals should be subjected to
close observation, so that one can take the proper steps when-
ever there is anv disturbance in defecation. Ducasse recom-
Obstipation in the Intestines of Carnivora. 373
mends in such cases the injection of pilocarpine followed by
eserine.
Literature. Bauer, D. t. W., 1905, 31.— Dammann, D. Z. f. Tm., 1875, I, 40.—
Ducasse, Bull., 1904, 772.— Ellenberger, A. f. Tk., 1884, X, 359.— Ferret, Eev. geii.,
1905, V, 121, 549.— Giinther, W. f. Tk., 1906, 583.— Hohne, B. t. W., 1906, 339.—
Humnierich, Z. f. Vk., 1908, 444.— Kaleher, ibid., 1909, 83.— Klemm, B. Mt., 1882,
XV, 147.— Klett, D. t. W., 1907, 209.— Ludewig, Z. f. Vk., 1906, 307.— Moller, A. f.
Tk., 1875, I, 277; Pr. Mil. Vb.. 1899, bis 19()S.— Piitz, Z. f. pr. Vet.-Wiss., 1876,
447.— Eeynal, Diet., 1874, 139, 143.— Sobelsohn, Monh., 1902, XIII, 308.— Wall, Die
Kolik a. Pferde, 1908.— Wolf, S. B., 1903, 191.
(b) Obstipation in the Intestines of Carnivora.
Occurrence. Accumulation of feces in the intestines is
common in dogs, much rarer in cats. Frohner, in 70,000 sick
dogs during the years 1886-1894, saw obstipation in 2% of the
patients. In the Budapest Clinic 2 to 3% of the dogs had obsti-
pation; in 1903, exceptionally, 7%.
Etiology. Obstipation is frequently produced by hard
bodies, especially frag-ments of bone, more rarely fruit stones,
pebbles or portions of soil which interfere with the passage
of the feces. Dry feeding, exclusive or abundant vegetable feed
(bread, dog biscuits, leguminosEe, flour paste) or exclusive feed-
ing with bones, produce dry, mortar-like feces which can be
moved along only slowdy. Hairs, blades of grass, etc., which
form firm masses in the feces act similarly. Obstipation, due
to swallowed hair, occurs not infrequently in cats.
Eetarded peristalsis is the cause of obstipation when it
occurs in consequence of lack of exercise (chained dogs, house
dogs), or when it is seen in older, debilitated animals. Chronic
intestinal catarrh may also lead to insufficient peristalsis.
The disease occurs as a secondary affection in consequence
of stenosis or obturation of the intestine, of painful conditions
of the abdominal muscles (rheumatism, pachymeningitis), or
of the neighborhood of the anus (inflammation of the anal
glands), or after matting of the hairs around the anus. Obsti-
pation is also usually present in chronic diseases of the cord.
Anatomical Changes. Feces collecting in some portion of
the intestines, usually in the colon or rectum, form very dry,
mortar-like, dark brown lumps. There are cases in which such
lumps of feces form firm cylinders as thick as an arm, which
fill the whole of the large intestine (Kitt) ; exceptionally the
whole intestinal tract may be filled Avith similar masses of feces
(Frohner). If the affection lasts longer, necrosis, hemorrhagic
or diphtheritic inflammation and even perforation of the intes-
tinal wall may develop.
Symptoms. In spite of repeated efforts the animals can-
not defecate or they void small dry lumps of feces, the surface
374 Obstipation in the Intestines of Carnivora.
of Avbicli is occasionally covered abundantly with mucus or
blood ; this occurs when the mucosa has become inflamed or has
been injured. Sometimes, in spite of existing obstipation, the
animals void a thin-fluid, very fetid stool ; this occurs when the
obstipation mass has liecome softened at the periphery or in the
center, so that the fluid contents from portions of the intestines
nearer to the stomach can pass by.
The abdomen is sometimes drawn in, sometimes bloated,
and the abdominal wall is then tense. On palpation of the abdo-
men one feels in front of the pelvic inlet, below the vertebral
column, and parallel to it a cylindrical, firm, sometimes hard
mass, variable in length (socalied fecal tumor, fecal cord). The
mass may be felt behind the liver and sometimes even further
up on the right side of the abdominal cavity and it is freely
movable; this mass is formed by the dry fecal masses in the
rectum and large intestines. In some cases, however, only one
or several, occasionally very large lumps of feces are found.
Sometimes swelling and reddening of the neighborhood of
the anus can be observed. The finger introduced into the rec-
tum feels hard fecal masses ; sometimes also fragments of bone ;
if a rectal speculum is used one sees the lumps of feces, also
a dark red discoloration of the mucosa, which may be covered
by gray membranous deposits.
The behavior of the animals varies from case to case. The
repeated fruitless efforts cause some anxiety and the irritation
of the intestinal wall occasionally produces pain expressed by
whining and curling up. In other cases the animals, in spite of
obstipation which may have existed for days, are comparatively
quiet and perhaps only show some listlessness and sluggish-
ness. Their gait, is stiff, they hold the tail straight or strongly
curved at its root.
The appetite may be preserved during the first day and
this aggravates the condition. The appetite diminishes, how-
ever, in the further course, and finally disappears while the
thirst becomes increased. Vomiting occurs exceptionally and
particles of fecal matter may be expelled.
The temperature remains normal for days, but if enteritis
has followed upon obstipation the temperature becomes elevated
and septicemic fever may finally set in.
Course. Obstipation of a not too severe type may be over-
come by the animals' own repeated efforts and, provided that
they have not been too long neglected, even grave cases, will end
in recovery if the proper treatment is instituted. If the disease
is left to itself after it has arrived at a later stage, there will be
progressive deterioration until enteritis, septicemia, peritonitis
or occasionally uremia (in consequence of compression of the
first portion of the urethra), close the clinical picture. If the
morbid affection has lasted a longer time, i. e., two to three
weeks or longer, even the proper treatment cannot save the
Diagnosis. Treatment. 375
animal any more, on account of the gangrene of the intestinal
mucosa which has occurred.
Diagnosis. Constipation in spite of fruitless efforts, com-
bined with the detection of desiccated fecal masses in the rec-
tum or colon, point to the correct diagnosis. If the animal has
previously been well and if the accumulation of feces can be
explained from the character of removed fecal masses, one may
assume primary obstipation. Otherwise a careful examination
of the organs is necessary in order to determine whether we
are not dealing with a case of secondary obstipation. Chronic
diseases of the spinal cord (including its membranes) have to
be considered particularly, because these often first attract our
attention through an obstinate obstipation. Diseases of the re-
gion of the anus and of the pelvic organs can be recognized
easily on the basis of the history and as the result of palpation
(sometimes to be carried out during narcosis). After long con-
tinued starvation or preceding diarrhea, defecation may be in-
frequent, but in such cases there is no accumulation of feces.
Treatment. If obstipation has not lasted long and if the
lumps of feces which can be felt from the rectum are not very
hard, the local treatment may be confined to the introduction of
large masses of water into the rectum; this softens the lumps
of feces, makes them slippery and stimulates the rectum to
contract. One may use pure lukewarm water, better soap suds
or water with oil, or pure oil. Thin fluids are allowed to run
into the rectum from an irrigator or a funnel provided with a
rubber tube ; low pressure must be used. The softening of the
feces may be hastened by cautious pressing and kneading. This
simple procedure, which must eventually be repeated, usually
suffices to remove the morbid condition. In mild cases glycerin
enemata are sometimes sufficient.
When the obstipation has lasted for a considerable time,
and when mortar-like masses or fragments of bone are present
in the rectum, they should be removed with the finger or with a
pair of forceps ; then the more anteriorly situated, usually less
hard masses, can be softened and removed with lukewarm water
irrigations; in such advanced cases massage is not indicated.
The artificial removal of fecal masses and rectal irrigations
sometimes have to be repeated for several days, until it has
finally been possible to remove piece-meal a fecal cylinder which
may have been 20-30 cm. long.
Laxatives should be used only in recent cases or after the
mechanical removal of the fecal masses near the anus, because
if used in old cases by themselves alone, they may make the
condition worse. The prescriptions to be employed are : Castor
oil (1-3 tablespoonsful in an emulsion with 1-3 to 1-4 part gummi
arabicum and 5 parts of water, or in gelatine capsules 3-5 gm.
each), calomel (dogs 0.20-0.30 gm., cats 0.1-0.15 gm.), aqua laxa-
376 Impaction in the Intestines of Ruminants.
tiva viennensis (50.0-100.0 gm.), occasionally with the addition
of sodium and potassium tartrate (5-10 gm.), extractum cas-
carsd sagradae (2-10 gm.), phenolphthalein (10 gm. for large, 5
gm. for small dogs). The neutral salts (see page 332) may like-
wise be used, and in very obstinate cases drastics may be em-
ployed (1-5 drops of croton oil in 10-30 gm. of castor oil) ; also
tubera jalapae (0.2-0.4 gm.). Drastics must be reserved for those
cases where no inflammation of the intesti.ial wall is present
and where fragments of bone or other hard bodies have not
penetrated into the wall of the gut.
Where accumulation of feces is due to a tumor, an abscess,
an enlarged prostate, a cicatric, surgical interference is neces-
sary.
The diet must be regulated so that the patients do not re-
ceive any food containing flour (bread, dog biscuits, pota-
toes, vegetables) or bones, but exclusively fluid food, such as
broth, soup, milk. Animals which are predisposed to obstipa-
tion should receive as little of carbohydrates as possible, and
they should be exercised frequently.
In order to prevent obstipation due to swallowed hair in eats, Gro-
bon recommends (Rev. vet. 1906, 21) to brush the animals daily and to
administer castor oil twice a month.
(c) Impaction in the Intestines of Ruminants.
Occurrence. Double mastication, preliminary preparation
and mixing with abundant fluid in the fore-stomachs of rumi-
nants make primary fecal impaction of rare occurrence in these
animals. The disease has been seen in cattle and in goats.
Etiology. The occurrence of primary impaction in rumi-
nants generally depends upon continuous feeding with undi-
gestible, dry feed (leaves or matted hay). Moist mouldy straw,
withered dry and rotten cabbage may also be the cause of the
disease. Mathis saw grave cases of fecal impaction in cattle
after long railroad transportation.
Symptoms. The disease is manifested by obstinate consti-
pation, by moderate bloating after each meal, however without
the accumulation of feed masses in the rumen, gradual decrease
of appetite and retardation of rumination. Signs of restlessness
are either lacking or are very insignificant. The feces are dry
like peat, sometimes covered with a good deal of mucus and are
voided in small amounts in spite of efforts. The intestinal
sounds are absent or weak. Rectal exploration reveals, in the
region of the right flank, sausage-like loops of intestines filled
with firm feces ; in small ruminants the desiccated feces may be
felt through the abdominal wall.
Diagnosis. Treatment. Impaction in the Intestines of the Hog. 377
The affection ends fatally only in the very gravest cases,
otherwise it usually leads to recovery within one week.
Diagnosis. Displacements of the intestines can be distin-
guished from impaction by the severe symptoms of colic and
by a rapid deterioration. Stenosis of the intestines can often be
differentiated only by rectal exploration.
Treatment. Injections of large quantities of water and tlie
administration of neutral salts (500-1000 gm. for cattle, 50-100
gm. for goats) are indicated; also aloes (40-60 gm. for cattle,
10-20.0 gm. for goats) ; tartar emetic (10-20.0 gin. for cattle,
0.2-2.0 for goats) alone or in combination with salts (tartar stib.
15.0 gm. sod. sulph. and magn. sulph. aa. 500 gm., given in
three doses during one day for cattle). Eserine, eseridine, pilo-
carpine or arecoline may likewise be indicated (see page 254).
The diet should be made up of potatoes, beets, bran or flour
soups, green feed, leaves of beets.
Literature. Dieckerhoff, Spez. Pathol., 1892, II, 450.— Eber, S. B., 1896, 30.—
Mathis, J. vet., 1897, 459.— Eobert, S. B., 1893, 120.— Rychner, Bujatrik, 1841, 113.
(d) Impaction in the Intestines of the Hog.
Etiology. Hogs develop impaction of the bowel in conse-
quence of exclusive dry feeding with grains or after ingesting
short cut chaff, or after the ingestion of much sand if the latter
has not caused enteritis. Sometimes continued stabling causes
the affection.
Secondary impaction is frequently seen after chronic hog
cholera or chronic tuberculosis, or after stenosis, due to a slowly
progressing enteritis.
Symptoms. One observes diminished appetite, increased
thirst, frequent grunting and efforts at defecation. In the be-
ginning the animals are still able to press out some lumps of
fecal matter, later on the constipation becomes complete. On
palpation of the abdomen of not too fat hogs, one can feel large
intestines filled with desiccated feces; occasionally one can de-
tect adhesions of loops of intestines. Oppenheim saw in a hog
with a high degree of impaction, retention of the urine, due
to compression of the neck of the bladder.
Grave cases end fatally in consequence of enteritis.
Treatment. Abundant injections of water (2-4 qts.), man-
ual or instrumental removal of the fecal masses accumulated in
the rectum, followed by the use of laxatives, usually relieve the
obstipation. Neutral salts (20-50.0 gm.) are best added to the
drinking water or powdered upon the tongue of the animal.
Since constant squealing of the hogs during the administration
of the laxatives may give rise to aspiration into the lungs, other
378 Impaction in the Intestines of Rabbits.
cathartics should be introduced into the stomach by the aid of
the stomacli tube (tartar emetic 0.5-1.0 gm., castor oil 50-100
gm,, dissolved in water or mixed with it), or eserine (0.005-0.02
gm.) given subcutaneously. Tartar emetic, castor oil or calomel
may be given in the shape of an electuary. Dietetic treatment
consists in feeding bulbs, fallen fruits, green feed, cut pumpkin,
sour milk or whey.
Literature. Oppenheim. T. Z., 1909, 227.
(e) Impaction in the Intestines of Rabbits.
Etiology. Rabbits develop impaction of the large intestine
after too almndant or exclusive dry feeding, particularly after
dry bran or undigestible food stuffs have been given continu-
ously.
Secondary impaction occurs after chronic intestinal catarrh
in the presence of enteroliths and sometimes in consequence of
painful affections of the rectum or of the parts in the region of
the anus.
Symptoms. There is at first retarded defecation, then com-
plete constipation, diminution of appetite and listlessness. Pal-
pation of the abdomen, which is very easy, reveals the presence
of desiccated masses of feces in the large intestines.
If proper treatment is instituted early the disease ends
in recovery.
Treatment. Repeated rectal injections of water, and soaj)
suppositories are to be employed (from tea to table spoonful
doses). Syrup with milk in equal parts, pills of the leaves of
senna (1-2.0 gm.) or of rheum (0.2-0.4 gm.). Tincture of rheum
(5-10 drops in water), also root of jalap (0.2-0.3 gm.), or calo-
mel (0.05-0.2 gm.) may likewise be used.
The diet should consist in green feed, juicy roots, lettuce,
etc.
Literature. Braun, Kaninchenkrankheiten, 1907, 109.
(f ) Impaction in the Intestines of Fowls.
Etiology. The disease is rare in domestic fowls which are
kept in the open air; if it occurs at all it is generally due to
foreign bodies (pebbles, feathers, animal parasites, pieces of
rags). More frequently, although still rarely, the disease is seen
in over-fed, highly bred fowls kept in confinement in cages, or
in house birds. These animals suffer from a combination of
heavy undigestible feed and sluggish peristalsis. Impaction in
the cecum, due to improper feeding, appears in enzootic form,
particularly among young turkeys. The matting together of
Symptoms. Treatment. Internal Closure of the Intestines. 379
the feathers around the cloacal opening may likewise prevent
defecation.
Symptoms. The birds drop dry feces in small amounts at
long intervals and with effort; this attracts attention since
under normal conditions their feces are dropped with great
ease and are soft and mushy in consequence of the admixture
with urine. If obstipation has lasted for some time there is list-
lessness, depression, lack of appetite, and attention is attracted
to the birds even if the irregularity in defecation has escaped
notice.
If the disease is neglected it may lead to death in conse-
quence of necrosis of the intestinal wall, and exhaustion.
Treatment. If there is a mechanical impediment it must
at once be removed; matted feathers may be untangled after
wetting them with water ; desiccated masses accumulated in the
cloaca can be removed with a spoon. To remove the feces con-
tained in the rectum, the careful injection of olive oil or soap
water is to be recommended ; in small birds a dull sound dipped
in glycerin or castor oil may be introduced into the rectum.
If the impaction is in some part of the intestines nearer to
the stomach, castor oil (table or tea spoonful doses), rheum
(0.4-0.6 gm. with butter or honey in pill form), or eventually
calomel (0.05-0.2 gm.) may be used with advantage. Neutral
salts may be given in weak solutions (1:200) with the drinking-
water.
The dietetic treatment requires green feed, soaked grains,
boiled bran, lettuce, carrots, fruit.
21. Internal Closure of the Intestine. Obturatio intestini.
B}^ obturation of the intestines is meant a sudden narrow-
ing or a complete closure of the lumen of the intestine hj some
body situated in the bowel. The affection occurs almost exclu-
sively among horses and carnivora.
Occurrence. Obturation of the intestines is a rare affection
of horses. Among the horses of the Prussian Army this form
of obstruction of the intestines was seen in seventeen years only
in 0.3% of the cases of colic; in the Budapest Clinic it formed
0.2 to 0.7% of the cases of colic. (Holterbach claims that for-
eign bodies in the duodenum are not rare in cattle.)
Etiology. Obturation of the intestines in horses is usually
brought about by enteroliths or lumps of fecal matter, more
rarely by parasites, exceptionally only by foreign bodies.
Intestinal calculi (enteroliths) are mainly composed of
phosphate of ammonia and magnesia (90%) ; they also contain
some (y2-lMi%) carbonate and phosphate of lime, common salt,
380 Internal Closure of the Intestines.
and chloride of calcium (Fiirstenberg). The most frequent
cause of calculi formation in the intestines is the continued
abundant feeding of wheat and rye bran (the disease is fre-
quently found among the horses of millers and bakers), which
contain an abundance of phosphate of magnesia. The latter dis-
solves in the acid contents of the stomach and of the small in-
testines, and is precipitated in the alkaline contents of the large
bowel; it combines with the ammonia formed during putrefac-
tive processes, and gives rise to phosphate of annnonia and
magnesia, crystallizing around bodies which may have acci-
dentally gotten into the large intestine (grains of oat, pebbles,
splinters of iron, swallowed tooth [Fobelot]). Zschokke, how-
ever, claims that intestinal disturbances play a considerable
role in the production of intestinal calculi. The latter are
formed in the large intestine, as a rule preferably in the stom-
ach-like dilatation of the colon. We here usually find one cal-
culus, variable in size, generally more or less spherical, some-
times weighing over twenty pounds; there may exceptionally
be several calculi, even many of them; in the latter case they
are irregularly formed. Colin examined horses for calculi; he
found them 23 times (2.5%) in 900 cases examined, always in
the stomach-like dilatation of the colon, only once in the cecum.
Calculi have exceptionally been found in the small intestine;
their mode of origin could then not be explained; in some of
these cases the calculi were probably gallstones, as pointed out
by Lewin.
Acfordiiig to Fiirstciilierg a new layer is formed around intestinal calculi after
each meal of l)ran. A calculus of 14 pounds with a diameter of six inches on section
showed 720 concentric layers; it would, therefore, have required 3(iO days for its
formation. In a case of Pastore a calculus of the size of a fist had been formed
in less than a year.
Aside from the true calculi we find in the large bowel
pseudo-calculi (phytoconcrements) and other concrements
which lack a definite structure and which owe their formation
to pasturing on sandy, marshy meadows, or to marshy feed ;
also to the habit of some horses to swallow and to nil)ble on
wooden partitions, or to drinking water from shallow brooks or
pools, or from wells containing much sand. The latter may form,
in the large intestines, mortar-like conglomerated masses with
the feces. In the formation of the latter (partictdarly if much
l)ran is given), phosphates and carbonates of lime, swallowed
hairs, dry vegetable parts or swallowed foreign bodies, take a
consideral)le part. (Deysine has reported a case in which he
found a swallowed sponge incrusted with lime salts.) The sur-
face of pseudo-calculi and concrements is usually uneven; Ihey
often have sharp corners or may be covered by a crust of phos-
phate of ammonia and magnesia. They are much lighter than
genuine enteroliths.
In a case of Grimnie several hair balls were found in the large colon of a l.orse
which had been fed for nine weeks with oat meal ; they were up to the size of a fist
Etiology. Pathogenesis. 381
and had been formed from the hairs of grains of oats. Wiesner found in a tliroe
months' okl foal a conerement, obstructing the terminal portion of the ileum, com-
posed of food particles, hairs and infiltrating lime salts.
Fecal balls composed exclusively of feces are more rare
than concremeiits. The intestinal Imnen of newborn foals may
be obstructed by meconium (Topper).
The lumen of the small intestines may be obturated by ani-
mal parasites such as ascaris, gastrus, larvae (Kater, Rexilius).
The anterior portion of the small intestine is onl}^ rarely
obturated by swallowed foreign bodies (Bech, Jacobin and
Clare, Angebauer, authors' observation). Closure by a hem-
atoma formed in the intestinal wall is also quite rare (Uhlig,
Kitt, Schleg & Jolme).
Obturation of the intestines of dogs is often produced by
foreign bodies swallowed in play or in retrieving (see page 312) ;
also by pieces of bone and cartilage, occasionally also b}^ hair
balls, lumps of feces, parasites (taenia) ; such foreign bodies
are much less frequently the cause of obturation in cats.
In ruminants and hogs obturation of the intestinal lumen
by hair or fecal balls, or ))y swallowed foreign bodies, or by a
hematoma (Eber) is rare. (Fetting found in a young heifer,
which had died of digestive disturbances, a young cat wedged
in the small intestine ; Wyssmann saw a case with obturation of
the large intestine by masses of fibrin ; Sporer saw a case where
a potato had become wedged in the small intestine and one case
where a vegetable stem formed the impediment.)
Pathogenesis. Foreign bodies formed in the intestines
(calculi), or arrived there from without, may sometimes remain
in a wider portion of the intestinal tract without doing any
harm at all. Zschokke found, in a miller's horse which had al-
ways been well, forty-two pounds of intestinal calculi, one alone
weighing twenty pounds. At other times calculi are the cause
of chronic intestinal catarrh (see page 340), or of intestinal
stenosis (see page 387). Closure of a narrow portion of the in-
testines is not at all rare if the bodies have been moved to such
places by peristalsis and have there become wedged in; the
closure may then be due to the foreign body alone or to it and
the masses of feces which accumulate at this site.
The site of the obturation varies according to the deriva-
tion of the obturating body. In horses genuine calculi and con-
crements, also lumps of feces generally become wedged into the
first portion of the small colon, more rarely somewhat more to-
wards the anus, occasionally also into the pelvic flexure of the
large colon; desiccated feces (chatf) are also sometimes found
in the last portion of the ileum or of the duodenum which they
obturate rather suddenly (see page 366). The large intestine is
usually obturated by fecal agglomerations in dogs. In all other
cases (foreign bodies, intestinal parasites) obturation usually
occurs in the horse and in all other animals, in the small intes-
tines.
382 Internal Closure of the Intestine.
If the obturating body does not stretch the part closed up,
because the comparatively large mass is simply held back by
the narrowing portion of the bowel without interfering with it,
as is, for instance, the case with large calculi situated in the
stomach-like dilatation of the colon, then the obturation of the
intestinal lumen leads to the same consequences as they are
found in fecal impaction (see page 366). If, however, the for-
eign body has been pushed into a narrower portion of the in-
testine, it will stretch and irritate the intestinal wall and cause
attacks of powerful convulsive contractions, that is, colicky
pains. In such and also in the previously mentioned cases, as
already explained when discussing the pathogenesis of fecal im-
paction, convulsive painful contractions of intestinal portions
situated nearer to the stomach will occur likewise. If the body
wedged in the intestinal lumen is pointed or sharp-edged, it may
produce continuous pain.
As in all forms of obturation of the intestinal lumen, the
peristalsis becomes abolished behind the obturated point, and
often increased for some time in front of the obstruction ; later,
however, the peristalsis also ceases in the portion between the
obstruction and the stomach as stretching of the bowel occurs
from the accumulating contents. Bloating occurs only after
some time in these portions, if their contents are more or less
fluid; the meteorism does not, however, reach a very high de-
gree, because normal intestinal contents do not form much gas
and the latter is easily absorbed. In closure of the posterior
portions of the large bowel feces collect in front of the obturated
point if the appetite has in the mean time remained fairly good ;
the feces desiccate and extend the lumen of the bowels. Sec-
ondary gastric dilatation does not infrequently occur under such
circumstances in horses.
Pressure or direct injury exerted by the obturating body
not infrequently brings on necrosis or inflammation, and these
may extend to the internal layers of the wall, even to the peri-
toneal covering. Necrosis or convulsive contractions of the in-
testinal wall may not rarely cause intestinal rupture. As long
as complications (inflammation, rupture, possibly high degrees
of bloating, dilatation of the stomach) are absent, there are no
general symptoms, such as are generally seen after absorption
of bacteria and their toxins, after peritonitis and in consequence
of severe bloating.
Symptoms. In horses the visible signs and sj^mptoms of
internal obturation are identical wdth those of impaction in a
part of the cases, particularly if the first portion of the small
colon has been closed up (see page 367), except as to defecation
and as to the onset of the affection. In obturation the clinical
picture develops suddenly in distinction from impaction of feces,
and after one or two defecations, complete constipation comes
on. In other cases there are severe attacks of colic without any
Symptoms. 383
premonitory symptoms which recur from time to time, usually
at shorter intervals. The animals throw themselves down reck-
lessly and roll energetically; exceptionally, when the obstruct-
ing concrements have sharp borders, the animals do not throw
themselves or roll, because this only increases the pain due to
injury by the calculi. The animals betray pain by restless trip-
ping, by looking around towards the abdomen, shaking the head,
and occasionally by painful neighing (authors' observation). Ab-
normal positions, such as dog fashion, kneeling postures, pecu-
liar stretching, may also be frequently ol)served. They are not
of any particular significance, because they are caused by the
abdominal tension or by the pressure upon the diaphragm and
are frequently seen in the course of other affections.
Examination of the abdomen in ol)turation of the small in-
testines shows a decrease or an entire absence of intestinal
sounds from the start, and in other cases after a number of
hours, eventually only on the third day of the disease.
Directly after the onset of the first symptoms, defecation
occurs only a few more times, often only once or twice, then
no more feces or intestinal gases are voided, in spite of the fact
that the animals make efforts at defecation. If the obturation
takes place gradually, diminished defecation occurs for some
time, and if the concrements which form the impediment are
quite irregular the discharge of thin-fluid feces may be kept up,
because these can pass between the irregular surface of the cal-
culus and the intestinal wall, through the clefts which have
remained open (authors' observation).
Rectal examination shows that the posterior portion of the
rectum is entirely open. If the arm is introduced up to the
shoulder, the examiner may feel the obstructing calculus or the
eoncrement, in horses which are not too large, in the first portion
of the small colon, immediately in front of the anterior pole of
the left kidney ; possibly also in the median line. Obturation in
the pelvic flexure or in the small colon ( socalled abdominal por-
tion of the rectum) can be felt with ease in all horses. An obtu-
ration of the ileum or of the dilatation of the large colon can
likewise be felt, unless the patients (horses) are very large
(see page 367). One can rarely expect to find masses of as-
carides in the small intestines.
Calculi and concrements may usually be felt on palpation
as hard, unyielding, frequently uneven, nodular bodies, but their
true shape may be covered up hj fecal masses which have be-
come deposited on them. The intestinal wall at the site of the
obstruction is usually moderately tender, but it may be extreme-
ly tender, as the authors have seen in one case, so that the
patient rears and throws himself down whenever the hand ap-
proaches this place. The obturating body may exceptionally be
in the rectum, so that it can be felt directly by the introduced
hand.
The temperature is at first normal, and respiration and
384 Internal Closure of the Intestine.
pulse deviate onlj' very inconsiderably from the normal figures
in consequence of restlessness ; the pulse remains usually below
50 in the beginning. Obturation of the anterior portions of the
small intestine forms an exception from the general rule be-
cause the early occurrence of dilatation of the stomach or of
enteritis frequently raises the pulse rate shortly after the onset
of colicky symptoms. Dilatation of tlie stomach may cause
])elching, retching or vomiting.
Obturation due to retention of the meconium on the second day
after l)irth, causes marked restlessness, pawing with the front legs,
wagging of the tail, stretching, pressing, lying on the back, dog-fashion
squatting, sometimes even convulsions (Topper).
If there is no improvement one usually sees in the further
course, rarely on the first, more generally on subsequent days,
an elevation of temperature ; also acceleration and weakness of
the pulse. These symptoms increase very slowly; they are
caused by the onset of complications (enteritis, peritonitis,
meteorism, rupture). Rupture of the intestines is not followed
by collapse, provided it has been small and, provided only solid
feces have gotten into the abdominal cavity, because then bac-
teria and their toxins are not at once alisorbed in larger
amounts ; but there develops the clinical picture of general acute
peritonitis, characterized by unevenness and tenderness of the
peritoneum, which can be ascertained on rectal examination;
one may also frequently be able to feel free particles of feces in
the abdominal cavity. If an exploratory puncture is made, one
obtains a fluid exudate containing particles of feces and numer-
ous bacteria.
The clinical picture in cattle is identical with that of intes-
tinal stricture (see page 389) (Holterbach), or one observes
more or less marked symptoms of colic, obstinate constipation
in spite of repeated efforts. The appetite is poor, rumination
has ceased and moderate bloating usually occurs. Intestinal
sounds are absent. Rectal exploration sometimes reveals the
presence of an obturating foreign body in the intestines, which
may be felt in the right half of the abdominal cavity (Sporer,
Feser).
In dogs we observe obstinate vomiting, possibly colic, ab-
sence of appetite, but increased thirst and complete constipation.
The animals are less lively, hide themselves, whine and cry on
getting up, on moving, and also while at rest ; they often change
their place of rest, are cross and excitable. In the further course
of the disease they become increasingly apathic ; there may be
convulsions, elevation of temperature, acceleration of pulse,
rapid emaciation. Palpation of the abdomen reveals marked
tenderness in places, and possibly the presence of the obturating
body (the latter may often be easily detected during narcosis).
A pointed foreign body (tooth pick) gave rise, after perforation
of the intestines, to the formation of an abscess.
Course. Diagnosis. Treatment. 385
Course. The disease is usually of short duration in larger
animals and in complete obturation; it then ordinarily extends
over two to three days, rarely over a longer period ; it may, how-
ever, occasionally last longer, one to two weeks (authors' obser-
vation) or even more. (In a case reported by Felder, the horse
died after a sickness of 30 days). In dogs, on the contrary,
intestinal obturation often lasts from one to three weeks. Com-
plete obturation is often preceded by the symptoms of intestinal
stenosis with occasional, more or less severe, disturbances of
defecation or colic.
Recovery occurs rarely spontaneously or only upon internal
treatment. It may, however, occur if the obturating body is
not too large and can therefore be pressed tow^ards the anus
and finally expelled by convulsive contractions of the intestinal
wall. Very exceptionally a calculus may return from the be-
ginning of the small colon into the stomach-like dilatation. ^
In the majority of cases complications lead to a fatal issue,
the end being ushered in by febrile temperature, frequent and
small pulse, collapse; the intense abdominal pains frequently
cease suddenly (rupture) or gradually before death occurs.
Diagnosis. Obturation of the intestines can be diagnosti-
cated positively only after the obstructing body has been felt,
either by rectal exploration or, in smaller animals, through the
abdominal wall. By means of X-rays one may often detect the
foreign body in dogs. The history may furnish valuable data in
dogs, and in horses a history of continued feeding with bran
and crushed grain or of a long stay on sandy, marshy pastures,
creates the suspicion of obturation by calculi or concrements
The disease is distinguished from primary fecal impaction
by the fact that a part oi the cases (of obturation) is compli-
cated by severe abdominal pains ; that a distension of the rectum
by fecal masses is absent in the beginning and eventually even
later, and that there is obstinate constipation from the start.
Fecal accumulation in the rectum is not seen in intestinal dis-
placements or in thrombosis of mesenteric vessels, but severe
bloating of some portions of the intestines and a weak acceler-
ated pulse are observed early.
Treatment. In the horse the expulsion of small calculi may
be brought about by laxatives, such as castor oil (500-600 gm.
with olive oil, with ether 50-70 gm., or with mucilaginous sub-
stances, some radix liquiritia? as an electuary), also pilocarpine
(0.20-0.30 g-m.). Eserine or chloride of barium should not be
used, because they may bring about intestinal rupture. If the
calculus is in the "neighborhood of the anus, it can be grasped
with the fingers of the introduced hand and it may be removed
by a twisting motion. Some intestinal concrements can easily
be crushed with the hand and can then be removed piece-meal.
One may also cautiously attempt the breaking up of a concre-
ment lodged in the first portion of the small colon. If the cal-
Vol. 2-25
386 Internal Closure of the Intestine,
cuius is situated more anteriorly one might try to push it into
the stomach-like dilatation (Colin) ; this attempt is, however,
rarely successful on account of the accumulation of feces in
front of the place of obturation, as the authors' observations
in this respect have shown. One may also try the injection of
large amounts of water (30-40 liters at one time).
Topper recommends Masch's meconotoriiim for the removal of
meconium which is impacted in the rectum ; this instrument has the
shape of a spoon and it must he introduced repeatedly with care. After
cleaning out the rectum an injection is given (1 quart of 1% Lysol
solution) and internally 1.0 calomel with 50 gm. castor oil.
If these attempts fail or if the size and shape of the obturat-
ing body exclude the possibility of success from the start, laxa-
tives should not be given, but a laparo-enterotomy might be
tried. However, the latter will be successful only in verj^ ex-
ceptional cases, since the union of the stomachlike dilatation of
the large colon into the small colon is usually displaced into the
latter, and it therefore becomes impossible to draw this portion
of the intestine into the wound of the abdominal wall, because
the former is too firmly connected wdtli the upper al)dominal
wall. The operative procedure appears indicated only in obtu-
ration of the small colon with its long mesentery or in obturation
of the pelvic flexure. The left side should be selected for the
abdominal incision. The right would be preferable in ol)tura-
tion of the head of the cecum, but this condition cannot be diag-
nosticated intra vitam. Hoffmann recommends the removal of
the calculi wedged in the posterior portion of the rectum, by
introducing the hand through the laparotomy wound and push-
ing carefully the stone towards the rectum where it will be
grasped and extracted by the hand of an assistant (water should
be introduced beforehand if the stone is of any considerable
size). Large calculi can, of course, not be removed by this
route.
If a large calculus is situated iu the stomaeli-like dilatation so that it occludes
the opening of the small colon, it is impossible to pull this part into the laparotomy
wounil as it is provided with a short meseutery only. I'rovided there is not yet any
considerable fecal impaction one may, however, try to draw the right upper portion
of the colon into the wound made immediately below the right costal arch, to incise
this portion of the bowel, introduce the liand into it and push it forward until the
stone can be grasped and extracted. An attempt of this kind was, however, futile
in a case of Plosz «& Marek because the upper right portion of the colon was so much
filled with firm fecal masses that it could not be drawn into the laparotomy wound.
One can, anyhow, expect success from laparo-enterotomy only if dry feces have
accumulated in larger amount in front of the obturating body and in the absence of
grave complications, such as enteritis, peritonitis, intestinal rupture. A case of
Felizet in which a calculus, the size of a child 's head, was successfully removed by
an operation made at the proper time proves that it may be carried out to bring re-
lief and recovery. In the cases reported by Eichard, Dollar & Eogers, by Hall, Boeder
and Lowe, and in three cases of Marek & Plosz the patients operated upon all died.
Obturating foreign bodies in cattle may also be removed by
operative procedure, as is shown by the observations of Sporer
and Feser.
Narrowing of the Intestine. 387
In a ease reported hj Sporer au obturating potato was crushed after lapar-
otomy had been made, and in another case a rough stalk was broken in the middle;
both cases then recovered. Feser successfully removed a piece of tin by laparotomy.
The expulsion of foreign bodies wedged in tlie intestinal
tract is favored in dogs by the administration of laxatives. For-
eign bodies in the rectum can be removed by hand or with proper
extracting forceps. If these methods are not successful, or if
they are not applicable from the start on account of the nature
of the obstructing body, laparo-enterotomy may be successfully
performed, as is shown by the reports of Felizet, Siedam-
grotzky, Frolmer, Degive, JPlosz, Marey and others. It is, of
course, not advisable to wait long with an operation if it is at
all indicated.
Literature. Achilles, Darnigeschwiilste beini Pferd, etc., Inaug. Diss., 1907,
(Lit.).— Alix, Bull., 1902, 681.— Deysine, Eec, 1891, 426.— Eber, S. B., 1896, 27.—
Felder, T. Z., 1902, 369.— Felizet Rev. vet. 1877, 170.— Feser, W. f. Tk., 1905, 438.—
Fiebiger, Z. f. Tm., 1902, VI, 52.— Frohner Monh., 1892, III, 491; IV, 305; V, 534.
— Fiirstenberg, Mag., 1844, 268.— Grimme, D. t. W., 1904, 3.— Hall, B. t. W., 1895,
151.— Hoflemann, O. M., 1904, 49.— Holterbaeh, B. t. W., 1906, 679.— Jacotin & Clerc,
A. d'Alf., 1882, 570.— Lowe, Vet. Journ., 1906, 75.— Plosz, Monh., 1896, VII, 109,
D. t. W., 1907, 702.— Plosz & Marek, Z. f. Tni., 1905, IX, 48.— Piitz, Z. f. Pr., Vet.,
Wiss., 1876, 273.— Eiehards, Dollar & Eogers, J. of comp. Path., 1894, 168.— Roder,
S. B., 1904, 293.— Siedamgrotzky, S. B., 1S77, 62; 1880, 19; 1882, 16.— Sporer,
W. f. Tk., 1902, 285, 306.— Topper, B. t. W., 1896, 123.— Wiesner, A. f. Tk., 1899,
XXV, 222; Zschokke, Schw., A., 1900, XLII, 249.
22. Narrowing" of the Intestine. Stenosis intestini.
Stenosis of the intestines is a more or less chronic disease
with a generally progressive diminution of the lumen of the in-
testine at a circumscribed place.
Occurrence. .Stenosis of the intestine is a rare affection.
It occurs in horses with about the same frequency as obturation
of the intestines (see page 379).
Etiology. The following are the pathologic conditions
which may be the causes of intestinal stenosis : Scar formation
in the intestinal wall caused by injury through foreign bodies,
by ulceration, possibly after gangrene of an intussuscepted
portion of the bowel, produces narrowing of the intestinal wall
(strictura intestini) in consequence of cicatricial contraction
of the newly formed connective tissue. Upon this basis intes-
tinal stricture is usually found in the small intestine, the small
colon, or the rectum, in domestic animals with the exception of
the hog. According to Bruckmuller, Sikorski, Bolton, in horses
occasionally, but according to the reports of the Berlin patho-
logical institute frequently, a cicatricial stenosis of the ileo-
cecal opening is noted, due to chronic inflammation of the mu-
cosa and caused by the continuous irritation of coarse feed
388 Narrowing of the Intestine,
(sliort-ciit chaff, l)uckwlieat straw). Ligation of the prohipsed
rectum often causes stenosis in liogs (Johne).
Chronic peritonitis which produces newly formed and sub-
sequently shrinking cicatricial connective tissue on the serosa
of portions of the intestines, may cause stenosis of the intes-
tines of variable extent. (Ross, Ziirn, Dignac, v. Oav., authors'
observation.) Intestinal stenosis is frequently produced in
chronic adhesive peritonitis, in consequence of kinking in loops
of intestines which have become adherent to the abdominal wall
or to neighboring organs, because the two branches of the ad-
herent loop pull upon the place of attachment by their own
weight. (Averous, authors' observation.) Sometimes localized
subacute peritonitis may produce intestinal stenosis in this
manner, as has been seen in the horse (authors' observation).
Neoplasms in the intestinal wall are not infrequently the
cause of intestinal stenosis (Achilles found intestinal tumors,
mostly sarcomata in 0.2% of the horses slaughtered in the stock
yards at Leipzig). Most frequent are polyps of the mucosa ; they
may be multiple in this place. Sarcomata are usually found in
the small intestine; they are either firm or soft, and they also
assume an infiltrating form (Eabe, Kitt) with the histologic
structure of a lymphosarcoma. Melanomata occur in the cecum
and rectum of the horse (Plarrison, Csokor). Carcinomata are
frequently seen in the region of the anus of the dog (Frohner) ;
they are, how^ever, rare in other parts of the intestinal tract and
in other animals. (According to the compilation of Acldlles only
six cases have so far been reported in the horse) ; these car-
cinomata in horses have no tendency to undergo ulcerative
changes. As rare neoplasms must be mentioned: fi))romata,
myxomata, lipomata, leiomyomata, adenomata, adeno-carcin-
omata, actinomj^comata (the latter are of course, not true tu-
mors).
Guenon removed from the rectum of a horse a pediciilated, very hard tumor
the size of a walnut; it was, according to Petit, formed in such a manner that a
calculus had formed in a gland of Lieberkiihn. This calculus had gradually dis-
tended the mucosa and had drawn it out with the formation of a pedicle. Tn a case
of Cadeac congenital valve formation in the rectum had been the cause of stenosis.
Calculi, balls of feces, foreign bodies, not infrequently cause
stenosis before entirely obstructing the lumen of the intestines.
Circumscribed dilatations of the intestinal wall (diverticulum in-
testini), which may either l)e congenital (diverticulum of Meckel
in the ileum) or acquired through the action of heavy bodies
(sand, calculi, fecal balls), and may constrict the lumen of the
part where they are located by compressing it when filled or by
twisting it through traction. These forms of diverticula are
most commonly found in the horse in the last portion of the
ileum, in the large intestine, or in the small colon.
Compression of the intestine by an aliscess or a neoplasm
formed in the mesentery or by enlarged abdominal organs
Pathogenesis. 389
(gravid uterus, filled rumen, enlarged ovary, enlarged pros-
tata) ; a spleen enlarged in consequence of hemorrhage may not
infrequently cause stenosis of the bowels. Hendrickx saw in a
horse a compression of the intestines due to a detached, partly
ossified cryptorchitic testicle, which subsequently broke through
the atrophic intestinal wall into its lumen.
Intestinal stenosis may also be caused by internal herniae
before they become strangulated; the clinical picture then usual-
ly terminates by the symptoms of complete incarceration. Para-
sites (ascaris, gastrophilus larvae [Kater, Rexilius],_ intertwined
ta?nife) will only exceptionally produce a picture similar to in-
testinal stenosis.
Pathogenesis. According to the character of the enumer-
ated causative factors, the intestinal lumen usually becomes
narrowed very gradually; in exceptional cases the stenosis re-
mains stationary or it only occurs temporarily (diverticulum,
internal hernia, compression caused by an overfilled rumen).
The narrower the affected portion of the intestine, even under
normal conditions, the firmer the feces, the more abundant and
the drier the ingested feed has been, the earlier, the oftener,
and the longer will the passage of feces through the con-
stricted portion be interfered with. The fecal masses accumu-
lating in front of the narrowed point stimulate the intestines to
forcible contractions at the place where the accumulation has
taken place; some of these are convulsive and cause colicky
pains. These forcible contractions will finally succeed in press-
ing the accumulated feces through the stenosed portion and the
time which elapses before this occurs depends upon the degree
of stenosis and upon the consistency of the feces. After the
feces have passed the narrowed point, the convulsive contrac-
tions and the pains cease. Hypertrophy of the forcibly contract-
ing muscularis and dilatation of the intestine will develop in the
course of time. The nearer to the stomach the constriction is
situated, the sooner after the ingestion of food will abdominal
pains come on, and a chronic dilatation of the stomach will
usually develop; such a condition may, however, also develop
in stenosis of the large intestine. In the latter condition attacks
of pain occur independently of the ingestion of food ; in stenosis
of the rectum they commonly come on before defecation. Those
portions of the intestines which are situated between the stric-
ture and the anus do not contain a great deal of feces, hence
they act sluggishly. The feces accumulate and decompose in
front of the stricture and frequently become instrumental in
producing chronic intestinal catarrh, which influemes the nutri-
tion of the animals unfavorably. The stenosis may finally lead
to complete occlusion of the bowels.
Symptoms. In the horse and in cattle a clinical picture is
observed at variable intervals, which is identical with that met
with in impaction (see pages 367 and 376) ; the attacks may last
390 Narrowing of the Intestine.
for a few hours only, or for several days (socalled habitual, re-
curring or periodic colic ) . With remitting mild or on the contrary,
very severe attacks of colic, there develops afterwards an in-
complete constipation. In stricture of the small intestine the
attacks usually occur shortly after the ingestion of food, and
they are often followed by dilatation of the stomach (see page
299). In stenosis of the rectum restlessness is noticed before
defecation. In cattle there occur, aside from the s^^nptoms of
intestinal obstipation, those of a periodically recurring atony
of the stomach or overfilling of the nmien (Storch).
During the attacks of colic, pulse, respiration and temper-
ature remain, as a rule, normal or are only changed insignifi-
cantly; an exception to this rule is noted, however, when a dila-
tation of the stomach or enteritis has set in, or where the under-
lying cause of the stenosis of itself leads to fever (abscess, peri-
tonitis).
During the intervals between the attacks the animals either
appear perfectly healthy, as for instance in moderate stenosis
of the small intestine, or defecation is scanty, occurring only
after longer intervals, or instead of being dry and small, the
feces may be softer tlian normal, a condition which is due to
secondary intestinal catarrh.
Eectal examination often does not merely reveal the seat
of the stenosis but also its cause. In stenosis of the rectum the
hand meets an impediment, either near the anus or somewhat
more distant from it, which cannot be removed either by
spreading the finger or by the injection of lukewarm water
(this distinguishes true stenosis from temporary constriction,
which can be overcome by the means indicated) ; one often also
can feel feces with the finger pushed through the constriction,
sometimes a dilatation and occasionally a kink. If the arm is
introduced up to the shoulder, narrowing of the small colon may
be detected, because all loops of this part of the bowel are in a
portion of the abdomen which can be reached from the rectum.
A stricture in the posterior third or possibly the posterior half
of the left loop of the large colon, or in the upper half of the
cecum, the terminal portion of the ileum, or in the loops of
small intestines situated below the renal region, nmj be detected
in the same manner, and in horses which are not too large they
may even be found in the stomach-like dilatation of the colon.
One finds the intestinal wall thinner at the constricted portion,
possibly adherent to a neighboring organ, or one may detect a
large abnormal formation in its lumen or in the neighborhood.
In front of the stenosis there is usually an accumulation of
feces. Palpation of the right half of the abdomen in cattle may
show stenosis of the rectum, stenosis or adhesions of the cecum,
stenosis of other portions of the large intestines or of some
loops of small intestine.
The presence of a non-incarcerated hernia of the diaphragm
may be assumed with some degree of certainty from the pres-
Symptoms. Course. Diagnosis. 391
ence of marked loud intestinal sounds in the thorax, of tym-
panitic sounds, varying at short intervals in intensity and pitch,
and heard at the posterior portions of the thorax ; also from the
occurrence of intense dyspnea in walking down steep roads or
from lying on the side. Diaphragmatic hernia may also
lead to asthmatic symptoms (Earner). Loud intestinal sounds
are also heard over the thorax whenever peristalsis is much in-
tensified and a tympanitic sound over the posterior lower parts
of the chest can be heard not infrequently if gas containing por-
tions of the large colon have for some reason or other been
pushed towards the thorax and have pressed the diaphragm
into it.
Intestinal stenosis in hogs and carnivora is accompanied
by gradually increasing obstipation. Eectal exploration reveals
a constriction of the rectum somewhere in the pelvis (tumors,
enlarged prostate, enlarged uterus, cicatrix). Palpation of tlie
abdomen shows a firm, hard body in the intestines, or in the
mesentery, diffuse adhesions with the formation of lumps or
the enlargement of certain abdominal organs.
Course. Stricture of the intestines does not lead to any
disturbances for some time; after a variable interval of time,
however, there occur, in larger animals, particularly in horses,
attacks of abdominal pains of variable duration. They recur at
first after long intervals, sometimes only after one to two years,
but they become more frequent as the disease progresses. The
intervals depend to a certain extent upon the nature of the feed
and upon the amount of work required of the animals (Earner).
As the attacks become more and more frequent and as obsti-
pation increases continually, complete and permanent intestinal
obturation may occur. In the mean time the animal has become
emaciated and death occurs from enteritis, peritonitis, rup-
ture or displacement of the intestines, exhaustion. In some
cases an animal in a fair state of nutrition may succumb, during
one of the first attacks, to rupture of the stomach or intestines,
or to enteritis.
Diagnosis. Stenosis of the intestines and its origin can
only be positively diagnosticated by rectal exploration or by
palpation of the abdomen. In the absence of positive findings
the presence of stricture of the intestine may be assumed with
a certain degree of probability from the history of certain pre-
liminary diseases, leading to narrowing of the lumen of the
bowel, and leading in shorter and shorter intervals to attacks
of colic with constipation, especially after the ingestion of dry
or firm feed; at the same time general symptoms are absent,
and a gradually increasing obstinate obstipation develops in
smaller animals. However, the symptoms here enumerated do
not permit the exclusion of fecal impaction or thrombosis of in-
testinal vessels from other causes.
392 Narrowing of the Intestine.
Treatment. In the majority of cases the treatment recom-
mended against fecal impaction is indicated (see there). In
the cases of narrowing of the intestine, which are due to a non-
incarcerated hernia or to an excessively large foreign body, it is
not advisable to use laxatives with intense action, because in-
carceration of the hernia or complete occlusion by the foreign
body may occur. In such cases one should confine oneself to
the use of the neutral salts. In rectal stenosis, local treatment
may be assisted by mild laxatives. If dilatation of the stomach
has occurred the use of the stomach tube and lavage of the
stomach are indicated.
If these methods are not successful, or if an improvement
cannot be expected from them in consequence of the nature of
the stenosis, relief may be attempted by operative procedures.
Pediculated tumors of the rectal wall should be removed
by crushing or ligation of the pedicle ; tumors with a broad basis
or those of the paraproctal connective tissue must be removed
by excision. Periproctal abscesses must be properly treated
after an incision. Douville removed a cyst from the rectum of
a horse by puncture, followed by injection of Lugol's iodine-
iodide of potash solution. Certain forms of stenosis situated
in front of the pelvis may be attacked through the rectum (tear-
ing of adhesive bands, displacement of enlarged organs). (Guit-
tard temporarily relieved in this manner, a stenosis caused by
an enlarged rumen.)
The great majority of cases of stenosis formed in parts
that are distant from the pelvis can be treated only by a lapa-
rotomy or eventually an enterotomy. It is absolutely necessary
first, to ascertain the exact nature and seat of the stricture by
rectal exploration, because laparotomy is a dangerous oper-
ation, particularly in the horse, and its successful performance
requires the selection of the proper place for the incision; the
latter should, if possible, be made at a place nearest to the site
of the intestinal stricture. In smaller animals, however, the
best place for the laparotomy incision is, as a rule, the median
line (linea alba). Stenosis caused by adhesive bands can be
removed most easily, because all that is generally necessary
after laparotomy is the severing of the constricting bands.
Plosz & Marek have successfully performed laparotomy in such
cases. Deghilage broke up adhesions of the small colon with the
hand introduced through an incision in the vagina. De Meis &
Parascandolo have removed a carcinoma of the cecum in a dog
by laparo-enterotomy.
Proper regulation of diet (green feed, bran slop, thin flour
pastes, milk, occasionally molasses) usually postpones the de-
velopment of complications and of an unfavorable termination.
Literature. Achilles, Unters. vieb. Darmgesehwiilste beim Pferd, etc., Diss.
Leipzig, 1907 (Lit.).— Averous, Eev. vet., 1903, 546.— Belton, Vet. Eec, 1905, 114.—
Cad^ac, Journ. vet., 1908, 51.3.— Damecoiirt, Rev. g6n., 1907, X, 251.— Deghilage,
Ann., 1907, 17.— Dignac, Eev. vot., 1907. :no.— Eckardt, P.. t. W.. 1,SS9, 41.—
Obstruction of the Mesenteric Arteries. 393
Grimme, B. t. W., 1892, 194.— Guenon, Bull., 1905, 122.— Guerrini, O. M., 1908, 434
(Lit. on iiitestin. sareonia). — Giiittard, Pr. vet., 1901, 441. — Hendrickx, Ann., 1909,
377.— Kater, A. f. Tk., 1887, XIII, 365.— Lasserre, Eev. vet., 1906, 292.— De Meis
and Parascaniiolo, A. f. Tk., 1904, XIX, 583.— v. Ow., B. Mt., 1880, 79.— Plosz &
Marek, Z. f. Tni., 1904, VIII, 257.— Poss, Z. f. Vk., 1899, 495.— Reichart, Z. f. Vk.,
382.— Eost, S. B., 1881, 60.— Eupp, B. t. W., 1906, 44.— Schimniel, O. M., 1905, 57.
—Schmidt, S. B., 1903, 310.— Sikorski, O., Eev., 1886, 175.— Thienie, Pr. Mt., 1868-69,
174.— Wyssmann, Schw. A., 1907, XLIX, 261.— Ziirn, B. t. W., 1904, 289.
23. Obstruction of the Mesenteric Arteries. Thrombosis et
emtaolia arteriarum mesenterialium.
{Verstopfimg der Gekrosarterien; Tliromhutisch-emhoUsclie
Kolih [German]; Congestion intestinale [French].)
Thrombosis of the mesenteric vessels is due, as a rule,
to inflammation and obstruction, caused by sclerostoma larvae;
it occurs in this connection only in horses, and leads often to
frequent temporary attacks of colic.
Many French authors classify intestinal disturbances due to throm-
bosis and embolism with "Congestion intestinale," to which also belong
catarrhal and inflammatory conditions (see page 337). This cannot be
approved, since it throws very heterologous affections together under
one head.
Historical. Larvje of sclerostomum were first seen in the mesenteric
arteries by Ruysch in 1665 and similar observations were then made by
several other authors. The causal connection between these parasites
and attacks of colic has since the beginning of the last century been
pointed out by several authors, especially by Rigot, Schutt, Hering, Rey-
nal, Bruckmiiller, Prehr and others. Bollinger (1870) made systematic
examinations of this pathologic condition. Modern investigations of
verminous aneurysm of the horse have more recently been made by
Sticker (1901), Glage (1905), Adelmann (1908). Disturbances of the
circulation of the blood and of the functions of the intestines following
thrombosis of the mesenteric arteries have been studied by Marek
(1907).
Occurrence. Bollinger's investigations, which have been
confirmed by other authors, have shown that 90 to 94% of all
horses with the exception of foals have a verminous aneurysm.
However, the statement of this author must be considered as
entirely unjustified, that one-half of all fatal cases of colic are
caused by thrombosis or aneurysm and that all cases in which
colic appears suddenly and without any apparent cause are due
to this condition. More recent observations (Matthiesen,
Franke, Schultze, Poppel, Glage) prove that the disease also
occurs in foals from the third month on. Poppel, indeed, lias
seen, in a foal ten days old, a dilatation of the anterior mesen-
teric artery as large as a pigeon's egg, and in it a thrombus
containing larvfc of sclerostomum.
Verminous aneurysm appears to be more common in foals than is usually
assumed. Among thirty-five slaughtered foals, from five to several months old.
394 Obstruction of the Mesenteric Arteries.
Glage found aneurysm of the anterior mesentery in fifteen, varying in size from
a walnut to a fist.
The following figures about the frequency of thrombotic infarction of the intes-
tinal wall are given from various sources: Dresden Clinic, 1899-1908, in horses dead
after attacks of colic, 9.5%; Berlin Clinic, 1891-1907, in 3%; Prussian army, 1892-
1908, 6.67f ; Budapest Clinic, 1900-1909, 14.4%. Wall claims that thrombotic-em-
bolic disturbances of the intestines are quite rare. Indeed there seem to be great
differences in the frequency of the aft'ection, according to periods of time and to
various countries.
Etiology. According to the investigations of Sticker,
thrombosis of the mesenteric arteries of the horse is caused by
the larvae of sclerostomum vulgare Looss (Sol. bidentatum
Sticker).
The mode of the migration of the sclerotomae larvae into the in-
testines and from there into the mesenteric arteries of the horse is at
present not yet known with certainty. According to Leuckart and Wil-
lach, the ova of the mature worm, inhabiting the large intestines of the
horse, are voided with the feces, and from these free ova the larvae are
hberated in water, on moist walls of barns, in manure. From here they get
again into the horse with drinking water, or with food contaminated by
manure, etc., and on moist marshy pastures. The correctness of this view
is confirmed by the observation of ]\Iieckley, who prevented the appear-
ance of verminous aneurysms in the foals of the Beberbeck stud by
having them drink only filtered w^ater ; Ostertag found in the unfiltered
water of this stud strongylus larvge. Other authors claim that the em-
bryos are already set free in the animal host.
It is claimed that when later on the larvse bore into the intestinal
Avail, some of them may quite accidentally get into the veins and with
the blood current into the liver, from where they reach the lungs, tbe
larger circulation, or the mesenteric arteries. (Colin, "Willach, Olt.)
According to other authors, however, the larvae get into the arteries in
their regular cycle of development (Leuckhart, Railliet, Sticker, Glage).
Poppel believes that intrauterine infection of the embryo is possible,
because he once found a verminous aneurysm of the size of a pigeon's
egg in a ten-days-old sucking foal. He thinks that this mode of infec-
tion may easily occur, since the embryos of sclerostoma are microscopic
in size (see also chapter on palisade worms).
In horses as well as in other animals there occurs excep-
tionally a transportation of emboli into the mesenteric arteries
in consequence of cardiac disease, endocarditis and aneurysm
of the thoracic aorta. The emboli in the mesenteric arteries are
usually not followed by serious consequences on account of
their small size. The authors have seen the case of a dog
where an ulcerative endocarditis was followed by an embolic
closure of arteries of the small intestines, and this led to
hemorrhagic infarct of the intestinal "wall. A. Koch and Ijei-
benger have each seen a case of aneurysm of the anterior and
posterior mesenteric artery in the hog.
Pathogenesis. The larva? of sclerostoma, according to gen-
eral belief, adhere to the intima and even bore into it, after they
have gotten into the mesenteric artery; this causes inflammation
Pathogenesis, 395
and the formation of blood coagula, also after some time, a
thickening and a dilatation of the vessel wall. Sticker holds a
different view, namely, that the larvae become lodged in the vasa
vasornm, cause infarction in the media of the vessel, and then
mesoarteritis, or peri- and endarteritis. These changes are seen
most frequently in the anterior mesenteric artery, or in the art.
ileo-coecocolica, rarely simultaneously or exclusively in a branch
of this artery; also in the posterior mesenteric artery or in the
art. cceliaca.
In 108 cases of aneurysms in horses Hering found the art. mesent. involved 100
times (92.6%), the arteria cceliaca five times (4.6%), the art. mesent. post, twice
(1.8%) and the art. renalis once (0.9%). Bollinger's sixty cases were distributed
as follows: Fifty-three times (83.3%), the art. mesent. thirty-two times in the
main trunk; ten times each in the upper and in the lower branch; once in a branch
of the small intestine ; twice (3.3%) in the abdominal aorta; twice (3.37( ) in the
art. cceliaca; once (1.6%) in the art. mesent. post.; and twice (3.3%) in the art.
renalis. In twenty-nine cases of aneurysma in the art. mesent. ant., Wall saw the
aneurysm in the main trunk of this artery only once (3.4%); in the other twenty-
eight cases (96.6%) it was found in the art. ileo-coecocolica. Adelmann found in
all of his ninety-five cases the aneurysm in the art. mesent. ant. ; in seventy-three
horses this artery and its branches alone were involved ; in one horse the art. mesent.
post, was affected simultaneously; in four horses the posterior aorta; in two horses
the art. cceliaca; in one horse the portal vein; in one horse the splenic artery and in
three horses the pulmonary arteries. In these eighty-five cases thrombosis was usu-
ally seen in the art. ileo-ccecocolica and also sixteen times simultaneously in the art.
col. ventralis ; ten times in the art. col. dors. ; seven times in the art. ileo-ccecalis, and
three times in an artery of the small intestine.
The formation of a thrombus leads to a narrowing of the
lumen, provided that dilatation is not commensurate with the
diminution of caliber, or if the end of the thrombus projects
into the lumen of a branch. The diminution of the lumen rarely
goes on to complete obliteration in a main trunk, but complete
obstruction of lateral branches occurs somewhat more fre-
quently.
Stenosis or complete obstruction of mesenteric arteries
may be brought about in a variety of manners. It may occur
that a thrombus formed somewhere increases gradually in size
until it closes the lumen completely. The more rapidly the
thrombus grows, the earlier may disturbances of circulation
come on after complete obstruction. There is also the possi-
bility that two or more neighboring and anastomosing arteries
are affected simultaneously by thrombosis ; in such a case even
a stenosis of not very high degree may become dangerous. One
cannot infrequently see that in non-obturating thrombosis of
the art. ileo-coecocolica or of the art. colica ventr., blood can get
in sufficient amount into the colon through the arter. colica dor-
salis, so that its blood circulation remains fairly normal. If,
however, the art. colica dors, becomes stenosed or completely
obstructed, local circulatory disturbances will come on with-
out fail. Cases are not rare in which a thrombus formed in a
main trunk will become elongated, and will reach and obstruct
the opening of an arterial branch. A thrombus formed in the
art. ileo-coecocolica and growing peripherally may reach or even
396 Obstruction of the Mesenteric Arteries.
grow into and obstruct the art. colica ventr., or one of the
art. coecales, or the ramus iliacus; if a thrombus in the art. ileo-
coecocolica grows centrally, it may spread into the art. colica
dors., or into one of the arteries of the jejunum. In such cases,
according to the observation of the authors, obstruction of the
branch occurs in the following manner: The blood current
moves the free floating end of the thrombus and eventually
presses it into the opening of one of the branches of the main
trunk. If the terminal free end has once been pressed into an
opening, then closure is intensified, because there is a decreased
blood pressure peripherally and an increased blood pressure
centrally. However, if a sufficient collateral circulation is estab-
lished, the blood pressure again may become evenly balanced in
front of and behind the obstruction, and the thrombotic plug
may again become free.
In the larger mesenteric vessels thrombosis may bring
about embolic closure of smaller branches. Since such emboli
are, as a rule, small, and since they therefore obstruct only
smaller arteries, they do not, as a rule, produce any serious
disturbances of circulation, either alone or in connection ^\dth
the primary thrombus. Only if arranged in arteries one above
the other, like the floors of a building, might emboli become dan-
gerous. No doubt every thrombus does not necessarily lead to
embolus formation. On the other hand, thrombosis in other
organs or in the aorta, may lead to embolism in the mesenteric
arteries.
The effect upon the circulation in the intestines of obstruc-
tion of the mesenteric arteries depends mainly upon the size
and the number of the obstructed vessels, upon the seat and the
degree of stenosis and upon the size of the anastomoses which
connect neighboring vessels with those that are thrombosed.
The arteria mesenterica anterior sive cranialis (Fig. 40 h.) supplies all por-
tions of the intestines with blood, except the oral portion of the duodenum, which
is supplied by the art. ccEliaca, and the middle and caudal third of the small colon
(socalled abdominal portion) of the rectum, which get their blood from the art.
mesent. posterior, s. caudalis (n). The arteria mesent. ant. forms a short, strong
trunk, only a few centimeters long ; this gives off, in front and somewhat to the left,
the art. colica dorsalis (d), which supplies all upper branches of the colon, and the
art. col. media («), which supplies the cranial third of the small colon. The two
last named arteries usually arise from a common trunk (c) ; somewhat more backward
and to the left arise the 17-20 jejunales (i), which supply the small intestines.
In this manner the main trunk becomes thinner and is now known as the art. ileo-
ccecocolica (/) ; it is two to four cms. long; it first gives off the arter. colica ven-
tralis (g), which supi)lies the lower branches of the colon; the remaining portion,
the art. ileo-coecalis, divides into the art. coecalis (l), lateralis (A) and the ramus
iliacus (m) to supply the cecum and the ileum. The arter. cnpcalis lateralis gives otf
a branch to the lateral wall of the right lower branch of the colon (art. colica
lateralis of Franck).
The most cranial artery of the small intestines (art. jejunalis) anastomoses
with the arter. pancreatico-duodenalis, that is, with the art. coeliaca in the region of
the duodenum, by a tolerably large arterial arch situated in the mesentery. The
different arteries of the small intestines communicate with the ramus iliacus by
similar archlike ana.stonioses (,?"). The art. colica ventralis and the ramus iliacus
are connected with the vessels of the cecum which among themselves possess rich
anastomoses. The art. colica dorsalis is continued immediately into the art. colica
ventralis at the pelvic flexure, and this forms the largest anastomosis of the animal
Pathoo'enesis.
397
liody (/() ; tlie art. colira veiitralis also forms anastomoses "vvitli the art. col. lateralis.
If one adds that there are anastomoses between the art. colica dorsalis and the art.
colica media, and also between the latter and the cranial branch of the art. mesent.
post, (e) and between all branches of the latter (o), one can easily see that blood
can get abundantly into the territory of the branches of the art. mesent. ant., either
from the art. cceliaca or from the art. mesent. post, and into the art. mesent. post.,
and also from neighboring vessels, even if either one of the arteries named is oblit-
erated and the pressure in it is decreased. It is also important and should be em-
jihasized that intestinal branches, whether they arise from main trunks or from
arterial arches, and the branches in the intestinal wall in the mesentery are con-
nected by rich anastomoses, as can be seen in Fig. 40.
Fig. 40. The mesenteric arteries of the horse. (Adapted partially from Ellenberger
and Baum ; the vascular anastomoses are drawn after a Teichmann-Preparation.)
Narrowing or closure of the lumen of the mesenteric arter-
ies produces a disturbance in the blood circulation of the intes-
tines onh^ if the arterial pressure in the affected portions of the
intestines becomes markedly lower and if consequently the cur-
rent in the capillaries becomes very much decreased. Marek's
animal experiments have shown that total and sudden closure
will not be followed by recognizable disturbances of circulation,
398 Obstruction of the Mesenteric Arteries.
it* an anastoniosiiig arcli, situated in tlio mesentery of the small
intestines or of tlie small colon (Fig. 40 j, o), or a branch aris-
ing from these arches or from the arteries of the colon or cecum,
has been closed up. The obstruction of an artery of the small
intestines (s), which has only two anastomosing arches, or the
obstruction in one place of one of the arteries of the colon or
cecum, near its peripheral portion, are likewise without danger.
In all of these examples it is, however, necessary that the re-
spective anastomosis has remained open. In the cases as given
above the rich anastomoses permit enough arterial blood from
neighboring arteries to get into the excluded territory, so that
a decrease of blood pressure does not occur.
In contradistinction to the above, there will be developed
either a temporary or a permanent disturbance of blood circu-
lation of the intestines if one or more arteries of the small in-
testines are occluded, from which there branch at least three
anastomosing arches with neighboring arteries, or with arteries
supplying the small colon. This may also occur in occlusion
of at least one artery of the colon or cecum near its place of
origin, or of two points not very near to each other (in super-
imposed arrangement of the emboli). If the art. ileo-ccecoco-
lica or the art. mesent. ant. are themselves occluded or much
narrowed in their lumen, circulatory disturbances are never
absent; the same is also the case if, together with the above
mentioned arterial branches, its anastomosing branch is also
obstructed. Obstruction of the peripheral arterial branches
may sometimes become dangerous when a stenosis in the cen-
tral portion of the neighboring artery is present simultaneously ;
the narrowing of the lumen may be unimportant in itself but
it may cause a diminution of the blood supply in combination
with embolism in the peripheral branch. In all of these cases
of anastomoses too narrow for the region which has been
totally excluded from the arterial blood supply, or in which the
narrowing in a main trunk has greatly diminished the floAV of
blood, the blood pressure becomes lowered, although without
ever sinking down to zero.
Lowering of the arterial blood pressure in the excluded
territory causes a decreased velocity of the capillary current,
because the difference between arterial and venous pressure,
which propels the blood through the capillaries, is diminished.
The decrease of the caliber of arteries and capillaries leads to
a more or less intense arterial anemia and, in consequence of
the retardation of circulation, to an accumulation of carbon-
dioxide in the l)lood and the tissues of the affected territory.
The retardation of circulation within a short time produces such
nutritive disturbance of the capillary walls that they lose their
tonicity and permit the constituents of the blood to extravasate.
The loss of tonicity may, however, also be due in part to irri-
tation by the intestinal contents. Capillaries of the intestinal
mucosa which have lost their tonicitv, will ])ecome strongly
Pathogenesis. 399
filled by blood from the collateral circulation, and tliis causes
more or less marked reddening of the mucosa, which is followed
by hemorrhage.
According to the degree of lowering of the blood pressure,
two types of circulatory disturbances in the thrombotic parts
may be distingiiished ; there are, of course, no sharp bound-
ary lines between these two types. In the milder form the occlu-
sion is comparatively small, considering the amount of arterial
blood which can still get into the affected territory ; the decrease
in the velocity of circulation is not very high; hence the ex-
travasation of the blood elements is insignificant and a nutritive
disturbance, which can be seen macro scopically does not occur.
In the mean time, the arteries supplying the affected territory
become dilated, the blood supply soon becomes sufficient, pres-
sure and velocity of current become normal again, generally
mthin a few hours, and the extravasated elements of the blood
are absorbed. In the milder form, therefore, there is always a
restitution of the blood circulation to normal conditions.
The severe form is characterized by very grave nutritive
disturbances of all the tissue elements of the intestinal w^all,
preferably of the walls of the capillaries and of the mucosa. In
consequence of the very considerable retardation of the blood
current, the permeability of the capillary walls increases from
the second quarter of an hour on, and the blood elements ex-
travasate more and more, in increasing amounts, first into the
loose tissue of the mucosa, later also into the other tissues of
the intestinal wall, to get finally into the intestinal lumen and
into the free abdominal cavity. A backward accumulation of
venous blood does not take place. A retardation of the lymph
current follows the decrease of pressure in the capillaries and
the former produces an accumulation of serous fluid in the
lymph spaces of the intestinal wall. All this produces an edem-
atous-hemorrhagic infiltration in the intestinal wall (infarctus
haemorrhagicus). With the profound disturbance of circulation
there develops a necrosis of intestinal villi, beginning at the
free end and progressing towards the deeper layers of the
mucosa. Necrosis of the mucosa may become manifest after
two hours, and the deeper layers show the earliest necrotic
changes after twenty-four hours ; this indicates that contact
with the intestinal contents plays a part in the production of
necrosis.
In some few cases of the severe type the circulatory dis-
turbances may disappear, but this, of course, takes a much
longer time than in the milder form, sometimes several days.
In obstruction of some arteries of the small intestine, a re-
establishment of the normal circulation may occur in only the
two terminal portions of the bowel, while the hemorrhagic in-
farct persists in the median portion. The limit up to which the
circulation may be reestablished after a sudden arterial occlu-
sion is as follows : Neighboring arteries of the small intestines
'400 Obstruction «{' tlic Mesentcrie Arteries.
Avitli five anastoniosiiig arelies, occlusion of an artery of the
colon or cecum near its origin, provided that their anatomoses
or the peripheral portions of these arteries are not likewise
thrombosed. The more anastomoses are obstructed or at least
partially occluded at the same time, the smaller must be tlie
occluded territory if the collateral circulation may become es-
tablished at all.
A very slowly progressing gradual narrowing of the lumen
of larger or of numerous smaller arteries does not necessarily
produce particularly grave disturbances, because the anasto-
moses and eventually the partly obstructed vessel have time to
gradually dilate. However, complete closure of the trunk of the
art. mesent. ant., of the art. ileo-coecocolica of the two arteries
of the colon, or of the arteries of the cecum near their places
of origin, also obstruction of several neighboring arteries of
the small intestines, will cause irreparable disturbances of cir-
culation, even if taking place gradually.
Complete inhibition of the arterial blood supply to some portion of the intes-
tines will cause anemic necrosis. After an artery and its capillaries have become
sufficiently empty so that the pressure has been lowered to the pressure of the veins
of the affected region, the circulation of the blood ceases entirely and the capil-
laries contain much less blood than under normal conditions. Since obstruction of
all anastomoses of a mesenteric artery, which is a necessary condition for the occur-
rence of an anemic necrosis, very rarely takes place under natural conditions, anemic
necrosis in combination with hemorrhagic infarction will very rarely be seen; such
was, however, the ease in an observation by Caspar of obstruction in the region
of the art. mesent. post. If all larger anastomoses of this artery are obstructed
simultaneously or successively, very small anastomoses that remain open will admit
enough blood only to produce a hemorrhagic infarction in the two end pieces of the
affected intestine, while the median piece does not receive any blood at all. An equi-
librium of the blood supply can, of course, not lie established in this case.
According to the claims based upon the experiments of
Virchow, Cohnheim, Panum, Litten, and in accordance with
the views generally adopted, thrombosis of the mesenteric arter-
ies leads to a fall of the blood pressure in the obstructed artery
to zero, whereupon in the severe cases, the blood from the veins
flows through the capillaries back into the artery. However, that
this is erroneous and that the course of events is as de-
scribed al)ove has been shown beyond doubt by the experiments
of Marek.
Attacks of colic, which were fatal within twelve hours, occurred in a horse after
complete compression of the art. ileocoecolica; the wall of the cecum was flaccid and
very friable; in it as well as in the wall of the caudal section of the small intestines
there was hemorrhagic infarction. Ligation of one arteria colica alone caused an
attack of colic which lasted one and one-half to four hours but which ended in recov-
ery, while the simultaneous ligation of the art. colica dorsalis and ventr., near their
places of origin, caused a fatal attack of colic, necrosis of the colon and hemorrhagic
infarction of its mesentery. Ligation of the art. colica ventr., near its place of
origin, followed after several weeks by ligation of its anastomoses in the iliac flex-
ure, caused an attack of colic lasting one day, which, however, terminated in
recovery.
The function of the intestine is only disturbed in thrombosis
of the mesenteric arteries when circulatory disturbances are
Pathogenesis. 401
established; the lack of arterial blood and the proportionately
increased contents of the blood and tissues in carbon-dioxide act
for some time as a stimulus to peristalsis. Some of the more
active intestinal contractions become convulsive, the intestinal
tube becomes hard and unyielding-, and colicky pains are caused
by compression and pulling of terminal nerve filaments in the
intestinal wall and its mesentery. Since contractions appear at
variable intervals in the excluded portion of intestines, and since
their duration is variable, the attacks of pain last a shorter or
longer period and appear after variable intervals. If arteries
have become thrombosed which supply very large portions of
the intestines, we may see a continuous colicky attack, because
individual places in the affected long piece of intestinal tube are
necessarily convulsively contracted, so that tliere may not be
any interval free from pain.
In cases with lasting anemia of the affected parts, the erst-
while increased intestinal peristalsis soon becomes sluggish and,
as shown by experiments, it ceases entirely after one to two
hours. The early cessation of peristalsis is due to the complete
stoppage of the arterial blood supply; as soon as the supply of
oxygen and nutritive material is used up this leads to a dis-
turbance of nutrition of the tissue elements, and the muscularis
then loses the power to contract.
It is different when hemorrhagic infiltration of the intes-
tinal wall has occurred. The blood current through the capil-
laries does not cease entirely, and even after thrombosis the
tissue elements receive a certain amount of oxygen and nutri-
tive material. To this is due the fact that the muscularis retains
its contractility, and in the presence of accumulating carbon-
dioxide it will therefore undergo severe convulsive contractions.
Nevertheless, in some of these cases there occurs, sooner or
later, a cessation of peristalsis, due to several factors. If the
territory affected by thrombosis is very extensive there may be
a severe and long continued lowering of the blood pressure,
which will so damage the nutrition of the muscularis that its
contractility is lost. The damaging effect of the lowered blood
pressure upon the nutrition of the tissues is intensified by an
edematous-hemorrhagic infiltration which occurs. An infiltra-
tion of a higher degree may mechanically interfere with mus-
cular contraction.
An important factor in the cessation of peristalsis is over-
distension of the intestinal wall by extravasated blood and still
more, by gases accumulating within a short time. This may
very easily occur in horses, since the intestinal contents are of
vegetable origin; the feed enters the intestinal tract compara-
tively rapidly, and abundant blood extravasation into the bowels
in the presence of bacteria leads to rapid fermentative and
putrefactive processes, as had already been shown by Bollinger
and Panum. In this manner gases are formed abundantly in the
infarcted intestine, and^ since they cannot be absorbed sufficient-
402 Obstruction of the Mesenteric Arteries.
ly into the blood, or not at all, they rapidly bloat the affected
bowel (circumscribed, local meteorism), and this occurs easily
since the irregular contractions taking place here and there in
the intestinal tract are not favorable to a regular passage of
the intestinal contents towards the anus.
The conditions for an active development of gases are, how-
ever, not given in mild forms of hemorrhagic infarction, hence
no cessation of the erstwhile marked peristalsis occurs, if, after
a certain interval, which is usually not long, the equilibrium of
circulation is reestablished. On the other hand, grave forms of
circulatory disturbances produce, in their further course, a
gradual diminution of peristalsis which leads to complete ces-
sation within several, occasionally within one to two, hours.
With the onset of circumscribed intestinal paralysis, per-
istalsis also ceases in the parts situated posteriorly, usually be-
fore the feces from the diseased portion have reached the rec-
tum. The paralytic portion has the same effect as a portion
ol)structed from some cause or other, and as soon as its per-
istalsis has completely ceased, portions of the intestines anterior
to it are stimulated to convulsive contractions by their accu-
mulating contents; these are usually not very intense and not
very prolonged. Finally the increasing contents produce grad-
ual cessation of contractility, wiiicli progresses towards the
stomach.
The effect upon intestinal peristalsis of circulatory disturbances due to throm-
bosis of the mesenteric arteries has been explained in various ways. Panum, Cohn
and Bollinger assumed that the thrombotic territory was paralyzed from the start.
However, this claim was not borne out by observations made in man. Bloody stools
have been observed not infrequently in man during the whole course of the affec-
tion, and similar observations have been made by Litten and Marek on experimental
dogs. However, if there was at once a circumscribed intestinal paralysis, such occur-
rences would be impossible. Indeed, animal experiments have shown beyond doubt
that the immediate effect of the circulatory disturbances is not at all an intestinal
paralysis, but intermittent convulsive contractions, producing colicky pains. Kader
states that after ligation of the mesenteric arteries in dogs and cats peristalsis
ceases after four or five hours. In his experiments, where external influences inhib-
iting intestinal movements were excluded, Marek found that immediately, or one or
two minutes after ligation of the artery, the whole length of the affected bowel per-
formed energetic convulsive movements simultaneously in several places. These
active contractions continued until the death of the animal occurred (the animals
were not kept alive longer than eight hours) ; and they even continued for an hour
and a quarter if the caclaver was kept in a warm box. If the intestinal loops were
so placed that some wei-e hanging down and soon became filled with intestinal con-
tents, their movements ceased sooner. If the arteria mesent. ant., some of its
branches and all of its anastomoses had been ligated, and hemorrhagic infarction
and in some part anemia had been produced, the movements in the anemic portion
ceased after one and one-half hours, while they were still going on in the infarcted
territory
The intestinal wall which is damaged in its nutrition, or
eventually necrotic through grave circulatory disturbances,
early permits intestinal bacteria to enter into the peritoneal
cavity; these then multiply rapidly in a serous exudate and pro-
duce circumscribed, later general peritonitis, which causes con-
tinuous inflammatory pain; the bacteria and their toxins are
also absorbed into the blood, general infection or intoxication
Anatomical Changes. 403
with their symptoms follow; some of the symptoms seen in
oertain cases may also he due to hloating of larger portions
of intestines.
AVhat has heen said in the preceding pages explains why
thrombosis of mesenteric arteries, though common in conse-
quence of the factors which cause it (sclerostoma), comparative-
ly rarely lead to recognizable functional disturbances. The
statement of Bollinger that three-fourths of all cases of colic
are due to aneurysma of the mesenteric arteries is beyond doubt
exaggerated. A thrombotic-embolic affection as the cause of
colic is only diagnosticated in about 15% of the cases of colic
seen in the Budapest CUnic (see also page 393).
Anatomical Changes. Aside from complications like en-
teritis or intestinal displacements those cases terminate fatally
in which the circulatory disturbances are not compensated. In
a certain portion of the intestines, generally in the colon, more
rarely in the cecum, or in both simultaneously, or in the small in-
testines and exceptionally in the small colon, we find on post-
mortem examination the mucosa and frequently also the serosa
dark blackish red, the mucosa forms pendulous projections, the
submucous tissue and the neighboring mesentery are more or
less infiltrated wdth a reddish-yellow serum and considerably
thickened (1-3 cm). Similar infiltrations are seen on the ex-
terior layers of the bowel-wall. The affected portion is, as a
rule, sharply defined, both from the oral and from the caudal
healthy portions, and the boundaries usually correspond to the
territories supplied by arterial branches situated above the
thrombosed point (see page 397). The intestinal contents in
the affected portion and in different cases at a variable distance
towards the anus appear dark tarry, bloody, sometimes only
reddish and occasionally of normal color, but always thinner.
The surface of the mucosa is covered by branlike dead shreds
of epithelia, sometimes also with masses of fibrin. In grave
cases the necrosis may have spread into the serosa and then yel-
lowish spots can be seen from the outside. Exceptionally only
do some portions of the intestine shoAV a yellowish or greenish
discoloration in consequence of anemic necrosis (in a case of
Casper a part of the rectum, and the small colon, were necrotic).
Yellowish or reddish-yellow serous fluid, often also a fibrinous
exudate is found in the peritoneal cavity. The evidences of
rupture of the intestines or stomach may also be present.
Then there are found thrombi or emboli in the trunk of the
mesenteric artery or rather in the art. ileo-coecolica, more rarely
in one of the arteries of the colon or in the arteriae jejunales,
rarely in the posterior mesenteric artery; emboli are usually
found in the smaller branches. The blood coagula are some-
times fresh in appearance, rather moist and elastic, at other
times drier and firmer, strongly adherent to the intima ; some-
times a number of thrombi are found in the same vessels follow-
404 Obstruction of the Mesenteric Arteries.
iiig each other. It occurs occasionally that a thrombus is not
found on postmortem examination as it existed during- life, be-
cause a movable occluding portion of the thrombus may have
been moved by section of the affected vessel from the opening
which it closed during life. The obstructed vessel, particularly
often the anterior mesenteric or the arteria ileo-coecocolica
shows chronic arteritis with thrombosis and usually also aneu-
rysmatic dilation. The blood coagulum usually contains the
sclerostoma larvae, sometimes 100 to 300 individuals, especially
in younger animals, while thrombi in older animals contain few
or even no larvae at all. Sclerostoma larvae are usually less
numerous in citv horses than in horses recentlv pastured
(Wall).
Contrary to the view of Sticker that one finds larvaj in different stages of devel-
opment according to the season in which the postmortem examination is made,
Glage has shown that larva^ and mature worms may lie found at all seasons in the
intestines or in the mesenteric arteries of the horse.
Symptoms. The disease sets in suddenly with symptoms
of colic without any discoverable external circumstances ; the
animals may be at a meal, at work or at rest. The authors' nu-
merous observations, however, seem to indicate that the disease
makes its onset more frequently during work than at other
times. This may be caused by the fact that the blood circula-
tion is more active during work and hence the detachment of
pieces of a thrombus may more easily occur. The s}^nptoms of
colic are either intense from the start, manifesting themselves
in reckless rolling and throwing, or the^^ are at first mild and
reach a higher intensity later on, or the great restlessness first
shown later yields to a more quiet behavior. The attacks of
pain occur after shorter or longer, sometimes after very long,
intervals. The other s^anptoms vary according to whether
compensation is established within a certain time, or whether
this is impossible. One may distinguish clinically a mild and
a severe type, depending upon this circumstance.
In the mild type, aside from the attacks of restlessness oc-
curring at unequal intervals, a variable intensification of the
intestinal sounds is observed in certain regions, sometimes over
a large portion of the abdomen, and frequent defecation. The
feces are normal except for their generally softened consistency.
Eectal exploration may reveal a pulsating dilatation or a
trembling of the wall of the anterior mesentery artery or of one
of its branches, occasionally also of the posterior mesenteric
artery; the condition of the intestines and of the other a1)dom-
inal organs is normal.
Pulse and respiration do not show any deviation in fre-
quency and quality, the sensorium of the patients is perfectly
normal in the intervals between the attacks of pain.
The restlessness becomes diminished, usually after a short
time, always during the course of the first day and recovery oc-
Synii^toms, 405
curs. In the severe type signs of restlessness, (Uffering in
intensity and the intervals between them, are likewise observed;
they are, however, accompanied by nnnatural positions, partic-
ularly in consequence of early bloating. The abdomen often
becomes distended at the beginning of the affection, because
circulatory disturbances develop first in the large intestine;
the small intestines and the small colon do not increase the
abdominal circumference, even if bloated, or only very slightly
on account of their comparatively small size. The intestinal
sounds are loud in the beginning for one or two or sometimes
for several hours ; they become less frequent and disappear en-
tirely ; the more rapidly the bloating of the intestines develops
and the more profound the circulatory disturbances, the earlier
do the intestinal sounds disappear. The percussion sound
either remains normal or becomes louder in consequence of the
bloating (see page 360).
According to the behavior of the intestinal contractions
defecation may be observed for a few or even for several hours,
but then constipation becomes complete and feces and gases are
no longer discharged. The feces are softer and in very rare
cases mixed with blood. The authors saw blood in the feces in
only three out of more than 200 cases of thrombotic-embolic
obstruction.
Rectal exploration shows a high degree of bloating in some
portions of the intestines (meteorismus localis s. circumscrip-
tus), usually affecting the colon, the cecum or both simultane-
ously or some loops of small intestines. The affected bowel is
much dilated, its wall very tense, elastic and not painful. In
bloating of the colon its left lower portion is enormously dis-
tended, not rarely reaches as high as the left kidney and dis-
places the left upper portion towards the median line or on the
contrary towards the left, sometimes even more or less down-
w^ard, especially when the cecum is liloated simultaneously.
The pelvic flexure is displaced into the pelvis or into the right
half of the abdominal cavity and the longitudinal l)ands of the
left lower portion of the colon run from left to right, occasion-
ally in a perfect spiral arrangement. The base of the bloated
cecum reaches into the left half of the abdominal cavity and
posteriorly into the entrance of the pelvis ; the base of the cecum
can be recognized as such by a longitudinal band running from
the right flank at first backward, then downward and to the left,
finally towards the thorax. The bloated loops of small intes-
tines present as arm-thick tense, elastic, sausagelike formations,
also the small colon ; the latter, however, displays a longitudinal
band along its surface. The other loops of intestines usuall)^
preserve their normal size until the end in contradistinction to
the bloated bowels. The findings in the mesenteric vessels are
the same as those in the milder form of the affection.
The pulse becomes weaker one to two hours after the
onset and rises to sixty beats per minute. Respiration and
406
Obstruct iuu of the Mesenteric Arteries.
pulse boc'Oine accelerated and forced (in bloating of the large
intestine the respiration is interfered with by the displaced
diaphragm. The temperature [Fig. 41 j is normal at the onset;
it rises soon, however, in consequence of the appearance of
complications [peritonitis, general sepsis, enteritis].)
While restlessness persists, becomes
less, or even ceases entirely in the fur-
ther course, the pulse becomes gradual-
ly weaker, the respiration becomes more
and more forced and difficult, uncon-
sciousness increases, tremor of the mus-
cles and staggering set in, finally the ani-
mals fall down and the end comes with
convulsions.
In rare cases the severe type of the
disease takes a protracted course. If the
circulatory disturbances persist for sev-
eral days Avithout reaching a very high
degree, the absorption of intestinal
gases will not be very much interfered
with, and there is neither an abundant
exudate, nor particularly active fermen-
tation of the intestinal contents. Since
the nutritive disturbances of the intes-
tinal mucosa do not attain a very high
degree, a diffuse peritonitis does not de-
velop, and complete paralysis of the
bowel either appears verv late or not at
all.
In cases of this kind restlessness may be observed, but
rarely unnatural positions. The circumference of the abdomen
is increased not at all or only very moderately. The intestinal
sounds, which are at the onset very marked and of long duration,
later on become less frequent without, however, ceasing entirely,
therefore the expulsion of feces and gases is not entirely sup-
pressed. The feces are sometimes hemorrhagic and fetid, and
now and then intestinal gases are expelled sparingly. Rectal ex-
amination sliow^s insignificant or moderate bloating, and in the
further course occasionally the accumulation of more abundant
masses of firm feces. Pulse, respiration and temperature show
some deviation from the normal without, however, reaching
anything like what is observed in the severe type and in cases
with a rapid course (Fig. 42). It also may happen that the
temperature rises considerably at the beginning, and that pulse
and respiration become quite markedly accelerated, to decrease
considerably later on (Figs. 41 and 42). The sensory functions
are clouded, the appetite is suppressed or poor.
The clinical jiicture lasts sometimes for several days, ex-
ceptionally over a week. Friedberger ol)served in one case a
duration of twenty-two days; Kremp one of twenty-one days;
T.
T
R. 1
2 3
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m
IfVO
iQ'.
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110
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r
i|t ~
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580
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_
Fig. 41. Fever curve in tlirou
bosis of the mesenteric
arteries.
Symptoms. Course.
407
the authors saw in one of their cases a duration of sixteen clays
before the fatal termination. The protracted form may end in
recovery or lead to death in consequence of enteritis, peritonitis
or general sepsis.
In rare cases displacement of the intestines is seen in either
one of the different types. In severe cases acute dilatation of
the stomach or rupture of the intestines may occur.
Course. The mild form of the disease lasts from a few
quarters of an hour to several hours, rarely longer, never more
Fig. 42. Fever curve in obstruction of the mesenteric arteries. Fatal outcome.
(Protracted course.)
than one day. The severe form has a duration of one to two
days, not infrequently only several hours ; rarely more than two
days and exceptionally two to three weeks, in the latter case it
is characterized by attacks of colic which come on after long
intervals. Sometimes mild cases of short duration follow each
other at such short intervals (soealled habitual, periodic, re-
curring colic) that one may at first sight gain the impression
that he is dealing with a single protracted attack.
The mild form ends in recovery, provided that a displace-
ment of intestines or enteritis have not occurred ; but such com-
plications are rare in the mild type ; the severe type usually ter-
408 Obstruction of the Mesenteric Arteries.
luiimtes fatally. However, even cases which lead to hem-
orrhagic infarction may terminate in recovery, as has been
shown by clinical observations in which a correct and reliable
diagnosis has been made.
Since obstruction of an anastomosis does not cause pain, death may occur after
the first manifest attack of colic, namely if an artery becomes thrombosed after its
anastomosis has previously become obstructed. Thrombosis of a larger trunk may
still more frequently lead to death during the first attack.
If an attack of colic has occurred, there is always the dan-
ger of recurrence with a final fatal termination.
Diagnosis. The anamnesis, that is, a history of preceding
similar attacks without any apparent cause, only excites sus-
picion of the affection, because repeated attacks of colic may
also be due to other causes and it is, of course, possible to en-
counter cases during their first attack. In the grave type the
erstwhile lively intestinal sounds become less frequent; after
some time, constipation usually speedily becomes complete ; rec-
tal examination reveals meteorism of certain portions of the
intestines; and a short time
after onset of the affection,
0----,^^-^^ ^ "ri^ .^5 usually within one to three
liours, gradually increasing
symptoms of general affection
develop. If an exploratory
puncture of the abdominal cav-
ity is made a yellowish or red-
dish fluid is usually obtained
containing small particles of
feces (Fig. 43), the punctured
large intestine sometimes dis-
charges a bloody, dirty red
contents, the feces voided in a
Fig. 43. Sediment of an intra-abdominal natural manner mav exccptiou-
serous exudate in thrombosis of the mes- „n„ v^ i, ^^^„^^i, „ ^.4 ' rni,^ ^^
enteric arteries, a. white, b. red blood ^lly be hemorrhagic. The rarer
corpuscles. more protracted cases are
characterized by general symp-
toms of moderate severity, and careful general and rectal ex-
amination shows no other intestinal affection, such as stenosis,
impaction or obturation. The mere presence of an aneurysm
in a mesenteric artery cannot be used as a pathognomonic sign
upon which to make a diagiiosis, since horses with such
aneurysms may suffer from other diseases. Nor has the finding
of ova of sclerostoma in the feces of horses which suffer from
colic any diagnostic significance, as was claimed by Adelmann,
since such ova are found, according to the authors ' own experi-
ence, in the feces of perfectly healthy animals. The probability
of the occurrence of the disease increases with the age of the
animals.
Diagnosis. Treatment. 409
Milder cases may be confounded with acute intestinal ca-
tarrh or with socalled convulsive colic, and the differentiation
may not always be absolutely positive. The occurrence of
symptoms of restlessness after errors of diet, after exposure
to cold, lively intestinal sounds being audible over the whole of
the abdomen, fetid soft feces with poorly digested particles of
food point to a catarrhal origin of the colicky pains. If such
s}Tiiptoms are not present, however, the differential diagnosis
may present great difficulty. The grave forms of mesenteric
thrombosis may be mistaken for torsion, volvulus, incarcera-
tion, or primary intestinal meteorism. The two former condi-
tions may be excluded by rectal examination, aside from a dif-
ference in anamnesis of the case, by frequently occurring, often
continuous attacks of restlessness and by complete constipation,
which usually supervenes very early. Primary bloating de-
velops after the ingestion of easily fermenting food and is char-
acterized by distension of all of the intestines. (Meteorismus
universalis.) Without rectal examination, one may confound
the affection with intestinal stenosis or fecal impaction. One
should, however, in every case of colic consider those disturb-
ances which might be referred to thrombosis of the mesenteric
arteries.
Treatment. Considering the nature of the disease, the ol)-
ject of treatment can only be the production of collateral blood
circulation or the diminution or removal of the effects of the
disturbed circulation. The establishment of a collateral circu-
lation should be attempted by walking the animals and by the
subcutaneous injection of camphor oil (every two to three hours
20 to 50 gm. up to 250 gm. pro die). Catfeine (5 to 10 gm.).
Occasionally the intravenous infusion of physiologic salt solu-
tion is indicated. In view of the possibility of detaching por-
tions of thrombi by increasing the velocity and pressure of cir-
culation, and in view of the fact that a collateral circulation is
easily established in the milder cases without any assistance
from without, this procedure ought to be reserved for the grave
cases, in which an additional embolism is a lesser evil than a
continuous grave circulatory disturbance. Venesection with
bloodletting which is in great favor with French veterinarians
can only do harm, since it leads to a decrease of blood pressure.
Subcutaneous injections of morphine (0.4-0.5 gm.) or rectal
injections of chloral hydrate (25-50 gm.) appear indicated in
all forms of the disease, first in order to relieve abdominal pain,
and second in order to suppress violent peristalsis, to prevent
the possible occurrence of intestinal displacement or of rupture
of the bowel. Breton recommends in colicky pains intraperi-
toneal injection of chloral hydrate 25 to 30 gm. in ten parts of
sterile physiologic salt solution, but this procedure can be dis-
pensed with and indeed it appears quite objectionable.
In the mild form one should abstain from the administra-
410 Obstruction of the Mesenteric Arteries.
tion of any other drugs except narcotics. In the grave form
puncture of the bowels should be made as early as possible to
prevent the occurrence of complete paralysis and to remove
gases from the intestines, which are irritating the latter and
positively endanger the life of the animal if they fill larger sec-
tions of the bowel.
Laxatives are useless and may be positively harmful.
Stimulation of peristalsis is not necessary in the milder forms,
while no procedure possible will stimulate peristalsis in the
affected bowel in the graver type of the disease. Laxatives
may, as already said, be harmful, because they will produce
increased movements everywhere in the milder form, and in
the severe type in those parts of the intestines which are sit-
uated in front of the affected portion. These movements in-
crease the abdominal pain and convey masses of feces into the
paralyzed portion; they increase bloating and accelerate the
development of inflammation or rupture. Mild laxatives may
possibly be given in the graver cases during the period of
recovery.
Resection of a portion of intestine and suturing of the severed
healthy ends may be tried in disease of shorter portions of the small in-
testine. In disease of the large intestines this attempt is absolutely un-
promising.
Prophylaxis. Li order to prevent the ingestion of the
larvae of sclerostoma horses should be prevented from drinking
dirty water from pools or marshes, and they should be kept
away from wet and marshy pastures. During stable-feeding
care must be taken so that the drinking w^ater is pure and free
from contamination with offal and feces. Sometimes water has
to be made safe by filtering or boiling. Mickley has succeeded in
the Beberbeck stud, where formerly many foals succumbed to
the disease, in eradicating it entirely since 1899 by the interposi-
tion of filtering boxes into the system of pipes of the w^ater
works. In studs or in large stables where many horses are
kept and where sclerostoma infection is frequent, all animals
should be examined according to the suggestion of Al-
brecht for the presence of sclerostoma and those found
affected should be separated and kept away from the
common pastures or exercise ground until free from parasites.
Removal of the manure and frequent changes of the bedding
straw are also indicated since the floor and the walls of the
stables where horses are kept frequently come in contact with
their feces and since they therefore become contaminated with
sclerostomata and their larvae, they ought to be carefully cleaned
and disinfected from time to time. Marshy rough feed from
marshy pastures should not be fed to horses. French veteri-
narians consider alfalfa and clover hay as dangerous in this
respect.
Whether the intravenous injection of atoxyl (100 gm. of a
3% solution), recommended by Dorn, is indeed valuable in
Thrombosis of the Arteria Coeliaca and Mesenteric Veins. 41 1
eradicating- sclerostomiasis in horses, lias not yet been conclu-
sively demonstrated.
Literature. Adelmann, Das Aneiirysma verminosuin eqiii, etc., Diss. Giessen,
1908 (Lit.).— Albrecht, Z. f. Vk., 1909, ■l61.— Berg, Z. f. Vk., 1907, 21.— Bollinger,
Die Kolik der Pferde iind das Wurnianeurvsma der Eingeweidearterien, 1870 (Lit.).
— Friedberger, D. Z. f. Tm., 1889, XIV, 215.— Glage, Z. f. lufkrkh., 1905, I, 3-41.-
Knoll, B. t. W., 1908, 529.— Koch, O. M., 1902, 535.— Krenip, Z. f. Vk., 1908, 65.—
Leibenger, W. f. Tk., 1907, 624.— Magnin, Eev. gen., 1906, VII, 529.— Marek,
A. f. Tk., 1907, XXXIII, 225 (Lit.) ; D. Z. f. Chirurgie, 1907, XC, 171.— Micklev,
A. f. Tk., 1905, XXXI, 500.— Poppel, D. t. W., 1897, 123.— Wall, Die Kolik d.
Pferdes, 1908. (See also Lit. on Palisade Worms.)
Thrombosis of the arteria coeliaca. Thrombosis of the arteria
coeliaca (see page 395), which is extremely rare, like thrombosis of the
anterior mesenteric artery, does not usually produce any disturb-
ances in general health. A case described by Friedberger (Z. f. pr.
Vet.-Wiss. 1875, 258) shows, however, that such a thrombosis may
also cause symptoms of disease. The celiac artery in the case referred
to contained two half cylindrical thrombi 17 and 25 mm. wide, the cen-
tral end of the thicker thrombus was free in the trunk of the art.
coeliaca. After motion the horse presented symptoms of severe colic
and from time to time made peculiar noises such as are heard when
horses are vomiting; it was also attacked at times by tonic convulsions.
These attacks could be produced at will whenever the animal was made
to move. Eleven days after the last attack the animal was killed and
the postmortem examination showed a bro^^^l red discoloration of the
gastric mucosa at the pyloric portion and signs of older hemorrhages
in it, strong injection of blood vessels of the submucosa and hyperemia
and hemorrhages in the first portion of the duodenum. The symptoms
observed during the disease of the animal were believed to be due to a
simultaneous aneurysm of the abdominal aorta, causing hyperemia of
the brain or an accumulation of carbon-dioxide in the central nervous
system; however, the symptoms were so similar to those observed by
Marek on experiment dogs after ligation or obstruction of the art.
coeliaca or some of its branches, that they may easily be associated with
thrombosis of the celiac arterv as it existed in this horse.
Thrombosis of Mesenteric Veins. Throml)osis of l)ranches of the
portal vein or of this vein itself has repeatedly been seen in domestic
animals. Thrombosis of the portal vein is not uncommon in cattle and
is caused by pressure of tuberculous masses or it may be due to injury
by foreign bodies. Gohre and Spann have likeunse observed thrombosis
of the portal vein in cattle. Goubeaux, Collin, Mollereau, Cabaret, Kitt,
Gratia have seen thrombosis of the portal vein of the horse ; Connochic,
a thrombosis of the anterior mesenteric vein; Siedamgrotzky, a throm-
bosis of both veins of the colon; in a case of Barrier there was com-
pression of the portal vein by a carcinoma of the stomach. The authors
saw a case in a dog where the large veins of the mesentery were com-
pressed by a tumor of the mesentery. Thrombosis of the mesenteric
veins is not rare in deeper inflammations or ulcerations in the intestines
(Kitt) and it is possible that coagulation of the blood in the veins may
occasionally be caused by thrombosis of the mesenteric arteries.
Symptoms of disease are produced only liy thrombosis or compres-
412 Internal Straiii;ulation of tlie Intestine.
sioii of the larger venous trunks, while thronil)osis of smaller individual
branches, or an incomplete closure of larger veins, remains unrecognized.
The mesenteric veins show anatomical conditions similar to those of the
mesenteric arteries, but they are much more easily dilated, hence the
conditions for establishing a collateral circulation in thrombosis of the
portal vein are ciuite favorable. Siedamgrotzky, Mollereau and Con-
nochic saw attacks of colic in the horse, Gohre in cattle ; the attacks
extended over a period of three weeks in Siedamgrotzky 's case. Cattle
show under these circumstances signs of a grave indigestion in addition
or to the exclusion of other symptoms (Gohre, Spann). The authors
have seen diarrhea and hemorrhages from the intestines in a dog due to
compression of several veins of the small intestines.
Postmortem examination either shows abdominal ascites or a hem-
orrhagic infiltration of the intestinal wall. Compression of the trunk
of the portal vein not infre(|uently causes chronic interstitial hepatitis.
Literature. Barrier, Bull., 1906, 283.— Connochic, D. t. W., 1898, 417.— (Ee-
view.)— Gohre, S. B., 19()(i, 72.— Gratia, Ann., 1906, 489.- Siedamgrotzky, S. B.,
1876, 30.— Spann, W. f. Tk., 1906, 185.
24. Internal Strangulation of the Intestine. Incarceratio et
strangulatio intestini.
{Darme'niklemmung, Darwrerschniinoif/, Darmeinschnuruug
[German].)
Internal strangulation of the intestines consists in a rapid
closure of the lumen of the intestine by pressure from some
body situated outside of the bow^els, so that strangulated or in-
carcerated portion of the intestine at once shows signs of stag-
nation of the blood.
Occurrence. Horses are more frequently affected by in-
ternal strangulation than other domestic animals with tlie ex-
ception of oxen in some regions where they suffer frequently
from socalled "spermatic duct strangulation" (see below^ under
"Etiology"). Of the cases of colic in horses about 1 to 1.5
per cent are due to internal intestinal strangulation and of the
fatal cases of colic about 5 to 13 per cent. Aside from the cases
in oxen referred to above this form of displacement of the
intestines is rare in cattle and other domestic animals.
statistics of the Prussian army for the years 1892-1908 show that of 71,532 oases
of colic among horses 1,069 cases (1.489^) were clue to internal strangulation, and
among these postmortem examination showed 304 (0.429^ ) to be diaphragmatic
hernia; 234 (337^) dis])]acenients through the foramen of Winslow; and during
1892-1906 there occurred 218 cases (0.357,) of strangidation through clefts in the
mesentery; 263 eases (0.437) of strangulation by ligaments, pediculated tumors,
etc. Among 8,426 cases of death from colic, 12.77 were due to internal strangu-
lation.
In the Berlin Clinic there were, among 8,686 cases of colic which occurred from
1897-1907 ninety-three cases (1.17) of internal strangulation, and among these
thirty-four cases (0.397'-) of strangulation in clefts or internal hernia: thirty-nine
cases (0.457,) of strangulation by ligaments, etc.; seventeen cases (0.27c) of dis-
Etiology. 413
placement through the foramen of Winslow. Among 1,408 horses dead from colic,
6.6% had suffered from internal strangulation.
The statistics of 1889-1894 and 1896-1908 of the Dresden Clinic show among
3,336 eases of colic, thirty-two cases (0.9%) of internal strangulation; among these
four (0.12%) of diaphragmatic hern-ia; twenty-three (0.69%) of strangulation by
ligaments, clefts, etc.; five (0.15%) of displacement through the foramen of Wins-
low. Among 500 horses dead from colic, 6.4% died of internal strangulation.
In the Budapest Clinic there were seen from 1900 to 1909 among 5,487 cases
of colic, fifty (0.9%) due to internal strangulation. Among 725 horses dead from
colic, 6.9% were due to internal strangulation.
From the above data it appears that internal strangulation is comparatively
frequent among cavalry horses and that among these cases those due to hernia of
the diaphragm, to displacement into the foramen of Winslow and into clefts formed
previously to the strangulation, are more common than they are among other horses.
Etiology. The intestines may become strangulated hj vari-
ous strands and bands present in the abdominal cavity. In
this respect are to be mentioned congenital diverticula of the
ileum (Meckels diverticula) ; exceptionally also acquired diver-
ticula of the intestines (Kitt) ; the ligament between kidney and
spleen (Marek, Forssell), the_ spleno-gastric ligament, the falci-
form ligament of the liver (Blanc), the urachus, the small omen-
tum (Dupuy) ; pediculated neoplasms (generally lipomata) aris-
ing from the abdominal wall or the mesentery, possibly also
from other abdominal organs, or exceptionally pediculated lobes
of the liver (Pecus) ; in horses also exceptionally a stump of the
spermatic cord, which has slipped back into the abdominal
cavity, or the spermatic cord of an undescended testicle (Gut-
brod) ; the larger omentum adherent to the anterior abdominal
wall and twisted into a cord, sometimes the anterior mesentery
itself (in a case of Dupuy and one of Prince, the cecum became
strangulated) ; finally postperitonitic connective tissue bands
with one free end or with ends connecting various abdominal or-
gans. Cysticercus tenuicollis caused strangulation of the duo-
denum in a hog (Spathe).
In other cases internal strangulation is brought about by
portions of the intestines getting into congenital or acquired
openings of the mesentery or of the omentum, or into torn and
partially detached portions of the peritoneum or into a cleft be-
tween separated muscles (Roy). Some of the above mentioned
ligaments may also tear and in this manner produce intestinal
strangulation.
In a similar manner there develops in oxen or young cas-
trated cattle, what is called internal hernia (Strangulatio
ducto-spermatica) a condition studied by a number of veteri-
narians, recently especially by Walch. This form of strangu-
lation occurs only after castration with twisting or rather tear-
ing off of the testicle, especially if the animals are castrated
during the first weeks of life. Walch has also shown experi-
mentally, that in such cases the reduplication of the peritoneum
(pouch of Douglas) attached to the spermatic cord between the
internal opening and the seminal vesicles, usually tears, so that
loops of intestines slip into the opening so made, either imme-
diately or later on. In other cases the stump of the spermatic
414 Internal Stranyulatiuu of the Intestine.
cord retracts after tearing off its peritoneal covering, and gets
from the spermatic canal into the abdominal cavity, or the
spermatic cord is torn in its abdominal portion. In either case
the remnants of the cord will either float as a free stmnp in
the abdominal cavity or it will become adherent to the perito-
neum and form a cleft. Since castration is performed accord-
ing to different methods in various places, the affection only
occurs in such regions where castration is performed as above
described. Walch found this abnormality of the spermatic
cord without strangiilation in oxen in 60 to 70 7o of the slaugh-
tered animals. Tearing of the fibrous tunic of the external
inguinal ring by a strong pull can also be detrimental if the
spermatic cord is severed transversely, and if the testicle and
vessels are then pulled off. A case of strangulatio ducto-sper-
matica in a horse has been described ])y Janson; in this case
the pouch of Douglas had likewise been torn. Metzger and
Strauss have exceptionally seen the affection in sheep. Tear-
ing of the reduplication of the peritoneum in sheep and in
other animals is rare, since this fold of peritoneum is more re-
sistant and smaller than in cattle,
Socalled internal-hernia will lead to intestinal strangula-
tion, either from the start or later on. Diaphragmatic hernia
occurs particularly in the horse, more rarely in cattle and dogs.
It is either congenital or formed during extrauterine life, the
diaphragm rupturing in consequence of too great, sudden intra-
abdominal pressure, or the accident may occasionally be due
to dilatation of the stomach or to bloating. Such ruptures are
most common in horses which have to jump (hence they are
most frequently found in army horses). Displacement of the
intestines into the foramen of Winslow occurs exclusively in
the horse and the intestine then gets between the layers of the
great omentum (enterocele omentalis). (What Lucet & Bru
have described as an enterocele omentalis in cattle, was, accord-
ing to Matliis, only a strangulation into a tear of the omentum.)
Tncareeration of external hernia, which is a surgical lesion, leads to the same
local symptoms and to the same clinical picture as internal strangulation.
Among the enumerated causative factors are some (incar-
ceration in narrow clefts) which are able to cause strangula-
tion at once, but additional predisposing causes are, as a rule,
necessary to bring this condition about. A slight filling of
intestines enables loops to slip into a preformed opening:
in this condition the intestines can also easily change their posi-
tion, and openings usually covered by the large intestine (fora-
men of Winslow, tears in the lower portion of the diaphragm)
can now become accessible to the small intestines. Active per-
istalsis, whether it be due to external or internal cooling, ca-
tarrhal affections, embolism, etc., strong action of the abdominal
press (pulling of a great weight, galloping, jumping, walking
uphill, efforts, rolling, falls, being run over), favor the displace-
Pathogenesis. 415
ment of loops of intestines into a cleft during energetic move-
ments of the body, or pedicnlated formations or bands wliicli are
free at one end may in rolling become twisted around loops of
intestines. Under similar conditions strangulation is produced
by the spleno-nephritic ligament, a variety of strangulation
which is not rare. (In live cases observed by the authors the
left portion of the colon was always strangulated.)
The jejunum, which is most motile and most slender, is
strangulated most frequently; other portions of the intestines
are less commonly aiTected in this manner.
Pathogenesis. If the opening into which a portion of in-
testines has become displaced is narrow compared with the
caliber of this part of the bowel, or if a liand-like body has been
twisted around the intestines, the intestinal wall and its mesen-
tery are compressed to a certain degree and the lumen becomes
closed. In other cases the pressure becomes effective only if
the other additional factors mentioned above have caused fur-
ther portions of intestines and mesentery to become displaced,
or after the portion of the intestine that was first displaced has
become bloated in consequence of kinking or has become swollen
in consequence of venous (passive) congestion.
The outflow of venous blood from the affected intestine and
its mesentery is interfered with in proportion to the pressure
exerted, while the thick-walled arteries with their high internal
pressure keep on pumping blood into the tissues, possibly in a
somewhat decreased amount. Hence, stagnation of blood
(stasis) soon occurs in the incarcerated portion of intestines
and also, owing to an increase in venous pressure, a diminution
of the velocity of the entire blood current with all the conse-
quences which have been discussed in detail under the head of
thrombosis of the mesenteric arteries (see page 396). At the
place of strangulation the compression produces an anemic ring.
The rapidly increasing stasis, and the overloading with car-
bon-dioxide due to it, excite strong, frequent and occasionally
convulsive contractions in the strangulated portion of intes-
tines, causing colicky pains. The frequency and the intensity
of these convulsive contractions may be the greater, the longer
is the portion of intestine which is strangulated. A stronger
pressure, which, however, does not completely shut off the arte-
rial blood supply, clearly causes a considerable overloading of
the blood of the affected portion with carbon-dioxide, and causes
stronger contractions. Everything else being equal, strangula-
tion of the small intestines which are rich in nerves causes
more intense abdominal pain than strangulation of other por-
tions.
Strong contractions may cause the entrance of more loops
through the place of strangulation by suction or traction if the
part situated towards the anus becomes distended, so that it
pulls on the part situated more towards the stomach (Wilms).
416 Internal Strauuulation of tlie Intestine.
Throwing down or rolling with snddenly increasing abdominal
pressure may, on the other hand, force more loops of intestines
through the place of strangulation by pressure from behind
(Kertesz).
The strangulated portion of bowel, which is filled with in-
testinal contents mixed with extravasated blood, will soon be-
come bloated, because the gases can neither be removed towards
the stomach nor towards the anus, nor can they be absorbed by
the blood. Peristalsis and pain finally cease in the strangulated
portion after it has been dilated ad maximum and after edem-
atous infiltration has occurred. Peristalsis of the portions
situated between the strangulation and the anus cease almost
at once or shortly after the strangulation occurred. Contrac-
tions persist for a long time in the portions situated anteriorly
to the point of strangulation, and some may later become con-
vulsive and cause pain; the latter is, however, not very severe,
as shown by the experiments of the authors. Peristalsis in the
last mentioned portion of the bowel decreases as the intestinal
contents undergo a more and more active fermentation, and
finally they likewise cease.
The gradually increasing swelling of the intestinal wall and
of the mesentery, and the involvement of more loops of intes-
tines produce increased pressure upon the sensory nerves that
are caught in the place of strangulation ; this causes a continu-
ous, but not severe pain, as experiments on horses show ; the lat-
ter may even be entirely absent where the strangulation is not
too severe. In the further course continuous pain, which increases
on pressure, is also caused by peritonitis which develops. The
general symptoms are similar in origin and character to those
encountered in thrombosis of the mesenteric arteries (see page
403) ; however, they vary in different species of animals as to
their appearance, according to variability in susceptibility to
microorganisms and their toxins. The shorter the strangulated
portion of intestine and the less firm the strangulation, the later
and the less severely will these general symptoms appear.
Anatomical Changes. The strangulated portion of intes-
tine appears, as a rule, dark to blackish red, distended and
tense, the wall thickened by serous-hemorrhagic infiltration,
friable, the intestinal lumen filled with a thin fluid, fetid, hemor-
rhagic mass, the mucosa blackish red, on the surface dirty yel-
lowish, smeary. The site of the strangulation is indicated l)y a
pale yellowdsh strip ; sometimes the strangulated portion shows
several segments, separated from each other by pale rings with
alternating reddened portions (gradual entrance of the strangu-
lated portion in sections). Aside from strangulation a circum-
scribed or diffuse peritonitis, and perhaps intestinal rupture
may be found. The peritoneal cavity contains a yellowish or
reddish serous exudate, frequently mixed with shreds of fibrin.
Symijtonis.
417
Symptoms. In horses, sudden, rarely gradually developing
symptoms of violent abdominal pain are observed; in some
cases the animals previously show the symptoms of stenosis
of the intestine. Usually the animals throw themselves down
recklessly, roll, kick with their feet, and their restlessness may
even assume the character of a maniacal excitement. Later
they avoid reckless throwing ; they lie down, but do so carefully,
or they stand still, ^
probably i n conse-
quence of the devel-
opment of periton-
itis, which causes
pain. Earely do the
animals behave quiet-
ly and with care from
the start, and do not
throw themselves
down, and in such
cases one might think
of a stronger con-
striction of intestinal
and mesenteric
nerves at the place
of strangulation.
Sometimes a reck-
less behavior persists
until the end. Stretch-
ing, lying down on
one side, squatting
dog fashion on the
haunches, kneeling,
lying on the back are
observed frequently;
these positions have,
however, no particu-
lar significance. The
restlessness may be
almost absolutely con-
tinuous, so that the patients are still hardly a moment, either in
standing or in the recumbent posture, or the restlessness comes
on in short attacks; this depends upon the intervals at which
the convulsive intestinal contractions occur. In strangulation
of the rectum or small colon, strong pressing down is seen oc-
casionally. The expression of the face betrays distressing pain
the same as in intestinal displacements in general.
The abdominal circumference is rarely increased, and if at
all only moderately so. Intestinal sounds may be increased for
some time in strangulation of the rectum or small colon; in
Fig. 44. Loop of small intestine strangulated by a lipo-
ma: (a), lipoma, (&), its pedicle, which forms a ring,
(c), strangulated loop of intestine with swollen and
much congested mesentery, (d) .
418
Internal Strangulation of the Intestine.
9
other cases they soon become less frequent and are eventually
suppressed.
Defecation ceases at once or soon; in exceptional cases,
when the strangulation is not complete, there may be only re-
tarded defecation in the further course of the disease.
Eectal examination shows that the rectum is empty and
frequently the strangulation of some parts of the intestines,
its seat and its origin, can be ascertained. In strangulation of
the rectum the hand meets an impediment and it is frequently
impossible to pass even one finger. The wall of the intestine
is folded in front of the obstruction and is tender; if it is pos-
sible to press the finger through the impediment this is found
coated with a dirty, reddish, fetid fluid. In strangulation of any
other portion of the intestines one can ascertain that there is
somewhere a much
bloated intestinal
portion which de-
creases in one place
to a folded string;
here the tissues are
tender and surround-
ed by a tense ring.
Sometimes one finds
pediculated tumor-
like formations, and
occasionally it is
even possible to de-
termine the direction
in which the con-
stricting band or the
])ediculated body has
l^ecome wound around
the bowel. If tlie
place 0 f strangula-
tion is in the anterior
portion of the abdo-
men, which cannot be
reached by the hand,
it is possible at most to demonstrate circumscribed bloating and
tenderness of certain portions of the intestines, or the examina-
tion may at first be perfectl}^ negative while later on a gradually
increasing bloating of moderate degree will be noticed of the
parts situated in front of the strangulation towards the stomach.
Fig. 45. Loop of small intestine (a, h) . strangulated
in a cleft of the mesentery ( r ) .
In strangulation of the intestines 1\y the ne]ihro-f-]ilenic ligament, one can
tain that the spleen is not in contact with the left abdominal wall as usual, and its
base has been displaced far downward, approximately to the middle of the left
abdominal wall, while the ligament has been drawn out to a cord 15-20 em. long.
In the ring which is not closed entirely and is formed by the nephro-splenic ligament,
the free upper end of the base of the spleen, which is usually horizontal, by the left
kidney and the left abdominal wall, one finds the left portion of the colon suspended
Symptoms. 419
on the nephro-splenic ligament; the iipper left loop of the colon usually rests
directly upon the ligament and appears strangulated, while the lower left loop
which is now directed upward and to the left is not compressed or very little. The
posterior half of the bloated left portion of the colon runs backward and down-
ward in a curve, and the upper loop is more or less situated in front of the lower
loop. If at the same time the pelvic flexure is directed forward and somewhat
laterally, the bands of the lower portions present a spiral course. Strangulation of
loops of small intestines, which the authors have seen occasionally in other forms
of colic, was never found in this affection.
According to Larsen the presence of some tense loops of small intestines in
the region of the right flank, directly at the abdominal wall, points to displacement
of the small intestine through the foramen of Winslow; this was also found in a
case of Forssell. The authors have had similar findings in displacement of the small
intestines, due to dilatation of the stomach.
In diaphragmatic hernia respiration is difficult from the
start on walking downhill, and in certain positions on the side.
Over the posterior and lower portions of the thorax one finds
tympanitic and often metallic sounds, which frequently change in
pitch. Soon there appear symptoms pointing to acute pleuritis
(tenderness on pressure upon the intercostal spaces, friction
sounds), or to accumulation of blood in the pleural cavity. In
diaphragmatic hernia of the left side the heart may become dis-
placed by prolapsed loops of intestines and the apex beat may
disappear.
A peculiar type of dyspnea was seen in a horse where a recent extensive rupture
of the diaphragm gave rise to a prolapse of the small intestines and the stomach.
In spite of marked and rapid excursions of the ribs a passive drawing in of the
intercostal spaces did not occur, but, on the contrary, a strong inspiratory drawing
in of the espigastrium, the flanks and the region of the loins. The cause of this
form of dyspnea was found in the large extent of the rupture of the diaphragm;
during each inspiration a part of the small intestine was drawn through the open-
ing of the diaphragm into the thorax and the intraabdominal pressure was diminished
in consequence.
In strangulation of the small intestine acute dilatation of
the stomach (see page 298) is frequently seen later on.
The behavior of the pulse, sensorium, temperature and
respiration are similar to what is seen in grave forms of em-
bolism and thrombosis (see page 406) ; the pulse rises after a
few quarters of an hour, or at least after a few hours, to above
sixty per minute, and as it grows faster it grows weaker, the
sensorium becomes clouded, respiration difficult and the temper-
ature rises.
In strangulation of a very short piece of intestine, it may
occur, however, that acceleration of the pulse and elevation of
temperature takes place very slowly and does not reach a high
degree. In a. horse where a piece of small intestine 30 cm. long
became strangulated by a pediculated lipoma, the pulse was
only 56 after 13 hours and the temperature 38.6%, yet, when a
laparotomy was made 2 hours later, fetid fluid was found in the
free abdominal cavity and necrosis of the intestinal wall.
The clinical picture in cattle is also characterized by
marked symptoms of colic. The animals kick with their hind
legs and push against the abdomen with their horns ; they shake
their heads, look around towards the abdomen, lie down, soon
420 Internal Strangulation of the Intestine.
get up again, trip restlessly from place to place and sometimes
step into the crib. The gait is sometimes stiff, because the right
hind foot is not placed sufficiently forward. The restlessness
ceases after several, usually after 6 to 12 hours ; it may, there-
fore, happen that, if the attack occurred in the evening, it is over
the next morning, and that only the condition of the bedding
straw shows that the animal has been restless during the night
(Walch). S}^nptoms of restlessness are absent during the fur-
ther course, and with the deterioration of the general condition
one observes only groaning and slight restlessness at longer
intervals, due to the peritonitis which has developed. Perspir-
ation is frequent at the onset of the disease.
The circumference of the abdomen is at first not changed;
later on moderate bloating occurs, due to moderate dilatation
of the portions of intestines nearer to the stomach, and also on
account of secondary bloating in the rumen. The intestinal
sounds are suppressed and cease entirely later on ; sudden pres-
sure on the right half of the abdomen later produces splashing
sounds and pressure upon the abdominal wall, especially on the
right flank, often produces sjmiptoms of pain. After restless-
ness has set in the feces are voided for a short time, for a few
hours at the utmost, and afterwards complete constipation
supervenes ; perhaps very little fecal matter or some mucus may
be expelled with great efforts.
Rectal examination, which, according to Walch, is best
made on the standing animal, will always (Walch) reveal the
spermatic-duct t3^pe of strangulation (strangulatio ducto-sper-
matica), and frequently also the other types. The rectum is
found empty. In strangulation of tlie spermatic duct type, one
finds a tumor, the size of a fist up to the size of a child's head,
occasionally as big as an adult human head, in the neighbor-
hood of the internal inguinal ring, as a rule on the right,
very rarely on the left side. The tumor is composed of
tense dilated intestinal loops and is adherent at one point to
the abdominal wall, where one can feel a tense cord. If the re-
tracted spermatic cord has become wound around the intestines,
the tumor is more motile and is nearer to the median line or
in the middle of the anterior margin of the pelvis ; in this case
one can also feel the strangulating cord. In strangulations of
other types the findings in cattle are the same as they are in
horses.
In spite of the fact that the animal has subsequently quieted
down, the sensorium becomes clouded. There is complete lack
of appetite and great weakness, so that the animals are no
longer able to get up.
The pulse early becomes rapid and weak, and it rises to
120 to 130 per minute; sinmltaneously with this acceleration,
the peripheral portions of the body become cool, the visible
mucosa, which is at first reddened, becomes pale. Tlie respira-
tion is accelerated from the start and becomes more difficult.
Symptoms. Course. 421
The elevation of temperature which sets in later, announces
the development of peritonitis or of general infection.
Dogs become depressed, they lie around a good deal, some-
times they cry out, groan, whine, constantly change their place,
sometimes look around towards the abdomen, get up suddenly,
roll, stretch their extremities stiffly, or remain for a long time
resting on their abdomen. They frequently exhibit an irritable
temper. Gagging or obstinate vomiting are seen frequently.
Constipation is complete from the start.
The abdominal circumference is at first normal, it may
become larger in the further course; the abdominal walls are
tense, and strong pressure at certain points excites pain. In
palpation of the abdomen, which must be made under a slight
narcosis if there is great tension, one can feel somewhere in the
abdominal cavity, distended painful loops of intestines ; some-
times the strangulation can be mapped out as a firm, stretched
painful mass.
The restlessness, which is not very great, decreases within
olie next hours, but the deterioration of the condition is shown
by increasing depression, weakness, elevation of temperature,
a weak and rapid pulse, continued obstinate vomiting and con-
stipation. As in serious diseases of dogs in general, one may
in this case observe a lowering instead of an elevation of tem-
perature.
In hogs Spathe described a clinical ])icture in intestinal
strangulation similar to that observed in dogs.
Course. The disease is characterized in all species of ani-
mals by a sudden onset; sometimes it follows upon a manifest
predisposing cause, which is preceded in infrequent cases by
the symptoms of intestinal stenosis. Pain is either intense from
the very onset or it may increase gradually, l)ut rapidly; this
depends upon whether the strangulation has l)een produced sud-
denly or has become complete only after some time. Severe pain
persists as long as the incarcerated intestines retain their power
to contract; according to variability in the degree of strangu-
lation this may last from a few hours to one day. Later on the
animals become apparently perfectly quiet or only occasionally
exhibit some signs of alxlominal pains which are caused by
contractions of the intestines situated between the place of
strangulation and the stomach, or by peritonitis which has set
in in the meantime.
If the animals are left to themselves they soon perish in
consequence of rupture of the intestines, general sepsis or in-
toxication. Horses usually, dogs frequently, succumb during the
first day while cattle remain alive for two to six days (Walch).
The possil)ility in the beginning of the affection of a spon-
taneous reduction of the strangulated portion of intestines must
be admitted in exceptional cases.
422 Internal Slrangulatiun of the Intestine.
Diagnosis. Internal strangulation of the intestine can be
diagnosticated with certainty only if rectal examination or pal-
pation of the abdomen furnish a positive result ; all other symp-
toms can at best furnish a more or less well founded suspicion.
If there is good ground for a strong suspicion an exploratory
laparotomy should be made in cattle and in dogs, occasionally
also in other animals; this enables us to determine, b}^ the aid
of the hand which is introduced through the laparotomy incis-
ion, the seat and origin of an existing strangulation. In steers
less than 9 to 10 months old, where a rectal examination cannot
be made, an exploratory laparotomy should be made in all cases
when sudden symptoms of colic have come on with constipation,
and where treatment during a period of twelve hours has not
brought about any improvement (Hoffmann). If there are
symptoms pointing to ol)struction of the intestines and one
hears over the posterior, lower parts of one side of the thorax
tympanitic or possibly metallic percussion sounds which are
variable in pitcli and intensity, if quite intense intestinal sounds
are audible in this region, and if symptoms of beginning pleu-
ritis or hemothorax appear soon, then a diagnosis of incar-
cerated diaphragmatic hernia appears safe, especially after an
exploratory puncture of the thorax has furnished hemorrhagic
intestinal contents. Aside from strangulation, circumscribed
intestinal meteorism is encountered also in torsion of
the intestine, in the grave form of thrombosis, in acute
dilatation of the stomach, hence this can only be utilized
as a suggestive symptom in connection with other symp-
toms, and with certain circumstantial evidence in those cases
where the exact site of the incarceration cannot be felt or other-
wise ascertained directly. However, if dealing with a strong
meteorism localized to a few loops of intestines, one is seldom
in error in thinking of intestinal strangulation, torsion or vol-
vulus. The clear, yellowish or slightly reddish serous fluid,
which is at first ol)tained by exploratory puncture of the ab-
dominal cavity, is found in internal strangulation, torsion, in-
vagination, and in the graver forms of thrombosis of the mesen-
teric arteries.
The differential diagnosis has to consider in particular
acute dilatation of the stomach, the grave forms of thrombosis,
torsion, volvulus and invagination of the intestine, incarcerated
genuine hernia, internal olistruction of the bowel and in cattle
also obstruction of the urethra by calculi.
Acute primary dilatation of the stomach of the horse can
be excluded with certainty, in the majority of cases, by anam-
nestic data, such as early difficulty in respiration, al)sence of
early and marked disturbances of defecation and rapid improve-
ment, and definite recovery after the proper use of the stomach
tube. Torsion, volvulus and invagination can only be differenti-
ated from internal strangulation by the findings on rectal exami-
nation. It is not of very great importance if it is impossible
Diagnosis. Prognosis. Treatment. 423
to differentiate the various forms of intestinal displacement,
since the treatment is the same in all three forms. Incarcerated
external hernia may be recognized on the basis of the symptoms
of closure of the intestines in connection with the local signs;
hence an examination of the inguinal ring and of the scrotum
should always be made whenever there are colicky pains, par-
ticularly in stallions. Changes of position and internal strangu-
lation niay be confounded with those types of intestinal obtu-
ration (impaction) which cause almost continual pain and ten-
derness upon pressure in well defined places of the abdominal
cavity (see page 382). Similar symptoms have occasionally
been observed in cattle in obturation of the bowel by blood
coagula. Aside from the result of rectal exploration, the con-
tinuous absence of general symptoms and anamnestic points
frequently furnish sufficient diagnostic data. Obstruction of
the urethra by calculi in male cattle is distinguished from in-
testinal strangulation by the following features: Urination
ceases in obstruction of the urethra, but not thj defecation
which goes on undisturbed, the patients exhibit peculiar pulsat-
ing motions of the urethra in the region of the intestines, rectal
exploration in the inguinal regions is negative and one can only
feel the urinary bladder in the shape of a flat cylindrical, thick
tumor, lying exactly in the median line.
Prognosis. The prognosis is unfavorable if rectal or oper-
ative correction of the intestinal strangulation can, for some
reason or other, not be accomplished, because spontaneous re-
covery occurs only very exceptionally if at all, and medicinal
treatment has no influence whatever upon the affection. The
operative procedure is determined preferably by the species of
the patient, also by the duration of the train of symptoms, the
general condition of the animal, the condition of the constrict-
ing body, and by the question whether reposition can be ac-
complished per rectum or only by a laparotomy. The prognosis
is most favorable in cattle, even in such cases where a laparot-
omy is necessary. (Hoffmann observed losses only in 5% out
of 185 cases.)
Dogs likewise stand the operation of laparotomy well. The
presence of a secondary peritonitis or of grave disturbances of
the general condition very much diminish the chances of oper-
ative procedure, and these are abolished completely if symp-
toms of collapse (unconsciousness, pale mucosa, subnormal
temperature, unrecognizable pulse, paralytic weakness) and
high fever in horses are already present. Exploratory puncture
may furnish certain data of prognostic value ; if a putrid smell-
ing fluid is obtained from the abdominal cavity there is no more
hope of saving the animal.
Treatment. The nature and the manner of the origin of
the affection determine the fact that only operative procedure
424 Iiitcnial Strangulation of the Intestine.
can accomplish something; the object of the operation is to
relieve the strangulated intestine; this may be accomplished
from the rectum in some cases, in horses as well as in cattle.
However, a laparotomy cannot be avoided in the majority of
cases in the horse and frequently also in cattle, and this oper-
ation is the only one possible in smaller animals.
One cannot lay down a uniform law for the reduction per
rectum, since local conditions vary not only as to different, but
even as to the same types of intestinal internal strangulation.
However, the more frequently rectal exploration is practiced
in the examination of patients, the more frequently are found
cases in which it is possible to liberate from the rectum loops
of intestines that are strangulated by bands or pediculated tu-
mor, either l)y untwisting a band or by tearing it or the slender
pedicle of the tumor. Perl succeeded in tearing with his spread
fingers the pedicle of a lipoma, the pedicle having strangulated
the rectum (the authors attempted the same procedure in two
cases of strangulation l)y pediculated lipomata, but they were
not successful).
Strangulation of the intestines by the nephro-splenic ligament may be over-
come in horses in the following manner: The right hand is introrjuced into the
rectum of the standing animal, and it is then pushed between the stretched nephro-
splenic ligament and the comjiressed Ijowel ; the latter is then grasped to the right
and below and is pushed towards the left, being at the same time pressed down
with the thumb. While executing this rotating motion towards the left, the back
of the hand attempts to displace the base of the spleen towards the median line of
the abdominal cavity. The intestines can usually be released within fifteen or
thirty minutes, occasionally within a few minutes. In four of the authors' five cases,
they succeeded without trouble, but in one case a laparotomy became necessary Tors-
sell has relieved cases of this type by this method ; he placed the patients on the back.
In spermatic duct strangulation of oxen one may, if the condition has not
lasted long, attempt to press the intestines which are not yet bloated through the
strangulating ring. As a rule, however, the animals are only seen after they have been
sick some time, then the spermatic cord must be separated or torn loose. After
the posterior portion of the abdomen of the patient has been elevated, the well-
greased arm is introduceil into the rectum up to the elbow, then one attempts either
to separate the duct or to tear it loose. The o]>orative jirocedure is variously de-
scribed by different authors. Walch grasps the cord between thumb and index
finger, then closes the hand and turns it downward and to the right, and also drawa
it backwards and to the left.
Servatius grasps the cord from above, from right to left and winds it once
around the index finger in a spiral ; he then closes this finger and presses it against
the thumb. Then he pulls towards the abdomen and tears the cord away from its
attachment. Tn animals more than two years old, when the attachjuent of the
spermatic cord is much firmer, he attempts to grasp it with the whole hand, brings
it to the back of the hand, winds it around the wrist and now tries to tear it loose
with one strong pull; if possible an assistant pulls at the same time on the scrotum.
Hoffmann draws the cord with the tip of the fingers or with the whole fist
from in front ui)wards and then from within l)ackwarservers have believed torsion to have occurred in consequence of
bloating, they were evidently mistaken; torsion occurred first and bloating later on
as a consequence.
Torsion of the cecum around its long axis is very rare, and
it is probably also caused by the mechanical influences pointed
out above. The shortness of the cecum when compared with the
colon and the position of the former, fully explain why displace-
ments of the cecum should be so rare.
Volvulus or torsion of the small intestine or of the small
colon have a much more complicated mechanism. Torsion may
be brought about by a loop of intestine with its mesentery be-
coming twisted around another loop, the latter with its mesen-
tery forming the axis (volvulus, formation of a nod, volvulus
nodosus), or by a longer loop turning around its own mesentery
(axial torsion, volvulus mesenterialis). In some cases the whole
small intestine of the horse, or the whole colon in the hog may
be twisted around the larger omentum with its mesentery, par-
ticularly if the body performs very abrupt motions, if the ani-
mal throws itself around or is rolled, as occurs frequently in
the unloading of hogs and calves. The production of torsion
is favored if the intestines contain an abundance of liquid or
dry feces or sand (Glage), or if they are the seat of a tumor.
However, total or even partial torsion of the mesentery is quite
rare.
Especially in horses one observes more frequently entan-
gling or volvulus of the small intestines alone; loops of small
intestines are very rarely twisted around the colon or cecum or
around the small colon, while loops of the small colon rarely be-
come twisted themselves. In many of these cases, reckless, ex-
Etiology. 429
tensive motions, throwing- down, rolling, jumping, etc., cause
loops of intestine to become twisted around others.
One may also consider another mode of production. Es-
pecially in the horse, loops of small intestine often cross each
other in several places under perfectly normal conditions; this
arrangement becomes more marked in increased peristalsis, and
loops of intestine with a longer mesentery can then move to
distant places in the abdominal cavity and below the heavy
loops of the large intestine. If the small intestine or the small
colon have changed their position in this direction, it may easily
happen that the mesenteric veins of the particular loop become
compressed to such an extent, that a certain degree of con-
gestion and swelling of the intestinal wall occurs. More active
movements of the intestines may now include further loops into
the displacement, particularly if neighboring loops cannot get
out of the way in consequence of tense filling; this will increase
the pressure upon the displaced loops and with it the venous con-
gestion (Wilms).
Predisposing causes also play a role in the production of
this form of volvulus or torsion, and as such must be men-
tioned : Greater filling or greater weight of individual loops of
intestine (impaction of feces, circumscribed meteorism, tumor,
calculi, parasites), relaxed aljdominal walls, and adhesions be-
tween individual parts of intestines.
Kinking of the intestines (turn around the transverse di-
ameter) is rare. It occurs most frequently after loops of intes-
tine have become adherent to neighboring organs or to the
abdominal wall. However, the small intestine or the small colon
will simply be narrowed without the production of disturbances
of circulation and its sequelae ; but the stenosis may finally lead
to complete closure as in a case of Averous in a goat. Kinking
of the left divisions of the colon (flexio coli) or to the cecum
(flexio coeci) occurs occasionally in the horse without prelimi-
nary adhesions; it is then undoubtedly due to the enumerated
mechanical factors. It is accompanied by rapid development of
congestion, because the vessels of these parts of the intestine
are included in the kinking. Kinking of the apex of the cecum,
with anemia and necrosis of this part (Johne) has been ob-
served a number of times.
One of the cases of the authors suggests the occurrence of partial kinking in
the large colon. The case was that of a horse that succumbed after having suf-
fered for five hours almost continually from colic. Postmortem examination showed
kinking of the median wall with its vascular mesocolon, deep into the lumen of the
bowel. The kink was found in the region where the transverse divisions go over
into the right divisions. The left and the transverse divisions showed a high degree
of venous congestion to the point of kinking; nothing abnormal, particularly no
thrombi or emboli were found in the arteries of the colon, tlie anterior mesenteric,
or the ileo-ccecolic artery. The origin of this kind of displacement may be ex-
plained by assuming that moderate bloating occurred from some cause or other and
that the median wall of the dilating division of the colon were pressed inward hj
some unknown mechanism.
430 Volvulus and Torsion of the Intestine.
Predisposition: The great length of the mesentery of the
small intestine in the horse, the fact that most of the colon lies
free in the abdominal cavity of this species of animals, the fur-
ther factor that horses are used for work of various kinds ex-
plain the frequency of volvulus and torsion in equines compared
with its rarity in other animals. Relaxation of the abdominal
walls and more voluminous feed are the reasons why torsion of
the large intestine is more common in heavy horses than in
lighter breeds under similar conditions.
Pathogenesis. The facts as to pathogenesis are on the
whole similar to those which prevail in internal strangulation
(see page 415). The main difference between internal strangu-
lation on the one hand and volvulus and torsion on the other,
lies in the fact that the intestine is not strangulated by another
firm tissue in the latter condition, but by other loops of
intestine.
Anatomical Changes. In torsion of divisions of the colon,
one finds the divisions distal from the twisted place distended,
dark purplish to blackish red, sometimes spotted with hemor-
rhages ; the mesentery of the two superimposed divisions infil-
trated with blood, often gelatinous, the veins in the intestinal
wall strongly filled. The latter appears more or less thickened,
it is easily torn and is infiltrated with a reddish, serous fluid;
the mucosa is blackish red, thrown into folds, pendulous, here
and there necrotic. The bowel contains an abundance of hemor-
rhagic fluid or pasty feces. The congestion is either sharply
defined towards the place of constriction or an anemic strip maj^
completely encircle the whole intestine or may be distinct only
on two opposite places of the periphery. Exceptionally the con-
gestion may not be very well marked, both on the serosa and the
mucosa.
The direction of the torsion may be from right to left, or
vice versa, and it may be determined by the relation of the two
left divisions of the colon or by the direction of the longitudinal
bands. Twists to the right appear to be somewhat more numer-
ous than twists to the left, although in twenty-six cases of tor-
sion Wall saw fifteen to the left and only eleven to the right.
The degree of torsion is very variable. Usually one finds
one-half or one entire twist, but several twists are by no means
very rare.
The site of torsion (place of twisting, torsion-stricture) is
usually found in the transverse colon (diaphragmatic flexure),
but, in consequence of falling down of the proximal parts in the
region of the right divisions, it ma^^ be displaced towards the
cecum or to the beginning of the small colon (place of torsion at
the root of the colon) and then the cecum mav occasionally
also be twisted. (Wall, Berlin report 1900-1901.)" Longitudinal
torsion confined to the pelvic flexure has only been described in
Pathogenesis.
431
one case (Berlin report 1901-1902) ; it is, therefore, a great
rarity. The place of torsion is also rarely found in the left
divisions (fig. 46).
Wall gives the following figures for twenty-six collected cases : Fifteen times
place of torsion right at the cecum, seven times in the transverse colon, three times
in the left divisions, once at the basis of the cecum, so that the latter had also been
twisted; it is possible that the place of torsion is more frequently at the cecum than
is usually supposed to be the case, since the finding of the place of torsion in this
region is coupled with great difficulties and hence the place may easily be over-
looked. In torsion at this place it may appear that only the upper division sinks
beside or below the ventral division to become strangulated at its junction with
the small colon, without elianging its position (authors' observation). In spite
of this, venous congestion develops because tlie vein is compressed either by the
prolapsed upper division or in torsion to the left by the tense mesocolon.
In kinking of the large
intestine the himen (just
like in kinking of any
other tubular organ) be-
comes narrowed or oblit-
erated by the inward pro-
jection of the wall, and
the parts beyond the kink
show signs of intense con-
gestion. In kinking of the
apex of the cecum the
shut off portion usually
becomes anemic and ne-
crotic.
In torsion of the mes-
entery of other portions
of the intestine, the mes-
entery itself is twisted
into a cord or there is a
volvulus when one por-
tion of the intestines has
wound around another
portion, and strangulated
it like a ring (fig. 47).
Parts of intestines stran-
gulated in this manner ap-
pear enormously distend-
ed and are dark red in
color.
The peritoneal cavity contains, in any form of volvulus or
torsion, a bloody serous fluid; sometimes circumscribed or dif-
fuse peritonitis is present, occasionally intestinal rupture.
The differential diagnosis of torsion or volvulus must consider hemorrhagic in-
farction of the intestinal wall in thrombosis or embolism of the mesenteric arteries
in those rare cases when on postmortem examination the displacements are not very
noticeable or are overlooked entirely. However, a careful examination of the blood
vessels, as to the size and position of any thrombi or emboli present, and careful
inspection will prevent errors. The sharp demarcation of hemorrhagic infiltration
Fig. 46. Torsion of the left divisions of the
colon towards the right in a horse also suffer-
ing from volvulus of the small intestine. (As
a rule torsion occurs more anteriorly. )
432
Volvulus and Torsio
till' Tutestine.
in a straight or eurveil lino is witliout sigiiilicauee, because it is likewise seen in
thrombotic or embolic infarction (see page 4U."}). It appears doubtful whether one
is justified, as Wall claims, to attribute congestion in the colon, in the absence of
any torsion, to a stricture which has existed during life, but whidi has become relieved
spontaneously before the animal died.
Postniortem ■displacement of tlie intestines can be distinguished from tliose
formed during life, because in the former case signs of congestion are absent.
Symptoms. External symptoms of torsion are in general
identical in varions species of animals with those of internal
strangulation of the intestine (see page 417). A decided dif-
ference exists in the main in the fact that volvnlns and torsion
generally lead to a considerable increase of the abdominal cir-
/
Fig. 47. Volvulus of the small colon. C small colon, R. rectum (according to
Mollereau ) .
cumference, because the large intestine or a considerable por-
tion of the small intestine are involved, hence a good deal of
bloating will occur.
In the case of torsion of the colon in the horse, rectal exami-
nation will show a high degree of meteorism. One finds both left
divisions, particularly the lower one, considerably distended
and reaching up to the upper abdominal wall, so that some-
times it is possible only with the greatest difficulty to force the
hand between the bloated bowel and the upper abdominal wall.
Firm feces cannot be felt through the mucli distended and very
tense elastic wall. If, however, the patients are examined at
once after the onset of the affection or if the latter progresses
exceptionally slowly, extensive bloating may be missed for some
Symptoms. 433
time. The other portions of the intestines first remain of normal
size, but may often be displaced by the colon out of their proper
place (especially the cecum). After a longer duration of the
disease the other portions of the intestine likewise become
bloated, but never to such an extent as the colon.
The position of the colon either remains normal or one
finds the two left divisions displaced towards the median plane
of the abdominal cavity, or even towards the base of the cecum.
The pelvic flexure is directed either backward or towards one
side, or towards the thorax, and the course of the divisions of
the colon is either straight or towards one side, or curved in a
bow. The mutual relation of the left divisions of the colon re-
mains either normal (in one complete torsion) or their relation
has changed so that the smooth upper division, becoming larger
towards the thorax, is situated either towards the right or left,
or below the much thicker lower division, and presents bands
and sacculations. If the pelvic flexure is displaced toward the
front, it can be palpated per rectum only in small horses. If,
however, the upper division is situated more or less laterally
from the lower division, the pelvic flexure is found more or less
horizontal on the lower abdominal wall instead of vertical as
found under normal conditions. The two free bands of the lower
division (one lateral and one median longitudinal band) show
the same course as the lower division of the colon itself, but
they are also influenced by the position of the pelvic flexure. A
spiral course of the longitudinal bands to the right or left can
be ascertained particularly in those cases where the spiral
formed in twisting reached' into the neighborhood of the pelvic
flexure, or where the latter has been bent towards the front,
otherwise the bands show a normal course. Pulling- on the colon
or on its longitudinal bands frequently causes pain to the pa-
tient. The point of torsion, where the divisions of the colon are
twisted into a spiral, tough cord, in a circumscribed place, can
only be recognized in those very rare cases where torsion has
occurred in the posterior half of the left division of the colon.
According to Jelkmann, in torsion of the colon the hand introduced into the
rectum feels the mesentery in the place of the fourth lumbar vertebra as a tense
and tender cord which runs from above to the left and downward ; one also feels a
second tense cord (one of the longitudinal bands of the left lower division) in the
region of the left flank. Moller, however, thinks that the characteristic feature is
the finding of the two free bands of the bloated left lower division as two tense
strings which run in a spiral direction from left to right or from right to left.
Kinking^ of the colon or of the cecum may be assumed when
the intestinal wall, in some place, forms a sharp angle, and when
the bent portion of the intestine is strongly bloated. The place
of kinking must, of course, be at a point accessible to rectal ex-
ploration, otherwise it cannot be recognized.
Curved bends of the colon, more rarely of the cecum, which are observed in
other colicky affection of horses, cannot be looked upon as kinking, because they do
not encroach upon the intestinal lumen nor do they produce circulatory disturbances.
Vol. 2-28
434 ^'olvulus and Torsion of the Intestine.
Torsion of the cecum can probably be often diagnosticated
by rectal exploration as was shown in a case which the authors
observed.
Torsion or volvulus of the small colon (often called the ab-
dominal portion of the rectum) can always be ascertained by
rectal examination. If a portion of the small colon, situated
very near the rectum, has been closed, the introduction of the
hand through the narrowed place is impossible, perhaps a linger
may be pressed through. One finds the intestinal wall folded
and tender in front of the impediment ; bloated loops of intes-
tines can be felt through the wall of the rectum. If torsion has
occurred more towards the front, the findings are similar to
those in strangulation of the small colon (see page 419), with
this difference, that in volvulus with the small intestine the
strangulated small colon is surrounded by bloated loops of
small intestine.
Formation of knots and partial mesenteric torsion of the
small intestine may in some cases be ascertained directly by
the observation that loops of intestine, which are bloated to
the utmost and very tense, suddenly pass over into a folded
cord, which, on pressure or on pulling, proves to be tender.
In horses that are not too large, total torsion of the small
intestine around the root of the mesentery may be recognized
by finding a folded, thick cord, in a vertical plane, supposed to
pass through the middle of the left kidney, immediatel}' below
the vertel)ral column, which leads towards the right or left and
is connected with a number of very tense loops of small intes-
tine. In some cases one may also find loops of small intestine
wound around the caudal portion of the left division of the
colon, or around the upper portion of the cecum. In a consider-
able proportion of cases one cannot find the seat of a torsion or
a volvulus of the small intestine, but can only ascertain very
great distension and eventually tenderness of some loops, while
the rest of the small and the large intestine are normal (circum-
scribed meteorism). Only rarely does rectal examination furnish
a completely negative result, namely, when the displacement has
occurred in the anterior parts of the abdominal cavity and when
only a short loop is involved.
Rectal examination, or palpation of the abdomen, may re-
veal conditions similar to those of internal strangulation (see
pages 419 and 420) in cattle, hog and carnivora. Probst saw
the case of a dog with torsion of the rectum and with l)loody
feces (probably the torsion was originally not complete in this
case). The authors saw a similar case in a horse with torsion
of the rectum.
Course. The clinical picture sometimes develops during
the course of other colicky affections, but, as a rule, it has a
very sudden onset. As in displacements of the intestines in
Course. Diagnosis. 435
general, either intense symptoms of restlessness occur at once
or they increase gradually in intensity. The disease is of short
duration, since death occurs rapidly, particularly in displace-
ments of the small intestine, sometimes after a few hours, usu-
ally towards the end of the first or during the next day. With
torsion of the large intestines, particularly with torsion of the
small colon, horses may live two or three daj'-s. In other do-
mestic animals the course is similar to that in strangulation of
the intestines.
The possibility of spontaneous recovery cannot be excluded
a priori ; Init spontaneous reduction may occur only in displace-
ments of smaller sections of the intestines and only in the be-
ginning of the disease, that is, as long as bloating in the affected
portion does not yet exist, which would, of course, make a spon-
taneous recovery impossible.
Diagnosis. Torsion and volvulus can only be diagnosti-
cated beyond doubt if rectal examination in large animals, or
abdominal palpation in smaller ones, reveals the place of twist-
ing or entanglement. The other signs, such as a spiral course
of the longitudinal bands of the colon, changes in the interrela-
tions of the left divisions of the colon, and their displacement
into other portions of the abdominal cavity has no great diag-
nostic value, since this is also found in other colicky affections.
If, however, the left upper division of the colon of a horse is
found along its whole palpable length, obliquel}^ below and to
the left of the lower division, then the existence of torsion of
the colon is very probable.
As already mentioned (see page 433), Jelkmann believes that the
presence of a tense, tender string running obliquely from above down-
ward and to the left in the plane of the fourth dorsal vertebra, and of
another tense string in the region of the left flank, is very characteristic.
Moller considers the spiral course of the longitudinal bands as decisive.
Forssell, on the other hand, thinks that the relation of the left divisions
of the colon and the course of the band is the determining diagnostic fac-
tor. It must, however, be pointed out that the longitudinal bands of the
left lower division may show the same course in every case of bloating
or in excessive filling of the colon, because the much-dilated lower di-
visions will rise up to the left kidney, the upper division is, at the same
time, displaced to the right or to the left, and in conseciuence of an
increase in length, these divisions, and also the pelvic flexure, become
displaced to the right or left and towards the thorax, which compels the
stretched longitudinal bands to assume a spiral course without, however,
encroaching upon the intestinal lumen or without the production of a
venous congestion. This is proven by the observations of the authors
and by those of other authors (Larsen, Klett, Behrens), who also believe
that torsion of the colon can, as a rule, not be diagnosticated with cer-
tainty by a rectal examination alone.
The direction of the torsion is determined by IMoller from the course
of the longitudinal bands. In torsion to the right, the band of the lower
divisions lead from in front towards the back and to the right ; in torsion
to the left in the opposite direction. Forssell gives the following rules;
436 Volvulus and Torsion of the Intestine.
1. If the left upper division lies to the right of the lower division
and if it passes here o})liquely forward, upward and to the left, then
we are dealing with a half twist towards the right. If the left npper
division passes ol)li(iuely forward and downward and to the left, then we
have a twist to the left of more than 90°.
2. If one feels the left upper division to the left of the lower
division and if it leads ol)li(iuely forward and downward and to the
right, then we are dealing with torsion to the right of more than 90° ; if
it leads obli(iuely forward and upward and to the right, then we are
dealing with a half torsion to the left.
3. In those rare eases where the left lower division completely
covers the upper division, the spiral course of the band and indentations
of the left lower division which may he present are the deciding factors.
Concerning the details of diagnosis, including differential
diagnosis, the reader is referred to the subject of internal stran-
gulation (see page 422). Even where rectal examination or
external abdominal palpation give information, the affection
cannot always be diif erentiated from internal strangulation, but
this is of no great importance, since the therapeutic procedures
are the same in both cases.
Treatment. The same principles as those laid down for the
treatment of internal strangulation (see page 423) govern on
the whole the treatment of torsion or volvulus. However, the
very nature of these affections brings it about that, except in a
case of torsion of the colon, reposition from the rectum is even
less frequently possible than in internal strangulation.
In torsion of the colon one should always roll the horses in
the direction of the torsion whether it be diagnosticated posi-
tively or only suspected. Forssell has recently had some good
results with this procedure.
Relief of torsion of the colon by rolling, according to Forssell, is hronglit
about as follows: According to the Stuttgart method the horse is best placed on
the side corresponding to the twist of torsion, that is, if torsion is towards the right,
the horse is placed on the right side. Before this is done the bloated colon must
have been punctured either through the left abdominal wall or through the rectum
(see page 363). Then the arm of the operator is introduced into tlie rectum; he
next tries to fix the pelvic flexure with his fingers (in mares one may make an
incision into the vagina for this pur])0se) ; indeed, according to Forssell, the intestine
becomes fixed Ijy its own weight. Then the horse is rolled on its back and abdomen
till the intestine gets into its proper position. (A horse had to be rolled nine times
in a case of Forssell before replacement occurred.) To prevent rupture of the
rectum, the fixation with the fingers must be interrupted from time to time. The
reposition of the bowel is usually announced by the expulsion of intestinal gases,
although sometimes flatus does not immediately occur. The restlessness persists for
a, few hours if the rolling was performed a few hours after the onset of the dis-
ease; if, however, the horses have been sick for fifteen or twenty hours, they become
quiet almost immediately after reposition. The after treatment consists in starva-
tion or in very careful feeding for several days.
The therapeutic value of rolling in torsion of the colon cannot be judged
accurately on account of the uncertainty of the clinical diagnosis and the compara-
tively small nund)er of observations in this respect. Forssell reports seventeen
recoveries in eighteen cases so treated. Other authors (Behrens, Hummerich) have,
however, not been able to get such brilliant results. Hummerich and Kalcher, on
the other hand (see pages 363 and 372) have been successful in treating many
Treatment. 437
cases of primary intestinal nieteorism and impaction by rolling which indeed is
nothing more or less than a particularly energetic abdominal massage; these diseases
may, as pointed out, easily be confounded with torsion of the colon on account of
the" frequent change in the inter-relations of the left divisions of the colon. It
appears at least questionable, therefore, whether indeed the majority of cases of
torsion of the colon can be cured by rolling. If the place of torsion is in the
transverse colon or more towards the periphery in the left divisions, then reposition
by rolling may easily succeed ; in torsions of the right division, which appear to
be more common, rolling cannot have any immediate effect, because the place of
torsion does not coincide with the place around which the colon turns in rolling.
Only very accidentally might the normal position be then restored. (In one of the
authors' cases with a torsion of all divisions of the colon to the left, repeated rolling
after twice puncturing the bowel remained without any effect at all.)
In consideration of experiences with the correction of torsion of the uterus, it
appears rather strange that rolling of horses with a supposed torsion of the colon,
in the wrong direction, should not lie at all detrimental ; that it should not be capable
of producing torsion of the colon in horses with other intestinal affections, and that
it should favorably influence bloating of the cecum, which is claimed to be caused
always (?) by torsion of the cecum around its long axis.
The correction through the rectum of torsion of the colon, according to
Jelkmann and Moller, is performed on the standing animal after a preliminary
puncture of the intestine. The posterior abdominal portion of the animal is first
elevated, the hand is then introduced into the rectum, and guided towards the left
abdominal wall. The hand then tries to push forward and inward the accessible
loops of the sjnall colon and those divisions of the colon which are above the former;
if the median line has never lieen reached the hand is guided upward, whereupon, in
favorable cases, the colon glides into the place of the loops of the small colon which
have been pushed aside ; in this manner the torsion may become relieved.
This procedure was recommended by Jelkmann and is indicated only in tor-
sion towards the left. Moller proceeds in another manner. He pushes with the
hand, introduced into the rectum, the upper division, which is twisted towards the
left, upward and at the same time the lower division downward and to the left.
The experiences of Larsen, Keutzer, Forssell, Straube, however, and the obser-
vation of the authors show that, even with a good deal of force and persistency, tor-
sion cannot be corrected because the colon is such a heavy body that it cannot
easily be moved in the closed abdominal cavity where neighboring loops of intes-
tines at once occupy every space that might be made free. Forssell also calls atten-
tion to the ever present danger of rupture of the rectum. Jelkmann, Moller, Malk-
mus, Zippel and others have had good results in those cases which belonged to the
type of cases recommended for their procedures by Jelkmann and Moller.
Kinking of the pelvic flexure can be corrected from the rectum by pulling to-
wards the pelvis (Diem). Sigl has relieved a ease of torsion of the small colon by
the injection of water into the section situated in front of the impediment.
When a reliable diagnosis lias been made laparotomy is
usually the only indicated procedure except in cases of torsion
and kinking of the large intestine. Aside from its danger to
life, however, even this procedure cannot always produce the
desired result, as is evident from the nature of the disease itself.
The experiences of the authors show that volvulus or extensive
torsion of the mesentery cannot be cured even by this operative
procedure. In torsion of the colon, laparotomy with subsequent
rolling may be indicated (Forssell). Concerning the indica-
tions for laparotomy the reader is referred to the subject of in-
testinal strangulation (see page 425).
In a case in a horse where loops of the small intestines had become twisted
around the small colon Meschkow was able to replace the displaced loops after open-
ing up the right flank; recovery took place. Sigl had a similarly good result in
volvulus of the small colon. Audeliert replaced divisions of the colon, alleged to
have been displaced, with the hand introduced through an incision into the wall of
the vagina. JPlosz & Marek were unable in two cases to reduce a mesenteric torsion
of almost all of the small intestine after laparotomy. Eies performed laparotomy
438 Intestinal Invagination.
in cattle in two cases; he siicceedeil once in correctinfj a ilisjilacenient. Jiihnk suc-
ceeded in this manner to correct invagination and torsion which were present simul-
taneously.
Since reposition of twisted divisions of the colon might he
brought about spontaneously by rolling, moderate rolling of the
patients may be permitted, but in torsion or volvulus of the
small intestine or of the colon this would only cause displace-
ment of the remainder of the intestine. In these cases, and in
torsion or volvulus in general, the pain should be relieved by
narcotics (morphine, chloral h^'drate). Intestinal puncture
(see page 363) is indicated, without any reference to further
treatment, whenever there is intense bloating; some cases of in-
testinal flexure (see page 429) or of other displacements of the
large intestine may occasionally assume their normal posture
after the escape of gases. The use of laxatives is contraindi-
cated. The favorable results claimed by Oeller and Older can
not be judged objectively on account of the insufficient clinical
diagnosis in these cases.
Literature. Audebert, J. vet., 1890, 88.— Behrens, Monh., 1908, XX. 57.—
Diem, W. f. Tk., 1908, 297.— Forssell, Z. f. Tm., 1907, XI, 401; D. t. W., 1908, 52.
— Glage, Z. f. Flhyg., 1900, XI, 10.— Hess, Schw., A., 1890, XXXII, 213.— Hum-
merich, Z. f. Vk., 1908, 444.— Jelkmaun, B. t. W., 1890, 33.— Johne, S. B., 1899, 221.
— Johnk, B. t. W., 1907, 951.— Keutzer, Pr. Mil. Vb., Lienaux, Ann., 1897, 664.—
Malkmus, Monh., 1892, III, 7.— Marek, Z. f. Tm., 1905, IX, 50, 53.— Mayer, Eep.,
1889, 125.— Meschkow, Petersb. Journ., 1895, 540.— Moller, Monh., 1892, 111, 1.—
Ohler, W. f. Tk., 1906, 521.— Ohler, W. f. Tk., 1904, 694.— Oppenheim, B. t. W.,
1900, 617.— V. Ow, B. Mt., 1886, 92.— Plosz & Marek, Z. f. Tm., 1905, XI, 50, 52.
—Probst, W. f. Tk., 1906, 81.— Reichert, Eep., 1888, 269.— Rossbach, B. t. W., 1907,
327.— Rnlf, A. L., 1904, 106.— Siedamgrotzky, S. B., 1876, 29.— Sigl, W. f. Tk.,
1902, 581; 1907, 41.— Straube, Z. f. Vk., 1907, 475.— Wall, Die Kolik d. Pferdes,
1908.
26. Intestinal Invagination. Intussusception. Invaginatio
intestini.
By intussusception one understands a stenosis or occlusion
of the intestinal lumen which occurs suddenly and is caused by
the invagination of one section of intestine into a neighboring
part, followed by a venous congestion in the invaginated portion.
Occurrence. Invagination is found most frequently (but
even then as a rare occurrence) in cattle and somewhat more
rarely in dogs, very rarely in the horse and in the hog. Some-
times it occurs in fowl (Kitt, Johne, Klee).
In the Prussian army during 1892-1908, invagination was seen in ninety-nine
cases among 71,532 cases of colic (0.14%) ; in the Berlin Clinic, 1897-1907, there
were nine cases of invagination among 8,686 cases of colic (0.1%); in the Dresden
Clinic in 3,336 cases of colic, five (0.15%); and in the Buy treating of symptoms of colic in a separate chapter.
And it is finally not at all superfluous to treat collectively the differential features
of all diseases which may give rise to the symptoms of colic.
Diseases of horses leading to the symptoms of colic are
very frequent. This is shown among other observations by the
statistics of the Prussian army, showing that three to five per
cent of all horses annually become affected with "colic," while
the proportion of the total morbidity to "colic" is like 100 to 11-
14. In veterinary clinics one-half or even more of all horses
brought to the clinic suffer from colic; this very high figure is
due to the fact that horses suffering from other diseases which
lead to less obvious symptoms than "colic" are not brought to
the clinic so frequently.
The mortality of colicky affections varies within wide limits
because the underlying diseases are different under different
conditions and in various localities. This figure varies be-
tween 10 to 17 per cent or perhaps even a little higher ; it is, on
an average, about 12 per cent.
Various circumstances afford the reasons why colicky affec-
tions are so common in horses. Horses appear to be more sen-
448 Colicky Affections in Horses.
sitive to pain than other species of animals. It is also part of
the nature of the horse to react to disagreeable or j^ainful sensa-
tions in a very marked manner. Moderate pains often do not
become noticeable at all in other species of animals, although
they are felt.
Another cause of the frequency of colicky atfections in the
horse are the anatomical conditions of the abdominal organs.
The stomach is comparatively small, the pylorus is situated be-
tween the blind pouch of the stomach and the stomachlike dila-
tation of the large colon ; this predisposes to overloading or
dilatation of the stomach. The unusual length of the mesentery
of the small intestine and the mostly free arrangement of the
voluminous large intestine of the horse, predispose to certain
displacements of the intestine under certain conditions (strangu-
lation, volvulus or torsion).
The physiologic condition of nutrition in horses likewise
contributes materially to the occurrence of colicky affections.
As shown by the experiments of EUenberger, Tangl and Scheu-
nert, part of the gastric contents pass into the intestines very
early, even towards the end of a meal ; the food is chewed only
once and not particularly well prepared, it may consequently
easily exert a deleterious influence upon the intestines, either by
undergoing an abnormal fermentation and irritating the intes-
tinal mucosa or by easily becoming inspissated. Part of the
ingested water also enters the small intestine immediately.
Very important are the methods of using horses and the
amount and character of attendance they receive. No other
domestic animal is so much exposed to errors in diet as the
horse, especially in big cities where horses often receive spoiled
food or improper food substitutes; often their meal time is not
observed regularly; livery stable and dray horses must often
work immediately after having been fed. The use of the horse
as a work animal also brings aliout its frequent exposure to
the inclemencies of the weather and to cold.
An important role must finally be attributed to thrombosis
of the mesenteric arteries which occurs practically without ex-
ception only in the horse, but is very frequent in this animal.
This affection accounts for a considerable percentage of the
** colicky" diseases.
Symptoms of Colic. Horses frequently look around to-
wards the posterior abdomen ; they trip about restlessly, groan,
paw and stamp with their front legs, and kick against the ab-
domen with their hind legs; if they become quiet for a time,
they stand with the back arched, the neck and head stretched;
they place the feet under the a])domen, switch the tail and are
dull and apathetic. If the pains come on during motion, the
animals have a short stiff gait; they do not like to move, soon
stand still and can be made to move onward only by energetic
urging.
Differential Diagnosis. 449
During the periods of restlessness the animals try to lie
down, doing so with great care; they may rest upon the abdo-
men with their legs drawn under it, or they rest upon the back
or roll from side to side. In other cases patients suddenly and
recklessly throw themselves down upon the ground, kick with
the feet and roll very recklessly. Often the animals assume ab-
normal positions ; they kneel on their front legs or sit on their
haunches ; they stretch out their front legs and elevate the
tiiorax and head (sitting dog-fashion) or they stretch out their
front legs and rest on the sternum.
The symptoms usually come on in the form of paroxysms,
between which the animals are quiet and worn out ; frequently,
however, they recover sufficiently and begin to eat, but a re-
newed attack soon interrupts the meal. Sometimes the restless-
ness is remarkably violent, the patients continually change their
positions with hardly noticeable pauses ; they constantly throw
themselves on the floor and assume various positions ; jump up
again, kick, paw, rear and bite into various objects within their
reach. During such violent attacks one may observe grating
of the teeth, trembling, nervous movements (pressing for-
ward, circulatory motions, shaking of the head).
Symptoms on the part of various organs depend upon the
causative morbid conditions. These symptoms have been de-
scribed in the preceding chapters.
Differential Diagnosis. Since some of these symptoms,
eventually also all of them, may be due to genuine colic or to
various other disagreeable sensations, it is alway^s necessary,
whenever symptoms of colic are present, to examine methodic-
ally all of the organs which may be the seat of the underlying
affection, and to arrive at a differential diagnosis according
to the principles laid down in the preceding chapters. Some-
times it may be necessary to ameliorate or remove a dangerous
symptom even before the institution of the general examination.
Sjanptoms of restlessness may be caused by the following
morbid conditions :
1. Diseases of the stomach: Acute and chronic gastric
dilatation (overloading of the stomach, including stenosis of the
pylorus), gastritis, gastric ulcer, parasites in the stomach.
2. Intestinal diseases: Acute enteritis (rheumatic intes-
tinal spasm, spasmodic colic), occasionally chronic intestinal ca-
tarrh, enteritis (including specific acute infectious diseases and
inflammations caused by poisons), meteorism, impaction, in-
ternal obstruction, stenosis, thrombosis of mesenteric vessels,
strangulation (also incarcerated abdominal hernia), torsion and
volvulus, invagination, intestinal worms.
3. Acute peritonitis.
4. Diseases of the liver and bile ducts : Lodgment of gall-
stones, acute, occasionally also chronic hepatitis, rapid increase
Vol. 2-29
450 Colicky Ali'et'tiuus in Horses.
in the size of the liver (for instance in consequence of hemor-
rhage), rupture of the liver.
5. Diseases of the urinary organs: Acute nephritis,
nephritic abscess, pyelitis, obstruction of the ureter, inflamma-
tion of the bladder, occlusion of the urethra.
6. Diseases of the sexual organs : Torsion of the uterus,
spasm of the uterus caused by movements of the fetus, labor
pains in normal delivery and in abortion.
7. Diseases of other organs: Pleuritis (very rare!) cer-
tain diseases of the esophagus (spasm, obstruction, stenosis,
dilatation), irritation of the rectum and its neighl)orliood by
worms (oxyuris, gastrophilus larvae), paralytic hemoglobine-
mia; also long-continued hunger and great exhaustion from
work.
In making a diagnosis, sjmiptoms of colic are only of minor
importance, because they do not permit the determination of the
underlying individual affection, or even of a group of allied
affections. Almost continuous restlessness is, however, ob-
served most frequently in acute gastric dilatation, in displace-
ments of the intestines, in the grave forms of thrombosis of in-
testinal vessels and in certain forms of obturation of the intes-
tines. Unnatural positions are seen, especially in forward dis-
location of the diaphragm, in intense intestinal tension or pain
in the abdomen (displacements of the intestines, impaction, in-
testinal calculi).
Icteric discoloration of the mucosa with simultaneous rest-
lessness points to disease of the duodenum, of the bile ducts or
of the liver.
Elevation of temperature from the onset points to an in-
flammatory or infectious character of the disease, while a sub-
sequent rise of temperature may l)e caused by a secondary in-
flammatory process.
In cases which have not yet progressed too far, a nearly
normal frequency and character of the pulse permits the ex-
clusion of grave inflammatory and infectious processes, also
pressure upon the diaphragm, and usually also displacements of
the intestines and the grave types of thrombosis. In the fur-
ther course of the disease and in young animals these features
can, however, not be utilized for a differential diagnosis. The
distribution of surface temperature usually runs parallel with
the character of the pulse and with the condition of the respira-
tion. The examination of the thorax occasionally furnishes
data for a diagnosis of diaphragmatic hernia.
Belching, retching, vomiting and a sour smell of the expired
air speak in favor of primary or secondary affections of the
stomach.
Enlargement of the abnormal circumference may be absent
in primary or secondary meteorism or it may be hardly ob-
servable if the abdominal walls are very tense or if the me-
teorism is confined to a small portion of the intestine; marked
Diirerential Diagnosis. Treatment. 451
extension of the alxlomou is usually caused only hy bloatint>- of
the large intestine.
Percussion of the abdomen hardly assists in arriving at a
diagnosis.
The intestinal sounds are of greater prognostic than diag-
nostic value. The absence of peristalsis in certain portions of
the intestines cannot be determined from the behavior of the
intestinal sounds, because, unless quite feeble, the latter are con-
ducted from one spot to all parts of the abdominal wall. If,
however, the sounds are persistently more frequent, and loudest
over certain sections of the abdomen, one may conclude that the
intestines of this region are in a condition of energetic per-
istalsis.
Complete constipation, coming on simultaneously with or
soon after restlessness, speaks for obstruction or paralysis of
the intestine; the absence of these symptoms at the l)eginning
does not, however, exclude these affections. Retarded defeca-
tion, and even complete constipation, is ol)served also during the
later course of disease of the stomach. Marked straining at
defecation is observed most commonly in diseases of the rectum
and in peritonitis. The character of the feces assists in some
cases in arriving at a diagnosis.
Rectal examination furnishes the most valuable data and it
should never be neglected. There is not a single reason in
favor of its neglect and many cases can be diagnosticated cor-
rectly on the basis of a proper rectal examination.
To make a careful rectal examination one should first inject two or three
quarts of lukewarm water into the rectum; this relaxes the rectal wall and makes its
internal surface slippery. Before introducing the hand the neighborhood of the
anus is inspected anil tumors, parasites or blood are noted if present. The oiled or
greased hand is introduced by overcoming the resistance of the rectum with the
fingers closed into a cone. It is then advanced carefully until the arm has been
pushed in as far as the elbow; while this is being done one can ascertain,
by palpating the rectal wall, whether the latter has been torn. The hand then
progresses in the direction of the thorax to find out whether the rectum is empty
(obstruction). Then palpation is made through the rectal wall in order to examine
the urinary bladder, the two abdominal rings (in mares the ovaries), the accessible
portions of the small and large intestines, the posterior or mesenteric root, the poster-
ior, upper portion of the spleen, the left kidney and, in horses that are not too large,
the anterior mesenteric root and the vessels contained in it. A man of medium size
is able, in not too large horses, after introducing the arm up to the shoulder, to
palpate the anterior portion of the left kidney and from there downward and
laterally a spherical segment of the abdominal cavity. If possible the examination
is made on the standing horse. Very restless horses must be first quieted by an in-
jection of morphine or by choral hydrate, or they must be restrained.
Treatment. In order to avoid serious errors, treatment
must always be directed against the underlying disease, which
has either been determined with certainty or at least with good
probability. The variable nature of the causes of colicky pain
excludes any uniform method of treatment; it is, however, al-
ways advisable to take the patients to a roomy closed place well
littered with dry straw, to prevent reckless throwing down and
impetuous rolling partly by narcotic means, partly by proper
452 Gastropliilus Larva? in the Stomach oi! t lie Horse.
attendance, to prevent if possible ruptures and displacements
(see chapters on internal strangulation, torsion and volvulus).
An exception in this respect are torsion of the large intestine
when moderate rolling may be permitted. The indiscriminate
use of laxatives and similar drugs is absolutely worthless, fre-
quently even harmful. While such drugs may be advantageous
in some cases, they will do harm in others when their use is
contraindicated.
Aside from the internal treatment of the underlying dis-
ease, operative interference will play an important role in the
future; this includes the introduction of the stomach tube, lav-
age of the stomach, the reduction of displacements, the removal
of obturating foreign bodies per rectum or by rolling, and
finally laparotomj^ and enterotomy. One must, however, al-
ways remember that laparotomy, and still more laparotomy
combined with enterotomy, are procedures that are quite dan-
gerous for the horse and they must still be perfected more be-
fore many animals can be saved by them.
Literature. Klett, D. t. W., 1907, 209 (with literature concerning rectal exami-
nation).—Wall, Die Kolik des Pferdes, 1908.
Colicky Affections in Other Animals. The same diseases that do
so in the horse, manifest themselves also with symptoms of colic in other
animals, but, for reasons already pointed out, the underlying conditions
are more rare. The other domestic animals usually react with less
marked manifestations to pain ; moderate pain usually causes no observ-
able symptoms.
The same principles must guide us in differential diagnosis and
treatment.
28. Animal Parasites in the Stomach,
(a) Gastrophilus Larvae in the Stomach of the Horse.
Occurrence. The larvae of bot-flies occur almost exclusively
in the stomach of horses after prolonged pasturing; they are,
however, seen occasionally also in horses which have been work-
ing along roads along which much brush growls. Foals from eight
months up to the age of three years are most commonly af-
fected, older horses more rarely. The bot-fly larvae disease is
seen most frequently after the stabling of horses in the fall.
The better breeds are particularly liable to be affected.
Etiology. Fly larvae, which are parasitic in the stomach
of horses, develop from the ova of brachyceric flies (Diptera
brachycera) which include the bot-flies, (Gastrus, Gastrophilus).
Between June and October, particularly during the liot days in
July, August and September, these rest upon the body of horses
in the open air, especially on the anterior portion of the body
(neck, mane, neighborhood of nose and mouth, front legs) ; the
flies either rest upon the skin or float in the air a few centime-
ters above the animals.
Etiology.
453
From the oblong ova (Fig. 51), opening by a lid and glued
to the hairs in a downward direction, there issne, after a few
days, slender larvae composed of
thirteen segments. The horses lick
these larvie, probably because of
itching, get them into their months
and ingest them with the food and
water into the stomach; here the
larvje bore into the mucosa and de-
velop. According to another view,
the larv« wander in the mouth from
various portions of the body of the
horse, or to a place where they can
be licked off. After about ten
months, that is, between May and
September, especially, however, in
July, they become detached from
the mucosa and get into the out-
side world with the contents of the
stomach or intestines. They change
into the chrysalis stage, either in
the ground or in horse manure. The
flies creep out after thirty or forty
days and after copulation the fe-
males deposit their ova on horses.
Fig. 51. Ovum with larvae of Gas-
troi)liilus equi. Figures to the right
double magnification, to the left
highly magnified.
The body of the bot-fly larvfe is oblong, pointed in front, rounded
off behind ; it is composed of eleven rings more strongly curved on the
dorsal aspect; the anterior rings are supplied with fine spikes at their
dorsal margin. The first segment is supplied with two chitinous mouth-
hooks, and above them two buttonlike antennae or feelers. The full-
grouTi larvae are up to 20 mm. long and reddish to yellowish-gray in
color.
The larva of the following species of Gastrophilus occur in the
stomach of the horse :
1. Gastrophilus equi (large ntoniaeh Ijot-fly) : A fiy twelve to fourteen
mm. long which lays its eggs preferably on the anterior portion of the body of the
horse. The larvae adhere to the esophageal portion of the stomach. This fly is very
widely disseminated and most larvae occurring in the stomach of the horse belong to
this species.
2. Gastrophilus haemorrhoidalis (rectum bot-fly) : Somewhat smaller, dark
brown, likewise widespread bot-fly; the females deposit their ova preferably on
tlie lips on the tactile hair of the horse, also frequently on other parts of the an-
terior portion of the body. The larviB are somewhat smaller, dark-red and they are
parasitic on the pyloric portion of the stomach of the horses, also in the duodenum;
after they are fully developed and shed, they remain for some time in the rectum,
where they assume a green color, after which they are voided.
3. Gastrophilus pecorum (cattle bot-fly) : Twelve to fifteen mm. long,
dark brown. The larvae are particularly common in Hungarian and Eussian horses;
they are thirteen to fourteen mm. long, of a dark brown color, are preferably found
in the stomach and duodenum and, after full development, remain in the rectum for
some time.
4. Gastrophilus nasalis (nose bot-fly) : Light chestnut l)rown, twelve to
thirteen mm. long, more rare than the preceding species. The yellowish-white larvae
454 Gastrophilus Larvae in the Stomach of the Horse.
are thirteen to fifteen mm. long and live exclusively in tlie jiylorie, portion of the
stomach and in the duodenum.
5. Gastrophilus flavipes occurs around the Mediterranean; the larvie are par-
asitic in the stomach of the donkej.
Pathogenesis. Bot-fly larvae may be present in the stom-
ach, even in considerable numbers, without disturbing its func-
tion markedly ; this may be due to the fact that they are most
commonly adherent to the left half of the stomach which plays
no important role in the digestive function. If, however, they
are present in very considerable nimibers and bore into the
glandular right half of the mucosa, they then cause pain to
their host and bring about nutritive disturbances. This is
partly on account of the withdrawal of blood and lyiuph but
mostly on account of disturbances of the motor and secretory
function of the stomach. Whether the hemolytic substances
which Weinberg has found in the larvae have a deleterious
effect upon the blood of the host is not known. The pylorus
or duodenum may exceptionally be obstructed by the larvae.
In the neighborhood of the defects which they have pro-
duced in the gastric mucosa, the larvae cause a chronic inflam-
matory process by poisonous metabolic products and by me-
chanical irritation. When the loss of substance is very consid-
erable, the power of resistance of the gastric wall is very much
decreased and an accumulation of gastric contents may easier
occur. In exceptional cases the larvae may perforate the wall
of the stomach or even that of the duodenum (Numan), or some
larger blood vessel is injured and hemorrhages may occur, which
may have a fatal termination (Ziirn, Dammann, Hertwig, Bruck-
miiiler, Thomas). As to the pathogenic effect, the larvae adher-
ing to the pylorus and the duodenum are the most dangerous
(G. haemorrhoidalis and nasalis).
The ulcers caused by gastrophilus larvie may, like any other loss of substance,
form the portal of entrance for various infectious microorganisms (Perroncito).
Anatomical Changes. On postmortem examination, one
finds the larvae in the stomach and sometimes in very great
numbers. Numan counted more than 1,000 in one case; Ker-
sten found over five quarts in another case; Rexilius saw the
stomach and the constricted duodenum filled ^^dth larvae, and
Kater the duodenum completely obstructed with gastrophilus
larvae. On the internal surface of the gastric wall one sees
round, craterlike depressions with a diameter of 3-4 mm. ; the
base appears red, and the margins are formed by the thickened
epithelial covering of the mucosa. In the glandular portion and
in the mucosa of the duodenum one sees around the place of at-
tachment swelling, redness and possibly also small hemorrhages.
Exceptionally there may be abscesses in the gastric wall.
According to Petit and Germain the base of the ulcers is formed by necrotic
tissue; in the neighborhood of the latter are chronic inflammatory changes with
infiltrating eosinophilic cells; small pegs of epithelial cells penetrate into the under-
Symptoms. Dia^^nosis. 455
lying tissue from the thickened epithelial covering. There is a proliferation of the
gastric glands and microscopically small adenomalike formations subsequently de-
velop in the tissues below the base of the ulcer. After the detachment of the
larvae cicatricial nodules remain in the mucosa.
Symptoms. Aside from those very rare cases which go
on to perforation, the invasion of a larger number of Gas-
trophihis larvse leads, particularly in foals, to symptoms similar
to those of strongylosis in lambs (stomach-worm disease of
lambs, Kroning). According to the intensity and the time of
the infection and the nutritive condition of the affected animals,
the symptoms come on either towards the end of the period of
pasturing or shortly after the stabling of the animals, or occa-
sionally only during winter. In the foreground of the clinical
picture are variable appetite, poor appearance of the animal,
pale discoloration of the mucosae, marked emaciation and occa-
sionally symptoms of colic. The heartlieat becomes thumping,
the pulse weak, the general condition poorer and poorer, and
the animals, which finally suffer from a complete lack of appe-
tite, have dwindled down to mere skeletons, so that they finally
cannot get up from the floor any longer. If proper treatment is
not instituted the animals may die from six to eight week after
an intense invasion (Kroning) or perhaps only after two to
four months; in milder cases spontaneous recovery occurs.
Kater observed in a horse the picture of stenosis of the duo-
denum ; Tegg that of pylorus stenosis ; Rexilius saw increasing
cachexia, lack of appetite and increased thirst.
The presence of larvae of Gastrophilus hgemorrhidalis and
(t. nasalis causes an irritable condition of the rectum, which
leads to symptoms of gastric catarrh (frequent defecation,
straining, itching, eventually excitement and restlessness, sim-
ilar to those in colic) ; straining may exceptionally lead to pro-
lapse of the rectum.
Diagnosis. The greatest significance must be attached to
the history of the case (onset of the disease shortly after a
rather long period of pasturing) with a negative result of the
examination of the various organs. Additional evidence is
forthcoming if Gastrophilus larvae are expelled from time to
time per rectum and if such larvae are found attached to the
rectum. Cachexia of foals (see page 342), can be excluded by
the fact that it disappears entirely during pasturing or at least
improves considerably. The presence of ascaris in the intes-
tines can be ascertained by finding the worms of their ova in
the feces. The exclusion of sclerostomiasis is always very
difficult and often can be made only on postmortem examina-
tion ; both diseases may occur simultaneously. Infectious anemia
attacks horses without difference of age and, in chronic cases
which alone have to be considered with reference to differential
diagnosis from gastrophilus infection, causes repeated attacks
of fever with little disturbance of appetite.
456 Gastropliilus Larva3 in the Stomach of the Horse.
Treatment. The ordinary antlielmintic drugs have no ef-
fect upon the very resistant gastrophihis larva?. The larvae,
however, are killed or narcotized by carbon disulphide (car-
bonenm snlphuratnm) which has been recommended by Per-
roncito and Bosso and they are then voided with the feces.
The drug is administered in gelatin capsules of 12-15 gm. (foals
only 6-8 gm.) three or four times at intervals of two hours, after
the animals have been starved for twelve to twenty-four hours.
The medicine is administered with the aid of a balling gun
or the capsules may have been lubricated with castor oil or
vaselin and they are placed on the tongue by the hand, pro-
vided the animals are not too young; they are then swallowed
by deglutition due to reflex irritation. One may improvise a
simple balling gun by splitting crosswise one end of a reed
12-15 cm. long; the four sections made by the cross incisions
must l)e rounded off. One end of the capsule, made slippery as
indicated above, is grasped between the four sections of the
reed and is pushed along the hard palate, back to the velum,
then the cajosule is swallowed (Tarr). After twelve to twenty-
four hours, one administers 250-500 gm. of castor oil, or tartar
emetic (6-10 gm.) with sweet milk or mucilage or an aloe pill
(15-30 gm.). The efficiency of carbon-disulphite has frequently
been confirmed (Bugarli, Cognesi, Hanke, Wessel, Kroning and
others) ; the discharge of the larvae begins as early as the next
day; they are found in the feces in various stages of develop-
ment. Animals which are greatly emaciated are much affected
by energetic treatment and some may even succumb to it (au-
thors' observation). Santy found oil of turpentine effective
(50-80 gm.) ; it is given in milk.
Larvae in the rectum may be removed manually or by in-
jections of soap-, vinegar-, or creolin-water ; also with carbon-
disulphide (5 to 10 gm. to one quart of mucilage). Labat rec-
ommends the inunction of the rectal mucosa with boro-vaselin,
whereupon the larvae become detached, without dying, and are
voided. The discharged larvae should be destroyed.
Literature. Kroning, Z. f. Vk., 1906, 202 (Lit.).— Petit & Germain, Bull.,
1907, 405.
Nematodes in the Stomach of the Horse. The fine filiform Spirop-
tera megastoma foi-ins firm tumors up to the size of a hen's egg in the
neighborhood of the left margin of the glandular mucosa; the worms
can be expressed from the opening of tlie tumor. This worm as well as
Spiroptera michrostoma, infect, according to Railliet, the gastric mucosa
of horses and produce in donkeys even ulceration of the stomach ; they
as well as Strongylus tenuissimus, found once by Mazzanti in the stomach
of a horse, are of no significance from a clinical standpoint. Weston
saw, however, several cases of ulceration in the pyloric portion of the
stomach or in the duodenum due to Sp. megastoma with subsequent
peritonitis and death. Petit & Germain saw adenomatouslike formations
in the stomach of a horse due to the presence of Strongylus Axei.
stomach-worm Disease of Sheep and Goats. 457
(b) Stomach- worm Disease of Sheep and Goats. Strongylosis ven-
triculi ovum et caprarum.
Occurrence. The disease occurs in marshy territories, ex-
posed to frequent rains and inundations, and it sometimes
causes great losses. Animals of all ages are affected, but pref-
erably only lambs, kids and yearlings. The affection is fre-
quently seen simultaneously with the lung-worm-, or the liver-
fluke disease.
Etiology. The disease is caused by strongylidae, most com-
monly by Strongylus contortus, more rarely by Strongylus fili-
collis, Strongylus vicarius, Strongylus circumcinctus, Strongy-
lus retortseformis, Strongylus Ostertagi or by other species of
strongylus.
strongylus contortus is a filiform worm one to two cm. long (females two to
three cm.) ; its red color is believed by the majority of authors to be due to blood
coloring matter obtained from the stomach; others, however, including Lignieres,
think that the coloring matter is not hemoglobin.
The embryology of the stomach strongylidce has not been definitely
settled; the investigations of Ransom, Plana and Stodter have shown,
however, that the ova of Strongylus contortus, Strongylus Ostertagi and
Strongylus retortfeformis, voided with the feces of infected animals, un-
der favorable conditions of temperature, discharge embryos which obtain
their nutrition from the excreta in which they were set free and grow
up to the size of about one mm. If the larva are then taken up by
sheep they attain their full length after a sojourn of two to three weeks
in the abomasum of these animals.
The resistance of the larvae is very great. According to Eansom they can
stand desiccation for thirty-five days, and according to Piana up to ten months.
They become immobile in much water; can, however, revive later on. They can
stand the cold of winter without any harm and remain alive on pastures for seven
or eight months.
Natural infection occurs during pasturing by the ingestion
of plants contaminated with Strongylus larvae, possibly also with
the drinking water. Lambs are said sometimes to become in-
fected during barn feeding (Michalik). Eggs as well as em-
bryos up to their fourth to fourteenth day of embryonic life are
not infective (Ransom).
Pathogenesis. The strongylidae bore into the gastric mu-
cosa and suck blood from it ; in this manner they disturb the nu-
trition of the hosts in a degree proportionate to their number.
More detrimental than the loss of blood is, however, probably
the absorption of toxic metabolic products (according to Grrosso
hemolysins) of the parasites.
The injuries produced by the parasites afford an opportunity for bacterial in-
vasion. Lignieres showed that a disease prevalent in Argentine and known under the
458
Stomach-worm Disease of Sheep and Goats.
name of Lonibriz (see Vol. I) was caused by a bacillus bipolaris entering through
such injuries made by Strougylus. Lignieres believed that the presence of Strongylus
has nothing to do directly with the disease, which he considered entirely due to the
bipolar bacilli. However, the general experience is against the view of Lignieres
that disturbances met with in the presence of Strongylus infection are due to bac-
terial invasion.
Anatomical Changes. The parasites usually adhere in
large numbers to the mucosa of the abomasum which presents
the appearance of ah acute or chronic catarrh, and occasionally
also small ulcers. The contents of the abomasum may show a
reddish discoloration. Sometimes the Strongylus worms can
be found only by a microscopic examination (Stoedter), but it is
generally sufficient to mix the gastric contents with water in
order to insure their detection (Ransom).
Symptoms. The onset of the symptoms occur a certain
time after the ingestion of the embryos; the s^^nptoms may
come on in the fall or only during winter
and they indicate nutritive disturbances
and anemia. The animals at first appear
less lively; they are feeble and remain
back in development in spite of a well pre-
served appetite. In the course of time,
the symptoms of anemia, hydremia and
cachexia set in, and the very much emaci-
ated animals finally die. In the later
course of the disease the feces are some-
times dark and fluid and are voided with
symptoms of colic; the feces then some-
times show Strongylus ova (Fig. 52) ; in
other cases convulsions and paralytic con-
ditions are seen. The blood shows many
poikilocytes (deformed red blood corpus-
cles, Wernicke) on microscopic examina-
tion and basophilic granules in the red blood corpuscles.
Fig. 52. Ovum of Strongyl
filicollis.
Treatment. Strongylosis may be treated with more or less
success with the following drugs : Oil of turpentine, alone or
mixed with stinking animal oil (of each one teaspoonful), kam-
ala (4-5.0 gm. per day in water or milk), picrate of potash (0.12-
0.20 gin. in an infusion of linseed on three consecutive days,
Eaabe), nut areca and also arsenic (for ten sheep daily 50.0
gm. of arecanut and 1-2 gm. arsenic mixed with l)ran, Moussu).
On account of its variability in composition creosote (given in
1% watery mixture, 60-120 gm. to lambs, 90-150 gm. to sheep)
often fails to produce favorable results. Sulphate of copper
has given good results in South Africa (1.257© watery solution
25 gm. for very young lambs, 45 gm. for lambs one-half year old,
75 gm. for yearlings and 90-100 gin. for adult sheep). The sick
and suspected animals should be given a nutritious diet.
Prophylaxis. Stomach-worm Disease of Cattle. 459
Prophylaxis. This consists in avoiding- wet, marshy and
suspicions pastures and the separation of the sick and of all
adult animals from the lambs and kids. The animals should
have access to good and, if possible, to running water ; eventu-
ally there should be elevated stone steps leading to the source
of water to prevent the animals from tramping into it or con-
taminating it with their feces (Stodter). If a continuous avoid-
ance of infected pastures is not possible, they ought tobe al)an-
doned as such for one or two years and ought to be utilized for
other purposes. Ransom recommends a procedure in this re-
spect which promises permanent results.
From October to March the annuals may be kept in a common barn without
consideration as to age, and they may be pastured together in April in a non-
infected pasture. In May the pasture is changed every two weeks, and in June
every tenth day, and between July and August every week in such a manner that
the preceding pastures are no more visited during the same year; in September the
change of pastures should again occur in longer intervals. Next year the same
pastures may again be visited in the same order of rotation, becaus-e the disseminated
ova or embryos have perished in the mean time. In the fall the adult sheep should
receive an anthelmintic course of treatment.
Another method consists in dividing the pasture by a small neutral strip into
two portions, one for the lambs and one for the adult animals. The lambs should be
allowed to be with their mothers only during sucking. If covering of the females
is so arranged that ewing occurs during the winter months, the lambs may be sepa-
rated from the ewes at the beginning of pasturing and they can then be pastured
in localities which have not been visited by sheep for one year.
Literature. Miehalk, B. t. W., 1891, .573.— Plana, Clin, vet., 1906, 1.5.— Eansom,
\et. Journ., 1907, 340. — Stodter, Die Strougyliden im Labmagen der gaziihmten
Wiederkauer und die Magenwurmseuche, Dis. Bern., 1901 (Lit.).
(c) Stomach-worm Disease of Cattle. Strongylosis ventricuh bovum.
Occurrence. Strongylidse are frequently parasitic in the
abomasum of cattle, but they produce disease only if present in
large numbers. The disease is then usually seen in young cattle
after they have been pastured. Sometimes the disease occurs
in an enzootic form (Harker, Penberthy, MacFadyean, Lien-
aux, Klein).
In the Berlin abattoir, Ostertag found Strongylus convolutus (Str. Ostertagi,
Stiles) in 90% of the cattle killed. According to Stodter the stomach strongylosis
of cattle is found everywhere in the world.
Schnyder, who has studied stomach strongylosis, claims that the disease known
in the country around the Zurich Lake as '' EaUbriindigl-eit" is a strongylosis
found during all seasons and in cattle of all ages, independently of dry or gi-een
feeding. He could demonstrate the presence of the disease in 0.2'% of all cattle.
Bang, however, calls attention to the fact that these cases, and others frequently
observed in cattle, may l)e a combination of gastric strongylosis with the much more
dangerous enteritis paratuberculosa Bang (see Vol. I).
Etiology. According to Schnyder 's investigations there
occur in the abomasum of cattle Strongylus Ostertagi Stiles
(Str. convolutus), Str. retorta^formis of Zeder, Str. Curticei
Giles (Str. ventricosus), Str. oncophorus Railliet, Str. filicollis
Rudolphi and the Str. contortus Rudolphi. One usually finds
several species simultaneously in the stomach and intestines of
cattle.
460 Stomacli-worm Disease of Cattle.
Concerning the embryology of tlie gastric Strongylns of cat-
tle, the mode of natural infection and the pathogenesis, the
reader is referred to what has been said under strongylosis of
sheep (see page 457).
Anatomical Changes. According to Schnyder and Blnnschy,
one finds in an advanced stage of the disease emaciation, anemia
and eventually hydremia ; the mucosa of the abomasum is swol-
len and edematous, raised in gelatinous folds, reddened here and
there and beset with grayish white nodules, the size of a pinhead,
with a small central pale vesicle (these formations are the so-
called worm nodules). One also sees erosions from the size of
a lentil to that of a finger nail. Sometimes the mucosa is cov-
ered with a heavy flocculent deposit. The Strongylns worms
may be found in the washings of the contents of the abomasum
(decanting the contents).
The mucosa of the small intestines, especially in the median
portions of the latter, here and there is swollen and loose, forms
coarse transverse and longitudinal folds ; it is reddened in spots
as it is in enteritis paratuberculosa.
Histologic examination shows that after entering the depressions and glands
of the fundus the worms penetrate down to the muscularis mueosfe and roll up
spirally, an exudate with round cell infiltration then occurs, and this forms nodules
with a central depression. Subsequently the tissue forming the nodule becomes de-
stroyed and a profuse proliferation of the tunica propria occurs. Though the worms
also get into the glands of the mucosa of the pylorus, nodules are not formed in this
part of the gastric mucosa, nor in that of the mucosa of the small intestine, but
there is a necrosis of the epithelial cells and of the lymph-follicles in the immediate
neighborhood of the parasites. After the worms have left the nodules in the gastric
mucosa, they bore into the mucosa of the small intestine with their head and project
free into the lumen of the bowel with their tail end.
Symptoms. The clinical symptoms of gastric strongylosis
of cattle come on late in summer or early in fall and are similar
to those of the worm disease in sheep (see page 457). After
mixing the feces with water and- pipetting off the latter, one will
find in it more or less numerous strongylns ova.
Watery stools are the most prominent symptom of the disease called
"Kalihrdndigheit," the fetid stools are voided in a curved stream and
usually contain small air bubbles. Thirst is increased. The further
course brings about rapidly increasing emaciation, anemia, diminution
of the secretion of milk, although the facial expression remains lively
almost to the end, temperature and pulse remain normal. There may be
an edema of the external region of the larynx and of the thorax even
during the first week of the affection. Temporary improvement occurs
occasionally.
Diagnosis. A relial)le diagnosis can only be juade b}^ ex-
cluding disease of all other organs and finding the ova in the
feces ; sometimes the correct diagiiosis is made only after the
animals have been killed or have died a natural death. The dif-
Stomach- worm Disease in Koes. Parasites in tlie Stom?cli of Swine. 461
ferential diagnosis has to consider particularly enteritis para-
tubercnlosa (see Vol. I).
Treatment and Prophylaxis. In cases not very much ad-
vanced Schnyder had good results from the administration of
flores cinse (150-200 gni. prepared as a decoction). One may also
use the drugs mentioned under worm disease of sheep ; the
doses have to be increased proportionately (see page 458).
Klein obtained favorable results with creosote.
The prophylaxis calls for measures like those recommended
against strongylosis of sheep (see page 458).
Literature. Blimschy, Unters. iiber d. Verand. d. Schleimh. b. d. Magen-Darm-
Strongylose, Inaiig. Diss., 1906 (Lit.).— Klein, Vet. Jahrb., 1906, 131.— Lienaux Ann.,
1900, 438.— Ostertag, Z. f. Flhyg., 1890, I, 1.— Schnyder, Beitr. z. Keuntn d. Magen-
Darm-Strongylose, Inaug. Diss., 1906 (Lit). *
Stomach-worm Disease in Roes. Roes are sometimes infected and
many may die in consequence of invasion by Strongylus contortus, Stron-
gylus Ostei'tag'i and Strongylus filicollis. In more intense invasions the
affection leads to hvdremie cachexia (Feser, W. f. Tk., 1903. — Stroh.,
Z. f. Flhyg., 1905, XV, 163).
(d) Parasites in the Stomach of Swine.
The following nematodes occur in the stomach of hogs :
1. Spiroptera strongyhna; a slender whitish worm, males 10 to
thirteen mm., females 12 to 20 mm. long; it forms small tumors in the
submucosa; it bores into the mucosa and may in this manner cause
serious gastritis. This parasite has repeatedly caused enzootics, ter-
minating fatally within three to four days (V. Ratz).
2. Gnathostoma hispidum (Cheiracanthus hispidus) ; cylindrical
worm, 2 to 3 cm. long, thickened at the anterior end, adhering to the
gastric mucosa or boring into it, the posterior end projecting free into
the lumen. The worm produces intense inflammation of the nuicosa,
thickening of the gastric wall, dilatation of the stomach, disturbances
of digestion, cachexia (Csokor) ; the parasite was found in Hungarian
hogs by y. Ratz and Stroese.
3. Simondsia paradoxa; found in England by Simonds, in Hun-
gary by V. Ratz in the stomach of swine; the females, 45 mm. long, \yere
seen inside of cysts of the gastric wall, projecting with their head into
the cavity ; the males are found free in the gastric contents.
4. Strongylus rubidus; This worm was found by Hassall and
Stiles in 25 to 75 per cent of all hogs examined in the stockyards of
Washington, D. C. ; Oppermann saw an enzootic outbreak of the disease
due to this worm among breeding sows of a farm in Westphalia, Ger-
many. The infection occurred while the animals were in an unpaved
yard continually contaminated with manure. The worms produce diph-
theroid chronic inflammatory changes in the gastric mucosa, which lead
462 I'arasitt's in the Stuiiiaoh of Caniivora and Fowl.
to profound aiuMiiia, cachexia and iinal death. The feces of the sick
animals showed ova of Strongylus rul)idiis in hirge numbers.
Literature. Opperniaim, D. t. W., 469 (Lit.).— Y. Eatz, Z. f. Tm., 1899, III,
322 (Lit.).
(e) Parasites in the Stomach of Carnivora.
In the stomach of dogs Spiroptera sanguinolenta is freijuently found
enclosed in tumorlike formations ; it usually does not produce disturb-
ances (see page 240). Cadeac claims, however, that Spiroptera tumor
may cause obstinate vomiting which occasionally leads to death.
Larvae of Gastrophiliis equi have been found a few times in the stomach of
dogs, they were probably swallowed with horse manure and had attached themselves
to the gastric mucosa (Eailliet). Asearis marginata and Tamia may get into the
stomach from the intestines.
OUulanus tricuspis is parasitic in the stomach of cats. It is a
slender worm one mm. long and is sometimes found in exceedingly large
numbers in the catarrhal gastric mucosa; the females, which are pro-
vided ^dth three nodules at the tail end, produce live embryos. The
latter subsequently wander from the stomach and intestines into various
organs (lungs, liver, diaphragm, pleura) where they may subsequently
be found encapsulated in cysts of the size of a pin head. The larva
voided ^dtli the feces or the bronchial secretion are found in the mus-
cles of small rodents encapsulated in a manner like trichinae, and cats
probably infect themselves from the meat of mice.
(f) Parasites in the Stomach of Fowl.
In the muscular stomach of fowls are found, aside from the Dis-
pharagus nasutus or Filaria nasuta previously mentioned (see page 244),
Spiroptera pectinifera, which sometimes may cause numerous cases of
death (Nicolas). The patient becomes emaciated in spite of good ap-
petite; the somewhat thin-fluid droppings contain particles of undi-
gested food; the emaciated animals usually die after four to six weeks,
occasionally only after several months. The muscular stomach then
presents ulcers up to the size of a penny, with elevated margins and a
hemorrhagic base, and the remainder of the mucosa is changed to a
brownish mass composed of pseudomembranes and mixed with worms.
In water fowls, especially in ducks, there is found in the glandular
stomach the Dispharagus uncinatus Rudolphi (Spiroptera uncinata Rud.,
filaria uncinata Rud.) ; this parasite causes elevations of the mucosa,
up to one cm. high which results in a narrowing of the lumen
(Hamann). What Wolff hiigel and Sturhan have found in the glandu-
lar stomach of ducks and described as Strongylus contortus is probably
identical with the above named parasite. The embryos of this parasite
are set free in the stomach of the host; they then get into the water
with the droppings and are taken up by a small crab (Daphnia pulex).
They develop in the abdominal cavity of the latter to larvfe 1.7 to 2 mm.
long. The infection of ducks occurs after the ingestion of the infected
small crabs.
Symptoms of disease are present only during a short period. The
sick animals refuse food, are feeble and listless; their motions are stag-
"Worms in the Intestinal Tract. 463
gering ; they have cliill eyes at the end of the first day ; open their hill
wide and succumb after being sick one day ; occasionally almost imme-
diately after the onset of the first symptoms.
For prophylactic purposes the sick animals should be killed and
ducks and geese ought to be kept away from the suspicious water. Dur-
ing the months of June and September the latter is usually yellowish
or brownish due to the presence of numerous small crabs.
Rust saw an enzootic among young ducks, infected in their glandu-
lar stomach with Tropisurus fissispinus (Tropidocerca fissispina) ; the
parasites had produced ulcerative changes of the gastric mucosa. The
infection had been produced likewise by Daphnia pulex.
Freese saw disease in young geese due to the presence of Strongylus
nodularis under the mucosa, less frequently in the dark-broAvnish epi-
thelial covering of the muscular stomach. The disease manifested itself
in progressive emaciation and feebleness in spite of good appetite, and
ended fatally within three to eight days. Some few species of this par-
asite are frequently found in otherwise healthy geese.
Literature. Freese, D. t. W., 1908, 713.— Hamann, Cbl. f. Bact., 189.3, XIV,
5.55.— Nicolas, J. vet., 1904, 136.— Eust, Pr. VI., 1905, II, 30.— Sturhan, Z. f, Vk.,
1903, 131.— Wolffhiigel, Z. f. Flhyg., 1903, XIV, 13.
29. Worms in the Intestinal Tract. Helminthiasis.
Worms parasitic in tlie intestinal tract produce disease in
a variety of ways.
Contact with the mucosa, adhesion to it, boring into it, pro-
duce an irritation, which, according- to tlie number of ^vorms,
may cause a circumscribed or a diffuse catarrh or even an in-
tense inflammation. Worms armed with hooks may penetrate
more deeply into the mucosa ; they may even perforate the in-
testinal wall and cause fatal peritonitis.
Great numbers of larger worms may unite in lumps and
may narrow or obstruct the intestinal lumen. On the other
hand individual worms may penetrate into a duct opening into
the intestines, especially into the bile duct ; they may occlude it
and prevent the discharge of a secretion or excretion ; they may
exceptionally get from the intestine into the stomach, esophagus,
pharynx, buccal cavity or larynx.
By withdrawal of nutritive material intestinal worms,
when present in larger numbers, cause emaciation, eventually
also anemia of the host ; in the production of the latter the
toxins (leucomaines or ptomaines [Linstow]) of the w^orms
play an important role.
Poisonous substances have been demonstrated in many helminthes. They pro-
duce destruction of the red blood corpuscles, reduction of hemoglobin, anemia with
poikiloeytosis, the appearance of nucleated red blood corpuscles, including megalo-
blasts and an eosinophilia of the blood. They also produce an increased decomposi-
tion of the proteids of other organs.
Many intestinal parasites may bring about secondary in-
fections in consequence of injury to the mucosa. Such secondary
464 Tapt'wunns.
infections, and inflammatory processes following upon tliem,
and also the poisonous jDroducts of worms are undoubtedly re-
sponsible for nervous s>^nptoms, such as excitement, convul-
sions and paralysis, which are sometimes seen, and are then
due to reflex irritation.
The intensity of the morbid condition varies according- to
the species and number of intestinal parasites and also accord-
ing to the individual irritability of the affected animals. The
larger worms, and particularly those provided with hooks, are
generally more dangerous, but even small worms, when present
in large numbers (for instance Taenia, echinococcus, Dochmius
trigonocephalus), may also cause serious disease. Both, differ-
ent species and ditferent individuals of the same species, show
great varial)ility as to irritability; this is most markedly shown
in dogs. These factors and the resistance of the worms to an-
thelmintics are important for the significance and prognosis of
the affections caused by intestinal parasites. The latter, Avhich
occurs in domestic animals, are tapeworms (Plathelminthes:
Cestodes, Trematodes) and roundworms (Nemathelminthes:
Nematodes, Acanthocephala).
Literature. Linstow, Kongr., Budapest, 1905, I, 387 (Lit.).— V. Eatz, VII,
Intern, hygieu. and demogr. Kongress, 1894 (Lit.).
A. Tapeworms. Cestodes.
Tapeworms are bandlike colonies of hermaphroditic indi-
viduals arranged in adhering segiiients. The anterior segments
of each animal, or animal colony, forms the socalled head (sco-
lex) ; it is to be looked upon as the mother of the colony which
continually forms new segments asexually, by longitudinal
growth and transverse segmentation, that is, individuals which
do not become separated, but adhere to each other. The more
distant the segments are from the scolex, the larger, wider and
longer do they get. Those situated caudally show more dis-
tinctly the sexual organs, which attain their full development
in the last segments of the band (strobila). The mature seg-
ments are also called proglottides. The individual seginents
are hermaphroditic ; the uterus usually contains numerous eggs,
and it shines through the external layer of the proglottides;
its characteristic shape may be utilized for determining the
species. The sexual openings or pores are on the margin of
the individual segments in Taenidae, and on the flat surface in
Bothriocephalidae.
The segments are formed by a doul)le layer of connective
tissue; the external layer contains small granules of lime. The
nutritive material of the intestinal contents of the host pene-
trate into the body of the worm through small openings of the
segments. The excretory products of the worm are voided
through a system of canaliculi contained in the lateral portions
Tmix'woiiu.s ill Iforscs. 4iK)
of llic sc^'hMMils. 'riic cjiiiarK'uli Icriiiiiiatc in an opening- on llici
|>(»sl(M'i()i" niari;in of llic lasl sc^incnl.
Tlio development of tapeworms occui'h as follows: After llic
ova, wliicli iii't' voitlfd willi llic sc^^iiifiil, li s .■m. hm;^ ;uhI .". ir, nitn. wide; rdimd in
tlin Miriiill iiiteNtilie, rxcept ioiKlll V iilso in llie mI oiilkIi. \\,-.u[ l>liinl, :! nini. lliirK wllli
well d('V.d()|>e.! Miickei'H, Ixdii ml ' I li.' Iie;hl un I lie ii|,|,.'r illni lowi'l' fi\>U'. two rounded
llii|.s. Tim o\ii are ),ol.VK('iial.
:(. Anoplocephala (T.) nianiillana: Only I .. im. ionj^ ami I (i inin. wide. Tim
oval HiicluM'H round on a Hpliericiil licad are |ii(i\inia lanceolata; D. setigera, D. fasciata.
In ducks: Drepanidiotsenia anatina; D. gracilis; D. sinuosa; D. megalops; D.
coronula ; D. conica ; Mesocestoides inbutif ormis. The larvae live in water arthropodes.
In turkeys: Drepanidiottenia cantaniana.
In pigeons: almost exclusively Davainea (T.) crassula.
Symptoms. As a rule the presence only of numerous tape-
worms brings about morbid symptoms in fowl. The animals
are then less lively, without appetite, or they eat, on the con-
trary, quite a lot of feed, but they emaciate in spite of this ; later
on there is diarrhea, and the animals then become completely
exhausted. There are also cases when death comes on quite un-
expectedly and where a postmortem examination shows the pres-
ence of numerous tapeworms; in other cases there are attacks
of dizziness, epileptiform convulsions, caused by marked inflam-
mation, obstruction or perforation of the intestine.
In a tapeworm epizootic among geese imported from Eussia, Cammerer noticed
nervous symptoms aside from emaciation and diarrhea. The animals became feeble
and their movements awkward; they kept on sitting quietly from the 4th or 5th
day of the disease, and permitted themselves to be caught without making any
effort to escape. On the 7th day they assumed a position like j^enguins, with the
head immobilized and directed to one point or resting upon the sternum. From
time to time the animals made an effort, fell, however, upon their abdomen and
then remained in this position or on their side, or they again rose by the aid of
their wings into the penguin position.
Diagnosis. Tapeworm disease can be reliably diagnosti-
cated only by finding the proglottides in the feces, otherwise
postmortem examination only can demonstrate the cause of the
affection.
Treatment. The treatment consists in the administration
of vermifuges, which are best given in the form of pills. The
most appropriate are: arecanut (pigeons 1 gm., chickens 2 gm.,
geese 4 gm., young animals 1-3 to 1-2 of those doses) ; this
474 Worms ill the Jiitcsliual Tract.
drug easily leads to syinptoins of poisoning in turkeys ; kamala
in the same doses as the preceding vermifuge; P^llinger found
kamala dangerous for geese: floi"es kusso (l-o gm.) ; sulphate
of copper (blue co})per vitriol in 2% solution 10-20 drops, or a
solution of 1-5 to 1000 given as drinking water) ; oil of turpen-
tine (0.25-1.0 with mucilage or oil). Seeds of pumpkin may be
given to chickens. All these drugs, however, sometimes fail on
account of the small size of fowl tapeworms, and on account of
their protected situation deep down in the cecal pouches.
As a prophylactic measure the droppings of sick birds
should be swept together daily and burned or buried; water
fowl should be kept away from infected ])odies of water ; or one
might, perhaps, attempt to kill the intermediary hosts by the
addition of disinfecting substances (lime) to the water.
Literature. Blanchard, Bull, de la soe. zool., 1891. — Caparini, Clin, vet., 1906,
841._Fuhnnann, Cbl. f. Bakt., 1909, XLIX, 94.— Klee, Vet. Jhb., 1905, 363.—
Poenarii, Arh. vet., 1906, 279.— Stiles & Hassal, Vet. Jhb., 1S97, 196.— Wolffhiigel,
Beitr. Zur Keiintnis d. Vogelhelininthen. Inaug. Diss., 1906 (Lit.). — Zurn, Z. f. Tm.,
1898, II, 447 (Eef.).
B. Trematodes.
{Sauf/wiirmer [German] .)
Trematodes are hermaphroditic single worms in the shape of a
leaf or tongue, with an intestinal tract ending blind, and with organs
for attachment. The latter as a rule consist of a mouth sucker and
a more caudally situated abdominal sucker.
Few trematodes live in the intestinal tract of domestic animals,
and these few species are rarely found ; they are of no clinical signifi-
cance in the temperate zone. The following are the intestinal tre-
matodes so far observed :
1. Aniphistoma collinsi, redworm, found in large nundjers in India in the
large intestine of horses and causing serious disease.
2. Gastrodiseus segyptiaeus, flatworni of the size of a bean, occurs in some
parts of Egypt in the gastro-intestinal tract of horses and cattle.
3. Aniphistoma tuberculatum has been found in the intestinal tract of Indian
cattle.
4. Hemistoma alatum, 3 to 6 mm. long, leaf shaped, flatworni with two thorn -
like projections at the anterior end. Occurs frequently among wolves and foxes,
rarely in dogs.
5. Echinostomum perfoliatum, 4 to 15 mm. long, reddish with a lancet-shaped
body; its wide kie .gallstone in the common
duct or in the neck of the gall bladder produces cramp-like
contractions of the wall of the duct. In this way horses and
occasionally cattle are attacked with colic-like pains (gallstone
colic). These pains may persist with remissions for some days
and then disappear. The colic is sometimes associated with
loss of consciousness (Birnbaum, Lewin).
On the second or third day of the attack, and in some cases
earlier, there is biliary pigmentation of the mucous membranes
which appears suddenly with the onset of pain, and disappears
as quickly when the pain ceases. In cases in wiiich the neck of
the gall bladder is obstructed there may be no evidence of jaun-
dice. During the attacks of colic there is a rise of tempera-
ture. The pulse may be either rapid and small or slow and
full, and not rarely irregular. In addition to the constipation
and diarrhea vomiting is seen in the dog. Wyssmann ol)served
sjanptoms of hemorrhagic nephritis in a horse.
The simultaneous occurrence of colic, jaundice, great de-
pression, and weak pulse affords the best indication as to the
nature of the condition, especially when the attacks of colic
are repeated at intervals. The sensitiveness to pressure and
the enlargement of the liver Avhicli can often be demonstrated
in these cases are of value for diagnosis. If the gallstone does
not move further, the jaundice gradually increases until the
patient finally dies showing symptoms of cholemia (see page
567.) Rupture of the gall bladder is followed by sudden col-
lapse, the animal dying in the course of one to two days from
acute peritonitis (Mollereau & Cagny). In a cow that had
died suddenly, Kohlhepp found intestinal contents in the great-
ly dilated gall bladder.
Treatment. During the attacks of colic, narcotics, such as
morphia, injected subcutaneously, chloral hydrate per os or per
anum, and inhalation of chloroform are indicated. Mild pur-
gatives, such as olive oil, are likely to assist in moving the stone
by causing an immediate increase in the flow of l)ile. Para-
scandolo removed a gallstone from the bile duct of a dog by
laparotomy, recovery being established in four weeks.
For the prevention of the formation of fresh stones, mod-
erate diet and plenty of exercise associated with an extended
course of neutral salts are indicated.
Literature. Eherhard, B. t. W., 1905, 116.— Frohner, Monh., 1894, V, 61.—
Kohlhepp, B. Alt., 1905, 100.— Lewin, Z. f. Vk., 1905, 62.— Parascandolo, A. f. Tk.,
1902, XXVTTT, 484.— Trolldenier, Monh., 1904, XV, 193 (Lit.).— Wyssmann, Schw.
A., 1906, XLVIII, 89 (Lit.).
Foreign Bodies in the Liver and Bile Ducts. Occasionally pointed
foreign Indies perforate the reticulum or ahoniasura and penetrate into
the liver. This as a rule leads to the formation of an abscess in the
liver and the animal presents the symptoms of traumatic gastritis
and purulent hepatitis. Saint-Cyr found the straw of a leguminous
Fatty Liver. 513
plant in the liver of a horse. Megiiin records a case in which he found
some awns of barley which had ol)viously come from either the stoma(;li
or duodenum lying lengthwise in the gastro-hepatic ligament. In the
first case, the straw perforated the portal vein and caused thrombosis,
and in the second, death was due to hemorrhage. On three occasions
Cadeac and Blanc found a needle in the liver of dogs. One of these
showed symptoms resembling those of rallies.
In the l)ile-ducts of oxen, pigs and horses large (luantities of sand
are sometimes found. This is due to the ingestion of dirty food. In
a case recorded bv Augenheister the greatlv dilated bile-ducts con-
tained 10 lbs. of sand.— (Guillebeau, Schw." A., 1900, XLII. 248.—
Miiller, S. B., 1903 260.)
3. Fatty Liver. Hepar adiposum.
{Fatty Degeneration and Infiltration of the Liver.)
Etiology. Tlie following factors may lead to an increase
in the fat content of the liver : Very rich diet in the process of
fattening, which is best seen in birds, insufficient exercise, di-
minished oxidation in the body brought about by anemia. On
the other hand, the liver often liecomes fatty when there is
sudden wasting of an animal as in diabetes mellitus and in cer-
tain diseases which run a rapid course. In these cases large
quantities of fat are reabsorjjed from the fat-containing tissues
by the liver, and then gradually consumed.
In many cases fatty liver is caused liy noxious chemical
materials which are either absorl)ed from the alimentary canal
or are circulating in the blood. The principal of these are the
bacterial toxins, fatty liver being a frequent lesion in acute
infectious diseases. Acute yellow atrophy of the liver is appar-
ently due to bacterial toxins. Certain poisonous plants produce
the same effect. Fatty liver may be associated with gastro-
enteritis, due to the ingestion of mouldy fodder. The effect
of lupines in this connection is remarkable. Of the mineral
poisons arsenic, antimony, lead and phosphorus are the prin-
cipal causes and especially the latter. The chief organic com-
pounds that cause fatty liver are carbolic acid and alcohol.
Pathogenesis. Recent investigations have shown that in
the process of fattening, obesity, sudden emaciation and in
poisoning by various substances the fat is brought to the liver
either from the food material or from the adipose connective
tissues of the body. The noxious chemical substances cause a
sudden and extensive disintegration of the tissues with the
result that a large amount of the reserve body fat is in a
condition for absorption and this is stored up for a time in
the liver. These substances also have an effect upon the liver
cells rendering them inactive and thus unable to deal with the
fat brought to the liver or to oxidize the partly synthesized fat.
The disturbance of the functions of the liver, owing to the
5l4 Fatly Liver.
jji-eseiifo of a large anioiiiit of stored up fat, is greatest after
tliere lias been a very large quantity stored. Where the fatty
condition of the liver is due to chemical substances there is a
derangement of function and of nutrition of the liver from the
very outset, this being due to the action of the chemical sub-
stance and not to the fat. In view of the fact that these sub-
stances cause considerable disintegration of the protein sub-
stances of the cells it is possil)le that a portion of the fat is
derived from the disintegrated proteins. Many authors deny
this possibility (F. Miiller, Pfluger).
It was at one time customary to describe two forms of fatty
liver; fatty infiltration, in which the fat was brought to the liver
from without, and fatty degeneration in which there was an
actual change in the protoplasm of the cell resulting in the
production of fat. This distinction is now no longer possible.
It would be better to distinguish l)etween a process whereby the
liver becomes fatty that is associated with destruction of the
liver cells and one in which the liver becomes fatty that is not
associated with any cell destruction.
Eosenfeld fed dogs experimentally for long periods with mutton suet and
after a period of starvation poisoned them witli phos{)horus. Chemical analysis
proved that the fat contained in the liver was mutton fat. Fowls that had been
starved until they had lost practically all their fat showed no fatty changes in the
liver when poisoned with phosphorus.
Anatomical Changes. The liver appears pale-yellow and
in severe cases may be as yellow as butter or ochre. In the
early stages the peripheral parts of the lobes are yellow. In
advanced cases the entire liver is intensely yellow in color. The
absence of a greenish tint excludes the possil)ility that the dis-
coloration is due to bile. The liver is enlarged (Neyraud saw a
horse's liver that weighed 14 kilos; and Kitt, a pig's liver
weighing 14.8 kilos), the edges are rounded, the consistency
is decreased, it feels greasy to the touch and pits made by
pressure with the finger persist. On cutting into it the blade
of the knife is found to be covered with a layer of fat. In
cases in which the protoplasm of the liver cells is involved the
liver may be actually smaller than normal on account of the
absorption of the destroyed liver cells. Evidences of this de-
struction can be seen under the microscope.
Symptoms. A fatty condition of the liver may be suspected
when the predisposing factors are in operation and the liver
is enlarged without there being any other symptoms of disease
of that organ. When the liver is enlarged there is an increased
area of hepatic dullness, and the edges of the organ can be
palpated. If the animal be very fat it is generally impossible
to ascertain whether the liver is enlarged but the general con-
dition of the animal makes it extremely likely that the liver
is fatty. In the horse, digestive disturbances and particularly
constipation are generally observed.
Treatment. Amyloid Disease of the Liver, 515
Occasionally fatty livers rupture aud the animals die suddenly as a result of
internal hemorrhage. There is sometimes slight abdominal pain (Neyraud). Neale
records a number of cases in Shropshire sheep which ended fatally after a sliort
illness and in which the only lesion found at the postmortem was extreme fatty infil-
tration of the liver. Rupture of the liver is especially frequent in well-nourished
fowls and geese (Johne).
Treatment. The treatment iinist l)e adapted to tlie nature
of the case.
Literature. Johne, S. B., 1879, 49.— Neyraud, J. Vet., 1892, 400.— 'Rievel
D. t. W., 1906, 49 (Lit.).
4. Amyloid Disease of the Liver. Degeneratio amyloidea
hepatis.
{Hepar amyloldeum, Amyloidosis hepatis.)
Etiology. Amyloid degeneration of the liver and other or-
gans occurs usually in protracted, exhausting diseases. In the
horse, in which animal it is most frequently seen, it occurs in
cases of chronic inflammation of the serous membranes, par-
ticularly of the pleura.
As regards the frequency of the condition in the horse,
Bold found amyloid liver in 4 per cent of all the horses exam-
ined postmortem. Rabe found amyloid degeneration of the
liver in practically 50 per cent of horses that had suffered from
chronic diseases of the serous membranes. The degeneration
also occurs in cases of bronchial catarrh, chronic interstitial
pneumonia, glanders and, exceptionally, occlusion of the bile
ducts. The observation of E. Noyer and Griiner regarding
the special part played by certain infectious diseases in the pro-
duction of amyloid liver are very interesting.
E. Noyer observed amyloid degeneration of the liver followed by rupture of
that organ in about 20% of horses used for the production of diphtheria serum.
Griiner found amyloid liver in every one of 46 horses that had died from contagious
pleuro-pneumonia. On the other hand the very rare occurrence of amyloid liver in
the domesticated animals has been recorded by Joest, Pflug, Forster, Paulicky and
Hissbach.
Rabe observed the condition in a bitch in connection with
carcinoma of the mamma ; Bruckmiiller, in cattle, as the result
of tuberculosis and chronic nephritis, and Ries in lymphan-
gioitis. Chronic suppuration, especially when it involves bone,
and chronic abscesses may also cause amyloid degeneration.
Attempts have been made to clear up the etiology of amyloid degeneration by
experimental investigation. The first experiments were made by Krawkow, who
gave dogs, rabbits, fowls and pigeons repeated subcutaneous inoeculations of cul-
tures of the straphylococcus pyogenes aureus. Pronounced amyloid degeneration
was produced and especially in the liver. The degeneration was also produced when
the chemical substances produced in the cultures were used for the inoeculations,
and in one case the systematic introduction into the body of the toxins of the bacillus
pyocyaneus was followed by amyloid disease. The experiments were repeated by
516 Amyloid Disease of the Liver.
Maximow with similar results and Davidsohn 's results with ral)bits, giunea pigs,
mice and fowls wore also positive. Lubarsch was able to i)rodu('e amyloid degenera-
tion in 3 or 4 weeks in rabbits and dogs by systematic subcutaneous injections of
oil of turpentine (suppuration!).
The nature of the change in amyloid degeneration has not been definitely
settled up to the present nor has it been determined how the amyloid material,
which possesses some of the characters of proteins, is produced. It is not known
whether the material is elaborated in the liver or whether it is brought to the liver
by the blood. The former view appears to be the more probable, the theory being
that the cells are in a cachectic condition and are therefore una])le to deal with
the proteid materials, which are consequently left in the tissue spaces and become
converted into amyloid material (Wichmann). On the other hand the observations
of Noyer and Griiner indicate that amyloid degeneration is the result of injurious
effects exercised upon the tissue cells by certain poisons.
Anatomical Changes. The liver is the organ that is most
commonly affected. In cases where the degeneration is ex-
tensive the liver may be enlarged three to four times. The
edges appear thick and ronnded, and tlie capsule is often con-
siderably thickened. The color varies from light l)rown to
yellow or gray. The lobulation is distinct because the periph-
eral part of each lobule is pale grayish-red and lardaceous,
the central 'portion being pale brownish-red, grayisli-l)rown, or
occasionally yellow. The consistency is more or less doughlike,
and in the later stages crumbling "like half-dried mortar. In
birds amyloid liver is granular and brittle. In the early stages
no abnormalities save slight enlargement, distinct lobulation
and pale color are observed.
Amyloid material may be demonstrated in affected organs by its color re-
actions. The application of Lugol 's solution for a few minutes to the cut surface
stains the degenerated parts mahogany-brown. The same test may be applied to
microscoi>e sections, the color being changed to a dirty violet or bluish-red by the
addition of 2'/f sulphuric aciosition of tlie liver-abscess Grififault advises punc-
ture in the Kith or 17th intercostal space close under tlie costal arch. The operation
is not without danger as infection of the iieritoneuni is likely to occur if the abscess
is superficially placed.
Treatment. Internal treatment is utterly useless. If the
diagnosis be sufficiently certain, surgical intervention may be
attempted.
Griffault operated as follows: An incision was made through the abdominal
wall as far as the peritoneum, immediately below the costal arch on the right
side. The peritoneum was tlien approached to Glisson's capsule so that its inner
surface was in contact with the abscess wall. The abscess cavity was drained and
washed out and a bandage ajiplied. In this way two animals were cured.
Literature. Albrecht, W. f. Tk., 1S98, 1. Biirgi, Cbl. f. Bakt., XXXIX, 549;
1906, XL, 79.— Griffanlt, Bull., 1904, 81, 402.— Kiinnemann, A. f. Tk., 1903, XXIX,
128.— Lisi, N. ErcoL, 1907, 49.— Mouilleron & Chautfart, Rec, 1906, 25.— Schumann,
Unters. iib. Abszesse in d. Leber, d. Kalbes. Diss. Leipzig, 1908 (Lit.).
10. Nodular Necrosis of the Liver. Necrosis nodosa multiplex
hepatis.
Nodular necrosis of the liver is characterized l)y the pres-
ence of tumor-like, dry nodules in the liver substance, which
undergo a process of gradual softening from the periphery.
Occurrence. The disease is of very frequent occurrence in
cattle. Cases in the sheep are more rare, and in the horse, pig
and dog quite exceptional. In the sheep it sometimes occurs as
an enzootic (Berndt).
Etiology. As shown by the investigations of McFadyean,
Bang, Schiitz, Kitt and Meyer, the cause of the condition is the
necrosis bacillus (Bang).
In natural cases the liver becomes infected by way of the
lilood stream. In most cases the bacillus reaches the portal blood
from the intestine. It is not essential that any lesion should be
produced in the mucous membrane. In new-born calves infec-
tion may take place by way of the umbilical vein. In 15 cows
examined by Berndt, either just l)efore or just after calving, the
bacillus could be found in the diseased uterus. In certain cases
a connection can be established between the disease and tjie use
of very dusty or mouldy food, or the stabling of the animals in
dirty stables.
Pathogenesis. Anatomical Changes. Sj'uiptonis. 529
Eisenmann found necrotic foci in tlie liver associated with chronic inflam-
mation in some eases of swine erysipelas. Caseous foci are sometimes found in
the liver of sheep and calves due to pseudo-tubercle bacilli. These foci bear consider-
able resemblance to necrotic lesions in the process of softening.
Pathogenesis. The necrosis bacillus is generally arrested
in the smallest branches of the portal vein, or occasionally in
the hepatic artery. Multiplication takes place there and the
bacilli pass through the vessel wall and penetrate into the sur-
rounding liver tissue. The center of the lesion gradually be-
comes necrotic and the bacilli are to be found in the peripheral
parts arranged in radiating bundles of filaments. An inflamma-
tory reaction sets in around the necrotic area, produced in part
by the products of tissue destruction and bacterial toxin and in
part by the necrotic tissue acting as a foreign l)ody (Mc-
Fadyean).
Anatomical Changes. The liver, which may be more or less
enlarged, is either normal or slightly yellowish in color. The sur-
face of the organ shows sharply defined rounded protuberances
of a light brown or yellow color. These are of a firmer con-
sistency than the surrounding tissue. The capsule of the liver
covering the superficially placed nodules is thickened and cov-
ered with a thick layer of fibrin. Some of the superficial nodules
may be eroded and covered with a purulent liquid. There is
often secondary sero-fibrinous peritonitis, which is most marked
in the neighborhood of the liver.
When the disease has been in existence for a long period
the nodules comprise a dry necrotic center, a zone in which the
inflammatory reaction has produced softening and an external
capsule of fibrous tissue. Finally the central part becomes con-
verted into a viscous yellow material resembling pus, and is
surrounded by a fibrous capsule which may measure 3 mm. in
thickness.
In cases of chronic swine erysipelas Eisenmann found the liver reduced in
size and beset with white or yellowish centers.
Symptoms. According to Berndt the symptoms are inap-
petence, high fever, weakness and painfulness of the liver. The
animals move with difficulty, respiration is accelerated and
shallow, pressure over the liver causes pain. After three days
the animals become very weak and lie down continuously. Res-
piration is very rapid and difficult, tliere is constipation fol-
lowed by diarrhea, the ,al)domen is joainful, the temperature
falls, jaundice sets in and the animals soon die. Otto saw two
cases in which there were s^anptoms resembling those- of par-
turient paralysis after the disease had been in existence for 1
to 11/^ weeks.
In cases where the number of lesions is small, or where sub-
sequent processes are less rapid, the symptoms are not severe or
there may be no evidence of any disturbance of health.
530 Chronic Interstitial Hepatitis.
Diagnosis. If no suppurative process can be discovered in
any otlier part of the body and if the cow be in the last stages of
pregnancy, or just calved, the symptoms already described (pain
on pressure over the region of the liver, jaundice, and later evi-
dence of peritonitis), justify a suspicion that the disease is in
existence. It is, however, difficult to arrive at a certain diagnosis
or to exclude the possibility of purulent or pseudotuberculous
hepatitis.
Treatment. Treatment has so far proved useless and the
immediate slaughter of the animal is indicated.
Literature. Benidt, A. f. Tk., 1895, XXT, 104; Pr. Vb., 1903, II, 35.— Eisen-
mann, Monh., 1907, XVII, 97. — McFadyean, J. of comp. Path., 1891, 46. — Meyer,
Unters, lib. d. multiple Nekrose d. Leber d. Eindes, Inaiig. Diss. 1903 (Lit.). — Otto,
S. B., 1899, 88.— Storch, Pr. Vb., 1903, 36.
11. Chronic Interstitial Hepatitis. Hepatitis interstitialis
diffusa chronica.
( Cirrhosis hepa tis. )
This condition consists essentially in a proliferation of the
interstitial tissue at the expense of the liver substance. In some
cases the new fibrous tissue does not contract, either for a long
time or at all, and atrophy of the liver substance is seen only at
places (hepatitis indurativa hyperplastica). In other cases there
is an early shrinkage of the connective tissue and a consequent
reduction in size of the liver and destruction of liver parenchyma
(cirrhosis atrophica hepatitis).
Occurrence. In certain districts the disease is of frequent
occurrence and not rarely there are outbreaks, causing great
losses, since, sooner or later it has a fatal termination. Large
numbers of cases are observed under certain conditions. Besides
these, large numbers of cases are due to the migrations of ani-
mal parasites, especially in pigs, sheep and oxen. Otherwise,
the disease is sporadic in all animals.
The form of chronic hepatitis known as ' ' Schweinsberg Disease ' ' was first
observed in Schweinsberg, Ohmtal. Since then it has been seen in some districts in
Bavaria and the Ehine provinces. The disease varies in severity from year to
year and attacks freshly imported horses more frequently than native ones. In
South Africa the disease occurs among horses and cattle, both sporadically and as
an epizootic (Eobertson). In New Zealand it is known under the name "Winton's
Disease" (Gilriith), in Nova Scotia as " Pictou Cattle Disease" (Wyath- Johnston),
and in South Dakota as "Bottom Disease" (Schroder, Smith).
Etiology. There is no doubt that the long continued ad-
ministration of poisonous materials produces primary chronic
hepatitis. In this connection plants used for food call for special
consideration. These plants in swampy districts contain some
poisonous material, the nature of which is not yet known. The
Etiology. 531
socalled * ' Schweinsberg Disease" was seen only in horses that
liad grazed on lands which are often flooded, or that had received
food grown on snch land, while the farms on higher gronnd
in the same district never had cases of the disease or suffered
only to a slight extent. The plants grown in these districts
contain some substance that is irritating to the liver tissue.
Schlegel and Adelmann have recently shown that the disease
may be no more than a generalized sclerostomiasis, and that the
chronic inflammatory changes in the liver are produced by the
migrations of the larv« of sclerostomes.
The idea that certain plants contain substances capable of
causing chronic hepatitis does not agree with the experience ob-
tained with regard to chronic lupinosis. However, the disease has
been observed after long continued feeding with several plants
of the Senecio group (S. Jacobea, S. latifolia, S. Burchelli)
in New Zealand, North America and South America (Smith,
Gilruth, Robertson, Wyath-Johnston, Schroder), and it has been
set up experimentally in cattle and horses by Gilruth and Rob-
ertson. Guittard has observed chronic hepatitis in geese fat-
tened on maize.
Gilruth fed two six-nionths-old calves on six pounds of S. Jacobea daily.
Both calves died at the end of four weeks. To the naked eye their livers appeared
unaltered but under the microscope there could be detected a perivascular connective
tissue, slight thickening of the capsule and coniuiencing destruction of the liver
cells.
Eobertson experimented with calves, adult bovines and horses, and found that
the administration of large quantities of S. Burchelli and latifolia caused gastro-
enteritis and venous hyperemia of the liver in a few days, while small quantities
fed over a period of weeks caused atrophic cirrhosis of the liver.
Since chronic hepatitis is frequently met with in people
addicted to alcohol, the idea suggests itself that alcohol may be
the cause of the disease in animals, in as much as it is present
in the swill tub. One must not lose sight of the effect of fer-
mentation products that may be formed in this food during stor-
age ; and especially, as it has been shown by v. Baumgarten and
Hansemann to be impossible to produce chronic hepatitis in
experimental animals by the systematic introduction of alcohol
into their bodies, either by subcutaneous injection or by inges-
tion.
In certain cases the disease is set up by chemical substances
contained in rotten or mouldy food, or by certain digestive dis-
orders of the alimentary canal itself. Of 350 pigs killed, be-
longing to innkeepers and brewers, Tschauner found 13 af-
fected, but out of 5,700 farm pigs killed at the same time, only
3 were found similarly diseased. The former had been fed on
the waste (potato peelings, etc.). Possibly the small percentage
of alcohol present among the fermentation products played some
part in the production of the disease. In a case described by
Begeng the disease was causally connected with a chronic gas-
tro-enteritis. Begeng agrees with Siegenbeck van Henkelom
that hypertrophic cirrhosis of the liver is produced by toxic
582 Chronic Interstitial Hepatitis.
materials present in tlie intestine, wliicii are conveyed to tlie
liver by the portal blood and set up irritation, causing prolifera-
tion of the connective tissue.
Krawkow was able to cause cirrhosis of the liver in experimental animals with
broth made from putrid horse tiesh. Boix had positive results with the sub-
cutaneous inoculations of monobasic fatty acids which tend to be formed by ab-
normal fermentative processes in the intestine.
Disease viruses are probably common causes of chronic
hepatitis. Joest produced a condition resembling- the Schweins-
berg disease, both clinically and as regards the lesions by long
continued injections of the bacillus suisepticus. Pronounced
lesions of chronic hepatitis were observed by Eisenmann in sev-
eral cases of swine erysipelas, and similar lesions may be
sequels to infectious diseases (post-infectious chronic hepatitis).
Langer found in calves' livers numerous necrotic foci often associated with
cellular infiltration, which closely resembled those seen in the human subject in
typhoid, cholera, scarlatina and measles. From these nodules a bacillus of the
typhoid type was cultivated (bacillus nodulifaeiens bovis), the cultures of which
produced similar nodules in the livers and kidneys of mice, guinea pigs and a calf.
Dantschakowa produced chronic induration of the liver in rabbits by repeated
subcutaneous inoculations of the staphylococcus pyogenes aureus at intervals of
4 days in 7 to 15 weeks. This was followed by a localized small-celled infiltration
and the development of a collagenic tissue in the center of the lesions and peripheral
extension of the infiltration.
Finally certain infectious diseases and poisons are capable
of setting up chronic cirrhosis of the liver.
The disease is very frequenth^ seen as a secondary con-
dition. It is caused principally by animal parasites (fluke, Cysti-
cercus tenuicollis, and the larvaB of sclerostomes). The sheep
and pig are affected chiefly, but it is also met with in calves,
horses and ral)bits. As already mentioned, Schlegel and Adel-
mann look upon the Schweinsberg disease as a generalized
sclerostomiasis (see page 530). The formation of fibrous tissue
is due partly to the destruction of liver tissue and partly to
toxic materials elaborated by the parasites themselves, particu-
larly the fluke.
Chronic hepatitis may be caused through chronic inflamma-
tion of the walls of the bile ducts arresting the flow of bile, and
by extension of the inflammatory process from the inter- and
intra-lobular bile ducts to the interstitial tissue, the amount of
connective tissue being increased. Engorgement with l)ile may
lead to impairment of the nutrition of the epithelium of the bile
ducts, and this may be followed by a bacterial invasion and so
cause a production of fi])rous tissue in the surrounding liver
tissue, or the tissue production may be due to the ill-effects of
the biliary engorgement on the liver cells themselves.
Purulent foci and tuberculous lesions may cause not only
cirrhosis in their inmiediate neighborhood, l)ut a diffuse lesion
throughout the liver.
Chronic venous congestion caused by certain diseases of the
Etiology. Pathogenesis. 533
heart and lungs, or by pressure on the posterior vena cava, may
cause not only dilatation of the hepatic vessels (nutmeg liver)
and an atrophy of the liver cells, but also an increase in the
amount of connective tissue. Chronic hepatitis may also be seen
in cases of thrombosis of the portal vein, which may either be
due to the derangement of the liver parench;^aua or may be
the result of the cirrhosis, Avliich has some previous cause.
Bleiehroder considers that the chronic hepatitis seen in the human subject as
a sequel to diseases oi" the blood originating in the portal area is produced in the
following manner. The blood in the portal vein has poured into it an enormous
number of lymphocytes from the spleen, these are deposited in the liver and lead
to the production of new connective tissue. This process would explain the en-
largement of the spleen which is suggestive of an infectious disease. The jaundice
is due to extensive destruction of red blood corpuscles and must therefore be con-
sidered as a pleioehromic icterus. The socalled Banti 's disease of the human subject,
the symptoms of which are anemia, enlargement of the spleen, ascites, increased
urobilin-content of the urine and frequently cirrhosis of the liver, is also possibly
brought about in this way.
Pathogenesis. When cirrhosis of the liver is due to some
irritant circulating in the portal blood, the process starts in the
interlobular branches. There is a cellular infiltration followed
by the formation of connective tissue. In this way the amount
of connective tissue surrounding several lobules becomes in-
creased in amount. By the subsequent shrinking of this tissue
the included lobules and the branches of the portal vein ramify-
ing in the proliferating tissue are subjected to pressure. De-
generation and sometimes necrosis and destruction of the liver
tissue follows, partly owing to the constant pressure exerted by
the contracting tissue and partly owing to the olistruction of the
larger vessels. In the later stages the connective tissue pene-
trates into tlie interior of the lobules.
Irritants in the bile ducts lead to the production of the in-
flammatory changes in their immediate neighborliood (cholan-
gioitic cirrhosis). As shown by Jiiger's extensive investigations
regarding cirrhosis due to flukes (q. v.), the inflammatory pro-
cess starts in the angle between adjacent lobules, either_ as a
cholangioitis or as a cellular infiltration of the connective tissue.
The process extends along the interlobular septa, following the
lymph stream, and finally attacks the peripheral parts of the
lobules. Localized cirrhosis appears to be caused in this way.
In some cases contraction of the connective tissue is delayed
or does not occur at all, but even in these cases there is com-
pression of the interlobular blood vessels.
In Schweinsberg disease of the horse, the inflammation in-
volves the liver parenchyma and especially the blood vessels,
producing a perilobular hypertrophic cirrhosis (Mugler). Kitt
formerly described the disease as a chronic parenchjanatous
hepatitis, with secondary formation of connective tissue.
In chronic venous congestion of the liver, the formation of
connective tissue commences around the hepatic and central
veins and then extends to the interlobular spaces.
534 Chronic Interstitial Hepatitis.
If the contraction of the connective tissue involves a large
number of capillaries and other vessels, the transverse area of
the blood path is greatly diminished and there is consequently
congestion in the portal area. Compression or obstruction of
the bile ducts, especially in certain forms of cholangioitic cir-
rhosis, leads to biliary congestion. The destruction of the liver
cells affects not only the secretion of bile and the metabolism
of the body, but may also induce s3^nptoms of poisoning. In
many cases new bile ducts are formed by a process of budding
from preexisting ducts.
Anatomical Changes. In cases where the connective tissue
has contracted, the liver has a tough and, in the later stages,
a leather-like consistency. When cut into the tissue grates
under the knife. At the outset there may be no visible reduc-
tion in the size of the organ and, in fact, it may be a little en-
larged. In the later stages the reduction becomes more and
more marked, until the liver may be only one half the normal
weight. The surface appears irregular and granular. In some
cases the surface is nodular. The serous covering may be thick-
ened at places and the edges may be formed simply of a double
fold of peritoneum. On the cut surface the compressed lobules
stand out like small granules against the pale red or grayish-
white connective tissue, which forms a wide network around
either groups of lobules or individual lobules. These granules
appear of a faint or deep yellow color, with a tinge of green, on
account of the fat and pigments contained in the liver cells. At
a distance the whole organ looks yellow.
According to Kitt the liver in cases of Schweinsberg disease is at first enlarged,
its surface uneven and of a reddish-brown or gray color resembling porphyry or
granite. With the development and shrinking of the connective tissue the condition
known as ' ' granular atrophy ' ' is produced.
In other forms of chronic interstitial hepatitis the liver
appears enlarged. The outer surface and the cut surface ap-
pear smooth, or at most somewhat granular and deep yel-
low or greenish-yellow in color (cirrhosis hypertrophica s, hy-
perplastica). Livers so affected may weigh as much as 20 kilos
in the horse and 20-25 kilos in the ox. Adam observed one
case in an ox in which the liver weighed 15.0 kilos (Kitt). In
the dog cirrhosis of the liver is frequently associated with fatty
degeneration.
In calves still another form of hepatitis is seen, characterized by a diffuse
production of connective tissue and by degeneration of the parenchyma. . Tn such
cases the liver is tough and firm, yellowish-red or fiesh-like in color and covered
with whitish spots and streaks. Tliere is acute swelling of the neighboring lym-
phatic glands.
Eauscher recognized the following types of chronic hepatitis:
1. Diffuse induration, including the socalled "porphyry liver," the enlarged,
leaden colored livers seen in cases of distomatosis, and the nutmeg and cirrhotic
livers seen in Schweinsberg disease.
Anatomical Changes. Symptoms. 535
2. Nodular induration with irregularities of the surface as large as hens'
eggs (hobnail liver of the ox and lobulated liver of the piy).
3 Granular atrophy, seen in the dog, ox and pig. ...
4 Cicatrized liver, seen in cattle and sheep and due to the cicatrization of
burrow's in the liver tissue made by parasites (Cysticercus tenuicollis and distonios).
5. Nodular fatty liver (dog), characterized by the formation of nodules as
large as hazelnuts or larger, and fatty degeneration and jaundice of the liver.
Evidence of congestion of the portal area and jaundice com-
plete the list of lesions. In Schweinsberg disease, pronounced
catarrhal gastritis is a constant lesion.
Symptoms. The onset of the disease is unnoticed as a rule
and even in later stages the symptoms are frequently only
those of an indefinite digestive disorder. Capricious appetite,
gaping and vomiting (observed l)y Moens in the horse) indicate
severe 2-astric catarrh. There may be either constipation or
Fig. 67. Enlargement of the area of hepatic dulness in chronic hepatitis in the horse.
Tlie area enclosed by the line indicates the area of duiness, the white dots the costal
arch, and the numbers indicate the position of the corresponding ribs. The liver in
this case weighed 19.7 kilos.
diarrhea. Horses show symptoms of colic after eating large
quantities of coarse food (especially straw mixed with dung)
causing dilatation of the stomach (Imminger). In cases in cat-
tle, caused by plants of the genus Senecio, there is severe di-
arrhea, tenesmus and often in consequence prolapse of the rec-
tum. Horses show s;^^nptoms of "sleepy staggers." Persis-
tence of these SJ^nptoms causes the animal to lose condition.
The mucous membranes appear pale and sometimes yellow. In
Schweinsberg disease there may be early congestion of the niu-
cous membranes. The skin is dry and its elasticity is dimin-
ished. The coat is rough and there is progressive wasting.
Animals lose their energy, tire easily and show signs of broken
wind.
The enlargement of the liver is only exceptionally sufficient
to cause it to encroach upon the hypochondriac region. In the
536
Chronic Interstitial Hepatitis.
liorse, carnivora and swine, tins encroachment may be bilateral
but in the ox it is only on the right side and then only as far
as the anterior part of the hollow of the flank. Similarly it is
only very exceptionally that the enlargement is sufficient to
allow of palpation of tlie organ per rectum. In these cases it
can be felt in the neighborhood of the last rib as a firm object
lying against the abdominal wall and moving in concert with
tlie respirations. Far more frequently in cattle the upper bor-
der of the enlarged liver can be felt by pressing inwards with
the fingers behind the last rib. In carnivora and emaciated
swine the liver can be felt through the abdominal wall under
both costal arches, in calves and small ruminants under the
right costal arch only. The hepatic area is very susceptible to
pressure, animals experiencing difficulty and exercising great
care in turning.
Fig. 68. Enlargement of the area of hepatic dulness in a cow due to chronic hepa-
titis. A. Normal area. B. Enlarged area. The dotted line marks the ])()sition of
the costal arch and the nund)ers indicate the corresponding ribs. The liver weighed
14.6 kilos.
An increase in the area of hepatic tlulness may be referred
without any further delay in carnivora, ruminants and swine,
to a somewhat pronounced enlargement of the liver. The same
holds good for the horse. In carnivora (figs. 69 and 70) the
enlargement extends downwards and backwards, usually reach-
ing the uml)ilical region. In ruminants (fig. 68) it extends
backw^ards and downwards to below the costal arch on the right
side, or into the anterior portion of the hollow of tlie flank. In
ruminants the normal area of dulness depends upon the qual-
ity of food in the stomachs and intestines. In the horse (fig.
67) in cases where the enlargement of the liver is considerable,
there is an area of dulness immediately behind the edge of the
Symptoms.
537
lung on the riglit side from the tenth to seventeenth intercostal
spaces. This may extend downwards to below the costal arch.
IFnder similar circumstances there is a smaller area on the left
side below the edge of the lung from the eighth to the tenth
intercostal spaces.
Fig. 69. Enlargement of the area of hepatic dulness in a dog due to chronic hepati-
tis. H. The enlarged area extending to the navel in the forward direction, as far as
the cardiac area (C). The costal arch is indicated by the dotted line. The dog was
of medium size, but the liver weighed 3 kilos.
Marked reduction in the size of the liver is sometimes in-
dicated by a decrease in the size of the area of hepatic dulness.
In these cases in the smaller animals the liver can be felt from
the costal arch only, the firm consistency and uneven surface
can, however, be appreciated.
Fig. 70. Enlargement of the area of hepatic dulness in a dog due to chronic hepati-
tis. The right side shown in Fig. 69.
Fairly frequently, and especially in dogs, there is ascites
which may persist without complications till death, or towards
the end of the disease there may be edematous swelling of the
abdominal wall and legs.
538 Chronic Interstitial Hepatitis.
Enlargement of the .spleen can be diagnosed in carnivora
and emaciated jDigs by xjalpation of the abdomen. In the horse
it may sometimes be discovered Ijy rectal examination.
In cattle, jaundice is freqnently seen, and towards the end
it is very severe. In other animals it nsnally sets in at a late
stage and is not very prononnced even then. This is quite in
accordance with the fact that the hyperplastic form of the dis-
ease is the commonest in cattle.
The specific gravity of the urine is higher, it is darker in
color and contains less uric acid than normal; but in some
cases albumin, sugar and urobilin are present. (In a liter of
urine from a horse, Mouquet found 7.25 gm. of uric acid, 0.12
gm. of albumen and 15.4 gm. of sugar. Urobilin was also
present.)
Towards the end of the disease, nervous symptoms make
tlieir appearance, the animals l^ecoming dull and lethargic. In
Schweinsberg disease and condition caused by plants of the
order Senecio, these symptoms are sometimes very severe, and
appear in the early stages. There is giddiness and unsteadi-
ness of gait, the animals lean forward with their heads against
the wall and attempt to go forwards, make gaping movements
and seem dull and sleepy. The appearance is suggestive of
staggers (Beichold, Imminger, Robertson).
In cases of secondary cirrhosis of the liver the symptoms
of the primary disease are present.
Course. The disease lasts for several months (usually
from three to six months in the case of Schweinsberg disease).
Tlie disease of the liver and the sul)sequent catarrh of the
stomach and intestine cause a loss of condition, pronounced
wasting and anemia. In the later stages there are often drop-
sical swellings. Finally in the last stages there may be hemor-
rhages in the mucous membranes, gums, skin, stomach or intes-
tines. Exceptionally rupture of the liver or dilatation of the
stomach (in the horse) may cause death unexpectedly, death
usually occurring only after the animal has reached a state of
utter exhaustion.
Diagnosis. The symptoms are never easily interpreted.
The insidious development of the disease, persistent digestive
disturl^ance, the possible presence of ascites and enlargement
of the spleen and sometimes of jaundice render diagnosis a pos-
sibility, but do not absolutely exclude the chance of error. Di-
gestive disturbances of this nature in horses in districts where
it exists suggest Schweinsberg disease. The following dis-
eased conditions of the liver cause a similar train of s\anptoms :
carcinoma of the liver in dogs (large tumorlike growths in the
liver are particularly suggestive of this), ainyloid liver in
which the organ is enlarged and firm, but its edges rounded
and smooth, peritonitis (the abdomen sensitive to pressure and
Diagnosis. Prognosis. Treatment. 539
sometimes elevation of temperature), chronic heart disease (en-
docardial sounds and evidences of congestion in various parts
of the body). In cases of ascites paracentesis abdominis should
be practiced, thus rendering thorough examination of the liver
more easy through the relaxation of the al)dominal wall.
It is rarely possible to distinguish with certainty between
hyperplastic and atrophic cirrhosis of the liver. Apart from
the changes of shape that may be ascertained by palpation and
the enlargement of the area of hepatic dulness, it may be taken
that ascites and enlargement of the spleen indicate atrophic
cirrhosis, while pronounced jaundice suggests hyperplastic
cirrhosis.
Prognosis. The disease is inevitably fatal, but there may
be temporary improvements.
Treatment. In the first place the probable cause should be
removed. The diet should receive careful attention, all sour
grasses or irritating materials should be excluded, and a change
of food should be given. Neutral salts may be tried, and the
ascites may be combatted by the administration of diuretics and
by repeated tapping. Imminger advises intratracheal injec-
tions of Lugol's solution in cases in the horse; others have had
no good results from this treatment.
Literature. .. Adelniann, Das Aneurysnia verniiii. equi etc. Diss. Giessen,
1908. — Begeng, tJber hypertroph. Granuiarzirrh. b. Eiiid. Diss. Leipzig, 1909
(Lit.). — Blanc, J. vet., 1S95, 274. — Bleichroder, V. A., CLA^I, 435. — Dantseliakowa,
Cbl. f. Bakt., 1904, XXXV (Eev.), .534.— Eisenmann, Monh., 1907, XVII, 97.—
Gilruth, The Vet., 1902, 436.— Imminger, W. f. Tk., 1889, 401, 449 (Lit.).— Jager,
A. f. Tk., 1906, XXXVI, 456.— Joest, Hb. f. p. M., 1903, III, 599.— W. Johnston,
Proe. Thirt. Ann. Conv. of the U. S. Vet. Med. Assoc, 1893, 120.— Langer, Unters.
lib. einen mit Knotchenbild. einherg. Process in d. Leber d. Kalbes. Diss. Giessen,
1904.— Marek, Z. f. Tm., 1906, X, 448.— Morot, J. Vet., 1896, 74.— Mugler, tlber
Leberzirrhose d. Pferde. Diss. Bern, 1909.— Nocard, A. d'Alf., 1877, 857.—
Putscher, B. t. W., 1881, 437.— Eaiiseher, Monh., 1905, XV, 1.— Robertson, J. of
Comp. Path., 1906, 97.— Schlegel, B. t. W., 1907, 49.— Schroder, Anini. Ind., 1891-
92, 371.— Smith, ibid., 1895-96, 180.— Tsehaiiner, Z. f. Flhyg., 1897, Vn, 164.
12. Neoplasms of the Liver. Neoplasmata hepatis.
Cancer of the Liver. Carcinoma hepatis.
Occurrence. Cancer of the liver is rare in all the domes-
tic animals but among them it is most frequently seen in the
dog.
Anatomical Changes. Primary cancer of the liver is usu-
ally adeno-carcinomatous in type. Secondary cancer of the
liver generally follows primary growths in the stomach and in-
testines, in which cases the cancer cells appear columnar as a
rule. The primary growths may also be situated in the peri-
toneum, mammary gland, pancreas or lungs. The lesions in the
liver may vary in size from a millet seed to a fist or even larg-
540 Xooplasms of the Liver.
er. They are either wliito or pale red in color. In many cases
they can be enncleated. The snperficially placed growths may
shoV a slight central depression (Krebsdelle). The cut sur-
face shows a snlphnr- or hntter-yellow network. The consis-
tency varies from that of marrow to that of fibrous tissue.
Lesions in the livers of cattle are frequently soft, and contain
a semi-fluid pulplike material, and in color they scarcely differ
from the normal liver tissue (Kitt). The portal lymphatic
glands are almost always affected. In cases of prinuiry hepatic
cancer, there is usually only a single large tumor, l)ut metastatic
lesions are almost always numerous. The weight of the organ
is increased according to the number and size of the lesions.
Chauvrat records a horse's liver weighing 21.6 kilos; van
Tricht, the liver of a cow weighing 22 kilos, and Wilhelmi, one
weighing 51 kilos.
Cases of cancer of the gall bladder have been observed (Gurlt, Bniekniiiller,
Kitt, Johne). The gall bladder is enlarged and nodidar, the wall is thick and
finii and the inner surface shows either pedunculated or sessile growths which at
places are ulcerated.
Symptoms. S>anptonis are first observed when the disease
has made some progress. There is gradual wasting and ane-
mia, the appetite is diminished, and in some cases there is
vomiting. In the dog there is striking atrophy of the muscular
system, the muscles of mastication being chiefly affected. This
gives the animal a peculiar facial expression (''Krebsgesicht,"
''Facies cancereux" [Trasbot]).
In ruminants and dogs an enlargement of the area of hep-
atic dulness can sometimes be demonstrated, or in small ani-
mals the enlarged liver may l)e felt below the costal arch. If
small nodules can l)e discovered, the suspicion is at once aroused
that the case may be one of cancer of the liver, especially
if other lesions (such as carcinoma of the mammary gland)
suggest that possibility. It must always l)e borne in mind that
tuberculous lesions in the liver may cause a similar clinical
condition and that the tuberculin test may be negative.
Nodules or growths may also be felt just behind the sternum in cases of
enlarged portal or mesenteric lymphatic glands, tiunors in the pyloric region,
pancreas, or mesentery. Finally greatly distended gall bladders and bile ducts
must be kept in mind.
In some cases there is jaundice, and in others ascites and
swelling of the spleen.
Course. Several months may elapse after the appearance
of the first symptoms, but finally the gradually increasing
cachexia leads to complete exhaustion.
Treatment. Spontaneous recovery never occurs and inter-
nal treatment is useless. No very satisfactory results are to
other Neoplasms in the Liver. 54X
be expected of surgical interference. (Parascandolo removed
a carcinoma from the liver of a sheep with good results.
Literature. Kasparek, T. Z., 1907, 470. — Markus, Beitr. z. path. Anat. der
Leber etc. Diss. Bern, 1902 (Lit.).— Parascandolo, Clin. Vet., 1901, 598.— Wil-
helnii, Schw. A., 1903, XLV, 156.
Other Neoplasms in the Liver. From a clinical point of view these
have only a su))ordinate interest as they generally remain nnobserved
during the life of the animal and can only be distinguished from
earcinomata when the primary growth is situated in some part of the
body or in some organ that is more accessible to investigation. Sarco-
ma of the liver most closely resembles carcinoma of that organ. Pri-
mary sarcoma of the liver is extremely rare, but metastases from
growths in the peritoneum, intestine or mesentery are oliserved some-
what more frecjuently. In these cases also, there is a gradually progres-
sive cachexia, enlargement and sensitiveness of the liver, and in some
instances jaundice and ascites. Cadeac records a case in which the
neoplasm involved the wall of the portal vein in an ox and caused,
the animal's death. In the liver' of the horse melanomata and mela-
notic sarcomata are not absolutely rare and these may be present in
large numbers.
Adenomata (Ad. simplex, fibrosum, Cholangiosum viride) are very
rare and cause symptoms only when they become carcinonuitous.
Angiomata are of fairly common occurrence in the ox, but rarely
cause any symptoms. The lesions are generally numerous. (Hem-
angioma cavernosum or Telangiectasia capillaris.) Trasbot records
a case in which a horse which had shown slight symptoms of colic
a year previously, died from hemorrhage following rupture of an
angioma, and Ball saw a similar case in a cat.
Tras1)ot found two lipomata in the liver of a dog, one of which
was as large as a child's head, and Ratz has seen lipomata in the livers
of birds.
Villus-like outgrowths sometimes occur in the gall-l)ladder, es-
pecially in cattle. These sometimes are simple papillomata and some-
times have the structure of a villous cancer. In the latter case, sec-
ondary cancer nodules may be present in the liver.
Literature. Ball, J. Vet., 1904, 191.— Jiiger, A. f. Tk., 1907, XXXIII, 71.—
Markus, Beitr. z. path. Anatoniie d. Leber. Diss. Bern, 1902. — Biihniekorf, Uber
multiple disseni. Kapillarekt. d. Leber usw., Diss. Leipzig-, 1907 (Lit.). — Euppert,
A. f. Tk., 1909, XXXV, 150.— Saake, D. Z. f. Tni., 1896, XXII, 142.— Trasbot,
A. d'Alf., 1879, 241.
Tuberculosis and Actinomycosis of the Liver. Tubercu-
losis of the liver is common in cattle, pigs and birds, more rare
in the dog, and is exceptional in tlie other domestic animals.
It is usually secondary to disease of the peritoneum, intestine
or mesenteric glands. Occasionally it is embolic and it is also
primary in young animals that have been infected by way of
the placenta. The liver contains at first only quite small le-
sions and later caseous or caseo-purulent lesions of consider-
able size. Tlie material contained in the lesions sometimes re-
sembles mortar. In some cases the lesions have the appearance
542 Auiiiial Parasites of the Liver.
of lymplio-sarcoiiiata, and very often there is a marked increase
in the weight of the organ. In the dog, the lesions somethnes
have a central depression, and thus to some extent resemble
cancer growths. In sucking animals, it is more or less likely
that the disease will only he recognized if, in addition to tuber-
culous lesions in other organs, enlargement of the liver and a
nodular condition of that organ can be discovered.
The lesions of actinomycosis are similar except that they consist of
a fil)roiis capsule enclosing a yellowish, soft, gelatinous tissue which is
hecoming purulent at places, and in which the actinomyces can be found
by microscopic examination.
13. Animal Parasites of the Liver.
Echinococci.
Occurrence. In cattle and pigs echinococci are of very fre-
quent occurrence but rare in solipeds and carnivora. The par-
asite is also found in man and in turkeys.
The distribution of echinococcosis is intimately related to the number of
dogs and the frequency with which they are hosts of the tsenia echinococcus. In
Ireland and, according to Vidal, in Tunis also there is scarcely an adult ox or
sheep that does not harbor echinococci. The diseas-o is also widespread in
Australia and India (lO'/r of all bovines). in Europe, Mecklenburg appears to
be affected most seriously. Madelung and Sahlmann found 25 to SO'/r of cattle,
75% of sheep and 5 to .S% of pigs infested. Metelmann found echinococci in
25% of cattle, 15% of sheep and 5% of pigs.
According to the statistics of 52 German slaughter houses drawn up by
Peiper 11% of cattle, 10% of sheep and 6.5% of pigs were affected. In 1S96-97
at the Berlin abattoirs the livers of 1,156 cattle, 1,9:59 sheep and 5,398 pigs were
seized out of a total number of 146,612 cattle, 895,769 sheep and 694,170 piga
(Ostertag). According to Liingrich the percentages of animals found to be in-
fested at the abattoirs at Eostock were 36%, cattle, 26.5% sheep and 5% pigs.
In goats and horses the number was 1%. At Stettin, Olt found 7.1% of cattle, 25.8%
of sheep and 7.3% of pigs affected. Schmidt calculates the annual loss in cattle
to amount to $37,500. At Budapest during the period 1899-1903 out of 511,031
cattle killed (including 20,000 buffaloes) there were 7,622 cases or 1.4%; 3,755
cases were found among 90,883 sheep (4.1%), and 5,105 out of 474,401 pigs or
1.1%. At Prague the percentage of affected cattle amounted to 23.2%. and of
sheep 5.5% (Prettner). In Eussia the incidence of the jtarasite varies from
0.1 to 80% in cattle, 0.01 to 60% in sheep, from 0.01 to 70^^ in pigs and from 0.005
to 40% in horses.
Lichtenf eld 's investigations regarding the distribution of the parasite in
the various organs are very interesting. These showed that the lungs were affected
in cattle in 69.3% of cases, the liver in 27%, the spleen 2.2%, heart 0.75% and
kidneys in 0.75%. In the sheep the figures were: lungs 52.2%, liver 44.9%,
spleen 2.9%. In the pig the figures were: lungs 18.8%, liver 73.1%, spleen
2.95%, and heart and kidneys in 2.25%. In 1.3% of cases there were parasites
in the subperitoneal tissue. In the horse the lungs were involved in 5.5'7(, and the
liver in 94.5% of cases. It was also shown that in pigs under two years old the
proportion between the number of cases in which the lungs were affected and
those in which the liver was affected is 12.8:82. In adult animals the proportion
was 39.3:46.4.
Echinococcus disease is comparatively frequent in man. In the central parts
of Europe 1 case is seen in 130 postmortems. Echinococcus multilocularis is prac-
tically confinftd to places where cattle are principally affected (Tyrol, Inntal and
the Menuningen district in Bavaria), whereas E. polymorphus is seen in those places
where sheep are the principal hosts (Iceland, Australia, Mecklenburg, Pomerania,
Dalmatia, Argentine).
Etiology. 543
Etiology. Echinococci develop from the embryos of the
taenia echinococcus (Siebold) which inhabits the intestine of
the dog. These embryos are liberated from ingested eggs in
the stomach and pass ont of the intestine into the portal circu-
lation. The vehicles of infection are food or water contam-
inated with the feces of dogs or with proglottides or tape-
worm eggs contained in these.
Echinococci are cysts of various sizes containing a clear, pale, yel-
low liquid the reaction of which is either nentral or slightly acid.
The li(iuid contains a little allinmen, a considerable proportion of salt,
and not infrequently succinic acid. The wall is composed of two
layers. The outer or chitinous M'all is the thicker, white in color and
under the microscope appears to be composed of a number of parallel
lamina3. The inner or germinal layer is yellowash in color, granular,
and sometimes contains in the deeper parts muscle fibres, granules
of lime and small blood-vessels. In the livers of cattle and more rare-
ly in the livers of pigs and sheep, a second form of parasite occurs, E,
multiloeularis or alveolaris, in which there are masses of cysts about
the size of peas united together by a fibrous, net-like matrix derived
from the outer layer. In this way tumor-like growths of various sizes
are formed. The central part is often caseous or calcified, while the
peripheral parts are composed of numbers of small cysts resting upon
each other, and the whole growth appears to be traversed in all direc-
tions by a recognizable fibrous network. According to Ostertag, Mid-
ler, Mangold and Posselt, this cyst represents a stage of special tape-
worm, the Taenia echinococcus multiloeularis, (see page 469).
At a certain stage there develop on the inner surface of the cysts small
prominences, the soealled brood capsules. Some of the cysts remain attached to the
wall and others are free in tlie liquid. They contain the new scoliees. In other cases
very small cysts develop between the layers of the wall. Some of these pass inwards
and eventually become free in the liquid and later grow into large bladders. There
may be large numbers of tliese daughter cysts within the mother cyst. These may
contain granddaughter cysts (E. endogenus, altrieipariens or hydatitosus). More
frequently the small cysts pass outwards and separating from the parent cyst
undergo further development (E. exogenus, scolicipariens simplex, granulosus or
veterinorum). Both endogenous and exogenous cysts may later give rise to scoliees
or daughter cysts.
Lichtenfeld found a larger number of fertile cysts in pigs under two years
than in older animals and also that the proportion existing between fertile and
sterile cysts was in cattle 24:76, in pigs 80:20, in sheep 92.5:7.5 and in the horse
38.9:61.1.
The experimental researches of Bobroff, v. Alexinsky, Deve and Ponomaroflf
have shown that echinococci may be transported not only to organs in close con-
nection with that primarily infested but also to others, scoliees being set free by
the rupture of a fertile cyst.
The development of echinococci is very slow. According to Leuckart small
foci measuring 0.25 to 0..35 mm. in diameter and enclosed in thin fibrous cap-
sules are found one month after infection. After two months they measure al;)ont
2.5 mm. and are already converted into small cysts. Towards the end of the
fifth month the cysts are about the size of hazelnuts, the two layers of the wall
are well differentiated and the development of the scoliees and daughter cysta
haa begun.
Anatomical Changes. The liver is enlarged in proportion
to the size and number of the cysts present in it, and in the
ox may weigh as much as 158 pounds (Ringk). In the pig, in-
544 Et'hinooooci.
festecl livers are .soiiietiiiies of enormous size (110 pounds, Ge-
rard). The surface shows rounded prominences of various sizes,
and there may be a considerable distortion of the organ. If a
cyst be cut into, there is a prompt escape of a clear, yelloA\isli
serous liquid and a rounded cavity is exposed. The interior of
the connective tissue capsule is lined l)y an elastic membrane
which is easily detaclied and torn, and tends to roll up. This is
the true cyst wall and l)ears on its surface small whitish promi-
nences, the brood capsules, and it may also contain several
daughter cysts and granddaughter cysts. The liver tissue in
the immediate neighborhood is very pale in color, and if nu-
merous cysts are present, develops fine but tough strands of
connective tissue. In dead cysts there is either a soft and
pulpy or a caseous mass in which shreds of the cyst wall can
be found. The nature of these shreds can easily l)e recognized
microscopically by their laminated structure. Hooklets com-
posed of cliitin can also be found in the caseous contents.
These facts together with the al)sence of young tubercles in the
neighborhood and of lesions in the portal glands, distinguish
such lesions from caseous tul)erculous lesions. Echinococci
sometimes undergo a purulent degeneration resulting in the
production of abscesses. In the contents of such abscesses,
fragments of the laminated wall or hooklets can generally be
demonstrated.
The Echinococcus multilocularis forms more tumorlike
masses than the E. yjolymorphus, the surface of the former being
beset with cysts. On cross section, these bear considerable re-
semblance to alveolar or colloid cancers and have the struc-
ture already described. Formerly such lesions were consid-
ered as cancers. Tlieir true nature was first discovered by
Virchow in 1855.
Similar cysts are more rarely found in the lungs and other
organs.
Pathog^enesis. In spite of the frequency of their occurrence
echinococci rarely cause any disturbance of health, even when
they are very numerous. Only when the infestation is enor-
mous and there are only scattered islands of liver tissue left,
do symptoms due to deficiency of bile make their appearance.
The greatly enlarged Uver may hinder the movements of the
diaphragm and possibly also of the al)dominal viscera, partic-
ularly the stomach and intestines. The portal vein may be
compressed by echinococci in its immediate neighborhood (Lu-
cas).
Joest's experiments upon animals contradict the view of Monrzon and Schlag-
denhauflfen that the liquid contained in the cysts contains a toxalbumen. Ac-
cording to Gherardini, in view of the situation of the cysts, any infection pro-
duced by their contents must be of a latent character. Griglio found various
bacteria in the cyst-contents (streptococci, staphylococci, and bacillus coli).
Symptoms. Treatment and Prophylaxis. 545
Symptoms. In cattle digestive disturbances, lasting for
weeks or months, liave been observed in some cases: capricious
appetite, inactivity of rumination, constipation, frequent tym-
panitis, etc. Exceptionally jaundice and wasting and the gen-
eral symptoms of ill-health have been seen. The area of dul-
ness may be greatly increased and may extend backwards to
the last rib and in the downward direction to the lower third
of the abdomen (see fig. 68, page 536). Palpation of this re-
gion may cause symptoms of pain. The enlargement of the
liver may be so great that the right half of the abdomen and
right flank are rendered prominent. By manipulation of the
right side of the abdominal wall, and by rectal examination,
one can, in cases where the enlargement of the liver is exces-
sive, feel the thickened and rounded edge of the liver and the
elastic nature of the prominences can be appreciated (Labarrere,
Landler). Respiration is usually shallow and accelerated.
Weinberg and Vieillard found that echinococcosis can generally
be diagnosed by the fixation of complement method.
The symptoms in the sheep are similar to those described.
The disease can only be distinguished from the similar con-
dition caused by flukes if the unevenness of the surface of the
liver can be felt through the abdominal wall.
In pigs Lucas also saw pronounced ascites in cases of heavy infes-
tation. The animals were quite unable to get onto their hind feet
and dragged them behind them. In spite of a good appetite, there was
marked wasting. In a case recorded by Schmidt, there was evidence
of jaundice, while in one published by Friedrich there was enormous
distension of the abdomen without any ascites.
Treatment and Prophylaxis. No satisfactory method of
treating echinococcosis is known. Since the disease is set up
by the ingestion of the eggs of the Taenia echinococcus, animals
should be prevented from eating food or drinking water that
are soiled with the feces of dogs. As this is g'enerally imprac-
ticable care must be taken that all organs of animals slaugh-
tered that contain echinococci are destroyed and not, as so
often happens, given to the dogs.
Literature. Feuereissen, D. t. W., 1908, 110. — Friedrich, B. t. W., 1906, 17.
— Criglio, Clin. Vet., 1906, 409.— Joest, Z. f. Infkr., 1907, II, 10.— Labarrere, Rev.
V6t., 1887, 619.— Landler, A. L., 1907, 207.— Lichtenfel.l, Cbl. f. Bakt., 1904,
XXXVI, 546, 651; XXXVIT, 64 (Lit.).— Lucas, Z. f. Flhvg., 1907, XVII, 267.—
Martin, Rev. Vet., 1907, 668, 734, 800 (Lit.).— Ostertag, D." Z. f. Tm., 1891, XVII,
172; Fleischbesehau, 1904, 464.— Pecard, Bull., 1906, 591.— Posselt, Miinch. in. W.,
1906, 5.S7, 605 (Lit.).— Piitzu, Cbl. f. Bakt., 1910, LIV (Orig.), 77.— Schmidt,
Z. f. Flhyg., 1907, XVIT, 270.— Vidal, Rev. A¥t., 1905, 240.
(b) Distomatosis. Fluke Disease.
(Liver rot.)
The disease is caused by the Distomum hepaticum and D.
lanceolatum, and it occurs more frequently in sheep than in
cattle. It is an acute or chronic inflammation of the liver and
546 Distomatosis
bile ducts, more commonly the latter. In the chronic form it
leads to serious loss of condition.
Historical. The earliest records of the disease are those of Schaper
von Gabueinus in 1547, and of Gemma a few years later. The term,
"Leberegel" (fluke) was first used in 1676 by Frommann. Valuable
clinical and pathological studies of the disease were made by Schaffer
(1764), Goeze (1782), Chabert (1879), and Bilhuber (1791). The life-
history of the parasite was elucidated by Mehlis (1831), v. Nordmann
(1832), Eschericht (1841), Steenstrup (1842), and especially by
Leuckart (1876), who determined the metagenesis of the fluke. Among
veterinary surgeons the names of Gerlach (1854), Delafond (1854),
Davaine (1860), Fried])erger (1878), Ziindel (1880), Thomas (1881),
and Ziirn (1882), are closely connected with the study of distomatosis.
Interesting investigations were made by Schaper (1889), and Lutz
(1892), regarding natural infection, and also by Schaper in connection
with the pathogenesis, symptomatology and pathological anatomy of
the disease.
Occurrence. The Distomum hepaticum is found in marshy
places everywhere, whereas the distribution of the D. lanceola-
tum appears to be more restricted, the parasite being far more
common in southern Europe than in northern. The geograph-
ical distribution of the D. hepaticum exactly coincides with that
of Limnseus minutus, wdiich is practically the exclusive inter-
mediate host of the parasite (Leuckart). After wet summers
the disease is very widespread and causes very heavy losses.
The severe form of the disease rarely occurs among adult cat-
tle, although they may harbor the parasite in their livers. It
is principally among calves that serious losses occur. Exten-
sive outbreaks of the disease sometimes occur among goats
(Romer). Swdne, buffaloes (Hungary and East Indies), cam-
els, wdld ruminants, hares and exceptionally horses, asses, dogs,
cats and rabbits are infested.
In 1873 a third of the sheep, which were valued at more than $200,000,
died in Alsace-Lorraine. In England the annual loss is computed at a million
sheep. Great losses were caused by fluke in Hungary and especially Upper Hun-
gary in 1889. On two farms practically the entire flocks were wiped out. The
disease was also very prevalent during the years 1893-1897. According to Popow
in certain districts of Poland in 1891 from 50 to 90% of the sheep died. The
liver fluke is not known in Iceland (Krabbe).
In 1876 the disease caused losses up to 40% of the cattle in Slavonia.
In 1883-84 36% of all the cattle, 7% of the calves and iyo% of the pigs
killed at the Berlin abattoirs were found to be affected. At Budapest during
the period 1889-1903 the percentages of affected animals were: 4.9% of cattle,
39.5% of sheep and 25% of goats. In 1902-03, 474,401 pigs were slaughtered
and of these 1.2% were seriously infested. At Okayama (Japan) Saito found
the Distomum hepaticum in 16% of cattle but the lesions were confined to the
bile ducts.
Etiology. The disease is caused by two varieties of dis-
tomes belonging to the Trematodes family of the Platyhelmin-
thes. These two parasites are called Distomum hepaticum
(Fasciola hepatica) and D. lanceolatum (F. lanceolata, Dicro-
Etiology.
547
coelium lanceolatiim). Both parasites are leaf-sliaped, elon-
gated and unprovided with appendages. The body is broader
towards the middle part and there are two suckers at the ante-
rior ends.
Distomum hepaticum measures from IS to 31 mm. in length by 4 to 13 mm.
in width, and is covered with minute spines that point backwards. At the anterior
extremity there is a conical process which carries at its apex the oral sucker.
On the under surface, about 3 mm. behind this, there is a second and larger
sucker. The eggs (fig. 72) are brown or greenish-yellow, oval, and provided at
one pole with a small cap. This cap may be rendered visible either by exerting
pressure on the eggs or by the addition of potassium hydrate solution. The eggs
measure
130 to 145 fi in length and 70 to 00 ^ in width.
Fig. 72.
The Distomum lanceolatum Is only 4 to 9 mm. in length and 2.5 mm. broad.
It is slender and lancet-shaped. The eggs which are brownish in color are also pro-
vided with a polar cap (fig. 71) and measure 37 to 40 [x in length.
Life-cycle of the Distomum Hepaticum. According to Weinland,
Leuekart, and Thomas, the life-cycle of the parasite is as follows : The
eggs of the mature flukes are passed out with the feces of the host
into the outer world. Provided segmentation has taken place, an em-
bryo develops under suitable conditions of temperature (at least ten
to twelve C.) and moisture in about three to six weeks. The em-
bryo escapes by raising the polar cap. It is elongated in shape and its
surface covering is composed of polyhedral cells and
thickly covered with cilia. These larvffi (mira-
cidium) are very actively motile in water. By means
of a movable spine at their anterior end they bore
their way into the body of certain fresh-water snai
The snails usually selected are Limnjeus minutus or
truncatulus, and more rarely L. pereger and others.
During the summer months they become converted
into sporocysts within two weeks.
Each germ-cell gives rise to five to
eight rediae, and each redia to fifteen
to twenty cercariae. The cercarige
pass out of the oral opening of the
rediae, and then leave the body of the
snail. The cercaria has a flat oval
body measuring 280 fx in length,
and 230 fx in breadth. It is also pro-
vided with a caudal appendage twice
that length. Two suckers and a bifid
intestine can already be distinguished
the water the cercaria work their way up grass-stalks and there secrete
a sticky, mucoid substance which serves both to encapsule them and to
cement them to the grass. In this condition the cysts measure about two
to three mm. If such cysts be ingested by certain animals the parasites
make their may up the bile-ducts and there become sexually mature, ac-
cording to Leuekart in three weeks, and according to Thomas in five to
six weeks. As a rule a proportion of the mature parasites die. The ma-
jority, after laying eggs, pass dowTi the bile-ducts and not rarely
accumulate in the gall-bladder. They then pass into the intestine,
where they promptly die and are digested. Only a few are passed into
the outer world in a healthy condition (Schaper). The eggs are passed
into the intestine with the bile, and are eventually expelled from the host.
According to Gerlach, the period spent by the distomes in the liver
Fig. 71. Egg of Distomum lanceolatum.
Fig. 72. Egg of Distomum hepaticum.
After swimming for a time in
548 Distomatosis.
is from nine to twelve niontlis. On the other hand, Leuckart and
Friedberger hold that the parasites coiiiinenee to migrate within three
to four weeks after infection or immediately after they have become
sexually mature. Schaper expressed the view that, like infection, migra-
tion of the parasites may take place during any part of the year.
The Limnffius minutus or truncatulus is a small snail measuring about V2 '"•
in length and provitleil with a brown, f^piral shell. It occurs especially on marshy
ground, in ditches and also in slow-flowing brooks. In the autumn it enters the
water, preferably in a ditch with a clay bottom, and passes the winter there.
The life-cycle of the D. lanceolatum is in all probability similar
but it is not yet known definitely. According to Plana, the pear-shaped
larva? penetrate the snail known as Helix carthusiana, and there develop
into cercaria?. Leuckart believes that the escape of the em])ryos into
the outer world is not spontaneous, but occurs in the intestine of a
special intermediate host.
Besistance of the Parasite. The eggs remain capable of germinating from
one year to another but do not resist drying or putrefaction. The larvae, accord-
ing to Friedberger, are not killed by night frosts, and the encapsuled cercarine
retain their power of development for weeks or even months (Leuckart). Salt
solutions are very ]ioisonous to the larvie and cercarias ( Ercolani and Perroncito),
A 2% solution is fatal in 5 minutes and a l^r solution in 20 to 35 minutes.
Natural Infection. As a rule infection results from the in-
gestion of green food carrying encysted cercariae. This is es-
pecially likely to happen on moist and marshy land, and on
land that is frequently flooded. Contaminated water must also
be responsible in many cases. According to Lutz, the latter
method is the common one in the Sandwich Islands. The cer-
cariae becoming detached from water-plants in shallow streams
collect at places where the water is shallow, and are then taken
up by the cattle when drinking. As some cercariap tend to be-
come encysted in the bodies of grass snails, infection may take
place through the ingestion at pasture of plants bearing them.
Spinola succeeded in infecting healthy sheep by feeding them
with grass snails.
Housed animals may be infected, infection generally tak-
ing place through cercaria-infected green food, and sometimes
through food from marshy land which has not been stored
very long.
The disease is introduced into districts previously free,
either by diseased domestic animals or l)y wild ruminants and
hares.
Infection generally takes place in the summer or autumn,
conditions then being favorable. According to Friedlierger and
Schaper, the infection may occur at any time of the year but,
for reasons easily understood, infection is less severe in w^in-
ter. Infection may occur during winter through the ingestion
of food cut fairly fresh, or in "open" weather when the ani-
mals can go to pasture.
The degree of infection depends in the first place upon
the extent to which the pasture, food and water are contam-
inated.
Pathogenesis. 549
In this connection the dampness of the ground is of chief
importance. The most severe infection occurs in places where
the climate is damp or the rainfall copious, and the temperature
comparatively high. Infection is also severe on flood land and
during wet seasons. The period during which dangerous land
is used as pasture, must also be taken into consideration. The
longer the land is used the greater the number of flukes in-
gested. A stay of a few hours only, or even less than an hour,
has in some instances led to serious outbreaks of the disease.
In most cases repeated infection of the same animals is ob-
served.
Susceptibility. Sheep and wild ruminants are the most
susceptible, the ox is a little less so and the goat a little less
than the ox. Swine, solipeds, and carnivora on the other hand
rarely become diseased in spite of being invaded by the parasite.
Young adult animals are more susceptible or their powers of
resistance are less.
The wide distribution of the disease among sheep convinces Bailliet that the
cercarife are to be found principally on the lower blades of grass which the sheep
eat, whereas cattle get only the upper ones. According to Humble and Lush sheep
with short lower jaws (parrot-mouthed) escape infection because they can only
bite the tips of the leaves.
Pathogenesis. All the available evidence shows that the
parasites, in migrating from the duodenum into the bile ducts,
move by elongating their anterior end and flxing the oral and
ventral sucker alternately. They spread rapidly through the
liver until they reach the smallest bile ducts, where they are
either arrested or may pass back again.
According to Gerlach, May and Spinola, the parasites gain access to the liver
by penetration of the capsule after having passed out of the intestine through the
wall. Luchs believes that the invasion of the liver is by way of the portal vein.
The flukes that have penetrated into the smallest ducts,
burst through these at numbers of places, and passing into the
liver tissue cause destruction of large areas of it and may con-
sequently be frequently found under the serous membrane, or
they may, by perforation of this, pass into the peritoneal cavity.
As a result of the mechanical irritation, due particularly to
the spiny covering of the parasites, and to the destruction of
the liver tissue, an acute inflammatory condition is set up
in both the bile ducts and the liver tissue. There may
also be hemorrhages. Under certain conditions abscesses are
produced in various parts of the liver. Schaper found strep-
tococci and staphylococci in such abscesses. Flukes may pass
into the portal or hepatic veins and in the latter case they maj
be carried to the right side of the heart and thence to the lungs
or even to peripheral parts of the body.
The majority of distomes that have penetrated into the
550 Distomatosis.
liver tissue probably die or they may make their way back into
the bile ducts, where they may become mature with those that
have remained there. A chronic inflammation associated with
the production of fibrous tissue is set up in the walls of the bile
ducts. At a later stage this inflammation spreads to the inter-
lobular connective tissue and results in cirrhosis of the liver.
The destruction of liver tissue following the migrations of
parasites also plays some part in the production of cirrhosis.
The toxic products of the metabolism of the parasites not only
cause irritation of the walls of the bile ducts, but also act upon
the liver tissue after absorption into the lymph stream.
Bacteria must also be taken into consideration in the produc-
tion of cholangitis. These may either be carried out of the
intestine by the flukes or they may be circulating in the blood
and, reaching the liver, find conditions suitable for multiplica-
tion in the diseased walls of the bile ducts.
Jiiger 's investigations have sliown that the absorption of tlie toxic material
produced by the fluke is followed by a cellular infiltration in the angles between
adjacent lobules. This in its turn is followed by a production of connective tissue
and an extension of the process along the interlobular septa. As shown by Schaper
an active proliferation takes place in the bile ducts by a process of budding.
The diffuse lesions of the liver tissue, the toxic metabolism
products of the flukes and the bacterial infection cause disturb-
ances of nutrition and of the process of blood formation. The
susceptibility of animals affected with liver rot to specific in-
fectious diseases may be increased (see hemorrhagic septice-
mia in Vol I).
Carre and Bigoteau quite wrongly affirm that the sjanptoms of hydremia
in cases of distomatosis are due to an intoxication brought about by the multipli-
cation in some part of the body of the bacillus of pseudo-tuberculosis of Preisz and
Guinard.
Anatomical Changes. If the invasion is extensive the liver
shows evidence of an acute inflammation (Hepatitis acuta trau-
matica distomatosa). The liver is enlarged, hjToeremic, its
serous membrane is studded with small hemorrhages, and may
be covered with a thin fibrinous deposit. The capsule shows here
and there small, round, sharpl3^-defined openings through which
a dirty red liquid exudes on pressure, and sometimes the an-
terior extremity of a fluke may appear. These openings lead
into irregular cavities in the liver tissue which contain blood,
liver debris and numbers of young flukes embedded in a pulpy
mass. If the liver be cut into, similar cavities are found in
other parts. The large bile ducts are dilated and contain large
quantities of muco-sanguinous bile and flukes in varying num-
bers. Exceptionally parasites escape into the peritoneum and
set up a severe peritonitis, or there may be severe hemorrhage
from the punctures caused by their escape.
In less severe cases of chronic distomatosis the liver may
Anatomical Changes. Symptoms. 551
appear healthy from the outside, but if palpated, hard cords
can be felt. On section these are found to be dilated bile ducts
with thickened and rigid walls. Pressure causes dirty, yellow-
ish-brown bile to exude, containing flukes in variable numbers.
Similarly altered ducts can sometimes be seen through the cap-
sule, especially on the posterior surface, as white firm nodu-
lated cords.
In more severe cases the liver becomes enlarged as a result
of the chronic interstitial inflammation which appears later,
and its consistency is at the same time firmer. The large bile
ducts appear greatly dilated, their walls thickened and hard,
and their inner surface is usually roughened by a deposition of
salts (calcium phosphate and a little magnesium phosphate).
In the lumen of the ducts greenish-brown, viscous bile and large
numbers of flukes in various stages of development are found.
In a single liver there may be 1,000 flukes or more. At a later
stage there is shrinking of the liver, the organ becomes tough
and the bile ducts appear as dilated tubes with calcified and
thickened walls. Marked glandular proliferation of the mu-
cous membrane of the bile ducts is almost always present
(Schaper). As a result of repeated invasions various stages
of the disease are often discoverable in a liver.
In severe cases there is usually ascites as well as general
wasting and anemia.
If D. lanceolatum be present in very large numbers (they may
number many thousands [Friedberger] ), migration of the parasites
may be fohowed by exactly similar symptoms, but as a rule the process
is limited to the bile-ducts and the chronic lesions produced are not so
severe as those described above.
According to v. Eatz the calcified nodules which sometimes occur in the livers
of horses are due to Hukes. In these nodules Olt found the remains of young
eehinocoeci and Mazzantini the embryos of filaria. Morot found distoines m
tubercle-like nodules in the xseritoneum, and Cocu in blood-clots on the valves of
the right side of the heart.
Symptoms. Unless the parasites are very numerous there
are no functional disturbances, and a moderate invasion may
cause no loss of condition. This has been shown over and over
again in slaughter houses.
In acute cases, the period elapsing between infection and
the appearance of symptoms is seventeen to tw^enty-one days.
In chronic cases one to two months may elapse (Gerlach, Ztirn,
and others).
In the majority of cases, sheep show no symptoms for a
month or two after infection, and the first symptoms seen are
slight fever, dulness, weakness and anorexia. Careful exam-
ination will show that the hepatic region is painful on pressure
and that the area of dulness is increased. The posterior border
may extend beyond the costal arch and can be palpated (Spm-
ola). Anemia due to a reduction in the hemoglobin content
552 Distomatosis.
and in the number of blood corpuscles may be demonstrated at
an early stage and even in slight cases (Schaper).
In chronic cases, usually about the end of the autumn,
there is edema. Simultaneously with the gradual paling of
the mucous membranes there is edematous swelling of the con-
junctiva which forms a prominent ring around the cornea, and
causes swelling of the eyelid. Doughy swellings make their
appearance along the trachea, under the brisket, and on the
abdominal wall. By this time the dulness and weakness are
pronounced, the appetite is suppressed, rumination slow, the
wool dry and brittle and easily pulled out, and it even comes
out spontaneously at places thus making the fleece ragged.
Large numbers of fluke eggs can be found with the microscope
in the feces. By this time there is evidence of hydrothorax
and ascites.
About the third month of infection, generally at the begin-
ning of winter, the wasting becomes more and more pro-
nounced and the edema and ascites are more evident. The
edema of the tracheal region decreases during the night and
reappears when the animals are at pasture during the day,
while the edema of other parts tends to decrease a little during
movement and to reappear with rest. In addition to edema-
tous swelling, Mergel observed abscesses on the neck and be-
low the flank which he believed were due to flukes.
Coincident with the increasing emaciation, symptoms of
anemia and cachexia become more and more prominent. In
some cases there is diarrhea, the feces containing large num-
bers of eggs. The milk becomes watery and less nourishing, so
that the lambs are poorly developed and may even die. Some-
times there is fever. Finally, the animals die from complete
exhaustion. During the whole period of illness there is no
jaundice or, at the most, very slight evidence of it.
More rol)ust and particularly older animals recover grad-
ually, especially after a moderate invasion, about the end of
the winter or in the early part of the spring. The edematous
swellings disappear, the appetite returns, and finally there is
apparent complete recovery. The tissue lesions in the liver
cannot be repaired and must eventually exercise a prejudicial
effect upon the nourishment of the animal.
In goats the symptoms are very similar to those seen in
sheep and diseased animals often abort, or their progeny are
very weakly.
Cattle, buffaloes and camels present similar symptoms, but
on account of their greater power of resistance the disease is
as a rule, less severe. In these animals, edematous swellings
along the course of the trachea and in the dewlap are more
rarely seen, but there may be digestive disorders such as an-
orexia, diarrhea, and tympanites and, in severe cases, anemia
and emaciation. A larger proportion of animals recover, and
Course. Diagnosis. 553
the disease may remain latent, altlioiigli the infestation may ho
severe (Wiegel). In exceptional eases, and especially among
yonng animals, death is due to utter exhaustion. According to
Vaelzen and Pease, many huffaloes are slaughtered in the East
Indies on account of distomatosis.
Very occasionally, the disease runs the same course in
solipeds (ass) as in ruminants, wasting, anemia, dropsy, and
in some cases jaundice heing observed (Prietsch).
In rabbits there is rapid wasting, hydrothorax, and as-
cites and, in occasional cases, swelling" and jaundice of the mu-
cous membranes (Braun).
Course. Acute cases in which sheep die in seven to nine
days after the onset of symptoms from acute hepatitis, are
only rarely encountered (Bonvicini). In some cases, death is
quite sudden, possibly owing to embolism of young flukes in the
vessels of the brain (Gerlach) or to hemorrhage into the peri-
toneum following perforation of the capsule of the liver. With
such exceptions the disease tends to become chronic. The
course of the disease is divided by Gerlach and Ziindel into four
stages. (1) The stage of traumatic hepatitis which begins soon
after infection, lasts four to thirteen weeks, and is character-
ized by slight sjanptoms of fever, digestive disorders, and en-
largement and sensitiveness of the liver. (2) The stage of
chlorosis. This sets in in the autumn, lasts six to twelve weeks,
and is characterized by symptoms of anemia. (3) The stage
of wasting as a rule sets in about four months after infection
during the winter months. In this stage emaciation and drop-
sy are pronounced and deaths are frequent. (4) The migra-
tion of the flukes occurs in the spring, a])out May or June (Ger-
lach). During this stage, symptoms disappear* and there may
be temporary or permanent improvement. The investigations
of Friedberger and Schaper have shown that this division into
stages is applicable to a certain extent in cases where there are
extensive outbreaks because there are a number of animals se-
verely and simultaneously affected. Such outbreaks generally
occur in the summer and autumn.
In most cases the stages cannot be marked off from each
other and the series of symptoms described above cannot be
followed out. The eggs of the parasites may be passed out and
the parasites themselves migrate at any time. There is great
variation in the duration of the disease. In some cases where
the infestation is severe, it may last only three months, and in
another case it may extend to a year or more.
Diagnosis. Obvious symptoms are seen in advanced cases
only, and more or less closely resemble those due to other
causes (tapeworms, gastric strongyles, etc.). The edematous
infiltration cannot be considered as characteristic of liver rot.
As a rule, no difficulty is experienced in practice, in arriving
554 Distomatosis.
at a diagnosis when there is a dead animal available for ex-
amination. Dnring life a certain diagnosis can be based upon
the discovery of the eggs of flukes in the feces. It must be re^
membered that in the early stages of the disease there may be
no eggs in the feces and in such cases, enlargement and sensi-
tiveness of the liver should arouse suspicion as to the existence
of liver rot. This suspicion may be supported by a history in-
dicating the likelihood of infection.
Microscopic examination of the feces can be carried out by diluting and
sedinienting the feces, or better still by repeated washing and filtering through a
gauze filter until the yellow color disappears (Lutz). The number of eggs in the
feces is very variable, depending probably upon the quantity of bile passing out
of the liver. According to Perroncito one finds an average of 10 eggs in each
preparation if 800 flukes are present, and Brusaferro puts the figure at 1 to 13
if 100 flukes are present. In severe cases, however, there may be as many as 30.
The feces of six young bovine animals liadly aff'ected with distomatosis were sys-
tematically examined by Hutyra & Marek, adopting Lutz's method, and only
isolated eggs could ])e discovered.
The eggs of the D. lanceolatum are found far more rarely, so that examina-
tions may be negative although there may be large numbers of the parasites in the
liver.
Prognosis. If the s;^Tiiptoms are pronounced, prognosis is
unfavorable. The SJ^nptoms may abate from time to time, but
there is scarcely ever a complete recovery. Young and weakly
animals are generally affected more seriously than older and
more robust ones, and cattle survive infection better than
sheep.
Treatment. No drug has as yet been discovered that is of
any use. All that can be done is to nourish the animals as well
as possible (good hay, corn, bran, oil cake, etc.). As a rule,
well-nourished animals offer more resistance than poor, debili-
tated ones. If the animals are anemic or show symptoms of
edema, they should be slaughtered as soon as possible.
The following dugs have been tried: benzine in doses of 5 to 6 gm. or for
cattle 60 to 120 gm. for 4 to 6 days (Bunck) ; naphthalin twice daily for a week
in doses of 0.7 to 0.1 gm. (Mojkovszki) ; turpentine (Perroncito) ; tincture of
iodine (de Romanet), creosote, picrate of potash, carbon bisulphide (Floris).
Prophylaxis. The simplest and best known prophylactic
measure among farmers is the avoidance of moist, low-lying
land, especially for young animals. If this be impracticable
suitable land not being available, or on account of wet weather,
sheep should be given seven to eight grammes of salt
(daily) mixed with hay before they are turned out, and if pos-
sible, their drinking water should contain salt in the proportion
of one-half per cent. Trasbot states that pine shoots mixed
with bran are useful, and Cadeac advises leaves. Further it
appears to be advisable to give the animals plenty of room so
that they may not be forced to eat the lower parts of the grass
(see page 549). It has been advised to sprinkle the fields with
salt and liine(?).
Other Distomes. Cj^sticercosis of the Liver. 555
In order to reduce the risk of infection it is advisable to
improve the pastures by drainage. Care should be taken that
the livers from diseased sheep and cattle be destroyed, or,
if given to dogs they should be cooked since living eggs may
be scattered over the land with the feces of such animals. Sclia-
per advises that affected animals should be housed or, at least
brought into enclosures on hard dry ground in order to lessen
the possibility of fresh infection of the pastures. The manure
of the animals can then be best used for arable land. Finally,
water snails should be collected and destroyed.
Literature. Albanese, Eev. Gen., 1908, XI, 147 (Rev.).— Brauii, Kanin-
chenkrkh., 1907, 67.— Cadeac, Eev. Vet., 1885, 10.— Carre & Bigoteau, Eev. Gen.,
1908, XI, 433.— Friedberger, D. Z. f. Tm., 1878, IV, 145.— Gerlach, Ger. Tierheilk.,
1872, 487.— Jager, A. f. Tk., 1906, XXXII, 410.— Leuckart, Parasiten d. Meuschen,
1879, 3-5 Lief., 1-5, 34.— Lutz, Cbl. f. Bakt., 1893, XIII, 320.— Pfeiler, Z. f. Fleisch-
hyg., 1907, XVIT, 174.— Prietseh, S. B., 1906, 64.— Schaper, D. Z. f. Tm., 1890,
XVI, 1 (Lit.).— Thomas, The Vet., 1883, 180, 469.— v. Velzen, Vet. Jhb., 1890, 91.
— Wedernikow, A. f. Vet.-Wiss., 1893, 143.— Wolflfhiigel, Z. f. Infkr., 1907, II, 546.
— Ziindel, La distomatose, 1880.— Ziirn, Tier. Parasiten, 1882, 207.
Other Distomes. In addition to the two types described, the fol-
lowing distomes occasionally occur in the domestic animals. Dis-
tomiim truncatum Rud. (D. conus, Amphistomum conicum), which ac-
cording to Braun is identical with the D. campanulatum of Ercolani,
and D. felinenm Riv. Both of these occur now and then in the livers
of cats and dogs (Creplin, v. Ratz, de Jong, Zwaardemaker, Rivolta,
Ercolani) and if present in large numbers cause dilatation of the bile-
ducts and chronic hepatitis. Distomum conjunctum was found by
Lewis enclosed in cysts or purulent centers in the livers of dogs in
India. According to Braun, the D. albidum occurs only in cats. D.
magnum is found in cattle in Texas (Stiles & Hassal). Monostomum
hepaticum has been found in pigs.
Literature. Braun, Cbl. f. Bakt., 1893, XIV, 465.— v. Eatz, Z. f. Flhyg.,
1900, X, 141.— Stiles & Hassall, The Insp. of Meats, 1898.— Zwaardemaker, V. A.,
1890. CXX, 197.
(c) Cysticercosis of the Liver.
{Hepatitis cysticercosa.)
Cysticercosis of the liver is an acute or chronic hepatitis
caused by the Cysticercus tenuicollis or C. pisiformis with sec-
ondary peritonitis.
Occurrence. Cysticercosis of the liver is seen principally
in lambs, young pigs and rabbits or hares. It is also seen in
calves (Falk) and in the cow (Piitz). In the first mentioned
species it usually occurs as a local disease and causes heavy
losses. Almost without exception animals between the ages of
a few weeks to several months are affected.
556 Cysticercusis uf the Liver.
ETizootics of eystioereosis of tlie liver have been observed by Kiihnau, Brusa-
ferro, Averadere and Moiissu. Similar outbreaks have been described in younjif
pigs l)y Diirbeek and Seller. The latter authors have made a special study of the
pathological anatomy of the disease.
Etiology. In cattle and pigs the disease is caused by the
Cysticercus tennicollis, which is the cystic stage of the Taenia
marginata which inhabits the intestine of the dog (see page
468). In rabbits and hares the cause is the Cysticercus pisi-
formis, the cystic stage of the Taenia serrata also an inhabitant
of the intestine of the dog (see page 468).
Infection occurs naturally through the ingestion of feces
of dogs harboring these parasites. The proglottides or the con-
tained eggs are rarely dropped directly into feeding- or drink-
ing-troughs. As a rule, the feces are dropped about on the
ground or in the neighborhood of drinking places and thus con-
taminate the food or water. Pigs may ingest them while root-
ing-
Susceiotibility. It cannot be determined whether there is
any difference of susceptibility among animals that harbor the
Cysticercus tenuicollis. The varying incidence of the disease
in the different species may be due to differences of surround-
ings. Age has some influence upon the susceptiliility, since
young animals are attacked more frequently and more severely.
The fact that animals are affected at the age of a few weeks,
shows that within that time the opportunity offers of ingesting
the eggs of tapeworms. Young pigs may also ingest the eggs
w^hile rooting.
Pathogenesis. The embryos of the Taenia marginata and
T. serrata are liberated from the eggs by the acid stomach
contents, and reaching the intestine bore through the Avail and
enter the portal veins by which they are carried to the branches
of the portal vein in the liver. They have been found there
four hours after the ingestion of the eggs (Hoffmann). Some
embryos may pass through the capillaries into the hepatic
veins, and thus be carried to the lungs or other organs. After
their arrest in the blood vessels they bore their way out, and
penetrating the liver tissue, make their way to the surface leav-
ing tracks behind them. Finally, some of them perforate the cap-
sule of the liver and reaching the peritoneal cavity develop
further in the omentum, mesentery, or peritoneum. Those that
remain under the capsule of the liver also undergo processes
of development. The same thing happens to the embryo ar-
rested in the vessels of the lungs.
A severe invasion causes a condition shnilar to that pro-
duced by a heavy infestation wdth flukes (see page 549). There
is an acute hepatitis often associated with hemorrhage and a
localized or wide-spread peritonitis. The rupture of large ves-
sels may cause fatal hemorrhage. If the animals survive, the
acute liepatitis is followed by an interstitial inflammation,
Anatomical Changes. Synijjtoms. 557
causing cirrhosis. In some cases the embryos in the lungs set
up broncho-pneumonia and even pleurisy.
Anatomical Changes. In the acute stage the liver is more
or less enlarged, although there may be no enlargement in some
cases. Its serous membrane is dull and may be covered with a
hoar-like fibrinous layer. In many cases the surface of the
organ appears nodular and the apex of each nodule shows a
minute opening. The liver itself has a speckled, mosaic-like
appearance (mosaic liver or trout liver) on account of the va-
riation of color of the lobules. Some of these are black or
blackish-red and others are pale red or grayish-brown. The
darkly colored lobules are enlarged. The consistency of the
organ is soft, and the tissue is easily broken down. Close ex-
amination sometimes shows within the dark-colored lobules
yellow points or transparent acephalic cysts measuring three
to four mm. in length, by one to two mm. broad. In the later
stages there can be seen burrows in the liver tissue which at
first were filled with blood and afterwards become yellowish-
gray in color as a result of degeneration of the injured tissue,
and the outpouring of an exudate. These burrows are some-
times sinous and sometimes wider at one end.
Microscopic examination reveals the presence of cysticerci in the little pools
of blood and cellular infiltration in the neighborhood and in the interlobular con-
nective tissue, especially at the angles of the lobules. Finally there is compression
and partial degeneration of the liver tissue.
Not rarely there is acute peritonitis or there may be liquid
blood in the peritoneum. In this blood may be seen numbers
of very minute pale-colored bodies (young cysticerci).
In chronic cases there is more or less chronic interstitial
hepatitis and shrinkage of the new connective tissue.
Symptoms. The symptoms of acute cysticercosis of the
liver set in a few days after infection. This has been proved
by the feeding experiments of Kiichenmeister, Leisering,
Leuckart, Baillet and Railliet. A kid infected experimentally
l)y Railliet l)ecame seriously ill nine days later. The severity
of the infection influences the duration of the period of incu-
bation, symptoms setting in later when the infection is not
very severe.
In young pigs the course of the disease is sometimes very
acute, animals dropping dead without apparent cause. In other
cases the symptoms are depression, staggering gait, and marked
dulness. Death may be sudden.
As a rule the evolution of the disease is more gradual.
Dulness, great weakness, inappetence, and thirst ma}?- be ob-
served, and in the later stages acute peritonitis with fever, dis-
tension of the abdomen and sensitiveness of the abdominal wall.
In such cases there is rapid emaciation. Death may occur with-
558 Cysticercosis of the Liver.
in a few days or the animals may live for some weeks until
there is marked anemia and debility.
Chronic Cysticercosis. This is the form of the disease
usually seen in the rabbit, but it occurs also in other species of
animals. The symptoms are chronic digestive disorders which
cause some loss of condition.
Diagnosis. The specific nature of the disease is best shown
by the demonstration of young cysticerci in liquid withdrawn
from the peritoneum. As a rule a diagnosis is only possible post
mortem, although a strong suspicion as to the nature of the
disease may be raised if there are a number of young animals
showing the symptoms described, and especially if the sur-
rounding circumstances are favorable to infection. In very
recent cases or when there are no burrows in the liver, tissue
diagnosis may be attended wdth difficulty even at the autopsy,
especially if no microscopic examinations are made. In such
cases other forms of acute hepatitis and other infectious dis-
eases (swine erysipelas, hemorrhagic septicemia) have to be
excluded. Acute distomatosis is more easy to diagnose be-
cause of the presence of young distomes which measure at
least one to three mm., either in the burrows in the liver tissue
or in the peritoneum.
Prognosis. Prognosis depends entirely upon the severity of
the infestation, but in acute cases it is unfavorable. Averadere
records a mortality of 38 per cent in an outbreak among lambs.
Chronic cases are fatal far more rarely, especially in adult
animals, and as a rule there are no sjanptoms in these cases.
Treatment and Prophylaxis. Treatment must depend upon
the nature of the case. As a prophylactic measure all dogs in
the neighborhood of the animals and especially sheep dogs,
should undergo a course of treatment for tapew^orms two or
three times a year or, if possible, should be kept quite away
from the animals.
Literature. Averadere, Rev. Vet., 1898, .3.3.3.— Brusaferro, Clin. Vet., 1893,
214.— Diirbeck, Moiih., 1899, X, 32 (Lit.).— Engel, W. f. Tk., 1878, 165.— Falk,
Z. f. Flhyg., 1898, VITI, 93.— Hoefnagel & Eeeser, D. t. W., 190.5, 444 (Rev.).—
Hofmann, B. t. W., 1901, 537.— Kleinpaul, B. t. W., 1907, 131.— Moussu, Eec,
1902, 657.— Neumann, Mai. parasitaires, 1892, 484.— Piitz, Z. f. pr. Vet.-Wiss., 1876,
169.— Railliet, Zool. mecL, 1895, 229.— Seller, A. f. Tk., 1903, XXX, 339 (Lit.);
D. t. W., 1907, 436.
Other Animal Parasites Found in the Liver. The following para-
sites are sometimes clinically important as occurring in the liver:
1. The larvae of sclerostomes. These reach the liver by way of
the portal blood and make burrows in the liver tissue in a similar man-
ner to cysticerci (Colucci, Megnin, Schlegel). Schlegel repeatedly saw
cases of chronic hepatitis which clinically resembled Schweinsberg
disease, (see page 530), in which the liver was enlarged two to three
Coccidiosis of tlie Liver. 559
times, and showed small nodules varying in size up to a pin's head,
especially close under the capsule. In these cases there were also
narrow tortuous burrows in the liver tissue of a red or reddish yellow
color. The contents of the nodules and burrows were either caseous or
calcified, but the larvae of sclerostomes could be demonstrated.
2. Eustrongylus gigas. This parasite was found by Lissizin in
the liver of a dog which had had convulsions for three days.
3. Linguatula denticulata (Pentastomum denticulatum) was
found in large numbers in the liver of a goat that had shown symp-
toms of debility for a long time. The same parasite was found in the
liver of an otherwise apparently healthy ox. The capsule of the liver
showed large numbers of openings measuring about 3 mm., and leading
into cavities each of which contained a larval linguatula. Similar cav-
ities were visible in the deeper layers of the liver.
4. Occasionally ascarides (Ascaris megalocephala, A. suilla) wan-
der out of the intekine into the large bile-ducts in the horse and pig
and may cause symptoms of colic or epileptiform seizures (Roll, Ort-
mann). In cats the embryos of the Ollulanus tricuspis which normal-
ly inhabits the stomach are sometimes found in the liver.
Literature. Gerlach, Hann. Jhb., 1869.— Limgwitz, Z. f. Flhyg., 1893, III,
218.— V. Ratz, Vet., 1890, 269; 1892, 305 (Lit.).— Schlegel, B. t. W., 1907, 53.
(d) Coccidiosis of the Liver. Coccidiosis hepatis.
Coccidiosis of the liver is an enzootic disease among rab-
bits, affecting the liver and tlie bile ducts and is caused by the
Coccidium oviforme.
Etiology. The Coccidium oviforme Leuckart (Eimeria
cunicnii) has a double outer membrane with one pole slightly
flattened and measuring 30 to 50 m in length, and 14 to 28 ^ in
breadth. (For the development of coccidia, see page 497.)
Natural Infection. The natural method of infection is by
the ingestion of food or water contaminated with the feces of
rabbits that are affected with the disease or that have coc-
cidia in their livers. Young animals are especially susceptible,
and in them the disease is apt to be severe. Adult animals,
on the other hand, are affected less seriously, and as a rule,
show no symptoms. Such animals are capable of infecting
young animals by means of their feces.
Pathogenesis. It is not yet known in what form and in
what manner the parasites reach the liver. They multiply in
the bile ducts and produce enormous proliferation of the epi-
thelium.
Anatomical Changes. The lesions vary in size up to a pea
or even a hazelnut, and take the form of whitish-yellow nodules
that are somewhat prominent and contain a creamy or cas-
560 Coccidiosis oCtlie Liver.
eous material. There is a connective tissue capsule. Coccidia
are found in enormous numbers in tlie content of the nodules.
Symptoms. The symptoms are disturbance of nutrition,
emaciation, weakness and, later, staggering gait, inappetence
and eventually jaundice of the mucous membranes. In the last
stages one observes diarrhea which is very persistent, a dis-
charge from the nose, and finally convulsions. Young animals
usually die in about two to three months, and wliole warrens
are often wiped out.
Diagnosis. It is quite easy to arrive at a diagnosis during
life by the demonstration of coccidia in the feces l)y means of
the microscope. The feces contain fewer coccidia than in cases
of intestinal coccidiosis. The two conditions are often ob-
served in the same animal.
Treatment and Prophylaxis. Treatment is of no avail and
efforts must be directed principally towards prevention. In
this connection attention must be paid to the separation of the
young animals from the adults as soon as possible, all visibly
diseased animals must be destroyed, hutches must be disin-
fected, kept dry and well ventilated.
Coccidia have been found by Johne in cavities as large as apples in the liver
of a pig. Perroncito and Rivolta reeonl their occurrence in the livers of dogs,
and they were found by Chierici in a cat 's liver that was somewhat enlarged and
showed signs of chronic cholangitis.
Literature. Johne, S. B., 1881, 60.— Neumann, Mai. parasitaires, 1892, 488
(Lit.).— Railliet, Zool. mod., 1895, 134.— Ziirn, Vortr. f. Trzte., 1878, I, H, 2 (Lit.).
Protozoal Hepatitis of the Pigeon (Caseous hei)atitis of the pigeon). Young
pigeons sometimes die suddenly as a result of multiple caseous lesions in the liver
without having shown any symptoms. In such cases the liver is enlarged and
contains large numbers of grayish-yellow dry caseous foci. The foci vary in
size from a millet seed to a hazelnut and are irregularly rounded in shape. Sero-
fibrinous peritonitis is also present. The disease was first described by Bivolta in
1878 and later by Jowett (1907). Both authors found protozoa in the liver lesions
provided with one or two flagella. This parasite was named the Cercomonas hepatia
by Rivolta. In 1910 two cases were studied carefully by v. Ratz who found that
the parasites were provided with three flagella and came to the conclusion that the
parasite was the Trichomonas cohnubae which usually inhaliits the intestine or
respiratory organs of the pigeon. Under some circumstances which are not known
they make their way out of the intestine and penetrate the liver, there setting up
nodular necrotic lesions.
He believes that the parasite found by Rivolta and Jowett was the Tricho-
monas (V. Ratz, Kozl., 1910, VIII, 184).
Section VII.
DISEASES OF THE PANCREAS.
References to diseases of the iJcincreas in the domestic
animals are very scanty in literature. This is in part due to
the fact that clinical investigation of the gland is impossible
in the case of herbivora and possible to a slight extent only in
the carnivora. The special methods of investigation that have
been employed to obtain exact information regarding the di-
gestive phenomena have not been undertaken from a veter-
inary point of view. It is chiefly in the horse, dog and cat that
diseases of the pancreas have been observed.
Symptoms. The fact that there may be no digestive s>niip-
tonis in a case where there is a disturbance of function of the
pancreas is due to the circumstance that to a certain extent
the pancreatic juice can be replaced by the other digestive
juices and by the intestinal bacteria. Disease of the pancreas
may show itself in two ways. In the first place, the hydroly-
sis and absorption of fat is incomplete and in consequence the
feces contain a comparatively large proportion of fat (stear-
rhea). In carnivora the feces are gray in color and have a
characteristic greasy appearance. According to Miiller, the
proportion of free fatty acids and soap present is considerably
reduced on account of the imperfect decomposition of the fat.
In the second place, sugar metabolism is deranged, with the
resulting production of diabetes mellitus both in experimental
animals and in natural cases of disease of the pancreas (see
Vol. I).
In certain diseases the pancreas can be palpated through
the relaxed abdominal wall and in such cases valuable informa-
tion may be gained, especially in carnivora. Nevertheless it
is extremely difficult to differentiate between pancreatic lesions
and tumors of the pylorus or enlarged portal lymphatic glands.
This difficulty is also present in cases where the enlargement
of the gland has caused jaundice or ascites by pressure on the
bile ducts or portal vein.
Megnin & Nocard described a catarrh of the pancreatic
duct. The duct was completely occluded by a catarrhal secre-
tion with the result that there was a production of connective
561
Vol. 2-3G
562 Diseases of the Pancreas.
tissue, subsequent shrinkage of wliicli led to atrophy of the
gland parenchyma. Catarrh of the bile ducts and chronic in-
terstitial hepatitis were present at the same time. During life
the symptoms shown by the horse were : jaundice, partial loss
of appetite, languor, unsteady gait and emaciation. The feces
were dry and pale in color. In two months the animal was in
a state of complete collapse.
Chronic Inflammation of the Pancreas. This was observed
by Siedamgrotzky in a horse, the animal showing loss of
hair, edema, leucocythemia and debility. The stroma of the
pancreas was greatly increased in amount, and the gland tissue
reduced, and the ducts were obstructed with viscid mucus and
calcified flakes. (Kitt found a similar lesion in a horse.) In
a case recorded by Wheatley, there was extensive cirrhosis of
the gland which weighed sixteen pounds, the ducts were dilated
and filled with material resembling albumen. The horse had
shown gradual wasting, edema and excoriation of the skin at
places.
Suppuration of the pancreas may be set up by the presence
of foreign bodies in Wirsung's canal. In a case recorded by
Goubaux in the horse, the foreign body was a straw stalk, and
in the dog, Bruclmiiiller records the presence of a needle in
the canal. The s^^llptoms presented were loss of appetite, ema-
ciation, occasional attacks of colic and susceptibility to pres-
sure in the hypogastric region. Schattler found hemorrhages
and a number of small abscesses in the pancreas of a horse,
caused by the penetration of a piece of wire from the duodenum.
The s^imiptoms shown were: loss of energy, frequent groaning,
and variable appetite.
Nodular fat-necrosis of the pancreas occurs in absolutely
normal lobules in fattened pigs (Marek, Eonai). It also
occurs exceptionally in the dog and horse. No s^anptoms are
produced and in cases where they cause sudden death they may
be associated with multiple hemorrhages of the gland. Hemor-
rhages in the pancreas and surrounding tissues were found in
two cases by Prettner and in one case l)y Mettam, in dogs which
had shown s^i^nptoms of vomiting, alxlominal pain and sudden
collapse. Prettner is inclined to think that the condition was due
to an infection from the intestine. In Mettam 's case the gland
w^as enlarged to a considerable extent and beset with necrotic
foci. In one case similar lesions were found in a horse that
had died from acute enteritis of the small intestine and peri-
tonitis.
Atrophy of the pancreas was found by Lienaux, Eber and
Sendrail in dogs dead of diabetes mellitus. In Lienaux 's case
the pancreas was reduced to 3 cm. in length and 1 cm. in width,
Disease of the Pancreas. 563
and in Sendrail's case it was shrunken to the size of a bean. In
a case of atrophy of the pancreas in a dog- observed by Miiller
there was emaciation in spite of the appetite being maintained ;
undigested muscle fibers were found in the feces and there was
an absence of free hydrochloric acid in the stomach.
Mention must also be made of the following abnormalities
that have been met wdth at postmortems. Calculi in the ducts
of the gland cause dilatation of the ducts, an increase of con-
nective tissue, and atrophy of the parench3T;na. Calculi of the
pancreas have been met with fairly frequently l)y Scheunert &
Bergholz, especially in the cow. The presence of the following
neoplasms has been recorded: adenoma (Lienaux), carcinoma of
the head of the pancreas, especially in the dog, and melanoma
in the horse (Bruckmiiller, Friedberger, Kasewurm). Echinococ-
ci, larval sclerostomes and intestinal worms have occasionally
been observed. Nencioni found chronic pancreatitis in an ema-
ciated cat due to a colony of distoma felineum in the gland.
Literature. Goubeaux, Eec, 1875, 807.— Guerin, Bull., 1906, III.— Marek,
D. Z. f. Tm., 1896, XXII, 408.— Megnin & Nocard, Arch. d'Alf., 1878, 601.—
Mettam, The Vet., 1901, 619.— Miiller, Dresd. Ber., 1906, 162.— Nencioni, N. Ere,
1906, 26.— Prettner, T. Z., 1894, 342.— Eeimers, Ann., 1887, 672.— Eonai, Husszemle,
1906, 33 (Lit.).— Sehattler, D. t. W., 1905, 206.— Sendrail, Eev. Vet., 1906, 229.—
Scheunert & Bergholz, Z. f. jshysik. Chemie, 1907, LII, 338.— Siedamgrotzky, S. B.,
1878, 30.— Wheatley, Journ. of Conip. Path., 1896, 44.
Section VIII.
DISEASES OF THE PERITONEUM.
1. Ascites. Hydrops ascites.
Ascites is the term applied to the collection of serum-like
fluid in the peritoneum not due to an inflammatory process.
Occurrence. Ascites occurs most commonh^ in the dog and
generally as a result of disease of the heart or liver. The disease
is seen in ruminants far more rarely, with the exception of the
general dropsy seen in cattle fed on products of sugar factories.
It is only quite exceptionally that the disease is observed in the
horse, pig and birds, and then it is generally a condition ac-
companying either chronic disease of the liver or the peri-
toneum.
The disease was found in 1/0% of 70,000 dogs examined by Frohner. Cadiot
saw 37 cases in three years at Alfort. Out of 28 cases 10 were due to disease of
the heart and pericardium, 8 to tuberculosis, 4 to pleurisy, 2 to malignant growths
in the liver and lungs, 3 to chronic interstitial hepatitis and one to cancer of the
liver.
Etiology. The principal cause of ascites unassociated with
general dropsy of the rest of the body and of the subcutaneous
tissue is congestion of the portal area. This congestion may be
due to compression of the portal vein by neoplasms, enlarged
h^nphatic glands or tumors of the pylorus or of the head of the
pancreas. Under these and other conditions there is thrombosis
of the portal vein. Portal congestion may also be set up liy
chronic diseases of the liver such as cirrhosis, echinococcosis,
and neoplasms. In these cases the interlobular branches of the
portal vein are subjected to pressure and the outflow of blood
from the portal area is thus obstructed.
In cattle ascites is due most commonly to tuberculosis. Other
chronic diseases of the peritoneum, such as neoplasms, may have
a similar effect. These growths may cause obstruction of the
mesenteric or portal veins or of the great lymph vessels and
prevent the absorption of the lymph. The more common sequel
to these lesions is chronic peritonitis.
As a part of general dropsy ascites occurs in cases of
thrombosis or compression of the posterior vena cava between
the liver and the heart, heart disease and chronic diseases of
564
Etiology. Anatomical Changes. 555
the lungs. Altliougli in these cases ascites is the result of passive
congestion of the venous system throughout the body, or at least
in the hind quarters, it very often remains the only symptom for
a long time, especially in dogs.
Ascites and other symptoms of dropsy are often seen in
animals that are cachectic. A similar form of the disease is
seen in cases of chronic nephritis, liver rot, parasitic pneumonia
and gastritis, or in cases where substances rich in water figure
largely in the diet (turnips).
In young animals, and especially in young dogs, uncompli-
cated cases of ascites apparently occur* The fact that such
cases often recover completely, suggests the uncomplicated na-
ture of the condition.
According to Hamburger this is a specific condition caused by an organism
named by him the "Bacterium lymphagogon" and which increases the quantity of
lymph through the action of its metabolic products.
Anatomical Changes. In the horse there may be as much
as 170 liters of liquid in the peritoneum (Brusasco) and in the
dog twenty liters (Hordt). The liquid is sometimes clear as
water and in other cases slightly turbid. It may be faintly yel-
low in color, watery, and contains at most only traces of
fibrin. The specific gravity is below 1,016, but, as a rule, very
nearly that; it contains 3.5 per cent of albumin and its chem-
ical reaction is either alkaline or neutral. The fluid is often
opalescent. By transmitted light it may have a yellowish tint
and by reflected light a greenish color. This is probably due to
the presence of blood pigment. When the transudation is due
to a rise of pressure in the portal system the liquid may be from
reddish to blood red in color. In cases of jaundice it'is green-
ish and bile pigments can be demonstrated in it. There is, as
a rule, only a small amount of sediment composed of a few white
blood corpuscles, desquamated endothelial cells infiltrated with
fat, granular debris, threads of fibrin, and not rarely a few red
blood corpuscles. In some cases the latter are present in large
numbers (Fig. 73).
The peritoneum appears in some cases smooth and glisten-
ing, but where the disease has been in existence for a long time
it is thickened and shows adhesions at places. The abdominal
viscera appear anemic and even atrophied. In many cases the
postmortem examination is completed by the discovery of some
primary condition.
In cats and dogs the transudate is sometimes comparatively rich in fat
(Ascites adiposus or chyliformis) and appears gray or milk white. The linuid
may be translucent or quite opaque and when allowed to stand a thick layer of fat
may form on the surface. The fat droplets are derived from desquamate.l enanptoms of a general nature and partly
by focal symptoms. The general symptoms are caused either
directly by diffuse disease of the cortex of the brain associated
with an increase of intracranial pressure, or b}'- an increase of
pressure alone. On the other hand localized symptoms are, as
a rule, associated with disease of definite portions of the brain
connected with certain functions. These two groups of symp-
toms may be present simultaneously, or either may be present
separately.
(a) General Cerebral Symptoms.
The most constant sjTiiptoms of disease of the brain are
various forms of disturbance of consciousness. There may be
numbness, dulness, stupor to varying degrees, or complete
coma, and they are generally associated with lessened sensibility.
The symptoms may set in suddenly as in cases due to hemor-
rhage, concussion or embolism. In other cases the onset is
slower as in acute encephalitis and meningitis, hyperemia and
anemia of the brain. Finally the symptoms may take weeks,
months or even years to develop as in chronic hydrocephalus,
tumors, parasites, encephalitis due to distemper in dogs. Not
rarely during the course of diseases of the brain there are re-
missions of the symptoms. In cases where the disease is less
extensive or is localized in the neighborhood of the medulla ob-
longata there may be a complete absence of them, and cases
have been observed in which in spite of a considerable but slowly
progressive reduction in the size of the cranial cavity the ani-
mals have shown no symptoms whatever.
In acute diseases of the brain, excitement is generally ob-
served, a condition of disturbed perception with simultaneous
acceleration of the motor reaction, which, as a rule, is of short
584
General Symptomatology of Diseases of the Brain. 585
duration and after its disappearance the particular disturb-
ances are aggravated.
Giddiness is a frequent symptom of disease of the brain and
usually results from a temporary loss of consciousness.
Abnormal movements are seen in both acute and chronic
conditions. They may be associated with loss of consciousness
and may affect either the whole body or only a part in the form
of tonic-clonic spasms (eclamptoid or epileptiform cases), and
also there may be forced movements and ataxia.
Both the frequence and rhythm of the respiration may be
altered. _ In complete loss of consciousness and in deep stupor
the respirations are deep and their frequence diminished. In
severe cerebral diseases respiration of the Cheyne-Stokes type
is not rarely observed. In this type of breathing after a num-
ber of respirations of different lengths there is a pause which
may last for several seconds to be followed by respirations
which at first are superficial and which gradually become deeper
and even dyspneic. This is followed by another pause and the
respirations become gradually shallow again. In other cases of
encephalitis and meningitis respiration of the Biot type is ob-
served. In this type a number of normal respirations are fol-
lowed by a long pause. Another type of respiration is also ob-
served in which a long pause follows a series of respirations
which are at first violent and gradually decrease. As a general
rule any serious change in the type of respiration is an un-
favorable point in connection with prognosis.
Changes in the rapidity of the pulse are frequently ob-
served. In diseases in which there is an increase of intracranial
pressure stimulation of the vagus slows the pulse rate, but
should there be any other factor in operation, such as fever, ex-
citement, heart weakness, which has an accelerating effect on
the pulse, stimulation of the vagus is without effect. In some
cases of serious disease of the brain there is acceleration of the
pulse which is of the utmost importance, as there are no other
factors tending to produce this in operation. In all these cases
the pulse may also be irregular. Considerable variations of the
number and rhythm of the pulse are observed in cases of
meningitis.
Vomiting is seen frequently in carnivora and swine in cases
of diseases of the brain, and especially in acute meningitis and
is due either to direct stimulation of the vomiting center or of
the sensory nerve fibers of the meninges. The vomiting center
in the other animals is far less sensitive to stimulation and, as
a rule, they do not vomit in cerebral diseases.
According to some authors (Esberg, Lustig) venous con-
gestion of the papilla of the optic nerve is caused by increased
intracranial pressure and especially in cases of chronic dropsy
of the ventricles. This should not be of very rare occurrence
in animals, but the majority of veterinary authors have not ob-
586 General Symptoms.
served this. Such sjanptoms would be most likely to arise in
cases of tumor-formation in the brain.
Exag-geration of the tendon reflexes has been observed es-
pecially in cases of chronic encephalitis owing to the cutting out
of the inhibitory effect of the cerebral cortex. Contrary to wliat
is the case in man the exaggeration of the tendon reflexes may
be due to the cutting out of the cerebellum. A diminution of the
reflexes and especially of the skin reflexes is often seen in rap-
idly progressive acute encephalitis owing to the increased inhibi-
tion of the cortex. In complete loss of consciousness the skin
and pupillary reflexes are entirely lost; the tendon reflexes are
often entirely destroyed and the pupils do not react to light.
On the other hand, the pupils appear very contracted and react
only very slightly or not at all to light in simple cases of in-
creased intracranial pressure, although there is no loss of con-
sciousness. The alteration of the tendon reflex and the reaction
of the pupil may be observed as local s}^nptoms.
The reflex test gives reliable results in animals. One distinguishes between
skin and tendon reflexes. The skin reflex is best tested by pricking the skin with
a needle or some other instrument, or often by the use of the percussion hammer,
and the tendon reflexes may also be tested with the percussion hammer or some
other hard object.
The following skin reflexes may be tested. The reflex at the withers, a twitch
of the cutaneous muscle following stimulation of the skin over the withers. In a
similar way the skin reflexes over the shoulder, abdomen, sternum, and flank may be
tested. The latter test may be applied in all the domesticated animals, the first
two to the horse and ox, while the withers reflex as a rule is alisent in the ox.
The gluteal reflex is a muscular twitch due to a pin prick in the neighborhood of
the hip joint. The cremaster reflex may be tested by stimulation of the skin over
the inner condyle of the femur, the testicle on the same side being raised. In many
stallions and in dogs there is a scrotal reflex, the scrotal skin becoming wrinkled
when it is stimulated or when cold water is poured on it. Stimulation of the skin
of the perineum causes sinking of the croup, elevation of the tail, contraction of
the S2)hincter ani, and in many cases contraction of the muscles of the croup.
The contraction or spasm of the sphincter ani externus which is produced by
stimulating the skin of the orifice, or by the introduction of some solid body into
the rectum is described by some as the anus reflex. The hock reflex is a contraction
of the distal end of the biceps femoris and the semitendinosus induced by per-
cussion of the tuber of the os calcis. Eeflexes of the sole are normally seen in
carnivora only and in the hind feet. They may be produced by touching the skin
of the sole and are evidenced by spasmodic volar flexion of the toes.
Schmidt observed spasniodic contractions of the muscles in the upper parts
of the legs set up reflexly in the following ways: pressure or percussion of the hoof
(pedal reflex), sudden pressure on the upper third of the pastern (pastern reflex),
on the inner side of the upper part of the metacarpus, and on the flexor tendons.
These reflexes must not be confused with withdrawal of the limb owing to pain.
The skin reflexes include reflexes of the mucous membranes which are in some
instances very complicated, as for example the reflexes of swallowing, coughing,
and the bladder reflexes. The eye and conjunctival reflexes are simple. The pupil-
lary reflex is similar. This can be shown in animals in a satisfactory manner only
by stimulation by means of light. The pupil becomes narrower when light falls
on it if the transmitting media of the eye are uninjured.
Among the tendon reflexes the patellar reflex is of considerable importance,
the arc being formed by the femoral nerve and its center. This reflex is not con-
stant in animals in the standing position. The animals must be placed on one
side and the upper hind ]eg is flexed to as great an extent as possil)le at the stifle;
for this help is necessary. The flexed leg being supported with the hand under the
hock, a smart blow is struck on median ligament of the patella causing extension
of the stifle joint in the backward direction. One must either wait until the animal
has ceased voluntary movements of the muscles attached to the patella or adopt
some means of distracting its attention from the legs. Under normal conditions
General Symptoms.
587
Fig. 78. Diagram of the course of the motor paths of the domesticated animals.
CoP. Cerebral cortex with the origin of the pyramidal tract shown in red. Co. Cerebral
cortex showing the diffuse distribution of the points of origin of the principal cortical
motor paths (black). Ca. Nucleus caudatus. Th. Optic thalamus. L. Nucleus
lentiformis. Nr. Red nucleus. Cqu. Corp. quadrigemina. P. Pons Varolii and D.
Belter's nucleus with the subcortical motor centers for the principal subcortical paths
(blue). 3-7, 9-10. 12 nuclei, R 3-7, R 9-10, R 12 roots of the corresponding cranial
nerves. Dp. Decussation of the pyramids in the medulla oblongata. Cl-2 roots of the
I and II cervical motor nerves.
588 General Syniptoinatology of Diseases of tlie Brain,
the reflex is most active in the dog, cat and sheep and least in the ox, the horse
occupying an intermediate position. It is as a rule more pronounced in young
animals. Eeflexes of the anconeus or gastrocnemius can scarcely ever be obtained
by striking their tendons under normal conditions.
In pathological conditions reflexes may be either exaggerated, diminished or
entirely absent. The exaggeration of the reflex is recognized by spasms which are
more extensive and follow each other with greater rapidity. The opposite is the
case when there is a diminution of the reflex, but great care must be exercised in
determining them because vohmtary movements of the muscles may prevent the
occurrence of twitches owing to the fact that the animals have to be kept still for
a considerable length of time during the investigations.
Disturbances of nutrition are observed, especially in the
later stages or in diseases of the brain of long standing. These
are for most part due to an insufficient quantity of food being
taken owing to severe disturbances of consciousness.
The diagnostic importance of general brain symptoms is
that they indicate either a direct or indirect disease of the whole
brain, but they are of no value in localization of the disease. It
should not be forgotten that general symptoms of a moderate
nature may be due to functional disturbances of the brain, such
as occur in acute infectious diseases and such as ordinarily
occur in severe internal diseases.
(b) Focal Symptoms.
The comparative rarity of localized nervous diseases in the
domesticated animals and the primitive methods of in-
vestigation of the nervous system of animals adopted in earlier
times sufficiently explain the fact that our knowledge regarding
the localization of diseases of the brain and focal symptoms is
somewhat defective. A brief outline of the focal sjanptoms
based upon cases of disease that have been published more re-
cently and upon the animal experiments carried out by various
authors appears to be justified.
As a general rule focal symptoms cause motor and sensory
disturbances. Motor disturbances are generally the more easily
observed and are evidenced either by paralysis or abnormal
movements.
Motor paths (see fig. 78). Experimentation has shown that there are great
differences between the motor paths and centers in man and animals, and that the
differences become more pronounced the lower the animal is in the scale of de-
velopment. The peripheral motor path, the oldest in the vertebrata, begins at the
nerve cells in the anterior horn of the gray matter in the spinal cord or in the
nuclei of the cranial nerves and terminates in an end plat in a muscle fil)er. The
cells of origin of this path are connected with the central motor path. In the first
place they are connected with the subcortical or principal centers by means of the
extrapyramidal or principal paths ; further, with Monakow 's fasciculus between the
nucleus ruber (Nr) and the lateral column of the spinal cord on the opposite side, by
a fasciculus connecting the corpora quadrigemina (Cqu) with the ventral column of
the opposite side, paths from the pons (P) which pass partly to the lateral column on
the same and partly to the lateral columns on the opposite side, and finally a path
connecting Deiter 's nucleus with the ventral column on the same side. The subcortical
motor centers are connected by nerve paths with the motor cells scattered through the
cortex and arranged around the sensory centers. These paths, after arising in the
cortex converge towards the capsula interna and then crossing over pass to the
subcortical centers of the opposite side.
Focal Symptoms.
589
In the mammalians the pyramidal tract arises within a definite area (the
psychomotor zone), which in the cases of the carnivora is accurately known. It
converges towards the white matter of the hemisphere and occupies a narrow space
in the internal capsule placed laterally to the optic thalamus. From here it passes
to the pons and medulla where either the whole of it or the greater part passes to
Fig. 79. Diagram of the system of coordination. Tlie sensory parts are on the
right, the motor parts on the left and the centers concerned in the middle. Cr.
cerebrum. Tli. M. C. qu. optic thalamus, methalamus and corpora quadrigemina,
Cbl. cerebellum. M. sp. spinal cord. Stimuli from the skin, muscles, tendons and
joints pass either to the spinal cord by way of the sensory roots or to the medulla
by way of the sensory root of the trigeminus (not shown in the figure). Some
are connected by the reflex collaterals directly with the motor cells in the cord
and medulla and others through Sp. Cbl. to the cerebellum, Sp. M. in the neigh-
borhood of the thalamus through Sp. Cr. to the cerebrum and then to the motor
cells in these centers. The motor impulses produced pass from the cortex by the
motor path Cr. Sp., from the thalamus by M. Sp. and from the cerebellum by
Cbl. Sp. to the motor cells in the cord and medulla. The cerebellum also receives
sensory impulses from the semicircular canals by way of the free vestibular nerve
(N. v.), the thalamus and corp. quad, from the organs of vision by way of the
optic nerve (N. o. ) and these are conveyed to the motor cells in the central
organs and cerebrum by the paths Cbl. Cr. 'and M. Cr. (Adapted from O. Forster).
the other side to be continued in the lateral column of the spinal cord. The fibers
composing this nerve path accompany the peripheral motor path, both in the brain
and in the spinal cord, so that a connection is established between the cortex of the
brain and the peripheral motor nerves without touching the subcortical centers. In
590 General Symptomatology of Diseases of the Brain.
the ungulates the pyiaiuidal tract is very poorly developed and can be traced as far
as the 4th cervical vertebra only (Dexler and Margulies). In the carnivora the
tract is more fully developed and can be traced as far as the sacrum, but it is less
distinct than in man.
In birds there are no direct motor tracts connecting the brain and spinal cord,
the whole central motor path being in connection with the subcortical centers. It
is only in the parrot that a nerve path comparable to the pyramidal tract occurs
(v. Kalischer).
The cells from which the peripheral motor paths arise a»e collected into
groups of varying size, having a common function, and forming numerous reflex
centers both in the brain and spinal cord, stimulation setting in action one or more
muscles, or under certain circumstances, whole groups of muscles on one or both
sides of the body in definite sequence. The complex reflex mechanisms which permit
the correlation of movements of certain parts of the body with movements of other
parts, such as running, walking, etc., are controlled by the subcortical centers. With
development the subcortical centers encroaches upon the sphere of action of the
cortex, liut apart from this other exactly similar movement can be carried out with-
out calling into play the reflex mechanism, the brain cortex taking part in numerous
reflex mechanisms to the exclusion of the subcortical centers. This is rendered
possible by the pyramidal tract which in the ungulates controls the head and neck,
and in carmvora the limbs also. The lower the position occupied by an animal in
the scale of development the greater the independence of the individual elements
of the motor paths on the opposite sides.
From the foregoing it is clear that the pyramidal and the extrapyramidal
tracts can convey the socalled voluntary impulses of the cortex and be effective on
both sides of the body. As all these j^aths and centers are disposed over a wide
area of brain, and as the subcortical centers are somewhat independent of the cortex,
lesions capable of causing total central paralysis in animals must be very extensive
and more so than those producing the same effect in man.
In the coordination and regulation of movements several portions of the
nervous system take part (see fig. 79).
Two principal portions control coordination and regulation; the sensory paths
which inform the cells of the central nervous system regarding the individual nmscle
functions, the position of the whole or of some part of the body, and the motor
paths which convey stimuli to the muscles depending upon the most varied sensory
impressions in the nerve cells. The component parts of the centripetal path are
not all of equal value as regards coordination. In certain muscular functions the
special sensory paths are involved, in others the vestibular or the optic paths; in
the equilibration of the whole or of parts of the body the paths leading to the
cerebellum or even the cerebellum itself may be concerned. Each part of the co-
ordinating system is functional up to a certain point. As the various components
are not of exactly equal value they are able, so to speak, to hand over the excess
to the opposite side. This is particularly the case with regard to the organ of
vision and consequently there is more or less ataxia of the eyes.
By means of the coordinating mechanism the body is in a position to carry
out each muscular function with ease and certainty and with the least possible waste
of energy.
The extent and severity of the paralysis depends upon the
portion of the intracranial motor path injured and the extent of
the injury. As the central motor path covers a somewhat large
area at its origin and local lesions of the brain tend to remain
limited in extent either permanently or for some length of time,
the paralysis is limited in cases of disease of the motor areas
and owing to the decussation of the fibers the sjanptoms are ex-
hibited by the other side of the body. The paralysis tends to be
monoplegic in type, affecting either one side of the face or one
limb. The paralysis is generally incomplete and only a more
or less pronounced paresis is observed. If several centers are
involved in the morbid processes there may be injury to motor
areas on both sides, causing asymmetrical monoplegia. Fur-
ther, it is to be observed that in cortical injuries the paralysis
Focal Symptoms. 591
is preceded by convulsions owing to stimulation of the cells be-
fore they are destroyed.
The further the disease is removed from the cortex the
smaller the diseased area sufficient to partially or completely de-
stroy the converging motor path. In the depth of the white
matter and still more in the internal capsule and the crura
cerebri somewhat more extensive lesions may cause paralysis
of the opposite side of the body (hemiplegia). In cases where
the crus, pons, or commencement of the medulla is injured it
usually happens that the central motor path and the nucleus or
basal process of some cranial nerve is involved, resulting in
nuclear or infranuclear paralysis of the cranial nerve on the
same side as well as partial or total paralysis of the other side
of the body. In cases where the the disease affects the nucleus
of origin of the nerve or the nerve root there is paralysis of the
part supplied by the cranial nerve alone.
Unilateral paralysis due to disease of the central motor
path and involving muscles that work in concert on both sides of
the body (eyes, mastication, muscles of the trunk) generally
passes unnoticed, although the paralysis, as a rule, is incomplete
in muscles that operate on both sides of the body independently
and is, as a rule, most obvious in movements that are not auto-
matic. The course followed by the extrapyramidal tract makes
it possible that in addition to marked paresis of the opposite
side there may be a certain degree of weakness in the muscles
of the diseased side. Clinical observations and animal experi-
ments adduce further proof that paralysis due to lesions of the
central motor path not rarely disappear either completely or to
a great extent in time.
The principal focal symptom is ataxia.
Under the term ataxia are included all obvious functional disturbances of
muscles that are not due to loss of power and are not the result of paralysis. Prom
this it follows that ataxia is due to some interruption in the sensory portion of the
coordinating system, that is in the centripetal portion. Great care must be exercised
in the diagnosis of ataxia in order to avoid the inclusion of an actual paralysis under
the term. True ataxia is very rarely observed in animals. It far more frequently
happens that ataxia and paralysis are present at the same time and it is very
difficult to decide to what extent the abnormal movements are due to paralysis and
to what extent due to ataxia.
It is customary to distinguish between peripheral, spinal, cerebellar, and cere-
bral ataxia, depending upon the seat of the lesion. When there is disease of the
peripheral sensory nerves all the nerve fibers passing to the spinal cord or medulla
and from thence to the cerebellum or cerebrum are blocked causing very severe
motor and static ataxia. It would be unusual if the motor fibers in a mixed nerve
were not also involved, in which case there would of necessity be paralysis also. In
view of the faot that the sensory tracts run in different columns in the spinal cord
it is quite likely that in cases of localized disease some of the other paths may re-
main intact. Owing to this, spinal ataxia may be less pronounced than peripheral,
and according to the localization of the disease may be obvious in connection witli
movement or equilibration. Eeferences to spinal ataxia in veterinary literature are
very frequent, but accurate knowledge shows that pure cases of the condition are
very rare and that in the majority of instances it is associated with spinal paralysis.
In cases of cerebral or cortical ataxia there is an absence of fine gradations of
movement, in carrying out any movement the muscles contract with greater force
than is necessary or the action may involve a greater or smaller number of muscles
than is necessary with the result that the movement is clumsy. Cerebellar ataxia, which
592
General Symptomatology of Diseases of the Brain.
from the point of view of diagnosis is far more important, is shown by the move-
ments of the animal resembling those of an intoxicated person; staggering for-
wards, backwards, or sideways, and finally falling, and there may be swaying
movements of the head. The animal appears to be trying to balance itself (figs.
80 and 81). During progression the feet are raised up high, in some cases abducted
and in others adductod, advanced with a swinging motion and set down heavily.
The animal cannot take food or water because the swaying movements of the head
in all directions upset any vessel containing food. When the muscles have no equili-
brating function to carry out, as for example when the animal is at rest and in
many of the movements carried out when the animal is lying down, the symptoms of
loss ' of equilibrium which before were pronounced apparently disappear entirely.
If the movements are more closely observed even a minimal disturbance of co-
ordination may be noticed.
Bilateral disease of the vestibular nerve may cause symptoms exactly resembling
those of cerebellar ataxia. This has been observed in a fowl in which suppuration
of the petrous temporal bone extending to the labyrinth resulted from bilateral
purulent otitis. In this case the brain was quite free from lesions.
The convulsions which occur in some cases of disease of the
motor areas of the cortex constitute the socalled cortical or
Jacksonian epilepsy. In this condition there are tonic-clonic
Fig. 80. Dog aflected with cerebellar Fig. 81. Dog affected with cerebellar
ataxia. ataxia.
(Illustrations made from two photographs, one taken immediately after the other.)
spasms of the whole body at long and variable intervals which
may be accompanied by slight loss of sensibility over a cir-
cumscribed area. This loss of sensibility may be absent. The
spasms always start in the same group of muscles and gradu-
ally spread to neighboring muscles or to the whole body. The
lesion is situated in that part of the motor area containing the
center controlling the group of muscles in which the spasms
start. In a case of staggers we were able to satisfy ourselves
that exceptionally a local sjanptom may become an epileptiform
attack associated with coma and involving the whole body, espe-
cially when the attack always begins in the same group of
muscles.
Spasms occur in the areas supplied by the cranial nerves
when the lesions are near the nucleus or nerve root. For exam-
Focal Symptoms. 593
pie, in disease of the crura or the pons there is marked contrac-
tion of the pupils with absence of, or exaggerated reaction, to
light, and possibly also strabismus. Spasms of the muscles of
the neck are due to stimulation of the sensory nerves in the re-
gion of the medulla and generally result from meningitis.
Finally, now and then a local symptom may be attributed to a
reflex in cases in which a circumscribed portion of the body is
involved.
Movement in circles is very rarely observed, but when this
does occur it is always in the same direction. This sjaiiptom
may accompany diseases of the portion of the central motor
tract extending from the cortex to the medulla oblongata, the
movement being either towards the diseased or the healthy side.
Movement in circles associated with lateral bending of the head
and neck is principally seen in diseases of the cerebellum or the
middle peduncle of the cerebellum, and it may also be observed
in association with unilateral blindness or deafness.
In cases of unilateral lesions of the anterior and medial portions of the
thalamus produced artificially in cats and dogs Probst observed lateral bending
of the head and movement in cireks lasting for some minutes, in the first place
away from the injured side and then for several days towards that side. Destruc-
tion of the tissues included between the posterior portion of the thalamus, the red
nucleus and the anterior pair of the corpora quadrigemina caused bending of the
head and movement in circles towards the injured side. Destruction of tissue in
the region of the posterior pair of the corpora quadrigemina, the pons and the
pyramidal decussation caused movements in the opposite direction while lesions of
the posterior part of the pons caused rolling.
Hyperextension of the head and neck is observed in disease
of the portion of the brain posterior to the cerebellum.
Rolling movements associated with rotation of the head
about its long axis in the same direction are somewhat fre-
quently observed in small animals. The animal, as a rule, lies
on its side and then rolls over. The eyes are often involved,
that towards which the rolling takes place being turned in-
wards and downwards and the other upwards and outwards.
In many cases the former only is involved. In view of the fact
that the nuclei of the cranial nerves are situated near the pedun-
cles of the cerebellum there are often functional disturbances
of these nerves (ocular motor, trochlear, trigeminus abducens,
facialis) .
Rolling movements are usually seen when the disease involves the
peduncles of the cerebellum or the surrounding tissues. Experiments
and observations have proved that such movements are not of neces-
sity associated with disease of the middle peduncle. They occur with
far greater frequency in cases of disease of the anterior part of the me-
dulla oblongata and the hemispheres of the cerebellum. Probst's ex-
periments have sho\m that unilateral lesions of the posterior part of
the thalamus may sometimes cause rolling movements, and IMontane
saw them in inflammation of the corpus striatum. The latter obser-
vation is, however, not absolutely conclusive as the possibility of the
presence of perhaps only microscopic lesions in the peduncles of the
594
General Symptomatology of Diseases of the Brain.
cerebellum cannot be excluded with certainty. Clinical observations
indicate that these symptoms are not always seen in diseases of the
cerebellar peduncles, although there may be bending of the neck,
movements in circles, and falling over to one side. Unilateral lesions
of the vestibular nerve or of the labyrinth may cause rolling (Biehl,
Authors' case).
Fig. 82. Diagram of the paths of the
sensory nerves (with reference to ]xjin,
]n-essure, temperature, taste and nms-
cular sense). G. spl., G. G. spinal
ganglion and Gasserian ganglion (the
ganglia of the vagus and glosso-
pharyngeal nerves are omitted for the
sake of simplicity), with the sensory
nerve paths from the skin, mucous
mpml)ranes, muscles, bones and joints.
Tlie fihers passing from the spinal
ganglion and entering the spinal cord
tlirougli the sensory roots in part turn
in the forward direction and run in
the dorsal columns (black) and reach
the nerve cells Nc. or Ng. (medullar
nucleus of the posterior columns).
From here a second path arises which
crosses over at R. (raphe) and runs
in L. (fillet) and is distributed to
the nerve cells (black) of the optic
thalamus Th. From here a third path
arises (Th. Co. black) which ter-
minates in a limited area of the cor-
tex from which the pyramidal tract
starts. A second jwrtion of the fibers
entering tlie cord arborise around the
sensory nerve cells of the dorsal cor-
nua. From these a tract starts (red)
which crosses over to the other
side and the greater part of this
passes forwards in Gower's tract, a
second portion in the anterior tract,
Cbl. zone, and then passes through the
lateral and dorsal portions of the lat-
eral fillet. LI. After splitting up be-
low the posterior corpora quadrige-
mina this terminates in the ventral
nuclei of tlie optic thalamus (red).
From this point projection fibers (red)
pass to the greater part of the cortex.
The fibers of the trigeminal root ar-
borise round the cells of the nucleus,
from whicli a second path arises and
crosses to the (iii])o-.ile side, passing towards the optic thalamus in the neighbor-
hood of the fillet. The ])aths and centers shown in black convey sensory im-
pressions relating to the localized senses, while those marked in red convey the
general sensory impressions ( temperature, pain, pressure, etc. ) ( v. Monakow ) .
In all the natural cases so far observed the rolling is towards the
diseased side but experiment has shown that it may be in the opposite
direction, notably after section or simple stimulation of the vestibu-
lar nerve.
Sensibility may be impaired by lesions of the sensory tract
leading to the cortex and in such cases there is, as a rule, les-
Focal Symijtoms.
595
sened sensibility of the paralyzed portion of the body. In ani-
mals this partial loss of sensibility is, as a rule, difficult or im-
possible to recognize on account of the disturbance of conscious-
ness which usually accompany such diseases. A symptom that
is far more easily observed is the anesthesia or hyperesthesia
of the portions of the skin or the mucous membranes supplied
by the vagus or the trigeminus in cases where either the nucleus
or the root process of either of these nerves is diseased.
In diseased conditions in-
volving an interruption of
the optic tract there are al-
so disturbances of vision
(see Fig. 83).
It has been shown by Dexler that
in the horse the greater part of the
fibers of the optic nerves decussate
and that the proportion of the fibers
from the inner portion of the retina
(nasal portion) which decussate to
those from the outer or temporal por-
tion which do not cross is 5:1. Thus
it happens that the optic tract and the
more central portion of the nerve path
of vision contain fibers coming from
both eyes and the greater number of
these are derived from the inner por-
tion of the eye of the opposite side
(fig. 83). The optic tract is similar
to the above in the ruminants and
swine, whereas in carnivora the pro-
portion of the fibers which cross to
those which do not is smaller.
Interruption of the optic nerve
causes amaurosis of the eye, dilatation
of the pupil and pupillary reaction is
lost. Regarding the lesions induced
in the chiasma, optic tract, thalamus,
corpus geniculare laterale, optic radia-
tion of Gratiolet, and center of vision
by destruction of the nerve path noth-
ing definite is known. Hemianopia
has been observed by Probst in dogs
resulting from lesions in the region of
the thalamus produced experimentally,
and by E. Balint as a result of lesions
in the occipital cortex. A similar con-
dition is seen in the human subject in
cases of unilateral injury to the optic
path posterior to the chiasma. Hemi-
anopia is an insusceptibility to light
in the temporal portion of the retina
on the same side as the lesion, and in the nasal region on the opposite side. Total
destruction of the chiasma would lead to blindness in both eyes and complete absence
of pupillary reaction, but owing to the difference in the proportion of fibers which
decussate in carnivora and herbivora lesions of the path posterior to the decussation
determine hemianopia in the former, whereas in the latter the disturbance of one
eye is far greater than that of the other. In view of the fact that in animals inves-
tigations of the power of vision cannot be so complete as in man the disturbances of
vision mentioned pro^sably pass unnoticed save in carnivora. Besnoit found total
blindness on the left side in a cow affected with tuberculosis and softening due to
thrombosis of the right hemisphere.
In cases where there is disease of the optic path between the chiasma and the
Fig. 83. Diagram of the optic paths in
the horse. R. Retina of the left eye, dark
portion showing the uncrossed fibers and
light portion showing the crossed fibers.
No. Optic nerve. Tro. Commencement of
tlie tract behind the chiasma. CM. Mey-
nert's commissure. CG. Gudden's commis-
sure. Tho. Optic thalamus. Cgl. Lateral
corpus geniculare. Qa. Anterior corpora
quadrigemina. SG. Optic radiation of
Gratiolet. Co. Occipital cortex (optic cen-
ter). (Adapted from Dexler and Ober-
steiner. )
596 Inflammation of the Pia Mater.
basal ganglia and including the latter disturbances of pupillary reaction are to be
expected, although this is difficult to determine in animals because the constant
movement of the eye makes it scarcely possible to use the ophthalmoscope. The
diminution or al)sence of pupillary reaction is comparatively easier to demon-
strate in animals in which the proportion of decussating fibers is somewhat large.
Diseases of the cortical paths of vision cause no disturbance of pupillary reaction.
Disturbances of the senses of liearinp^, taste or smell some-
times occur in diseases of tlie brain, but tliey can only be discov-
ered witli difficulty, if at all, in the dog.
Literature. Beyer & Lewandowsky, Engelmann's A. f. Phys., 1906, 4.51. —
Bickel, Meehanismus d. Bewegungs regulation, 1903. — Dexler, Ergebn. d. Path.,
1896, III, 2, Abt., 492; 1900, VII, 401; Nervenkrkh. d. Pferdes., 1899.— Dexler &
Margulies, Morph. Jahrbuch, 1906, XXXV, 443.— Forster, Die Physiol, u. Pathol,
d. Koordination, 1902. — v. Kalischer, Abh. d. Preuss. Akad. d. Wiss. Anhang, 1905.
—Marburg, Engelmann's A. f. Phys., 1904; Suppl. Bd., 193, 457.— Monakow,
Gehirnpathologie, 1905.— Petren, Skandinav. A. f. Phys., 1902, XIII, 9.— Philippson,
Le systeme nerveux des animaux, 1905. — Probst, Sitzungsber. d. K. Akad. d.
Wiss. in Wien, 1905, CXIV, 3, Abt.; Monatsschr. f. Psych, u. Neurol., 1900, 387;
Arch. f. Psych, u. Nervenkrkh., 1900, 721. — Eothmann, Engelmann's A. f. Phvs.,
1907, 217.— Schmidt, Z. f. Tm., 1907, XI, 420.— Schrader, Pfliiger's A., XLIV, 175.
— Thomassen, Ann., 1893, 241; 1894, 1.— Trendelenburg, Engelmann's A. f. Phys.,
1906, 1.
1. Inflammation of the Pia Mater. Leptomeningitis.
{Acuie men'mfiitis, Enceplialifis, Acute hydrocephalus, Suh-acute
encephalitis, Meningo-encephalitis. )
Leptomeningitis is the term applied to inflammatory pro-
cesses which commence in the pia mater, but which, on anatom-
ical grounds, tend to spread to the superficial layers of the brain
substance.
Of the meninges only the arachnoid and the pia mater tend to be-
come the seat of primary disease. This may be due to the richness
in blood of the pia mater. In view of the fact that small blood vessels
penetrate the superficial layers of the brain substance from the pia
mater, the diseased process is almost certain to spread to the brain
and practically every case is one of meningo-encephalitis. But such
cases may be included under the term meningitis in view of the fact
that the process starts in the membranes, the brain being affected sec-
ondarily.
Occurrence. Simple acute meningitis occurs more fre-
quently in the horse than in other animals and cases are most
frequent during the hotter periods of the year. On the other
hand, there is no particular difference in the incidence of sec-
ondary meningitis in the different species.
According to Christiani there was an increase in the number of cases of
primary meningitis simultaneously with every addition of horses to the stables in
the Prussian army and the number of cases increased in proportion to the increase
in the number of horses. The disease reaches its maximum during the second and
third quarters of the year, just as does the socalled Borna disease.
Etiology. 597
Etiology. Simple meningitis (primary or idiopathic men-
ingitis) is with few exceptions cine to an infection, the infective
material reaching the brain by way of the blood stream. The
causes of the disease are only imperfectly known.
In the horse primary meningitis is not rarely a sporadic
case of enzootic cerebro-spinal meningitis and is set up by the
cause of that disease. This view receives strong support from
the more recent investigations of Christiani. This author found
diplococci agreeing with the cause of Borna disease on the one
hand and with the micrococcus of cerebro-spinal meningitis of
Weichselbamn in all its characters on the other, in the spinal
fluid of practically all his cases of socalled acute hydrocephalus
in the horse. The diplococci were never found in horses suffer-
ing from other diseases of the brain.
There is no room for doul)t that for certain cases of pure
meningitis in the horse and in otlier animals other infective
materials are responsible. On the otlier hand, observations made
on the human subject show that organisms present in the healthy
body may play some part in the production of the disease, either
owing to some exaltation of virulence, or owing to some de-
crease of resistance on the part of the body. Streit found the
bacillus necrophorus in meningeal exudates of two horses.
According to Poulsen sporadic cases of simple meningitis
occur in cattle at all periods of the year. Cases are more fre-
quent in young animals than in adults and the cause is not ex-
actly known. Poulsen further observed cases following calv-
ing which were apparently due to this, but quite distinct from
parturient paralysis. This disease he named puerperal menin-
gitis. The disease developed without exception one or two days
after calving, never later, and never before calving. Christiani
found diplococci comparable to the streptococcus of Borna dis-
ease in a goat affected with acute meningitis.
Miscli found cocci in two cases of meningo-encephalitis in
the rabbit, cultures of which set up a similar disease by in-
travenous inoculation into experimental animals.
According to Klee a special form of acute meningitis occurs
in the pigeon (the socalled staggers [see disease of the vestibular
nerve] ) caused by a bacterium measuring 1 to li/4 i*- in length.
There are certain exciting causes that play some part in the
production of simple meningitis. Among these may be men-
tioned: bad weather (cold and wet), chills, concussion of the
brain, long exposure to the sun, transport by train, intensive
feeding, overexertion, etc. Up to the present no exact observa-
tions have been made to ascertain to what extent the direct rays
of the sun may be responsible for meningitis. Cases are prin-
cipally observed in young animals and in geldings that are
housed in hot, damp stables, and fed on a rich diet ; circum-
stances which predispose to infectious disorders. Christiani,
on the other hand, was unable to show that even a long period
in a stable that was damp had any predisposing effect. It is a
598 luliamuiation of the Pia jMater.
generally accepted idea that the progeny of animals subject to
staggers are more easily affected than the progeny of healthy
animals.
Secondary meningitis may lie due to a large variety of
causes. The most common cause is probably a pyogenic bac-
terium of some kind or the streptococcus of strangles. In cat-
tle cases due to the bacillus of tuberculosis are comparatively
common. Koske proved that the meningitis met with in cases
of infectious rhinitis in the pig (see page 4) was due to the
bacillus pyocyaneus. Many other organisms may be responsi-
ble for the condition.
The infection may be carried into the cranium through
wounds resulting from kicks, trepanning, etc. Not rarely men-
ingitis may be due to disease in neighboring parts ; tuberculosis
of the cranial bones in cattle, caries of the petrous temporal
bone in dogs and pigs, and more rarely in horses, necrosis of the
atlas may be the starting point, the infection reaching the men-
inges either directly or by way of the blood vessels or nerves.
Similarly general inflammation of the eye, diseases of the mid-
dle ear (in dogs and swine), chronic catarrh of the nasal sinuses
in the horse and cattle, deep-seated inflammation of the wall of
the pharynx, suppuration in the parotid region may lead to
acute meningitis. Foreign bodies penetrating the cranial cav-
ity from the pharynx may also act as vehicles of infection (Dur-
rechou). Finally, rupture of a cerebral abscess on the surface
of the brain or in the ventricles may cause purulent inflam-
mation.
Infective material may reach the meninges by way of the
blood stream in cases of strangles, ulcerative endocarditis, tu-
berculosis, injuries to the stomach (Kabieaux), etc., and also
from gangrenous foci in the lungs and possibly also from worm
nodules in the intestine (Hess).
Frankel's discoveries regarding the presence of bacteria in the brain in gen-
eral infectious diseases are interesting. Bacteria, and in lo% of cases pyogenic
bacteria, could be demonstrated in the brain of men that had died from suppurative
or other bacterial diseases of some kind, but who during life had shown no symp-
toms of brain disturliance. Microscopic examination revealed the presence of
small inflammatory, necrotic and hemorrhagic centers and a very slight degree of
perivascular infiltration. In favorable cases these lesions may disappear without
any symptoms having been shown or in others they may sooner or later lead to
meningitis.
In occasional cases secondary meningitis may be due to the
invasion by animal parasites, such as the larvie of the Scleros-
toma armatum, the gastrophilus in the horse, CEstrus bovis in
cattle, the larvae of ticks and ccenurus cysts in the sheep, cysti-
cerci in the dog and pig.
Pathogenesis. The inflammation of the membranes and
the cortex causes an active hyperemia which is accompanied,
Pathogenesis. Anatoniieal Changes. 599
especially in the membranes, by a cellnlar infiltration. The dis-
covery made by Dexler in a case of the socalled Borna disease
associated with the investigations made in hnman medicine
(Sclmltze) indicate that when the inflammation is not snppnra-
tive it may affect the deeper portions of the cortex in some
cases and the snmmits of the gyri in others. This affects the
macroscopic characters of the lesions, as in the latter case the
alterations are clearly visible to the naked eye. Chemical sub-
stances which are directly injurious to the nervous tissue, and
the effect of which on the blood vessels has started the inflamma-
torv process in association with the increased intracranial pres-
sure due to hyperemia and extravasation, cause a series of
symptoms indicative of cerebral disturbance. In view of the
fact that the lymph spaces of the subarachnoid are in com-
munication with each other and with those of the spinal cord the
inflammation easily spreads to the whole of the surface of the
brain and generally extends to a less degree to the meninges of
the cord. The roots of the cranial nerves passing through the
membranes are very often involved. The stimulation of the
nerve endings in the membranes due to the inflammation and
the increased intracranial pressure cause pains in the head.
Anatomical Changes. The acute inflammation may in cer-
tain cases remain localized though, as a rule, it tends to become
diffuse. The congestion of the vessels may be so slight that a
definite diagnosis can only be arrived at by means of micro-
scopic examination. In tlie great majority of cases there is an
accumulation of more or less turbid exudate which may be
either colorless or reddish in between the dura and the arach-
noid and sometimes under the pia mater (hydrocephalus ex-
ternus). Far more rarely the exudate is fibrinous and sur-
rounds the dilated blood vessels, making them appear as yel-
lowish-white streaks. In cases of diffuse meningitis all these
lesions are found, involving also the pons and medulla and to a
less extent the membranes of the spinal cord. The lesions may
be particularly prominent in the anterior portions of the hem-
ispheres in cases of primary meningitis in cattle (Poulsen) . As
a general rule pus tends to collect at the places where the in-
flammation started, causing the pia mater to appear as a thick
membrane saturated with pus, Avhile round about there is evi-
dence of hyperemia and serous inflammation only (purulent
meningitis). In cases of tuberculous meningitis there are, in
addition to purulent and gelatinous infiltration of the meninges,
grayish translucent or yellow tubercles varying in size from a
poppy seed to a hemp seed along the course of the larger vessels
at the base of the brain.
The cortex and the contiguous white matter appear sat-
urated with serous liquid, moist, and swollen, and in conse-
quence of this the convolutions appear less prominent. On the
cut surface are visible vessels extending inwards from the pia
600 Inflammation of the Pia Mater.
mater and petechiae, the majority of wliicli are caused by the
escape of blood from vessels that have been cut throngh and
which may be wiped away. More rarely there are small hem-
orrhages which cannot be wiped off. In exceptional cases there
may be smaller or larger softened centers.
Almost without exception the venous plexuses in cases of
inflammation of the pia mater appear gelatinous, while the ven-
tricles of the brain contain a yellowish, turliid liquid which
sometimes contains flocculi or fibrin or even pus (hydrocephalus
internus acutus). If the inflammation is confined to the venous
plexuses and the choroid plexuses (meningitis internal) the ven-
tricle wall is sometimes softened.
In chronic inflammation of the pia the membrane ap-
pears thickened and opaque, especially along the course of the
vessels, and it is closely adherent to the cortex.
Symptoms. Acute meningitis is accompanied by general
symptoms of brain disturbance which gradually reach their
maximum within a shorter or longer period. At the commence-
ment disturbance of consciousness shows itself by the dullness
of the animal; they take less notice of their surroundings, but
stand wdtli staring eyes and frequently take up unnatural posi-
tions. They do not respond to accustomed calls, a sudden noise
startles them, but they promptly fall into a sleepy state again.
Animals can only be induced to move with difficulty, and while
moving are difficult to lead; their movements may be clumsy
and stumbling, or in some cases the feet are lifted high and
the head is held up. Dogs are particularly restless and fre-
quently change their position and attempt to hide themselves.
They make no response wdien called and do not recognize their
owners. They are likely to snap at one 's hand.
From time to time and frequently within a few hours of the
onset of the disease there are symptoms of excitement and even
of mania. Horses attempt to walk through or over any object
that may stand in their way; they sometimes stand with their
heads pressed up against a wall and move their limbs as if they
were w^alking. In many cases they kick and bite at the manger,
neigh, rear, move in circles, and finally collapse, or in some cases
fall over backwards, by which time they, as a rule, have several
wounds about the head and face. In cattle there is sudden rest-
lessness, stamping of the feet, the head is held up and the ap-
pearance is wild and staring. They bellow, stagger, strike out
at any object or person near them with their horns, lash their
tails, and climb into the manger. Finally, they go down and
general convulsions set in which may be started by a very sliglit
external stimulus, and which recur a number of times. In cases
of tuberculous meningitis, SA,aiiptoms of excitement are, as a gen-
eral rule, absent. Swine utter piercing squeals, root al)out in
the straw, and try to climb the walls of the sty, S^miptoms of
mania occur far more rarely in the other species of animals.
Symptoms. 601
In dogs such sj^nptoms are exceptional; tliey wander about in
an aimless fashion, howl and sometimes bite at the bars of their
kennels.
The period of mania is, as a rule, of short duration, not
more than a quarter or half an hour, and is followed by a period
of deep depression. The animals are utterly indifferent to their
surroundings, and if made to move, do so with the greatest
unwillingness. They lie stretched on the floor, lifting their
heads now and then and moving their legs as if walking, or they
stand with eyes closed and the head supported either against the
wall or in the manger. The limbs take up unnatural positions,
either widely separated or even crossed, the result of which is
that they collapse.
The respiration during the period of excitement appears to
be accelerated, but afterwards is, as a rule, retarded, deep, and
toward the end is sometimes of the Cheyne-Stokes tyi^e. The
pulse may be accelerated or slower then normal, and it is full.
The frequency is altered by the very slightest of influences. In
the later stages it is weak and scarcely perceptible.
In carnivora and swine there is sometimes vomiting, par-
ticularly in the later stages.
At the commencement of the disease, animals, and espe-
cially dogs, appear to be in a state of hyperesthesia. With the
increase of the disturbance of consciousness this decreases until
strong stimuli may provoke no reaction. In cases of extensive
meningitis there is often increased sensibility and warmth of the
roof of the cranium.
Local symptoms are rarely observed and then, as a rule,
in the later stages only. Cramp of the muscles of the eyes
causes mystagmus, rolling of the eyes or strabismus. In cattle
the strabismus tends to be a convergent one. The pupils are
generally unequally dilated, and the reaction to light is either
slow or entirely absent. These symptoms are sometimes asso-
ciated with spasms of the muscles of mastication or trismus.
In a proportion of cases there are contractions of the muscles
of the lips, alas of the nostrils and ears, while in some cases
there are spasms of the neck. Fibrillar twitchings or muscular
contractions are also seen in some cases in the muscles of one
or other of the limbs. Individual muscles may become para-
lyzed. In this connection the squinting due to paralysis of some
of the muscles of the eyes is of importance, because when asso-
ciated with unequal dilatation of the pupils and rigidity it indi-
cates some diseased process involving the base of the brain.
In addition to this there may be observed paralysis of the
pharynx, of the muscles of the face, tongue and levator of the
upper eyelid. Very rarely there is hemiplegia.
There is often an elevation of temperature, this being one
of the first symptoms. In the larger animals a rise of tempera-
ture occurring in the later stages is not infrequently connected
with some septic infection or pneumonia.
602 Inllamuiation of the Pia Mater.
Tliere is partial or complete loss of appetite. In their mo-
ments of semi-consciousness animals will pick up food, but they
chew it in a clumsy fashion and let it fall out of their mouths
again, or appear to forget that they have it in their mouths.
\\ hile drinking they will lower their heads into the w^ater until
their nostrils are covered. As a general rule the animals are
constipated and the elimination of urine is retarded.
Careful clinical observations have shown that during the course
of an attack of cerebral meningitis, there are often pronounced symp-
toms of spinal meningitis.
At the present time little is known regarding the symptoms
of chronic cerebral meningitis. In view of the fact that it is
the cortex that is chiefly involved disturbance of the functions
of the cortex might be expected. Some cases of staggers might
be due to chronic peri-encephalitis. Lecarpentier observed
twisting of the head and rolling to the right in a young dog
affected with ossification of the tentorium cerebelli and com-
pression of the motor branch of the trigeminal nerve.
Course. The symptoms vary from case to case and make
their appearance in varying sequence. Horses die, as a rule,
within two or three days after the first appearance of symp-
toms ; that is to say, before the excitement or stupor has become
sufficiently pronounced to allow of a sufficiently accurate diag-
nosis to be made. There are cases, however, in which the onset
of the mania is apparently sudden ; this being quickly followed
by a period of great depression and death within twelve hours.
Tliere are still other cases in which the animals appear merely
exhausted for several days, the exhaustion being associated with
loss of appetite, difficulty of moving, dullness, etc. ; the symptoms
peculiar to the disease becoming pronounced towards the end
of the second or third w^eek. There are all gradations between
these two extremes and in practice the differentiation between
the acute and chronic forms is not sharply marked and is of
little actual value. In cattle primary meningitis generally lasts
for one-half to two days, whereas tuberculous meningitis is, as
a rule, subacute.
With regard to the sequence of the symptoms it may be
said that the disease generally commences with dullness, fol-
lowed by a period of excitement. This in turn is followed by
loss of consciousness and in a proportion of cases by paralysis.
These stages frequently merge into each other and there may be
a complete absence of paralysis. In other cases the periods of
excitement and stupor alternate at varying intervals, and not
rarely there is obvious improvement in the animal. In a horse
affected with leptomeningitis of the medulla oblongata Frohner
observed that the head was suddenly held in an oblique position
and there was also joaralysis of the muscles of deglutition with-
Diagnosis. 603
out any sensory disturbance. Pronounced improvement may
be observed in protracted cases. The animal may improve to
such an extent that it may return to work, but after a time the
disease may reappear and possibly in a more severe form, death
occurring shortly after. Such relapses may be due to great
heat or to some external stimulus.
Complications are of frequent occurrence, the most common
of which are h3^postatic pneumonia or pneumonia due to foreign
bodies, septicemia or pyemia.
Diagnosis. In well-marked cases diagnosis is not, as a rule,
attended with any difficulty, especially if the history of the case
affords any information as to the nature and the manner of the
infection. In this connection the following points are of im-
portance: suddenly occurring disturbances of consciousness,
squinting due to disease of the nerves controlling the muscles
of the eyes, contraction or unequal dilatation of the pupils,
spasms of the muscles of the neck, trismus, active congestion of
the papilla of the optic nerve, paralysis of the cranial nerves
which is present in some cases, vomition in the dog and pig, and
painfulness of the top of the cranium. If the disease is not
fully developed and only symptoms of a general nature are to
be observed diagnosis presents considerable difficulty and may
be impossible.
Dullness and stupor are observed in a number of infectious
diseases, but in these cases the symptoms of brain disturbance
are not pronounced and there is an absence of impulsive move-
ments. In malignant catarrh the disease of the eyes (opacity
of the cornea and fibrinous iritis) and the nose supplies a satis-
factory explanation of the direct cause of the dullness. The
differential diagnosis of rabies, suspicion of which may be
roused by the attacks of mania, is based principally upon the
absence of muscular spasms and the fact that rabies terminates
fatally in eight or nine days at the most. Simple acute cerebral
hyperemia may sometimes cause symptoms of excitement and
dullness to a slight extent. Differential diagnosis in this in-
stance is based upon the rapid and f avoral)le course run by the
disease. In the absence of a complete series of characteristic
symptoms it is scarcely possible to distinguish between simple,
acute meningitis and purulent meningitis. In the case of the
horse acute relapses of chronic dropsy of the ventricles have
to be taken into consideration. The primary meningitis occur-
ring in cows at calving differs from parturient paralysis in
that there is fever, the pupils are contracted and in some
cases there are general convulsions.
Certain poisons (lead, santonin and bacterial toxins) some-
times cause meningitis which is so similar in its characters that
a diagnosis can be made only by a postmortem examination.
In the dog pentastomatosis and helminthiasis must be taken
into consideration, and in the ox and sheep staggers. Deep-
604 Inflammation of the Pia Mater,
seated inflammation in the neck sometimes causes spasms of the
muscles and other symptoms, but in such cases there are no
disturbances of consciousness, such as are seen in cases of men-
ingitis.
Accurate differentiation between serous and purulent men-
ingitis is only possible if the circumstances suggest that the in-
fection is of a purulent nature. In cases of suppuration the.
symptoms are generally very severe and death takes place in a
very short time. Tuberculous meningitis may be diagnosed
Avitii certainty if tubercles can be discovered on the iris or in the
posterior portions of the eye. In cattle the presence of tuber-
culous meningitis is very probable when there are disturl)ances
of function of the nerves leaving the base of the brain, or synip-
toms of a slowly progressive meningitis appear in an otherwise
tuberculous animal.
Prognosis. Meningitis is a dangerous disease in that re-
covery rarely occurs save in the case of puerperal meningitis in
the cow, in which instance a cure may often be effected, pro-
vided treatment be commenced in time. The longer treatment
is delayed the more unfavorable the prognosis, and should
symptoms persist for more than five days recovery is scarcely
to be expected. About 75 per cent of cases terminate fatally
and in the others, although acute symptoms disappear, some
secondary disease almost always remains which greatly de-
creases tiie value of the animal. In the horse dropsy of the ven-
tricles is possil)ly the commonest sequel. It may appear imme-
diately after the disappearance of the acute symptoms, or its
appearance may l)e delayed for wrecks or even months. It some-
times occurs after repeated acute relapses. Among the sequelae
may be mentioned : amaurosis, deafness, staggers resulting from
atrophy of the cortex, paralysis of individual muscles or groups
of muscles.
In animals that recover there is a tendency to relapses.
Treatment. The first thing to do is to get the animal into
a dark, quiet place where it can move (restraint only excites it),
and where it cannot injure itself should it have an attack of de-
lirium. In fine weather animals may be placed in the open in
enclosures. Injuries to the head may be avoided by applying
bandages. The straw should be short so that the animal may
not get entangled in it. Dogs must be confined in roomy
kennels so that they cannot bite people or other animals.
Herbivora should be given good hay and roots and fresh
green food as far as possible, with occasional bran mashes or
gruel. Carnivora should have milk, soup, and boiled salt meat
finely minced. Brandy and wine are useful in small animals.
If tlie animals do not take food of their own accord they must
be fed (see page 123), provided that it does not excite them.
Animals will sometimes take sufficient food if it be placed in
Treatment. 605
their mouths. With the idea of supplying nourishment for the
nerve cells Fambach gave horses daily injections of water or
salt solution containing 0.5-1.0 gm. of lecithin which had been
previously dissolved in alcohol. As a rule four or five injec-
tions sufficed. Subsequent investigations showed, however, that
this had no special action. The bowels may be regulated by the
administration of salts, enemata or castor oil, and cats and dogs
should be given calomel (0.3-0.4 gm. or 0.05 gm.). Where there
is loss of consciousness or difficulty in swallowing owing to
pharyngeal paralysis, the drugs may be introduced with the
food by means of an esophageal tube.
Cold water, snow, or broken ice may be usefully applied
over the frontal and parietal regions. This is best done by
means of rubber bags or bottles. In cases of severe and per-
sistent stupor cold douches may be given for periods of five or
ten minutes. These methods must be applied only if they can
be adopted without exciting the animal.
In the very early stages bleeding may be practiced ; Klemm
advised the subcutaneous injection of pilocarpine (0.2-0.4 gm.
for a horse) in order to reduce the blood pressure in the brain.
This treatment has often been adopted, although good results
have not been obtained as a rule. Alleviation or even consid-
erable improvement has been observed in subacute cases fol-
lowing injections repeated for several days. Under certain cir-
cumstances the drug is prejudicial. Arecoline may be given
with the same object, the dose being 0.06-0.8 gm. Potassium
iodide or other iodine preparations may be given to accelerate
the absorption of the exudate, large animals receiving 10-15 gm.
and small animals 1-2 gm. daily.
Smart rubbing of the neck and the inner surfaces of the thighs is advised by
many authors and especially in France. Intravenous injections of tincture of
veratrine are of doubtful value.
Where there is great restlessness chloral hydrate given in
enemata, and subcutaneous injections of morphia are indicated
because the animal is likely to injure itself severely. Morphia
may stop vomiting in the dog and pig.
Surgical intervention will probably prevent the extension of
secondary meningitis where that is due to injuries to the
cranium or to disease of neighboring organs.
During the period of convalescence the animals should be
nursed with great care in order to avoid any relapse, and they
should be cautiously put to work only after all disturbances of
consciousness have completely disappeared for several days.
Literature. Argyle, Vet. Journ., 1904, 162.— Augustin, Eev. Gen., 1905, V,
264.— Besnoit, Eev. Vet., 1906, 641.— Cadeac, J. Vet., 1901, 14; 1902, 193; 1907,
588.— Christiani, A. f. Tk., 1909, XXXV, 253 (Lit.).— Frohner, Monh., 1908, XIX,
129.— Hamoir, Ann., 1906, 391.— Hess, Schw. A., 1896, XXXVIII, 198.— Misch,
V. A., 1903, CLXX, 158.— Poulsen, Maanedsskr., 1908, XIX, 182; Pr. Mil. Vb.,
1899-1908.— Eabieaux, J. Vet., 1901, 729.— Siedamgrotzky, S. B., 1888, 20.— Streit,
B. t. W., 1906, 385.— Thomassen, Ann., 1893, 243.
606 Epizootic C'erebro-sjiinal Meningitis.
2. Epizootic Cerebro-spinal Meningitis. Meningitis cerebro-
spinalis enzootica.
{Bo ma Disease.)
Epizootic cerebro-spinal meningitis of the domesticated ani-
mals is an independent infectious disease characterized by in-
flammation of the membranes of the brain and spinal cord and
the adjacent nerve tissues. In certain districts the disease is
enzootic and even tends to be epizootic. In many cases there
are no macroscopic lesions.
Under this term we shall here consider only those cases of menin-
gitis which are capable of spreading epizootically, although such cases
may, under certain circumstances, occur sporadically. This compre-
hensive definition meets both scientific and practical demands. It has
been proved that in diffuse cerebral meningitis the inflammation often
spreads to the membranes of the spinal cord to a varying extent, the
dissemination of the infective material being favored by the commu-
nications which exist between the subarachnoidal spaces of the two mem-
branes. It is not advisable to separate such cases from those that af-
fect the membranes of the brain only and class them with simple
cerebro-spinal meningitis. For on the one hand it is quite possible
that in one case the inflammation may remain restricted to the mem-
branes of the brain only and in other cases extend to the membranes
of the spinal cord, on the other hand cerebral meningitis is as a rule
secondary to some other primary diseased condition and does not spread
epizootically. It is possible, however, that some forms of secondary
meningitis, such as are met with in influenza and strangles, may in some
cases become epizootic, but in such cases the secondary nature of the
disease is obvious.
Examination of the facts regarding the pathogenesis of this disease
indicates decisively that the socalled Borna disease must be ranged
with enzootic cerebro-spinal meningitis.
Schneidemiihl objects to the description "Borna Disease" on the grounds
that it is not historically correct. The disease did not first occur in the Borna
district, but had already been observed in other parts of Germany and in other
countries. "Cramp of the neck" (Genickstarre) is also not so good a term to
apply to the socalled Borna disease as to some other kinds of cerebro-spinal menin-
gitis as the symptom is not infrequently absent. ' ' Inflammation of the brain
and spinal cord" cannot be considered as quite correct, for as a matter of fact
when inflammatory lesions are present the affection of the brain substance is
secondary. A more correct term would be ' ' Meningo-encephalitis and Menin-
go-myelitis. ' '
Historical. The disease of the horse observed in Wiirtemburg in
1813, and subsequently described by Worz as *' Heat-stroke" (Hitzige
Kopfkranheit) was probably an enzootic cerebro-spinal meningitis.
The disease which spread through Europe in the years 1824-1828, and
which was described by Francjue as "Fever of the Nerves" was prob-
ably the same. Sporadic and enzootic cases of the disease were ob-
served in several of the northern American States by Large (1847)
and later by Liautard (1869). In 1878 and 1879 it attracted the at-
tention of the veterinary surgeons in Saxony, especially in the dis-
Historical. 607
tricts of Zwickau, Plauen, and Auerbacli, and during the period 1883-
1886 it became epizootic. From 1894 onwards it spread more wide-
ly and became more malignant in character, and especially in and
around Borna. This accounts for the name Borna disease. In 1880,
Kocurek observed an epizootic cerebro-spinal meningitis in a district
in Upper Hungary, where in 1875-1876 Raisz had seen an outbreak of
cerebro-spinal meningitis in the human subject. The disease is of fre-
quent occurrence in Belgium (Marcq, "Mai d'Aizeau).
In 1896 Siedamgrotzky and Schlegel, and Johne, simultaneously
carried out extensive bacteriological and pathological investigations as
to the nature of the disease. Further researches were made by Oster-
tag in 1900. Wilson and Brimhall investigated the disease from clin-
ical, bacteriological, and anatomical points of view during an outbreak
in North America (1898-1903). Streit (1902), Harrison (1905), and
Christiana have also made investigations. Histological investigations
by Dexler (1900), and more recently by Oppenheim (1907) have fur-
nished proof that Borna disease is an inflammatory one.
In 1867 an enzootic cerebrospinal meningitis was described by
Meyer in cattle. This appeared to be primary in some cases, and there
was never any plastic exudate. Schmidt (1888) saw cases in which there
were hemorrhages of the pia mater, and the cerebrospinal fluid was
gelatinous; while Utz (1896) in a similar enzootic found no pronounced
lesions. The disease was observed in calves by Roder in 1896.
Cases of a contagious nature were observed in sheep by Stohr,
Eichbaum, and Wilke on one occasion in a district where there were
cases of cerebro-spinal meningitis in man. Roloff (1868) observed it in
a flock of lambs. Microscopic examination showed only perivascular
cellular infiltration of the pia mater. Schmidt (1868) described an epi-
zootic among sheep in Eastern Prussia, in which there were punctiform
hemorrhages of the pia mater and cellular infiltration of the membranes
of the brain. Popow (1882) and Wischnikowitsch (1889) believed that
in an enzootic occurring in Russia, in which there were lesions in the
lungs, the possibility was not excluded that the meningitis might be
secondary. Prietsch (1896) saw an outbreak in a flock following drink-
ing from a brook which was suspected of containing the infective ma-
terial of the socalled Borna disease. In 1899 Walther described the
occurrence of the disease in the district around Borna. Further obser-
vations have been made by Savigne and Leblanc regarding the disease
in sheep, calves, and lambs.
In 1868 cerebro-spinal meningitis was observed by Renner in the
dog. In one town there were 20 cases, almost exclusively confined to
hounds. In these cases there was a purulent exudate between the mem-
branes. The disease was not distemper.
Several diseases more or less resembling cerebro-spinal meningitis have been
described by a number of authors, but these are apparently of a different nature.
Apostolides (1880) described a very fatal disease occurring in Cairo and the sur-
rounding district (more than 500 horses, 700 mules, and 200 asses died). This
disease was, according to Nocard and Leclainehe, a septicemia analogous to Mas-
sauah typhus. In the cases published by Pearson, Martin and Lucet, the possi-
bility of poison does not appear to have been excluded, and McCarthy and Eavenel
have apparently observed symptoms of meningitis in certain eases of poisoning.
Occurrence. The disease appears to be associated with cer-
tain low-lying districts, and tends to break out either every year
or at intervals of a few years. The outbreaks are variable in ex-
608 Epizootic Cerebio-spinal Meningitis.
tent. Sometimes the}- are very extensive and cause severe
losses and at other times there are only sporadic cases. The
outbreaks tend to be more severe in years when the rainfall is
heavy. It is observed, as a rule, on cultivated land only. In
the majority of cases the disease occurs in aifectod districts
only on certain farms or on certain parts of a farm, and there
may be only one animal affected in a stable, while in other cases
there may be a large number diseased and the death rate may be
high. The severity of the disease appears to vary with the sea-
sons. As a rule the first serious outbreaks occur in January
and February. The maximum is reached in May or June and
from this time they gradually decline, and in the last quarter of
the year there may be either sporadic cases only or the disease
may disappear entirely. This cyclical occurrence, which is par-
ticularly noticeable in affected districts in Germany, is prob-
ably dependent upon the heavy rainfall and the warmth of the
earth during the second and third quarters ; these factors in all
probability favoring the development of the cause of the dis-
ease (Liebener). The sporadic cases which apparently occur
everywhere are probably an independent type of meningitis
(Christiani).
In Germauy the disease is especially eommon in Saxony, Thiiringen and
Wiirtemburg. In Saxony the following districts are chiefly affected: Borna,
Grimnia, Zwickau, Planen, Auerbach, Chemnitz, Leipaig, Bautzen, Glauehau and
Eochlitz. In 1896 there were 1,198 horses attacked, and in the years 1903-1908
there were 439, 590, 264, 213, 1,095, and 508. In 1903 compensation amounting
to $140,536 was paid for 439 horses, and during the period 1904-1908 the com-
pensation for 2,903 horses amounted to $346,496. The disease has been known
in the Province of Saxony for the last thirty years, but it was in 1896 that it first
became widely disseminated. The districts principally involved were Merseburg
and Erfurt, Deiitzsch, Eckartsberga, Querfurt, Saalkreis, Merseburg, Weissenfels,
Ziegenriick, Weissensee, Langensalza. The following are the numbers of cases
during the period 1897-1908: 86, 137, 499, 317, 162, 81, 109, 224, 52, 62, 492, and
127. In the years 1901-1906 the disease was reported in Schwarzburg-Rudolstadt,
and isolated cases occurred in Saxe-Coburg-Gotha and Magdelnirg.
The disease was observed in Hungary in 1S80-18S2 and again in 1897 and
1898 in horses in the district of Zemplem. About 200 animals were affected.
Fresh outbreaks have been rejjorted since that time.
Two great outbreaks have been reported in Belgium.
Cases have occurred in horses in Great Britain and Eussia, more than 200
horses dying in the Don Province in 1902.
In North America, New York, Pennsylvania, New Jersey, Minnesota, On-
tario, and Illinois appear to be the most seriously affected. About 4,000 horses
and mules were destroyed in the valleys of the Brazos and Colorado rivers.
Etiology. Epizootic cerebro-spinal meningitis is due to an
infection.
In the subarachnoidal fluid of a horse affected with the socalled
Borna disease, Siedamgrotzky & Schlegel found a micrococcus and more
rarely a diplococcus measuring about 0.6 /x. On the surface of gelatin
this organism formed dirty white, sharply circumscribed colonies about
the size of linseed. These colonies showed a characteristic dense-look-
ing point at the center. In broth there was diffuse turbidity and a
large amount of flocculent deposit. Intravenous inoculation with cul-
tures into horses in one case produced no effect ; in a second, there were
Etiology. 609
symptoms of a slight brain disturljance, and the micrococci were dem-
onstrated in the cerebro-spinal fluid ; while in a third, the injection was
followed by symptoms of sleepy staggers. Subdural inoculation into
horses caused severe meningo-encephalitis, the cocci being demonstrable
in pure culture in the exudate.
Johne found diplococci in the cerebro-spinal fluid, and in one case
in the blood of diseased horses. The cocci measured 0.4 to 0.8 jn; and
some were free and others included within cells. After staining with
Ziehl's stain and washing with dilute acetic acid, the organisms showed
special shapes resembling coffee beans or wheat grains. They were not
constantly Gram-fast.
The cultural characters resembled those of the Siedamgrotzky-
Schlegel organism and short chains were formed. Growth was partic-
ularly luxuriant in the condensation water of agar when the cultures
were incubated. This organism was called by Johne, the Diplococcus
intercellularis equi, on account of its morphological and biological re-
semblance to the causal organism of contagious cerebro-spinal menin-
gitis in man. Typical symptoms of Borna disease followed the sub-
dural inoculation of the organism into two goats and three horses. All
the horses recovered while the goats died. At the postmortem of one
of the goats a purulent and fibrinous spinal meningitis was discovered.
Similar diplococci were found by Marcq in diseased horses in Belgium,
Organisms morphologically resembling the diplococcus of Johne
were found by Ostertag in cases of Borna disease. The organisms oc-
curred only in very small numbers, and were very rarely included with-
in cells. They were as a rule present in the subdural and ventricular
fluid of the brain and occasionally in the blood, liver and urine, but
only very exceptionally in the substance of the brain. On artificial
media short chains were formed; division was in two planes; the or-
ganism was non-motile, and Gram-fast. Growth on artificial media was
scanty, but it was particularly abundant in the condensation water of
agar. The organism grew equally well on acid and alkaline media.
In broth there was uniform turbidity, contrary to what is the case with
the streptococcus pyogenes. Gelatin was not li(iuefied. Multiplication
of the cocci occurred in water containing ammonia or nitrous acid.
The optimum temperature for growth was that of the body. Resis-
tance offered by the organism was slight, desiccation causing rapid de-
struction. The organism soon died in pure water, while they remained
alive for 4 months in moist substances. IMultiplication occurred in wa-
ter containing drainage from stables.
The microorganism designated by Ostertag as Borna-Streptococ-
cus was pathogenic for the horse, but not for the laboratory animals.
Subdural inoculation into horses was promptly followed by the usual
symptoms. According to Profe, repeated intravenous inoculations at
short intervals caused a disease resembling Borna disease, while a sin-
gle inoculation or a number spread over a long time caused a condi-
tion that was not at all typical, and quite transitory. Goats and sheep
are susceptible to subdural inoculation, but not to so great an extent
as the horse. Cattle and pigs are refractory. The introduction of the
organism under the skin, into the nose, eye, ear or alimentary canal
is not followed by any symptoms in the horse.
Streit isolated an organism closely resembling, and possibly iden-
tical with the streptococcus of Borna disease from a case of epizootic
cerebro-spinal meningitis in a horse in Ontario, as did also Grimm in
southern Germany, while Harrison observed a quite different organ-
(310 Epizootic CV'it'bro-spiiial Meninyilis.
ism. Christiani found an exactly similar orgaiiism in primary spo-
radic meningitis in the horse, and in a goat (see page 625).
In an outbreak in Minnesota, Wilson & Brimhall found an organ-
ism corresponding with the Micrococcus meningitidis cerebrospinalis of
Weichselbaum in the central nervous system of a cow. In other out-
breaks in cattle, horses, sheep and pigs only Frankel's diplococcus pneu-
moniffi could be found. The latter organism was also found at the same
time in men dead of cerebo-spinal meningitis. Horses inoculated sub-
cutaneously, intravenously, subdurally, in the brain and lumbar portion
of the spinal cord, all died showing typical symptoms of cerebrospinal
meningitis; and diplococci were found in pure culture in the central
nervous system of the experimental animals. A similar organism was
found by Trambusti in the meningeal exudate of a sheep, by Manfred
d'Ercole in two calves, and Zangheri in a horse.
Bacteriological investigations have, therefore, not as yet
given any perfectly satisfactory results, although it is probable
that Siedamgrotzky & Schlegel, Johne, Ostertag, Streit, Grimm,
Christiani, Marcq, and possibly also Wilson & Brimhall, were
dealing with the same organism which had in some way varied
its characters somewhat. Further investigations are necessary
to decide whether the cause of the socalled Borna disease is
always present in cases of cerebro-spinal meningitis in the horse,
and whether it plays any part in the production of the disease
in other species, at least in a proportion of cases. The obser-
vations of Prietsch, Walther, Proger and AVilson & Brimhall
appear to indicate that this is the case. A solution is also re-
quired to the question as to what relationship exists between
the organism described by Johne and others to the diplococcus
intracellularis of the human subject. According to Johne the
two may be distinguished by the fact that the organism which
occurs in the horse may be present in the central nervous sys-
tem without causing lesions but simply an intoxication. Ac-
cording to Ostertag there is no connection between the two or-
ganisms. Christiani, on the other hand, was unable to find any
differences between the streptococcus found by him and the
diplococcus intracellularis of Weichselbaum.
There is the possibility that epizootic cerebro-spinal men-
ingitis in the lower animals is not an etiological entity, and as
the diplococcus intracellularis and the d. pneumoniae occur in
man, each may be responsible for epidemics of the disease in
the human family.
Natural Infection. Under natural circumstances infection
takes place through the medium of infected water or food. The
fact that at the postmortem there is usually found catarrhal
pharyngitis and gastro-enteritis suggests the possibility that, in
spite' of the negative results so far obtained experimentally l)y
feeding, the infective material enters by the alimentary canal
and in some unknown way gains access to the blood stream and
thus is enabled to exercise its toxic effect.
Natural Inrec-tioii. Pathogenesis. (j]^X
Water contaminated with nitrogenous materials and all
food coming into contact Avitli it are equally dangerous in this
connection. Ostertag & Profe have been "able to isolate the
Borna streptococcus from Avater containing anmionia and nitrous
acid obtained from the drains of infecte'd stables. According
to Liebener the organism may exist in the ground and its dis-
semination depends largely upon the nature of the flooring.
Where the subsoil is loamy the infective material may l)e washed
down by heavy rains and finally be carried into streams.
It is not certainly known how the infective material reached
the ground or water, but, although its presence in urine is the
exception, yet it is possible that it is by means of the urine of
diseased animals. It is probable that under suitable conditions
the organism can maintain a saprophytic existence, and that un-
der certain circumstances that are not as yet known it becomes
pathogenic.
No observations have been made in veterinary medicine as to whether the
organism may be present in the upper air passages of otherwise healthy animals
and under certain conditions develop pathogenic characters.
The disease is not transmitted directly from animal to ani-
mal. Some observations appear to suggest at first sight that
this does occur, but it is far more probable in such cases
that the infection is carried by food or water which has at some
time been in contact with diseased or infected animals.
Susceptibility. Naturally the horse is the most susceptible
animal, followed in order by the sheep, ox and goat, while the
pig and dog are only very exceptionally infected. In certain
outbreaks several species of animals have been affected at the
same time.
Breed and sex exercise no influence on the susceptibility,
while intensive feeding, especially with clover hay, appears to
increase the susceptibility. Young animals appear to be more
susceptible than old ones, but this is not always the case.
Recovery from one attack leaves the animal with no im-
munity.
Pathogenesis. When the causal organisms reach the mem-
branes or the neighboring part of the cortex toxic materials,
either secreted by them or set free by their disintegration, injure
the vessel walls and the adjacent tissues. As a result there is
set up an inflammatory process associated with cellular infiltra-
tion and sometimes hemorrhage. This holds good both for the
socalled Borna disease and for other forms of cerebro-spinal
meningitis. In certain cases there is only the escape of a liquid
that is poor in albumen and the formation of small, scattered
centers of cellular infiltration, and even these may in some cases
be absent. The final result appears to he influenced not only
by the virulence of the infective material, but also by the species
of animal affected.
612 Epizootic Cerebro-spinal Meningitis.
Borna disease was recognized by Siedamgrotzky as a
serous leptomeningitis and by Kitt as an inflammatory process.
Dexler was able to demonstrate evident signs of inflammation,
namely, centers of small-celled infiltration in the membranes of
the brain and cord, the adjacent layers of the nervous tissue and
in the venous plexuses (see Figs. 84 and 85). The last named
author considered Borna disease to be a meningo-encephalitis
and myelitis. He admits that there is bacterial intoxication as
in the case of other inflammatory diseases of the In-ain, such as
rabies. In some cases the toxic effects and in others the in-
flammatorj'- processes gain the upper hand, depending upon
the intensity of the infection. Dexler 's view was further sup-
ported by the results of the histological investigations of Wil-
son and Brimhall. These authors pointed out at the same time
the discrepancy between the lesions and the disturl^ance of
health, a point already remarked by Dexler. More recently
Oppenheim has proved the presence of diffuse meningitis in-
volving also the superficial layers of the nervous tissue in a
typical case of Borna disease.
How difficult the discovery of the inflammatory lesions is, is shown by Dex-
ler's case mentioned above. In this case preliminary microscopic examinations of
the various parts of the central nervous system proved absolutely negative, and the
lesions were only found by systematic examination of a number of pieces of the
brain.
According to Schmorl and Johne, Borna disease is a pure intox-
ication of the central nervous system which leads to dropsy of the men-
inges and ventricles, owing to injury to the endothelial lining of the
vessels caused by venous stagnation. In view of the fact that both in
natural and in experimental cases the streptococcus of Borna disease
occurs but sparingly in the cerebro-spinal fluid, Ostertag believes that
the organism is destroyed in the blood of the animal, and that the
toxin thus liberated is able to exert its effects upon the nervous tis-
sues.
Apart from the toxic effects the nervous tissues are injured
more or less severely by the products of the inflammation. Tlie
escape of liquid raises the intracranial pressure and pro-
nounced disturbances of function are caused by the cellular in-
filtrations.
Anatomical Changes. In susceptible animals the only
lesions that are found are, as a rule, dilatation of the veins in
the pia mater of the brain and cord and an increased quantity
of clear yellowish liquid in the sub-arachnoid space and the
ventricles. Endothelial cells are sparingly present in the liquid
and a few red and white corpuscles. In five cases investigated
by Johne the percentage of albumen in the liquid varied from
0.035-0.17 per cent.
Occasionally there is localized gelatinous infiltration around
the vessels. The brain substance appears more or less moist.
Anatomical Changes.
613
In one case Joline found scattered small reddish-yellow centers
in the cortex and corpus striatum. The roots of the nerves ap-
pear to be uninjured.
Histological investi-
gations carried out by
Johne and 8chniorl, and
by Ostertag yielded nega-
tive results ; Dexler in
one case, and Wilson and
Brinihall in all the eases
investigated f o u n d a
small-celled infiltration in
the meninges and brain.
Dexler found this espe-
cially at places vphere the
arachnoid bridges over fis-
sures in the lirain and
also in the immediate
neighborhood of blood ves-
sels in the peripheral
parts of the brain and
cord (see figs. 84 and 85).
Oppenheim found a dif-
fuse thickening of the pia
mater due to an increase
in the amount of connec-
tive tissue and also round-
celled infiltrations in the
pia mater and in the su-
perficial layers of the cor-
tex. Very occasionally
there were cellular infil-
trations around the blood
vessels in the deeper tis-
sues. At places there were
small hemorrhages.
Peculiar "nuclear
inclusions" were demon-
strated by Joest and
Degen in the cells of the
ganglia. Applying a modi-
fication of Mann's stain
for the demonstration of
Negri bodies, the large
ganglion cells of Am-
mon's horn showed small
bodies staining intenselj
with eosin and containing
an unstained part. These
bodies were as a rule
rounded but sometimes
oval and occasionally di-
vided into two halves.
The nature of these bodies
which are apparently char-
acteristic of epizootic
cerebro-spinal meningitis
of the horse is not known.
Fig. 84. Disseminated infiltration with leucocytes of
the ventral column of the first cervical segment of the
cord in a case of Borna disease. Enlarged 30 times.
(Dexler).
Fig. 85. Round-celled infiltration and lacuna-forma-
tion in the pia mater of the cerebrum in Borna disease
(Dexler).
In the other species the lesions are similar to those found
in the horse, or as is sometimes the case in that species, there
may be a yellowish-white fibrinous or purulent exudate along
the course of the vessels of the membranes covering the base
614 Epizootic C't'ix'bro-sjjiiial Meningitis.
of the brain and medulla. The cerel)rospinal fluid in such cases
appears turbid and contains flocculi or fibrin or pus.
Symptoms. Little is definitely known regarding the i)eriod
of incubation. Noack observed symptoms in a horse from a
healthy district nine days after its introduction into an infected
district. In some cases there are digestive disturbances, loss
of appetite, frequent gaping, jaundice (very characteristic ac-
cording to some authors). In the horse there may be symp-
toms of colic, catarrh of the pharynx and respiratory tract;
these being accompanied or followed by gradually increasing
depression and dullness which continue to the end. During this
period the animals may blunder into objects in front of them
and fall down. From time to time there may be attacks of
vertigo which may cause immediate collapse.
S}^llptoms of excitement are observed and these are prin-
cipally due to external stimuli. This may manifest itself either
as fear, pronounced restlessness, or even in exceptional cases
in attacks of mania. For the rest the symptoms of excitement
resemble those of meningitis (see pjage 600), although they may
not appear until the end.
Within a short time, and in some cases quite early, spasms
occur in certain groups of muscles of the head. There may be
squinting, unequal dilatation of the pupils (rare), spasmodic
elevation of the ala? of the nostrils and lips. Very frequently
there is grinding of the teeth, intermittent trismus, etc. To
these is added difficulty in swallowing from the very outset and
it may be the most prominent symptom. Animals retain their
appetite and take in food and chew it, but are unable to swallow
the food or saliva that collects in the mouth, and as result there
is a flow of saliva from the mouth. In some cases the food col-
lects in the pharynx and causes severe pharyngitis. There are
often spasms of the muscles of the neck, the head being drawn
back by the tense muscles, and the animal rests with the breast,
the lower border of the neck and the chin against the wall. In
the horse there are sometimes spasmodic contractions of the
muscles drawing the head back. In some cases the contractions
are more powerful on one side with the result that the neck is
drawn to that side. It is useless to try to overcome the mus-
cular cramp and get the neck into the proper position, such at-
tempts only increasing the spasms. Not uncommonly there is
only a more or less obvious stiffness of the muscles, which may
be discovered when attempts are made to move the head pas-
sively, and frequently the spasms are quite absent. With the
extension of the inflammation along the cord the muscles of the
back are similarly affected. In many cases brief contraction
of the muscles of the back and other parts of the body are ob-
served at short intervals (Schmidt). In many cases the spasms
principally affect the extremities and the verteln'al column may
be curved throughout its length (opisthotonus).
Symptoms. 615
Sensibility may be increased at the outset but later, and not
rarely from the beginning, gradually decreases in proportion to
the dullness. In certain parts of the body, neck, along the ver-
tebral column, etc., there may be pronounced hyperesthesia up
to the last. Animals show this increased sensitiveness by rub
bing or biting the particular parts. Reflex irritability is in
creased at the commencement and this may persist throughout.
Slight external stimuli are sufficient to cause spasms of certain
muscles and even general cramp. In entire animals and even
in castrated animals there may be frequent or persistent erec-
tions, and in mares the corresponding symptoms are seen.
In some cases there is paralysis. Paralysis of the muscles
of the face causes distortion of the features. The tongue hangs
out of the mouth and swallowing is impossible. In many cases
there is weakness of the hind quarters.
The temperature is variable, but is, as a rule, somewhat ele-
vated, and in the horse oscillates between 39° and 39.5° C. Ex-
traordinarily high temperatures are onlj^ rarely encountered.
In one case observed by Mergel and Knabe the temperature
was 41° C, and in one seen by Ekkert 41.6° C. It commonly
happens that there is a rise of temperature at the outset only,
there being a fall to the normal afterwards. Sometimes the
temperature rises to a marked extent at long- intervals. Per-
sistent high temperature indicates a complication of some sort.
The rate and rhythm of the heart's action are variable, com-
paratively slight external stimuli causing marked acceleration.
Marked and persistent acceleration of the pulse indicates either
a complication or paralysis of the vagus. Respiration may be
either more rapid or slower than in normal animals.
Appetite is, as a rule, poor from the outset. Prehension of
food is rendered difficult, owing to cramp of the lips and muscles
of mastication and paralysis of the pharynx. Diseased horses
are unable to use their lips in the prehension of food and they
bite right into the food, mastication being frequently inter-
rupted. There is constipation and the abdomen appears
drawn in.
In the later stages the gait is verj uncertain, and in some
cases movement is impossible, the animal lying unconscious on
the ground. Respiration is shallow and rattling and sometimes
of the Cheyne-Stokes type, the limbs are extended and are
sometimes moved in the horizontal direction (socalled swim-
ming movements). There may or may not be symptoms of
paralysis or cramp at the time of death. The immediate cause
of death may also be due either to general sepsis following bed
sores, pneumonia due to foreign bodies or fracture of the skull.
According to Kiihn, the symptoms of Borna disease are very va-
riable. In some cases there is hemiplegia, in others rapidly progressive
paralysis of the lips, tongne and pharynx; and in still others, a striking
change in the disposition of the animal, previously quiet horses becom-
ing vicions (as seen in a case by Kalkhoff). Now and then, horses will
516 Epizootic Cerebro-spiual Meningitis.
not go forAvards, or they flex the joints of their limbs that the body
abnost comes into contact with the ground.
In some cases there is a vesicular eczema (Fambach, Knabe).
Course. The symptoms described do not always follow in
the order given, nor are they all present in every case. They
vary considerably in severity. As a rule the inflammation starts
at the base of the brain and extends to the medulla and spinal
cord, but sometimes the order is reversed. In six cases seen
by Noack the disease commenced with paralysis of the quarters.
The inflammatory processes may remain more or less localized
up to the time of death, spinal symptoms being consequently
absent. In other cases these may be the more prominent.
The duration and termination of the disease are also varia-
ble. In the mildest cases there is simply dullness for five to
eight days, followed by complete disappearance of the symp-
toms, (in the other hand, there may be severe spasms or even
paralysis on the first or second day, death following after a
short interval. On an average the disease lasts from one to two
weeks, symptoms gradually coming to a crisis, or they may
abate for a time and finally disappear. In many cases slight
symptoms persist for some length of time. In certain cases
there is a temporary improvement, followed by a relapse, espe-
cially when the animal is put back to work.
In well-marked cases the disease tends to be fatal, although
the mortality varies in different outbreaks within wide limits.
Kocourek observed recovery in 50 per cent of cases, while in the
case of Borna disease and even in milder outbreaks at the most
20 to 25 per cent of the animals remain alive, and sometimes the
majority or even the whole of the diseased animals may die.
Recovery is, as a rule, incomplete, various sequels being ob-
served, dulness, amblyopia, amaurosis, lumbar weakness, epilep-
tiform seizures. These may disappear in the course of months.
Diagnosis. Diagnosis is based upon the epizootic nature
of the disease and the simultaneous appearance of symptoms
due to disease of the membranes of the brain and cord. In this
connection the spasms of the neck, and the presence of symp-
toms of disease of the bulb and spinal cord, are of the utmost
importance. In infected districts the diagnosis may with great
certainty be based upon a far less complete series of symptoms.
The symptoms described differentiate the disease from cerebral
meningitis, including hydrocephalus internus, tubercular men-
ingitis, staggers (ccenurosis), rabies, vertigo, epilepsy, poison-
ing, etc. In cases of tetanus there is stiffness of the neck and
other portions of the body, but there are no clonic spasms and
consciousness persists to the end.
Treatment. Treatment is in general principle like that for
cerebral meningitis (see page 604). Cold applications, such as
icebags, are the best local treatment. The spasms may be mod-
Treatment. Prophylaxis. Veterinary Police. 617
ified by the administration of anti-spasmodics, which may be
given either subcutaneously or per rectmn. Schmidt records
the recovery of four horses following snl)Cutaneons mjections
of dialysed pyocyanase. In Germany satisfactory results have
been obtained in mild cases by long-continued administrations
of small doses of calomel (2 gm. daily), or subcutaneous injec-
tions of turpentine. Subcutaneous injections of emulsions of
healthy brain tissue are without effect. Lecithin, advised by
Fambach, has been proved to be useless. Fambach and Zech,
among others, have not been able to convince themselves of the
value of the sublimate-atox^d treatment advised by Dorn. Sta-
tistics show that none of these or other treatments have much
effect upon the mortality of the disease. At the present moment
there appears to be no prospect of treating epizootic cerebro-
spinal meningitis successfully.
Prophylaxis. In order to hinder the spread of the disease
food, water, and pasture, should be changed, and in all cases
healthy animals should be isolated from the diseased, and if
possible removed to a different stable altogether. Special care
must be taken that the drinking water contains no nitrogenous
materials, and particularly the drainage from the stables must
not be allowed to contaminate the water. According to Kuhn
green food, roots or raw potatoes should be given to horses m
affected districts and horses used in agriculture should have
their feet thoroughly washed in 10 per cent creolin every night.
Veterinary Police. From this point of view the inclusion
of epizootic cerebro-spinal meningitis among the notifiable dis-
eases appears to be advisable. Regulations should be inade
with reference to improvement of local conditions, disinfection,
isolation of diseased animals, and careful disposal of carcasses,
but it does not appear to be necessary to limit movements of
healthy animals on infected premises.
The disease lias more recently been soliedoled in the Kingdom of Saxony and
in the Prussian Province of Saxony.
Literature. Christiani, A. f. Tk., 1909, XXXV, 253 (Lit.).— Dexler^ Z. f.
Tm 1900 IV 110.— Eichbaum, Stohr, Wilke, Pr. Mt., 1865-66, 135.— Francis,
Anu Vet. Eev., 1905, US.-Gonigew, Journ. f . allg. Vet. Wiss., 1906, 242.-Grimm
Unters. iib. bei d. sog. Kopfkrh. d. Pferde gefund. Bakt. Diss Giessen., 1907
(Lit.).-Joest & Degen, Z. f. Infkr., 1909, VI, 348.-Johne, D Z. f. Tm., 1896,
XXII, 371: S. B., 1896, 57.-Kalkofe, Z. f. Vk., 1908, 247.-Klett, D. t. W., 1898,
329 (Lit.).-Kocourek, D. Z. f. Tm., 1891, XVII, 133.— Kiihn, B t. W 1908,
173.-Liaiitard, Eec, 1869, 36i:-Marcq, Ann., 1909, ll.-Martin Am. :^^Pt- ^f^v
1898, 829.— Noack, S. B., 1908, 41.— Oppenheim, Z. f. Infkrk, 190/ 11^ 148.—
Ostertag, ibid., 1907, II, 152; B. t. W., 1900, 433.-Pr6ger S. B., 1896. l^o.-Een-
ner, Mag., 1868, 451.— Eoloflf, Pr. Mt., 1868-69, 147.— Eoder, S. B., 1896 140.--
Eussinow, Journ. f. allg. Vet. Wiss., 1906, 242-Sehmidt Mag 18/0, 186; A f.
Tk., 1887, XIII, 459; Monh., 1909, XX, 435.— Siedamgrotzky & Schlegel, A f Tk.,
1896 XXII, 287.— Streit, B. t. W., 1903, 577.— Utz, D. t. W., 1896, 259.— Walther,
S. B.', 1899, 'so.- Zangheri, Clin. Vet., 1904, 217.
618 Cerebral Hyperemia.
3. Cerebral Hyperemia.
A number of diseased conditions have been ascribed, especiall}^ by-
old authors, to hyperemia of the brain, which were due either to
diseases of the brain that were not recognizable to the naked eye, or to
disease of other organs. Marked congestion of the vessels of the l)rain
and the membranes were held to be sufficient to explain the symptoms.
It must be remembered, however, that such congestion may be due to
the head being in a position lower than the body either at the time of
death or after, and experiments by Johne, Kitt and Dexler have shown
that there may be pronounced congestion of these vessels in healthy
animals or animals that have died from other diseases. The older ob-
servations cannot therefore be taken as accurate, and it remains un-
decided to what extent these postmortem alterations were taken into ac-
count by the old authors. In the vast majority of cases, the diagnosis
was based simply upon clinical symptoms or upon references to the
subject in the older literature. Examination of the causes mentioned,
shows that the nervous symptoms Avould be of (juite a different kind,
and that in many cases not only would there be no hyperemia, but an
actual anemia.
It cannot be doubted that variations occur in the amount of arterial
blood in the brain ; but, as rightly pointed out by Dexler, and as ob-
served in the human subject, these variations are manifested more by
subjective than objective symptoms. The recognition and correct in-
terpretation of these symptoms is associated with great difficulty. It
is certainly rare to find deep-seated disease of the brain unassociated
wuth active hyperemia, which is recognizable clinically, and at the post-
mortem.
Etiology. The following are some of the influences which
may determine an increased flow of blood to the arteries of the
brain: increased cardiac activity, loss of tone of the cerebral
arteries, overexertion, rough handling during the process of
breaking-in, severe psychical disturbances during transport by
train or boat, rutting, fear, hypertrophy of the heart, acute
poisoning with alcohol and other narcotics, direct rays of the
sun falling on the head, too great heat, etc. A kind of collateral
hyperemia is set up wdien large areas are cut off from a supply
of arterial blood as in thrombosis of the posterior aorta or other
large vessel, and when the abdominal vessels are compressed
owing to t^anpanites. Acute inflammatory processes of the brain
and membranes are always associated with hyperemia, but such
instances are more conveniently considered in connection with
the causal condition.
Passive congestion may be caused by compression of the
jugular veins by the splehius muscle, tumors, enlarged thyroids,
and any sort of inflammatory swelling. It may also be set up
by a weak heart, chronic lung disease, or compression of the
lungs owing to gastric or intestinal tjniipanites.
Anatomical Changes. In case of acute hyperemia of the
brain and membranes the brain substance is reddish or yellow
Symptoms. Course. Diayiiosis. 619
in color, the venous plexuses of the pia are deep red and there
may be echynioses. The lesion described may often be missed
in spite of there having been active hyperemia during life,Jje-
cause it tends to disappear for the most part after death (Kitt,
Dexler).
In passive hyperemia there may be ol)served a pronounced
congestion even in the small vessels and the tortuous course of
the veins may be traced on the surface of the brain, between the
convolutions, and even into the cortex. Small hemorrhages
may be found along the course of the vessels, an increase m the
otherwise clear cerebrospinal fluid and a saturation of the tis-
sues with serum.
Symptoms. In cases of active hyperemia the period of ex-
citement may be followed by one of depression with repeated
recurrences of excitement. In slight cases the animals are rest-
less and excited, the eyes are bright, the pupils dilated, and the
pulse and respiration accelerated. The cranium feels abnor-
mally hot and the mucous membranes of the head are injected.
There appears to be some disturbance of consciousness as is in-
dicated by awkwardness of movement, alarm, and loss of
appetite. . n i i
Passive hyperemia is generally characterized by depression,
cyanosis of the mucous membranes, difficulty of respiration, and
a small rapid pulse. It-must be remembered that the brain pos-
sesses great adaptability to slowly progressive circulatory dis-
turbances, and consequently symptoms are usually absent m
cases of severe but long-standing congestion.
Course. Simple arterial hyperemia generally passes off
within a few hours. In favorable cases the condition returns
to the normal either suddenly or gradually, and within a fey
hours all symptoms may have disappeared. Venous hyperemia
is a temporary condition in cases in which the cause of the con-
gestion can be removed. In other cases it is persistent, increas-
ing from time to time, and may lead to the production of great
depression.
Diagnosis. In slight cases the normal condition of the ani-
mal, as regards its cerebral functions, its age and strength, must
be considered. The periodic appearance of sexual impulse must
be taken into consideration, for this sometimes causes similar
changes in animals. The possibility must not l)e lost sight ot
that the svmptoms of hyperemia mark the onset of some acute
infectious' disease, or that some organic disease of the bram,
stomach or intestine may be behind it. Diagnosis and prognosis
in the early stages must be made, taking into consideration the
possible development of further symptoms. As a general rule
organic diseases of the brain may be excluded if one or two days
pass without further development. In the horse exacerbations
620 Sunstroke and Heatstroke.
of chronic dropsy of the ventricles or encephalitis may be easily
mistaken for hyperemia of the brain.
Treatment. In slight cases it is sufficient to bring the ani-
mal into a large airy box where it can be quiet, and supply it
with easily digested food and fresh water.
In severe cases of active hj^oeremia, prompt venesection in
the early stages may give very good results, cold compresses
applied to the head, and irrigations with cold water may bring
about the disappearance of the hyperemia. For internal treat-
ment purgatives are indicated, but overdosing with drastic
drugs may do harm.
Efforts must be made to get rid of the cause of the hyper-
emia if possible, and animals that are liable to be affected for
any reason must be guarded against excitement.
Literature. Dexler, Nervenkrankheiten cl. Pferdes, 1899, 188.
4. Sunstroke and Heatstroke.
Etiology. Severe nervous disturbances not rarely occur
in animals that are exposed to the direct rays of the sun during
hot weather while at work, or driven in large herds, or trans-
ported in open cars. But similar cases also occur without the
animals being exposed to the sun, the symptoms being due sim-
ply to the heat. Cases come under observation especially in the
army during drill, maneuvers, or war, in droves of pigs, sheep
and cattle, and during transport by rail. The occurrence of such
cases is comparatively rare in the temperate zones.
The disease named by Bongartz '' Summer heaves" (Sommer-
dampfigkeit) belongs to this class of disease. This atfects horses sud-
denly that are working in the open. A proportion of the disease termed
"fatigue diseases" (Ermiidnngskrankheiten) also comes under this
heading (Bartke, Schiraraelpfennig) .
Pathogenesis. The direct rays of the sun falling on the
cranium may possibly cause dilatation of the intracranial ves-
sels and thus cause hyperemia, but the severe disturbances
which are sometimes fatal within a short time can hardly he
caused solely in this way. The possibility must be considered
wdiether the sun's rays, the chemical and not the heat rays,
cannot be the cause of the inflammatory processes. Such a pos-
sibility is difficult to conceive in spite of the fact that Amato
believes that the nerve cells may be injured by ultra-violet rays.
A more probable view is that the direct rays beating upon the
cranium cause excessive heating of the central nervous system,
thus setting up paralysis of the vaso-motor and respiratory cen-
ters. As a result of this, there is a drop in the arterial blood
Symptoms. Diagnosis. Treatment. 621
pressure and respiratory disturbance. If the loss of heat be
diminished owing to a high external temperature or close crowd-
ing of animals and the body heat be increased by muscular exer-
cise, the temperature of the animal body may be raised so high
(40'' to 45° C) that nerve paralysis may be produced without
the direct effect of the sun at all. It is quite easily understood
tliat a general rise of body temperature is scarcely ever absent
when an animal is exposed to the direct rays of tlie sun. A
sharp distinction between sunstroke and heatstroke is upon
these grounds both impracticable and unnecessary.
Experimental evidence has recently been furnished by Marinesco that nervous
symptoms may be caused both by the direct rays of the sun, and also by an in-
crease in the boily temperature in animals kept in very hot but quite dark boxes.
Christiani has demonstrated the diplococcus of sporadic meningitis in the
cerebrospinal fluid of horses that have died from heatstroke. But in these cases
there may have been primary meningitis owing to the unfavorable effect of the heat.
Symptoms. In the earliest stages there is a rapidly pro-
gressive dullness and depression, the gait is uncertain and
stumbling, sweating is observed, and the expression of the face
is anxious. There is palpitation of the heart, the pulse is accel-
erated and weak, and respiration difficult. The mucous mem-
branes are in the early stages injected, but afterwards become
pale and even bluish. The temperature may be as high as
45° C or even higher. In rare cases, the animals show
symptoms of excitement which may amount to mania.
Towards the end, there is violent trembling, the animals
falling to the ground and dying in convulsions, if prompt assist-
ance is not forthcoming. In some cases death is sudden with-
out any remarkable disturbance of health having been observed,
in other cases animals die in from one to three days.
In the soealled summer heaves ("Sommerdampfigkeit") Bon-
gartz observed sudden difficulty of respiration, causing heaving move-
ments of the entire body. "While going uphill or drawing a heavy load,
animals often fell, and sometimes dropped dead. If brought into warm
stables respiration remained difficult for some hours, and there was
marked dullness. During cooler or wet weather, there was a rapid im-
provement in their condition. In cases where the attacks occurred re-
peatedly, the animals became emaciated.
Diagnosis. In making a diagnosis the following conditions
must be carefully excluded, acute infectious diseases, and es-
pecially septicemic conditions (anthrax, swine erysipelas) en-
cephalitis, relapses in cases of chronic hydrocephalus, epilepsy,
congestion or edema of the lungs. Special importance attaches
to the last two since they are likely to be set up by the same
external influences.
Treatment. If possible animals should be placed in a
shady, cool spot or in water, and cold water should be poured
-622 Cerebral Anemia.
over the upper parts of their bodies, and cold applications
placed over the cranium. If necessary, drugs having- a vaso-
constrictor action may be used, oil of camphor (20 to 30 gm. sub-
cutaneously for large animals and 1 to 5 gm. for small), caffein,
(4 to 8 gni. or 0.1 to 0.5 gm. subcutaneously), small doses of ether
or alcohol. If there are signs of edema of the lungs, venesection
may be practiced. According to the observations of D'Anchald,
the shelters found in many large towns, the object of which is
to prevent the occurrence of the disease, are injurious rather
than useful.
Literature. Bartke, D. t. W., 1898, 101.— Bongartz, B. t. W., 18S9, 259.—
D'Anchald, Bull., 1907, 607.— Marinesco, Compt. E., 1906, S.').'?.
5. Cerebral Anemia. Anaemia cerebri.
Etiology. Acute cerebral anemia follows large losses of
blood, and may be caused by excessive quantities of blood pass-
ing to other organs (too sudden escape of exudates or transu-
dates from the large body cavities, or of gas from the alimentary
canal, too rapid parturition). Anemia of the brain of varying
severity may result from cardiac weakness and general dilata-
tion of the vessels, in severe infectious diseases, or various kinds
of poisoning. It is only very occasionally that cerebral anemia
in animals is due to constriction of the vessels of the brain own-
ing to some psychic influence or severe irritation of the skin.
Among these should be included shock following severe injuries to the ab-
ranes in a 10-months-old calf, the vessels of the superficial layers of
the cortex being similarly affected around some hemorrhages in the brain sub-
stance.
Plugging of the vessels of the brain is followed by degeneration
of the nerve elements and neuroglia cells, the ])rain substance being thus
converted into a pulp-like mass (softening of the brain).
It is at present impossible to give a general survey of the
632 Obstruction of the Vessels of the Braha. Encephalitis.
symptoms, as the references to this kind of case are very sparing. It is
obvious that the local symptoms will depend upon the portion of the
brain affected ; and general symptoms will depend upon the local symp-
toms shown. As in hemorrhage of the brain, thrombosis or embolism of
the arteries is responsible for the sudden appearance of general symp-
toms of brain disease. These may disappear sooner or later, but they
may also be responsible for the death of the animal. In cases of throm-
bosis of the veins or venous sinuses symptoms make their appearance
more gradually as in encephalitis.
In Boelmann's case a mare appeared to be dull and its gait was uncertain,
the head was drawn round towards the left side, and the animal moved in circles
in this direction. At a later stage the animal showed the following symptoms:
Paralysis of the left eyelid, partial closure of the left nostril, insensibility of the
left half of the head, dullness and later ulceration of the cornea of the left eye,
the lower jaw drawn towards the left. Eight days later the animal could no longer
stand and death occurred on the 24th day. At the postmortem an old thrombus
1.5 cm. in length was found in the vein of Galen at the point where it enters
the sagittal sinus, and another in the neighborhood of the corpus callosum. There
was softening of the entire left hemisphere but especially in the middle part.
In a steer suffering from suppuration of the submaxillary gland Moussu ob-
served, two weeks after the commencement of the disease, increased excitability,
and eight days later symptoms of excitement alternating with dullness. At the
postmortem it was found that the suppuration had extended along the internal caro-
tid and thus reached the base of the brain, and caused inflammation of the venous
sinuses followed by thrombosis.
A'osshage saw the following symptoms in a case in which there was throm-
bosis of the posterior cerebellar artery: Paralysis of the right side of the body,
staggering gait and paralysis of the left facial nerve.
In a case in which there was diffuse calcification of the arteries of the brain
and membranes Huynen observed coma, elevation of the head, involuntary move-
ments and a staggering gait. The train of symptoms recalled sleepy staggers.
Literature. Berlin, O. Vj., 1879, LI, 142.— Boelmann, Ann., 1885, 275 (Ref.).
—Huynen, ibid., 1907, 80.— Moussu, Eec, 1899, 313.— Schiitz, A. f. Tk., 1878, IV,
145.— Vosshage, D. t. W., 1902, 483.
10. Encephalitis.
The cause of encephalitis is usually of an infective nature
and the diseased areas are circumscribed. There may be centers
of suppuration (purulent encephalitis), or there may be non-
purulent areas which are red, yellow, or grayish in color and
have undergone a process of softening. In some cases there are
no areas of inflammation visible to the naked eye (acute non-
purulent encephalitis).
It has already been pointed out that in cases of meningitis, the
inflammation of the membranes extends to the superficial layers of the
cortex, the reason being that the same blood-vessels are common to both.
In such cases the inflammation of the cortex is secondary, and as a rule,
makes its appearance in the later stages of meningitis. Besides cases of
this type, encephalitis occurs in the domesticated animals in which the
inflammation involves the cortex only, or if the pia mater in the im-
mediate neighborhood be involved it is only to the very slightest de-
gree. The inflammation of the brain substance is the principal lesion ;
and the meningitis is not responsible for any observable symptoms.
Distinction between purulent and non-purulent encephalitis, is of
Purulent Encephalitis. 633
importance from the clinical point of view, as well as from the patho-
logical; since at least in many cases, special methods of treatment may
be adopted in eases of the purulent form of the disease.
(a) Purulent Encephalitis.
{Cerebral Abscess.)
Occurrence. The majority of cases occur in young animals
and especially in foals, few cases having been recorded in adult
horses. Kofler found cerebral abscess in twelve horses out of
forty killed on account of staggers. In the otlier species of
animals the disease is very rarely observed.
Etiology. Purulent encephalitis generally results from
metastasis in diseases in which pyogenic bacteria are circu-
lating in the blood (see page 597). In the horse the majority of
cases of cerebral abscess are causally connected with strangles,
the vessels of the brain being plugged with emboli composed of
infective material. This is supported by the fact that strangles
streptococci have repeatedly been demonstrated in the pus. Ac-
cording to Dexler strangles is the cause in about 60 per cent of
cases. Purulent encephalitis appears to be of very rare occur-
rence in other diseases, but it does occur in such conditions as
puerperal septicemia (Williams), smallpox (Roll), ulcerative
endocarditis, glanders, suppurative pneumonia, pleurisy, and
finally pyemia. Trolldenier found a pathogenic streptothrix in
cerebral abscesses in a dog (see Vol. I).
Further causes of cerebral abscess are: injuries to the
cranium, and the upper part of the parotid region, suppuration
or caries of bones near the brain, and in particular the petrous
temporal bone in the dog and the middle ear in the pig and birds,
acute inflammation of tlie upper portions of the nasal cavities
or the sinuses and the throat, the infective material reaching
the brain either along the course of the nerves or the blood ves-
sels. Animal parasites may also be responsible for the condi-
tion, the larvEB of the CEstrus and Coenurus in the sheep, in cattle
larva? of the CEstrus bovis that have wandered into the cranial
cavity, larvae of the Gastrophilus in the horse. Finally, the
condition may be caused by the penetration of foreign bodies
from the pharynx. Durrechoux found a needle in an abscess of
the cerebellum in a pig.
Pathogenesis. When a portion of the brain becomes in-
flamed abscess-formation results from the collection of large
numbers of pus cells and a softening of the brain tissue. When
there is rapid enlargement of the abscess the intracranial pres-
sure is increased, white corpuscles escape from the vessels in
enormous numbers, and the vessels are dilated. As a result
of this, and also owing to the effect of the bacterial toxins on
634 Purulout Encephalitis.
the nerve cells, general symptoms make their appearance, and
where certain parts of the brain nndergo degeneration there
may also be symptoms of a local nature. On the other hand, if
the process of abscess-formation is slow, the general symptoms
may be quite insignificant or even absent.
Anatomical Changes. In cases in which the disease has
])een in existence for some time the inner surface of the abscess
appears to be covered with a finely granular membrane some
millimeters in thickness, the socalled "pyogenic membrane."
The pus is white or reddish in color and sometimes has an offen-
sive odor. In very exceptional cases the pus appears to be
mixed with blood, owing to the rupture of a vessel on the inner
surface of the abscess cavity. In the majority of cases the ab-
scesses occur in one of the hemispheres and more rarely in the
cerebellum. If they are superficially placed the disease may
extend to the membranes and set up suppurative processes
there. In deep-seated abscesses rupture may occur in the ven-
tricles. When the lesions are due to metastasis the abscesses
are usually more numerous. Joline found ten and Delamotte
and Brocherion fourteen abscesses in the brain. Abscesses
caused in other ways are usually solitary and vary in size. In
a case recorded by Priimer the cerebellum was converted into
a cavity full of pus. Frohner records a case in which pus col-
lected in the lateral ventricles as a result of fracture of the
frontal bone (pyocephalus).
Symptoms. The rapid development of one or more ab-
scesses causes a rise of temperature, provided there is not fever
already, owing to some primary disease, and the temperature
is subsequently maintained with pronounced variations. As
in the case of meningitis there is a rapidly progressive dullness,
which at intervals may give place to symptoms of excitement
which may amount to mania. In other cases there is great
uneasiness from the outset, but exceptionally there may be no
evidence of excitement even up to the time of death. Although
both the dullness and the excitement tend to be very marked,
these cannot be taken as characteristic of suppurative encepha-
litis. In many cases there are fibrillar contractions and clonic
spasms in various parts of the body, and there may be forced
movements. Paralysis of various cranial nerves has been ob-
served. Death may take place within a few days or a week or
two, the symptoms and especially those of excitement having
gradually become more severe.
Witii the foregoing must be included cases in which the
cerebral abscess remains latent for a time and then causes death
in one or two days, the animal showing the symptoms al-
ready descril)ed (Bouchet, Eoder, Johne). Such a course of
events is likely to happen in cases in which the process of ab-
scess-formation has proceeded slowly up to a point and then
Syinptonis. G35
for some unknown reason becomes rapid and involves the mem-
branes, or bursts into the ventricle. Cases in which the ab-
scess-formation occurs in the frontal lobes of the hemispheres
appear to take this slow course.
In the great majority of cases wiiich run a less rapid course
symptoms of disease are to be observed for a longer time, and
particularly those of dullness or loss of consciousness. Forced
movements are seen with comparative frequency, the movement
in the majority of cases being in circles and more rarely in other
directions.
In these cases there is a tendency for the symptoms of ex-
citement to make their appearance at variable intervals, the ani-
mals suffering from attacks of mania, alternating with severe
depression. There may also be epileptiform seizures during
the periods in which the animals appear to be in perfect health
(Lydtin, Trolldenier). Noack had a case of this sort under ob-
servation for three months.
Sudden blindness is occasionally observed as a focal symp-
tom. In a case recorded by Bouchet in which there was an ab-
scess in the middle of the left hemisphere and fibrous basilar
meningitis, a foal went blind during the night. The right pupil
did not react to light at all, while the left reacted for some
time. There was total blindness of the right eye, but move-
ments with the hand in front of the left eye were appreciated
by the animal for some time. In a case recorded by Thierry,
in which there was an abscess in the right hemisphere, there
was sudden amaurosis of the left eye. No accurate tests were
made regarding the sight of the other eye.
Unilateral paralysis was observed by Haase in a case in
which there was an abscess in one hemisphere directly under
the membranes. In a case recorded by Greiners a foal sweated
profusely after every meal for a period of four months. At
the postmortem an al)scess the size of a hazelnut was found in
the right half of the cere])ellum. Shortly before death the ani-
mal had shown respiration of the Cheyne-Stokes type. A pig
which had an abscess the size of a hazelnut in the right half of
the cerebellum staggered in its gait, walked in circles to the
right and fell on its right side in such a way that its snout
struck the ground first (Kertesz). In a case recorded by Haas
a cow was observed to carry its head to the left side owing to
the presence of an abscess the size of an apple in the left hem-
isphere. Any attempts to make the animal carry it straight
caused attacks of mania. A horse in which there was an ab-
scess in the posterior portion of the vermiform process of the
cerebellum showed giddiness and an uncertain gait, and fell fre-
quently (Jacoulet).
In some of the less acute cases there is no elevation of tem-
perature, but it is probable that systematic testing would show
a rise in some cases.
636 Acute Non-purulent Encephalitis.
Diagnosis. This can only be based on the appearance of
general or local sjanptoms indicating that the brain is involved
in diseases in wliich there is a known tendency for pyogenic
bacteria to invade the brain. The very acute cases cannot be
disting-nished from cases of acute meningitis. Cases in which
the course of the disease is slower can be differentiated by their
longer duration, the striking improvements which occur at
times, the absence of sensitiveness over the cranium and the
special local symptoms which not rarely make their appear-
ance. The presence of a primary abscess in some part of the
body is in itself no proof that the occurrence of cereljral sjanp-
toms is due to purulent encephalitis, because meningitis may
also occur under the same circumstances. One must also not
lose sight of the fact that in many cases of suppurative en-
cephalitis an animal that was previously apparently in perfect
health may become seriously ill owing to secondary meningitis
and succumb to it in a very short time. In cases of tumor for-
mation in the brain differential diagnosis can always be based
on the absolutely negative history of the disease, its slow de-
velopment, the presence of a primary growth in some other
organ, or in neighboring portions of the cranium, and finally
from the engorgement of the optic disc. A periodical rise of
temperature also indicates suppurative encephalitis.
An accurate analysis of the focal symptoms that may be
present in cases that are not very acute renders a localization
of the disease possible, but a very careful investigation appears
to be necessary in this connection.
Treatment. Provided a correct diagnosis has been made
regarding the nature and localization of the disease, and this in
the present state of knowledge is of rare occurrence, surgical
interference may be resorted to. Good results have followed
this treatment in the liuman subject. At the most a favorable
result might be expected in the case of an encapsuled abscess
superficially placed in a hemisphere; operation appears to be
hopeless from the outset in cases where there are multiple ab-
scesses deeply placed.
Literature. Cad^ac, J. Vet., 1897, 28; 1907, 588.— Dexler, Nervcnkrkh. d.
Pferdes, 1899, 200 (Lit.).— Johne, S. B., 1879, 14.— Kofler, Monh., 1908, XIV,
71._Niei3g]^ Pj., Mt., 1856-57, 122.— Noack, S. B., 1893, 125.— Picard, Ann., 1904,
531.
(b) Acute Non-purulent Encephalitis. Simple acute encephalitis.
Acute non-purulent encephalitis results from an infection
or intoxication which in many cases is the result of an infectious
disease. In the majority of cases tliere are numerous centers
of disease and these may be hemorrhagic in character.
Historical. In 1878 a case was recorded in the horse by Fried-
berger, and this was followed later by cases described by Thoraassen,
Occurrence. Etiology. 637
Montane Desoubry and Nesmeloff. The eases of cerebral apoplexy in
cattle recorded by Vath in 1892 were apparently in reality cases of
encephalitis. More recently Dexler (1899, 1903, 1904) described a dif-
fuse hemorrhagic inflammation of the brain substance in cases of so-
called "blind staggers" and other diseases in the horse. He has given
a very clear account of the disease from a clinical point of view and
also of the pathological anatomy. A contagious hemorrhagic encephali-
tis was observed by Buckley & MacCallum in Maryland (North America)
in 1900. Cases of acute encephalitis have also been recorded by Lesbre
& Forgeot, also by Marek. The communications by Kolesnikotf, Brusso
& Galli-Valerio, Dexler, Nissel, Lienaux, Marek, Marchand, Petit &
Coquot, and Pecard, regarding encephalitis in cases of influenza, must
be mentioned.
Occurrence. In all probability all the domesticated ani-
mals are likely to be attacked, altliougli up to the present cases
have been recorded in horses, cattle, dogs and sheep. From
these records it appears that the horse and the dog- are most
frequently affected. Even the non-specific form of the disease
may sometimes become contagions.
71:l:^^ogy. The nature of the inflammatory processes in-
volving the brain substance indicate that non-purulent encepha-
litis is certainly due to an infection or a bacterial intoxica-
tion (post-infectious encephalitis, Dexler). The infective ma-
terial cannot always be detected in the brain tissue, although in
given cases no doubt exists as to the infectious nature of the
disease. This may be due either to the disappearance of the
infective material after the inflammation has set in or to the
fact that its action is more accentuated on other organs. As
already mentioned bacteria occur with great constancy in the
brain in infections of a general nature (see page 598).
According to Dexler and others there is not rarely in cases
of influenza in the horse a non-purulent, hemorrhagic diffuse
encephalitis, similar lesions being simultaneously present in the
spinal cord. Encephalitis, as a rule, sets in during an attack
of pneumonia or severe catarrhal influenza, but in some cases
only after the disappearance of the symptoms of these diseases.
The striking s^Tnptoms of cerebral disturbance wdiich occur in
many outbreaks are often due to an insignificant diffuse en-
cephalitis.
The cause of the inflammation of the brain which in some
cases is hemorrhagic and in others resembles influenza enceph-
alitis as described by Dexler in blind staggers and more recently
in horses dead of other acute diseases of the brain is not yet
known. Here infection of an unknow^n nature must be ac-
cepted. According to Dexler it may be derived from the lungs,
intestines, or other organs, and it is not necessary to demon-
strate the cause of the condition in the brain, because it may
produce its effects only through toxins circulating in the blood
or it may meanwhile have disappeared from the diseased tissue.
6.')8 Acute X()ii-j»uruleiit Eueeplialitis.
The most recent iiivestig-ation indicates that in many cases there
are grounds for connecting the disease with influenza, but one
cannot generalize regarding this, because the occurrence of dis-
eases that are similar from the point of view of pathological
anatomy in the other species — cattle, sheep and dogs — cannot
be placed in comparison with it. In the contagious outl)reaks
recorded by Buckley & MacCallum no cause could be found
either culturally or histologically. The cause was also unknown
in the cases recorded by Friedberger, Thomassen, Lesbre &
Forgeot, Marek, in the horse, Arloing in the ass, Vatli and
Hamoir in cattle. Montane, Hamoir, Nesmeloff, Desoubry and
Marek in the dog.
In the dog there can be no doubt that the most frequent
cause is distemper, the encephalitis appearing at the same time
as other symptoms or after their disappearance. Whether the
virus of distemper is itself the cause or whether it prepares the
ground for a subsequent infection or intoxication is not yet
decided, but the probability is that it is the virus itself or some
toxin elaborated by it.
The socalled Borna disease should probably in certain cases
be considered principally, if not entirely, as a non-hen:::^ :;ic
inflammation of the brain and spinal cord.
The non-hemorrhagic encephalitis occurring in rabies has
long been known and will not be further referred to here (see
Vol. I).
In no single case has the sun been proved to be the cause
of encephalitis (sunstroke), but a priori the possibility of such
an effect being due to chemical effects produced by the rays is
not excluded. In this case, as in many skin diseases, the rays
of the sun should be considered rather as predisposing causes.
It is probable that certain foodstuffs exert only a predis-
posing action. Many authors have considered the legiuninosa?
as direct causes of encephalitis. As a matter of fact there are
no grounds for the belief that many foodstuffs are capable of
setting up an inflammatory process in the brain in a manner
similar to the skin rashes caused by foods in association with
certain determining factors. The presence of certain nervous
symptoms is not always demonstrable, because there may be
simply functional disturbance. Butler observed a non-hem-
orrhagic encephalitis in horses by feeding them on damaged
rye and claimed to have produced it experimentally.
Overexertion which in many cases is followed by encepha-
litis is no doubt only a predisposing cause.
Anatomical Changes. Lesions may be found in any part of
the brain, the liemisplieres, basal ganglia, the peduncles, cere-
bellum, or its peduncles, the medulla, the gray or white matter.
In the fore brain it is usually the gray matter that is involved
(Dexler). As a rule there are numerous inflammatory centers
scattered over the brain, but occasionally only a single center is
Anatuiuical Cliauges.
639
to be found. The centers are, as a rule, the size of a pea only
(Fig. 87), but exceptionally they may be as large as a hen's
egg (Friedberger). The larger ones are softer than the sur-
rounding tissue and sometimes pultaceous in consistency, and
their cut surface is, as a rule, somewhat gelatinous and translu-
cent in appearance. Very small lesions that are not hemor-
rhagic escape recognition with the naked eye, because they are
not different in color or consistency. In many cases there is a
pronounced tendency to hemorrhage so that the surface of the
brain, the walls of the ventricles, or the cut surface appear lie-
set with reddish-brown hemorrhagic spots varying in size from
mere points to areas of considerable size (acute hemorrhagic
encephalitis). These large hemorrhages are rarely of even
color throughout, but have a variegated appearance owing to
the presence of small hemorrhages round about them. In the
latter stages the centers become yellow in color owing to de-
struction "of the blood pigments. Should the animal survive,
a cvst forms owing to the absorption of the detritus, or there
Fig. 87. Area of inflammatory softening of the most anterior portion of the right
half of the medulla oblongata in a dog. The animal showed rolling movements to
the right. In the diagram on the right a indicates the pons, b the trapezoid body,
and c the position of the section.
may be a scar formed. Should the area of inflammation be near
the ventricle of the brain, or involve the venous plexuses, a more
or less reddish turbid fluid collects in the ventricles (acute
hydrocephalus internus). Areas of inflammation near the sur-
face of the brain may lead to the production of extensive or
circumscribed patches of meningitis.
The hemorrhagic form of the disease occurs more fre-
quently in the horse than in the other species. Encephalitis
due to distemper rarely causes hemorrhages and if present they
are unimportant. The hemorrhages found by Brusso & Galli-
Valerio were single. Marek has observed a single case of soft-
ening of the brain in distemper.
Histological investigations were made by Dexler. Encephalitis in cases of
distemper has been investigated by Krawjesky, Brusso, Galli-Valerio, Lienaux,
and more recently by Marchand, Petit & Coquet, and Pecard. In the eases in
which there were no hemorrhages Dexler found perivascular and other cellular in-
640 Acute Xoii-purulent Encephalitis.
filtrations, the cells being round and Marsehalko 's plasma cells. In one case there
was edema of the neighboring tissue. In the hemorrhagic form there was a very
small infiltration of leucocytes, but in the perivascular spaces red blood corpuscles
were found in large masses and at greater distances from the vessels there were
red corpuscles either scattered aliout or arranged in rows. The endothelial cells
had proliferated and were enlarged, the lumen of the vessel being reduced. The
true nerve tissue in the neighborhood of the small centers showed very little alter-
ation (destruction of the medullary sheath, swelling of the axis cylinders, and at
places destruction of the chromatin bodies of the nerve cells), while the larger
centers were composed of softened masses. Degeneration of the medullary sheaths
could be followed in both forms of lesion. Not rarely inflammatory lesions were
found in the pia mater.
In a portion of cases there was in addition to inflammation
of the brain a similar disease of the spinal cord.
Symptoms. The symptoms of encephalitis due to any gen-
eral disease, such as influenza and distemper, are sometimes ob-
scured by those of the primary disease and so may remain quite
unrecognized. But in any case of this kind the attention of the
observer will be directed to some organic disease of the brain,
if by no other symptom, by the pronounced dullness in com-
parison with the severity of the primary disease.
In the majority of cases the sjanptoms of brain trouble are
very striking. In cases where the inflammatory processes de-
velop rapidly or where the inflammation extends, general sjnnp-
toms of cerebral disturbance are never absent ; these, as a rule,
when there is rapid extension, appear suddenly, are very severe,
and are ushered in by somewhat severe hemorrhages. They
closely correspond with the other acute diseases of the brain;
rapidly progressive disturbance of consciousness is a prominent
symptom except in cases in which the disease sets in suddenly
owing to hemorrhage occurring at the outset. The animals ap-
pear dull and listless and are easily fatigued. They are indif-
ferent to their surroundings and stand with their heads dropped
or supported upon some object; appetite is greatly decreased
or quite absent, and they stand for a long time with half-closed
eyes, and their limbs in unusual positions. Occasionally they
lose their balance. As a result of this sleepy condition sensi-
bility is decreased. A gradual progression of these s^aiiptoms
leads, as a rule, within a short time to a condition of semi-con-
sciousness or even coma.
In horses, and more rarely in other animals, the dullness is
followed by symptoms of excitement, which may be either very
slight or may amount to actual mania. This is especially so in
a case of hemorrhagic inflammation in the neighborhood of the
ventricles of the brain in a horse described by Dexler. After
the period of excitement the dullness is, as a rule, still more
marked. Occasionally in cattle there are similar symptoms of
excitement, but in the other species, and particularly in dogs,
no other symptoms are observed save pronounced restlessness.
Spasms are often observed involving either individual mus-
cles or whole groups of muscles, or they may involve all the
voluntary muscles in paroxysms and possibly during the whole
Symptoms. 54]_
duration of the disease. Forced movements are sometimes ob-
served and they are, as a rule, in the nature of movements
either in circles, forwards or backwards.
When the disease is not very extensive, and especially when
it involves portions of the brain remote from the cortex,* symp-
toms of a general nature may be insignificant or even absent.
Focal symptoms occur very commonly, but owing to the
severe disturbance of consciousness they remain unobserved,
or at least they cannot be certainly recognized, save with great
difficulty. Paralysis is very common. In some cases it is total
hemiplegia (Storch), sometimes hemiplegia alternans (Leiser-
ing and Thomassen), and finally there may be paralysis of some
of the cranial nerves (ptosis, strabismus, fixed dilatation of the
pupils, paralysis of the optic nerves, of the muscles of mastica-
tion, the pharynx, tongue and larynx). Extension of the in-
flammation may lead to a varying amount of paralysis of the
whole body with irregular movements of the limbs ; dogs can in
some cases creep along on their bellies or if supported may be
able to walk. Lienaux believes that this kind of disturbauce is
due to disease of the cerebellum. He observed it in cases of
encephalitis due to distemper, associated with exaggeration of
the patellar reflexes and nystagmus. It has been shown that
it may also follow inflammation involving the cerebrum. When
the respiratory center is involved death soon occurs with symp-
toms of dyspnea.
In the carnivora rolling movements are often o])served, and
especially in cases of encephalitis due to distemper (Fried-
berger & Frohner and Marek). These types of forced move-
ments are often associated with rotation of the head on its long
axis, and it is more rarely associated with deviation of one or
both eyes. The disease generally involves the peduncles of the
cerebellum or the neighboring tissues (see page 593).
In distemper encephalitis after the disappearance of the
general spasms, and in some cases without these s>anptoms hav-
ing appeared at all, there are observed more or less rhythmic
clonic contractions of the muscles supplied by the facial and
trigeminal nerves, resulting from a local inflammation in the
neighborhood of the nuclei of these nerves.
In cases of extensive disease of the cerebellum, cerebellar
ataxia is observed. An especially interesting case of this sort
was observed by Marek in a dog, in which there was an exten-
sive perivascular infiltration in the medullary layer of the
cerebellum, and at places also in the cortex, tlie animal being
the subject of distemper.
As soon as the dog voluntarily innervates its muscles, trembling movements of
that part of the body set in. Thus a nervous shaking of the head was observed in
attempts to raise it. In making efforts to stand the animal fell over frequently,
while in standing position the toes were extended and great efforts were made to
maintain balance j these, however, were more marked during progression. During
movement the limbs were swung forward, sometimes with abduction and sometimes
with adduction and the feet were put down clumsily, and the animal soon fell either
on its side, or forwards or backwards. Every effort to defecate was promptly fol-
Vol. 2—41
642 Acute Non-purulent Encephalitis.
lowed by a fall. Movements were further disturbed owing to the eyes being affected.
Unnatural attitudes were either not corrected at all or only after a time. The
animal was capable of swimming, and only now and then turned on its side so that
its head went under water. The eye reflexes were exaggerated up to the death of
the animal which occurred more than a mouth later. There was no demonstrable
loss of muscular power.
Loss of sensation in circumscribed areas owing to serious
disturbances of consciousness is observed with comparative
rarity. Exceptionally amaurosis lias been observed (Pr. Mil.
Vb., 1897). Dexler saw hyperidrosis in a horse.
There may be a variable amount of fever and in some cases
the temperature may be as high as 41° C, but in the majority of
cases it is not so high, and in protracted cases it may be absent
altogether. The pulse varies, as a rule, with the temperature.
Excitement causes a slight acceleration of the pulse. From the
commencement there is some disturbance of appetite, but after
the onset of severe symptoms, and even in cases that are appar-
ently primary the animal ceases to take food altogether.
In many cases in the later stages symptoms of meningitis
and myelitis set in. The cases of encephalitis recorded by
Buckley and MacCallum closely resemble cerebrospinal men-
ingitis.
The diffuse encephalitis seen in cases of distemper, causes a pe-
culiar train of symptoms which was described in detail by Nissl, and
afterwards by Dexler, whose observations were made on a number of
cases. There is a gradually progressive loss of consciousness associated
with pronounced local symptoms and severe motor and sensory dis-
turl)ances. In the early stages there is dullness, and more rarely a
certain amount of restlessness; later, they make no response when
called, without showing actual disobedience. They no longer recognize
their masters or surroundings, are unable to find places that they are
accustomed to, blunder into obstacles, climb over them awkwardly, or
remain standing in front of them for hours in a senseless manner, and
take up the most uncomforta])le attitudes. They lose their power of
finding their way about absolutely, and will not attempt to escape
through the open door from a room that is unfamiliar to them. If
placed upon something at a height, they either make no attempt to jump
down or simply fall off. The sense of smell is dulled, animals breathing
ammonia without making any efforts to avoid it. Sounds, which under
normal conditions produce an active response, are not noticed. The
sleepy condition gradually merges into coma, the primary disturbances
of the sense organs being thereby obscured. Owing to the fact that ani-
mals will not take any nourishment of their own accord, and possibly
owing to other unknown causes, there is rapid loss of condition, and
death takes place on an average within a])out one to three months. This
condition of dementia should not be termed a psychosis in the true sense
of the term ; since it is brought about by organic disease of the brain,
and is manifested by local symptoms (Dexler).
In a ease recorded by Marchand, Basset & Pecard a dog gnawed the lower
parts of its hind legs. It wouhl be incorrect to include this among the true forms
of mania because a similar condition was set up by Goltz by transverse section of
the spinal cord, by Marek by excision of the sciatic nerve, and it is also seen in
severe sensory disturbances and even in other cases in which there is no mental
disturbance.
Course. Diagnosis. 643
Course. In the majority of cases the disease lasts only a
few days, usually two to five, and in many cases death occurs
in even a shorter time, while in rare cases the animal may sur-
vive for weeks or even months.
In cases in which the disturbance of consciousness sets in
rapidly and in severe form there are frequently focal symptoms
also. Both the general and local symptoms increase in severity
as the inflammation extends and the local symptoms may also
increase in number and their distribution may become more ex-
tensive. In such cases death is not long delayed. The general
cerebral symptoms and the local symptoms may decrease, or,
except in the early stages, disappear. Such a course indicates
disease either of the crura or the cerebellum. Obviously such
symptoms may cause death in a short time owing to some seri-
ous complication or to some portion of the brain essential to
life becoming involved. In the few animals that recover there
is a tendency to relapses, and according to Dexler this is espe-
cially the case in animals that have had hemorrhagic inflamma-
tion in the neighborhood of the lateral ventricles. In such cases
there is a great likelihood of the recurrence of attacks of mania
and staggers.
Even if a relapse does not occur the animals, as a rule,
show permanent sensory disturbances. Evidence of the occur-
rence of such cases of encephalitis should be found more fre-
quently, and especially in horses that have suffered from stag-
gers and at the postmortem of which nothing can be found to
account for the staggers. In dogs and in other animals there
may persist a tendency to epileptiform fits. In rare cases there
are persistent local symptoms which depreciate the value of the
animals. There is no doubt that in certain cases of encepha-
litis there is complete recovery and this possibly explains the
complete disappearance of the severe symptoms observed in
some animals affected with distemper or' influenza.
In the sub-acute forms there is, as a rule, a gradual loss of
consciousness, and the cases terminate fatally owing to the fact
that the animals take little nourishment. In the liorse there
may be relapses of the inflammation from time to time.
Diagnosis. If general, and what is of more importance,
local symptoms of one of the diseases mentioned in the para-
graph devoted to etiology are present, and there is no pain of
the cranium, diagnosis is easy. In dogs encephalitis due to dis-
temper may be diagnosed^ if there are rhythmic spasms of the
same groups of muscles. "In cases that appear to be uncompli-
cated the appearauce of cerebral symptoms associated with a
rise of temperature, acceleration of pulse, and absence of pain
over the cranium, raises the suspicion that they are simple cases
of encephalitis; suppurative encephalitis is excluded if no pri-
mary suppuration can be found in any part of the body and no
injury to the cranium can be found. The disease is easily con-
644 Chronic Dropsy of the Ventricles.
fused with meningitis if the cranium becomes painful on pres-
sure owing to simultaneous inflammation of the membranes,
and certain symptoms which contraindicate meningitis (hem-
iplegia, rolling, cerebellar ataxia) are not present. It is im-
possil)le to exchide basilar meningitis with symptoms of a more
general nature, or meningitis involving the neighborhood of the
ventricles (meningitis interna). Hemorrhage or embolism are
indicated by the sudden onset of severe symptoms. Such cases
may be excluded by careful investigation of the history of the
case, the condition of the other organs, and the temperature.
The disease is distinguished from chronic dropsy of the ven-
tricles by the fact that severe cerebral symptoms develop with
comparative rapidity, and by the presence of local symptoms.
Sometimes it is necessary to distinguish the disease from acute
uremia.
Treatment. Directions given in connection with meningitis
(see page 604) are applicable, but, as a rule, treatment is with-
out avail.
Literature. Dexler, Ergebn. d. Path., 1896, III, 2, Abt., 508 (Lit.) ; 1900,
VII, 483 (Lit.) ; Nervenkrkh. d. Pferdes, 1899, 103 (Lit.) ; Monatsehr. f. Psych,
u. Neurol., 1903, 97 (Lit.); 1904, 99 (Lit.).— Frohiier, Monh., 1908, XIX, 133.—
Lesbre & Forgeot, J. Vet., 1902, 1.57.— Lienaiix, Ann., 1900, 487.— Marchand, Bas-
set & Pecard, Eec, 1906, 813.— Marchand, Petit & Coquot, ibid., 1905, 419.—
Marchand, Petit & Pecard, ibid., 1907, 357.
Chronic Encephalitis. Very few references are to be found in lit-
erature to the occurrence of lesions apart from chronic meningitis.
These take the form of white or grayish translucent firm nodules in the
l)rain which, to all appearances, have been caused by an acute encepha-
litis. Buckley and MacCallum found sclerotic nodules in the brain of
a horse that had recovered from a hemorrhagic intlammation of the
brain, and had afterwards shown symptoms of staggers. Lellmann
concludes from some observations made by himself that multiple scle-
rosis of the brain occurs as frequently in animals as in man. but it is
only an assumption without any anatomical proof. Finally in a dog
that had recovered from distemper, Meissner found a bladder-like
swelling and thinning of the dura mater over the right hemisphere in
the region of the parietal bone, a flattening of the convolutions, and on
the mesial surface of the hemisphere, a cavity extending to the ven-
tricle (porencephalia). During life there was a certain amount of
awkwardness, lack of intelligence, bilateral amaurosis and occasional
attacks of cramp and movement to the left.
11. Chronic Dropsy of the Ventricles. Hydrocephalus inter-
nus chronicus.
{Chronic Hydroccpliahis; DiintJmess.)
By this term is indicated a chronic disease of the brain
characterized by the presence of abnormally large quantities of
cerebrospinal fluid in the ventricles of the brain with consequent
Occurrence. Etiology. 645
dilatation of these cavities, an increase in the size of the brain,
and an elevation of the cranial pressure. The disease may be
primary or secondary to some other disease of the brain.
Occurrence. The disease is seen most frequently in the
horse in which animal it is the commonest cause of sleepy stag-
gers. Up to the present there is no very exact information as
to its frequency. Having regard to the anatomical observations
made by Dexler, it remains to make investigations to decide
how often the condition is the cause of staggers, and how often
it is the result of some other diseased condition of the brain.
No stress can be laid on the results obtained in the past because
no comparison was made with regard to the anatomical altera-
tions found, and measurement of the size of the ventricles al-
lows of a great chance of error.
There are some oases on record of dropsy of the ventricles in the dog (Froh-
ner saw 20 eases among 70,000 dogs), the pig (Schindelka), and also in other
species, l;ut either the true nature of the disease is not represented, or no proof
has been adduced that the cases are actually cases of rdironic internal hydrocephalus.
In many cases the possibility of confusion with other chronic brain lesions not
recognizable with the naked eye is not excluded.
Etiology. The lateral ventricles of the brain communicate
with the third ventricle through the foramen of Monro, and this
is in communication with the fourth ventricle by means of the
aqueduct of Svlvius. As shown by Dexler the cerebrospinal
fluid mav reach the sulj-arachnoidal space from the fourth ven-
tricle by \vav of the two lateral foramina, and here be reabsorbed
by the Veins. Cerebrospinal fluid may collect in the ventricles
first if an abnormally large amount of serum escapes from the
venous plexuses in the ventricles and cannot pass freely through
the relatively small aqueduct, or when the outflow of the other-
wise normal amount of liquid is prevented owing to a narrow-
ing or obstruction of any of the paths of communication. Dex-
ler was the first to supply a satisfactory explanation of the
collection of the cerebrospinal fluid. According to this the imme-
diate cause of chronic internal hydrocephalus is stenosis or
occlusion of the aqueducts of the brain.
Dexler 's investigations have shown that the tentorium cerebelli in the horse
is for the most part ossified and that its membranous part is composed of very
tough connective tissue. The tentorium encloses a space measuring 4.2 cm. m
height and 3.5 cm. in width, allowing for individual variations, and terminates
above in an angle. This space is occupie.l by a very small portion of the vermiform
process of the cereliellum and the corpora qua.lrigemina together with the aqueduct
of Sylvius and the crura cerebri. The oral surface of the tentorium cerebelli lies
behind the convex surfaces of both occipital lobes of the hemispheres; the medial sur-
faces of these coming into contact with each other. In view of the fact that the bram
is enclosed in a bony case and that the brain tissue which contains a large amount
of fluid is incompressible, pulsation of the brain at each systole is only possible by
the expansion of the brain at the systole into the subarachnoid space, the ventricles,
and into the cavity of the tentorium cerebelli. Wince the tentorir.ni is very rigid,
pulsation of the brain in the horse is conveyed only to a comparatively small
portion of the brain Iving behind the tentorium. Consequently the portions of the
occipital lobes resting on the walls of the tentorial cavity are pressed into the ope^
646 Chronic Dropsy of the Ventricles.
ing at each heart beat aud in time may form a three coruered protrusion 2 mm.
in height. This often occurs in normal adult horses when adhesions may form with
the part on the opposite side.
In the other domesticated animals the anatomical relations differ in important
details from those obtaining in the hor^e. In the dog the falx cerebri completely
separates the posterior portions of the hemispheres, the tentorium cereljeili is
completely ossified, and its edges closely cover the anterior pair of corpora quad-
rigemiua. In ruminants the medial surfaces of the hemispheres are in close con-
tact throughout their extent, the tentorium is purely fibrous and has a very wide
opening which allows the anterior third of the cerebellum to extend into the larger
cranial cavity, and the posterior portions of the hemispheres cover the cerebellum
to a considerable extent. In the pig the opening of the tentorium is somewhat
smaller than in cattle but it is sufficiently large to allow of somewhat extensive
contact between the cerebellum and the hemispheres. While in the dog the separa-
tion of the cerebrum from the eerelielhim is complete making protrusion impossible,
protrusion is prevented in ruminants and pigs owing to the fact that the space
lietween the cerebrum and cerebellum is too great. Swelling due to j>ressure (pro-
tiusion) is possilde then only in horses. From the anatomical point of view the
horse occupies the middle position.
Under the action of repeated or long-continued pulsation
of the brain, or increased intracranial pressure, a large portion
of the occipital lobe is forced through the tentorial opening and
this causes more or less pronounced pressure upon the corpora
quadrigeniina lying below. The compressed corpora assist in
the compression of the aqueduct, thus hindering the outflow of
the fluid from the ventricles (lateral) into the fourth ventricle
and thence into tlie sub-arachnoid spaces. Once this passage is
obstructed the forced collection of cerebral fluid in the ventri-
cles causes a rise in the intracranial pressure and this causes
greater protrusion of the occipital lobes and still further com-
pression of the aqueduct. Once the process is started recovery
is impossil)le, the condition becomes aggravated with intermis-
sions, and gradually in most cases leads to complete occlusion
of the aqueduct of Sylvius.
All factors which cause a rise of intracranial pressure
either for any length of time or repeatedly iivdj set up chronic
dropsy of the ventricles. In this connection special mention
should be made of acute meningitis, frequently repeated or per-
sistent cerebral hyperemia, acute encephalitis, tumors of the
brain, etc.
Not rarely the disease appears to be primary and makes its
appearance without any of the above-mentioned diseases being
in existence (primary internal hydrocephalus). In such cases
the excessive pulsation of the brain is due to various sensory
impressions, excessive work, labored respiration, variations of
temperature, poisons, etc. As a rule no increase of blood pres-
sure can be demonstrated.
In no instance in his accurate investigations did Dexler find any histological
alterations in the venous plexuses, choroid plexus or ependyma lining the ventricles.
He therefore thinks it probable that the normal quantity of fluid escapes from the
plexuses and that the congestion is not therefore })roduced by an excess of fluid
escaping from the veins. If this were true, as cannot be shown in cases following
acute inflammatory processes, there would be no pronounced protrusion of the
occipital lobes or compression of the aqueduct.
Etiology. Anatomical Changes. 647
Rarely the disease may be set up in other ways. The for-
amen of Monro may be occhided by parasites (echinococci,
ccenuri), tumors in the neighboring tissues, closure of the lateral
foramina owing to chronic meningitis. Possibly cases of this
sort occur in other animals.
Cholesteatomata* which are found comparatively frequently in connection
with the choroid plexus in the horse probably are not causally connected with
hydrocephalus iuteruus because they are as often absent in animals so diseased and
present in otherwise healthy horses as in animals that are affected with dropsy
of the ventricles. In exceptional cases the ventricles even when cholesteatoniata
are present as large as a nut or larger do not contain more liquid than normal.
Predisposition. It is generally supposed that a predis-
position is hereditary. As a matter of fact experience shows
that thoroughbreds and racing breeds are rarely affected with
sleepy staggers, whereas heavy breeds are often so affected. It
appears to be not impossible that in heavy breeds the anatomical
formation of the cranium is less favorable (small cranium with
relatively large tentorial opening), permitting greater protru-
sion of the occipital lobes or exerting a prejudicial influence on
the pulsation of the brain. In view of the fact that the cranial
formation is a hereditary feature, predisposition may also be
transmitted from generation to generation. The fact should
not be lost sight of that the heavy breeds do the heaviest work
and consecpientl}^ are more likely to suffer from repeated ele-
vations of intracranial pressure. There is no recorded evi-
dence of the hereditary nature of the disease.
in support of the hereditary theory it is stated that staggers is of so
common occurrence in many district:: and particularly in mountainous districts
that horse-breeding is impossible (Trasbot). The frequent occurrence of the
disease may be connected with local conditions such as chronic poisoning with bad
food or it may be connected with repeated infections which set up chronic diseases
of the brain.
As a rule it is mares and geldings that are used for work
that suffer most. Trasbot saw the disease principally among
stallions.
Age plays some part in the production of the disease. The
majority of cases occur in horses from six to fourteen years
old. The disease seldom occurs before that, and in animals
under two years old it has not been observed. The disease has
been connected with the changing of the teeth, but this cannot
play any part in its production.
The occurrence of hydrocephalus ex vacuo has not as yet been observed in
animals, because animals rarely reach such an age that senile atrophy of the brain
tissue would lead to dilatation of the ventricles.
Anatomical Changes. The lesions produced by the pres-
ence of liquid under pressure in the ventricles depend upon the
severity and duration of the disease. These may in part dis-
appear when the pressure is relieved, but they may persist up
*See footnote, page 656.
648
Chronic Dropsy of the Ventricles.
to the time of death. The quantity of liquid in the ventricles
in cases of hydrocephalus may be from 40 to 120 grams (Her-
ing). Dexler was able in a single case only to show increased
pressure in the cranial cavity after death.
According to Dexler there is in the first place dilatation of
the lateral ventricles and of the anterior part of the third ven-
tricle. As a result of this the brain, the weight of which is
found to be normal after the escape of the liquid, is enlarged,
and the liquid passes into the lymph spaces of the cranium and
especially into those of crura cerebri, the pituitary body, the
decussation of the optic nerves and the fossa of Sylvius. In
view of the fact that the brain is enclosed in a bony case the
dilatation of the lateral ventricles cannot be very great. The
Fi'^. 88. Chronic hydrooepliaus internus. Section posterior to the hemispheres.
a. Swellinij- formed by the medial portion of tlie occipital lobes (c) ; b. Posterior
border of the flattened corpora cpiadrigemina; d. Aqueduct of Sylvius reduced in
caliber to a lissuredike opening, e. Optic chiasma.
dilatation is most pronounced in the middle portion of the ven-
tricle and in the vertical direction, and least in the inferior
horn, l)ecause in healthy horses there is often some adhesion
here and this prevents dilatation. The olfactory bulbs are
somethiies dilated to a certain extent. The septum pellucidum
between the two lateral ventricles is stretched and sometimes
perforated. The posterior part of the third ventricle appears
reduced in size owing to tlie bulging of the corpus mammilare
into tlie lumen. In consequence of this the aqueduct appears
to be either greatly reduced in caliber or even completely closed.
On the other hand, the anterior third of the ventricle appears
to be l)roader, the recessus infundibuli occluded owing to the
Auatomit'al t'liaui
649
bulging- of the pituitary body and the optic recess is usually en-
larged. In severe cases the middle portions of the optic thai-
ami, the optic decussation and both the optic tracts appear to
be flattened. The portion of the epiphysis above and in front
of the conarium is sometimes dilated.
On the medial surface of the occipital lobes there is a tri-
ang-ular protrusion, the size of which depends upon the extent
of the disease; this protrusion generally shows normal convo-
lutions (Fig. 88a). The depressions appear shallowest where
the two prominences are in contact. The enlargement of the oc-
cipital lobes already mentioned exerts pressure in proportion
to the enlargement in the backward direction on the corpora
quadrigemina, forcing the anterior pair apart, and presses tliem
against the base of the
brain. The enlarged oc-
cipital lobes also exert
pressure with their
lateral surfaces on the
corpora quadrigemina
towards the middle line,
thus flattening them and
forming a saddlelike de-
pression on the anterior
pair (Fig. 88b).
The aqueduct ap-
pears to be reduced in
caliber not only on ac-
count of the compres-
sion of the posterior
part of the third ven-
tricle, but also owing to
the pressure by the cor-
pora quadrigemina, with
out there being any ad-
hesion of its walls. The
cerebellum is pushed
further back, the surface
of the crura cerebri is
smooth and not cordlike,
the oculomotor nerve
appears to run a longer course and is pressed flat (Fig. 89). The
anterior border of the pons is sometimes curved in the upward
direction.
In a portion of cases there is gelatinous infiltration of the
venous plexuses, formation of cysts with delicate walls, clioles-
teatomata* and thickening of the ependyma.
In an acute relapse there are small hemorrhages under the
epend^^na, and there may be even centers of softening. The
ventricles frequently contain a turbid liquid which in some cases
*See footnote, page 656-
Fig. 89. Chronic liydroceplialu^ interims. View
of the base of the' brain shown in fig. 88. a.
Optic chiasma. b. Corpn^ nianiillare, forced
backwards, wrinkled and showing a depression,
c. Crus cerebri elongated and flattened and
sliowing an oblique furrow, d. Oculo-niotor
nerve, flattened and stretched, e. Pons Varolii,
wider than normal and Avith its anterior border
curving forwards.
650
Chronic Dropsy of the Ventricles.
contains flocculi of fibrin, the latter being tlie result of meningo-
encephalitis.
Symptoms. xVll the symptoms of the disease are referable
to the pressure which affects all portions of the brain anterior
to the tentroium cerebelli, the hemispheres and the large basal
ganglia. Consequently general cerebral symptoms are ob-
served to be most prominent, but there are also disturbances of
the body functions.
The disturbances of
consciousness cause,
aljove all, a change in
the demeanor of the ani-
mals (Fig. 90). The ani-
mal appears to be more
or less indifferent to its
surroundings and stands
in a sleepy condition
with head sunk, half-
closed eyes and a vacant
expression. The head is
frequently rested upon
some object, there is
either little or no move-
ment of the ears and the
animal does not always
turn them towards a
sound, but frequently in
the opposite direction
(socalled reversed ear
movements). Faint
sounds usually call forth
no reaction on the part
of the animal, but louder
noises, such as the bang-
ing of a door or clap-
]ung the hands, make
the animal collect itself,
l)ut it soon relapses into
t!i(^ sleepy state (nar-
colepsy).
Appetite is vari-
able; the animal may
take hay or straw into
its mouth, but allows it to hang out between the lips. Both eat-
ing and drinking appear to be abnormal ; the animal buries its
widely opened mouth quickly into the food, gets too large a
quantity into the mouth and chews it slowly. While drinking
the head is lowered down until the nostrils are covered by the
water and it is soon withdrawn suddenly owing to difficulty of
respiration. In many cases the horses make movements as if
90. Horse "svith internal hydrocephalus.
("Dummy.")
Symptoms. 651
eating while drinking or forget to swallow. Some animals con-
sume their usual diet, others eat sufficiently only to allay hun-
ger. In many cases animals prefer to eat off the ground or out
of the manger rather than from the rack. This is not because
the pressure varies with different positions of the head, be-
cause the same or a similar tendency is seen in other chrome
diseases of the brain in which there is no increase in the intra-
cranial pressure. . ra^ - i
Sensibility appears, as a rule, to be decreased. Affected
animals take no notice of slight pressure on the skin, do not at-
tempt to remove flies, remain more or less quiet if pricked with
a needle, the coronet be trodden upon, the flank pinched, the
hairs around the muzzle be pulled or the ears seized. The
sense of perception of position is sometimes in aljeyance, the
legs being placed in quite unnatural positions, sometimes widely
separated and at other times crossed. If the animal be placed
in an unnatural position it will remain in it for a long time until
some disturbance of balance or other stimulus causes it to cor-
rect it.
xVbnormalities of movements are shown by the reluctance
with which an animal moves when urged to do so. In some cases
the animals are restive, making sudden plunges. It is partic-
ularly difficult to move a horse backwards, the forelegs are
moved with this object, but the hind feet remain stationary un-
til movement is forced owing to loss of balance. While walking
or trotting the feet are lifted unusually high and are put down
clumsily, as if the animal were walking through water. If the
ground" be uneven the head is held either very low or excessively
high.
Skin reflexes are, as a rule, abolished, but sometimes
they are exaggerated. In some cases (Hutyra & Marek) the
patellar reflex was exaggerated to a marked degree.
Abnormal movements are not actually rare and m the ma-
jority of cases the animal has a tendency to go towards one
side, in contradistinction to moving in circles. The head m
such cases is often held obliquely.
The sense of vision is sometimes disturbed and the evi-
dence of fright, which is not infrequently seen, is probably due
to this. In severe cases the sense of vision may be quite lost,
or there may be complete amaurosis. Lustig records venous
congestion of the optic papillae and marked redness round about
them ; others, however, have not observed this and Hutyra and
Marek have not been able to confirm this.
It is very probable that the other organs of sense suffer some disturbance of
function. There are great difficulties in the way of ascertaining the existence of
such anomalies in animals.
The heart action is slower and in the horse may fall to
thirty to twentv per minute, and it may also be arhythmic, but
it is 'full and soft. Respiration is also slower, nine and seven
{j52 Chronic Dropsy of the Ventricles.
per minute, and the rhythm and type of respiration vary.
Movements of the intestines are sluggish; there is some consti-
pation and what feces are passed are dry and in the form of
small balls.
The above-described sj^nptoms are, of course, present only
when the disease has reached an advanced stage, and even then
one or other may be absent. In the early stages the abnormali-
ties are very slight and it requires very careful examination of
the animal to discover them. Regiilar work which has been
learned through its having been done for a long time is almost
as much an anatomical function as eating and drinking, and for
the most part it may be carried out without voluntary impulses
and consequently it may be done passably well in spite of the
withdrawal of the cerebral influence. Disturbances of the last-
named function are noticed much later, the better bred the ani-
mal, the more active its temperament and the more thoroughly
it is accustomed to its work. The person riding a horse gets
the earliest intimation of disturbance of the functions, in that
the horse does not carry out certain movements with its ac-
customed precision (jumping, etc.) ; difficulty is experienced in
making it change its pace and it makes unnecessary movements.
Draft horses are, as a rule, not observed to be ill until there are
pronounced symptoms.
The symptoms presented by an animal are likely to vary
considerably. A sudden rise of the intracranial pressure or an
exacerbation of the inflammation, which often occurs in cases of
dropsy of the ventricles, may cause a transitory aggravation of
the animal's condition. In this connection work is of the ut-
most importance, for if the animal be worked until it breaks out
in a sweat the symptoms which up to this time may have been
very indefinite are aggravated to such an extent that the ani-
mal may now show the typical symptoms. A similar but less
important effect may be produced by very hot weather, warm
damp stable, oestrum, rich diet, etc. The opposite conditions
are conducive to an improvement in the animal and in the early
stages may cause a temporary disappearance of all symptoms.
The effect of external influences upon the synii^toms explains the experience
conimonly met with in practice, namely, that when a horse that is affected with
sleepy staggers changes hands it may show symptoms under its new conditions
that had not been observed by the previous owner.
There has been observed a suddenly occurring exacerbation
of the condition associated with fits, and in many cases the
latent disease is first made evident by such an attack (socalled
mad staggers), or it may be started in this way (Dexler). The
animal does not answer to the reins, cannot be moved, or it
takes fright Avithout any reason at well-known olijects or even
a light. It attempts to break through, or even does break
through by sheer force, objects standing in its path. If the
seizure occurs while the animal is in the stable it rears up, at-
Syiiiptums. Course. Diagnosis. (J53
tempts to free itself and falls over backwards. After an attack
which at the most lasts for an hour or two there is a period of
depression and great dullness, which gradually passes off after
some hours.
The acute attacks which are observed in cases in which the
hydrocephalus is preceded by meningitis or encephalitis are of
much greater importance. These attacks cause an exacerba-
tion of the inflammatory processes (see pages 600 and 640), and
not rarely cause death, although the condition of the animal is
not dangerous.
After the passing of these acute attacks, which sometimes
last for several days, there is almost always a turn for the
worse.
The symptoms above described are characteristic in a general way of the
disease known as staggers which is most frequently caused by dropsy of the ven-
tricles. But staggers should not be identified with chronic hydrocephalus because
this has a far wider significance than chronic dropsy of the ventricles. Similar
symptoms are observed in all diseases of the brain which are of a chronic nature
and which are associated with a rise in the intracranial pressure, or destruction
of the brain substance (neoplasms, parasites in the cranial cavity, exostoses on the
inner surface of the cranial bones, chronic inflammation of the brain, etc.).
Course. Chronic dropsy of the ventricles of the brain runs
a slow course and apart from the occasional exacerbations there
is no fever from first to last. Owing to the accumulations of
the fluid and to the consequent rise of intracranial pressure
certain s^miptoms make their appearance which at the outset
are scarcely recognizable and which scarcely affect the animal's
condition, but which in the course of time become so severe that
the animal can be used for rough w^ork only. In some cases the
slow evolution of the disease is interrupted by marked im-
provements and by relapses from time to time. In addition to
the factors mentioned above, the season exerts an influence on
the disease, there being an improvement in the winter, the ani-
mal becomijig worse in the summer. It is very exceptional for
the disease to progress so far that the animal is absolutely
without intelligence, takes scarcely any food, and as a result
falls off greatly in condition. If the animal does not die during
an acute exacerbation or from some other concurrent acute dis-
ease it is usually slaughtered before it becomes absolutely
senseless on account of its very limited use.
Diagnosis. In the advanced stages of the disease the symp-
toms due to distur])ance of the cereliral functions are so obvious
that they can be recognized in an instant. In the early stages
their recognition is associated with great difficulty and a sys-
tematic examination of the horse is essential. Skill is very nec-
essary in this, because a practiced eye at once suspects loss of
intelligence from the general facial expression and particularly
from the appearance of the eye, even when there are no abnor-
malities of movement, sensitiveness or reflexes. The age,
654 Chronic Dropsy of the Ventricles.
breed, condition and the evidence of wear and tear of the animal
mnst be taken into consideration. It appears to be most useful
to have the animal put to do some fatigaiing work, because the
somewhat indefinite sj^uptoms, as a rule, tend to become accen-
tuated shortly after and also because fresh ones may make their
appearance. The animal should be watched the whole time
that it is at work, special notice being taken as to whether it
responds to instructions. After being allowed to stand in for
a time a fresh searching- examination should be made.
Points that are of special importance are : unnatural posi-
tion of the feet, supporting the head on the manger, leaning up
against the wall, the periods of rest during feeding. Abnor-
malities of sensibility have a very limited importance because
they are very variable from animal to animal. Above all, a
diagnosis should never be based upon the presence of individ-
ual symptoms; several s^anptoms must be present before a
diagnosis can be made. Further, it must be remembered that
the sum total of the sjauptoms described is not absolutely path-
ognomic of the disease, but they may be met with in other dis-
eases in which there is great dullness.
In examinations carried out on 372 sound army horses Droge showed that
quite sound horses will keep their legs crossed, but especially when fatigued or
during very hot weather. A positive result was obtained by Droge in llSc of
animals in winter and 30% in summer.
All acute, and particularly febrile, diseases must be ex-
cluded, although these are frequently associated with depres-
sion of the functions of the brain. The elevation of the internal
temperature and acceleration of the pulse, the presence of
s^anptoms of disease of some other organ and the history of
the case are, as a rule, sufficient to prevent one from making an
error. Inflammatory conditions of the bones of the face and
their sinuses are accompanied by great dullness in many cases,
but the local symptoms (discharge from the nose and pain) are
sufficient to explain this. The disease can still less be con-
founded with loss of liveliness during the changing of the teeth
or sexual excitement. The short duration of these conditions
is enough to differentiate them. Chronic diseases of the stom-
ach and liver which are now and then accompanied by depres-
sion are easily excluded on account of the systematic symp-
toms present.
The acute attacks seen in hydrocephalus may be easily con-
fused with acute inflammation of the brain or its membranes.
In these cases symptoms of excitement alternate with sj^np-
toms of depression as in the acute seizures in dropsy of the
ventricles. Differential diagnosis must be based upon the his-
tory of tlie case and upon any local symptoms that may be pres-
ent. If the case is one of an acute seizure resulting from dropsy
of the ventricles, certain disturbances of function will have
been present before, while fever, paralysis of cranial nerves,
and particularly spasms of the neck muscles, indicate meningitis.
Prognosis. Treatment. 655
The above diseases having been excluded it remains to de-
termine whether the cerebral disturbances are not the result of
some other chronic disease of the brain. As a rule it is very
difficult, if not impossible, to ascertain what is the primary dis-
ease, but the abnormal movements, the acute attacks occurring
at long intervals and lasting for some days, the alternation of
improvement with relapse generally indicate internal dropsy of
the brain. Paralysis of individual cranial nerves and the ex-
hibition of symptoms on the part of the opposite side of the
body indicate either the presence of tumors or parasites in
the brain. Finally in cases of hydrocephalus internus only
is improvement observed under treatment with diaphoretics.
The differential diagnosis of chronic encephalitis and menin-
gitis is fraught with still greater difficulty because these condi-
tions sometimes lead to a gradual depression of cerebral activity.
Prognosis. When once the disease has started it pursues
a steady course, gradually increasing in severity; however,
there may be periods during which the disease, although still
present, is at a standstill. Prognosis is very unfavorable, al-
though the disease does not prevent the horse from doing cer-
tain kinds of work. The more pronounced the dullness, the
more serious are the disturbances of power of locomotion and
the more limited the usefulness of the animal. Should symp-
toms appear indicating that the nutrition of the body is upset
it is no longer Avortli while to keep the animal alive. Riding
horses are most depreciated by the disease, because greater de-
mands are made of them as to accuracy of movement, etc. Dis-
eased horses are consequently fit for draught work only, and
that at a walking pace. In judging individual cases, besides
the diseased conditions, the following points must be consid-
ered : for what kind of work is the horse used, under what con-
ditions does it work, and whether it is possible to do away with
any prejudicial conditions of its work. Finally, in forming a
prognosis the possibility must be considered that acute attacks
may occur and cause death within a short time or make the ani-
mal dangerous.
Treatment. When once the disease has set in treatment is
of no avail, but by careful regulation of the diet the progress
of the disease may be rendered slower and thus the animal may
remain capable of work for a longer time. Above all, diseased
horses should be spared as much as possible and used for light
work. Food should be given in sufficient quantity to maintain
the condition of the body and allow the work to be done. It is
not advisable, as many believe, to keep the animals hungry.
The food should be easily digested so that constipation may be
avoided. Fresh green food is the best in the summer. Finally,
the patients should be placed in clean stalls that are not too
warm.
656 Congenital Hydrocephalus. Tumors of the Brain.
In cases in wliicli there is impaction of the intestine medici-
nal treatment may be resorted to and it is best to give large
doses of nentral salts, althongh now and then aloes ma^^ be nsed
witli advantage. In cases where there is loss of conscionsness
two or three snbcutaneons injections of pilocarpin hydrochloride
(0.30-0.50 g.) or arecolin (0.05-0.10 g.) give some relief. Viborg
and later Dieckerhoff advised tincture of veratrine. Six to
eight grams were injected intravenously and as long as there
Avas difficulty of respiration, sweating and nausea the animals
were left loose in a large box. In acute attacks the same treat-
ment as used in acute meningitis is indicated (see page 604).
Hayne advised puncture of the olfactory bulbs so as to allow the liquid to
escape. This treatment is dangerous as it may lead to a fatal meningitis and
produces no lasting results (Hering, Eoll, Dieckerhoff).
Literature. Dexler, Z. f. Tm., 1899, 242 ..(Lit.).— Droge, Z. f. Tk., 1907,
496.— Meissner, B. t. W.. 1899, 239.— Schindelka, 6. Z. f. Tk., 1891, IV, 106.
Congenital Hydrocephalus. (Hydrocephahis interniis congenitus).
This developmental anomaly is equally common in foals, calves, lambs,
and dogs, and the condition is more pronounced than the acquired dis-
ease. In very pronounced cases the brain appears to be enclosed in a
thin-walled sack, which is filled with a clear or slightly turbid serous
liquid, the medullary substance forming a thin layer inside the wall.
Since during fetal life the bones of the cranium are not yet joined ; the
cranium enlarges enormously, the parietal and frontal bones bulge, and
the orbits are reduced in size, and the head assumes a characteristic
shape, the cranium being large out of all comparison with the rest of
the head. Such a head may lead to dystokia. As a rule, the animals
die soon after birth, but they sometimes remain alive ; and apart from
the abnormal shape of the cranium, show no symptoms of disease, al-
though the cortex of the brain mav be almost entirelv a))sent. (Forgeot
& Nicolas, Bull, de la Soc. des Sci.'Vet. de Lvon, 1906, 115.— Jellinek, T.
Z., 1907, 435.— Marchand & Petit, Bull., 1907, 261.)
12. Tumors of the Brain.
Occurrence. Tumors within the cranium are of very rare
occurrence. In the brain itself the socalled cholesteatoma*
is comparatively frequently found. Dexler found them in 22.5
per cent of 204 horses examined. They develop in connection
with the venous plexuses beneath the cerebellum or in the lateral
ventricles. The majority are about the size of a pea, but in
some cases they attain the size of hen's or goose's eggs. As
a rule they cause no disturbance of health. By investigations
with tlie polarization microscope Schmay showed that clioles-
teatomata present the characters of chronic granulating in-
flammation and has termed them granuloma cholestrinicum.
*(Tlie type of neoplasm referred to by continental authors as cholesteatoma is
termed, in English veterinary literature, psammoma, the name cholesteatome being reserved
for a growth of a totally different nature which is very occasionally met with in the substance
of the cerebral liemispheres. — Translator's Note.)
Oecurrenee. Pathogenesis. Analoinical Changes. Symptoms. 657
Gliomata and gliosarcoinata occur as ill-dcliucd reddish growths.
Sarcomata and, in the horse, mehmotic sarcomata occur in the
actual brain substance, the growths being metastatic. The same
is true for carcinomata. In cases recorded by Trasbot and
Holterbach the primary growth was in the testicle or the mam-
mary gland. Isolated or multiple tuberculous growths occur m
the brain substance in a manner resembling true neoplasms.
The following tumors have been observed in connection
with the meninges: fibromata, lipomata, angiomata, sarcomata,
epitheliomata, papillomata, myxomata and melanotic sarcomata.
Finally, dermoid cysts and odontomata occur in the brain or in
its immediate neighborhood. In a case recorded by Roth in a
goat the brain tissue was reduced to a layer a few millimeters
thick owing to the presence of an odontoma weighing 310 g.
From a clinical point of view tuberculosis of the meninges must
also be included, this being of very common occurrence in cattle.
Tumors of the cranial bones may cause injury after break-
ing through the bones, by causing the development of exostoses
on the inner surface of the cranial bones or they may develop
directly on the inner surface of the cranium. Similar effects
may be produced by tuberculous growths (Moussu and Frick)
and bv actinomycotic lesions (Pieroni). Finally, neoplasms in
the neighborhood of the parotid may extend through the for-
amen lacerum into the cranium.
Pathogenesis. The injurious effects of tumors in the
cranial cavity are due to the rise of intracranial pressure which
they occasion. This varies with the size of the growth and at
first affects its immediate neighborhood only, but owing to more
extensive grow^th may involve more distant portions of the brain.
In this wav nerve cells and fibers are subjected to pressure and
even destroyed. Many of the cells round about may l)e stim-
ulated.
Anatomical Changes. In cases in which the tumor is in
the brain tissue itself the portion containing it is enlarged, its
convolutions flattened out and the medullary substance pale in
color and dry. Tumors of this kind are generally found in the
hemispheres,' in the cerebellum and exceptionally in the corpus
callosum (Cadeac), in the pituitary body (Wolff, Mollereau),
in the olfactory bulbs (Marchand, Petit & Coquot) and in the
pineal gland. Tumors in connection with the membranes or the
bones are, as a rule, situated about the base of the brain. Tu-
mors in connection wath the base of the brain not only exert an
effect on the brain tissue, b,ut the roots of many of the cranial
nerves may be also involved.
According to Ziirn enlargement and induration of the pineal gland are mat
with in the fowl and the pigeon and cause cerebral disturbances.
Symptoms. Neoplasms that are by no means small may be
found at the postmortem of animals wdiich have shown no symp-
658 Tumors of the Brain.
toms during life. Tumors in certain parts of the hemispheres,
the ventricles and other parts of the brain may reach a consid-
erable size without of necessity causing any symptoms. The
reason of this probably is that owing to the slow development of
the growth the brain accustoms itself to the altered conditions.
In the cranial cavity of a horse that had shown no symptoms
during life Blanc found a melanoma as large as a hen's egg.
The general cerebral symptoms presented are a more or
less pronounced and slowly progressive dullness and awkward-
ness, which in some cases may increase until there is actual loss
of intelligence. In the case described by Roth mentioned above
the goat behaved as if it had no brain. Hand in hand with the
dullness there is slowing of respiration and of the pulse, and
peristalsis is retarded. Very often there are attacks of giddi-
ness or forced movements, the animal walks in circles or leans
up against the wall of the stable with the head drawn round to
the side (Brade, Jessen). It is only exceptionally that severe
symptoms develop within a short time and cause the death of
tiie animal, but this is particularly the case in tuberculosis of
the brain.
From time to time there may be symptoms of excitement
and in cases of tuberculosis in which there are lesions involving
the brain in cattle there are epileptiform seizures at increas-
ingly short intervals as the disease progresses.
In other cases the muscular spasms are limited to the mus-
cles of the head and neck or other parts of the body and in many
cases only mystagmus and trembling are observed, and espe-
cially during movement.
Careful examination will reveal congestion of the optic
papillae as has been shown by observations of Scott and Wolff.
Amaurosis has in some cases been observed in connection with
these lesions, but in many cases the sight appears to be unaf-
fected.
The local symptoms presented will, of course, depend upon
the position of the tumor. As a rule, there is paralysis of cer-
tain nerves which gradually develops, and in the later stages
may l)e severe, and may be extended to nervous tissue in the
neighborhood. Hemiplegia, hemianesthesia, cerebellar ataxia,
Jacksonion epilepsy, blindness are sometimes observed. In
some cases, there are alterations in the shape of the cranium.
The following focal symptoms have been recorded in the cases which have
been described with accuracy: Amaurosis of the left side owing to the presence
of a tuberculous center the size of a haselnut posterior to the decussation of the
optic nerves (Uhlig). Muscular atrophy on the left side of the face with limited
mobility and sensitiveness of the left half of the upper lip in a dog as the result
of the presence of a glioma as large as a hazelnut which enclosed the Gasserian
ganglion and extended backwards as far as the nuclei of the VI-A^IIIth cranial
nerves (Gratia). A similar case was observed by Lydtin in a horse, but the atrophy
was limited to the muscles of mastication. Paralysis of the facial nerves on the
right side with lateral displacement of the head and neck to the same side, and
dragging of the left hind foot were observed in a horse having a sarcoma starting
Symptoms. Diagnosis. Treatment. 659
in connection with the right petrous temporal boue and extending under the right
half of the cerebellum, along the roots of the facial and auditory nerves as far
as the pons and the restiform bodies on the right side (Pr. Mil. Vb., 1891).
Paralysis of the facial nerves and complete blindness in cases in which except for
large cholesteatomata* in the lateral ventricles no (?) other lesions of the brain
were found (Walley). Nystagmus, incoordination of movement, increased sensitive-
ness of the limbs (?) due to a tumor situated behind the cerebellum (Eutherford).
Paralysis of the left half of the tongue and partial paralysis of the same side of
the body owing to the presence of a sarcoma in the left half of the medulla
oblongata immediately behind the decussation of the pyramids (Hallander). Twist-
ing of the left eyeball in the outward direction was caused by a tumor originating
in connection with the petrous temporal bone (Frick). Cadiot and Rogier observed
cerebellar ataxia in a dog having a tumor in one-half of the cerebellum. Hebrant
noticed unsteady gait, giddiness, swinging movements of the legs, exaggeration of
the patellar reflexes, and in the later stages movement in circles to the right and
right-sided facial paralysis in a dog having a sarcoma between the posterior vermis
of the cerebellum and the right supero-lateral surface of the medulla oblongata.
Cad#ac and Eoquet record paralysis of the trigeminal nerve in a dog having an en-
dothelioma involving the root of that nerve. In a case recorded by Besnoit of tuber-
culosis of the brain with multiple centers the size of a nut and one larger area
of softening in the right hemisphere there was blindness on the left side.
Diagnosis. A diagnosis can only be arrived at when in ad-
dition to symptoms of a general nature indicating pressure on
the brain, there are local symptoms present. It must lie borne
in mind, however, that a more or less similar train of s^anptoms
may be caused by animal parasites, abscesses, and in many
cases by hydrocephalus internus and chronic meningitis. The
differential diagnosis is not difficult Avhen certain accessory cir-
cumstances, such as primary neoplasms in some other organ,
tuberculosis, alteration of the shape of the cranium, suggest the
presence or otherwise of a growth. The diagnosis of a tumor
may, in all cases, be based upon the local symptoms, although
not with absolute certainty, when these have gradually pro-
gressed without intermission, fever is absent, and there is con-
gestion of the optic papillae.
On the grounds of a careful examination of a case occurring in a foal Wolff
gives the following symptoms of tumor growth in the region of the pituitary body:
Depression, vomiting, congestion of the optic papillse with resulting atrophy of
the optic nerves, ptosis, gradually progressive loss of consciousness, retardation
of the respirations and pulse. Further investigations must show whether motor
and sensory disturbances are also present.
Treatment. In this connection no experiments have been
made upon animals up to the present. No results are to be ex-
pected from internal treatment ; at the most long-continued ad-
ministration of potassium iodide or some other preparation of
iodine might possibly be tried. Provided the diagnosis be prac-
tically certain and that it is supposed that the neoplasm is
close to the roof of the cranium, surgical interference might be
resorted to.
Literature. Besnoit, Eev. Vet., 1906, 577 (Lit. on cerebral tuberculosis). —
Bissauge & Naudin. Eec, 1904, .5.— Cadeac & Eoquet, J. Vet., 1908, 65.— Hamoir,
Ann., 1906, 232, 391.— Hebrant, Ann., 1904, 438.— Marchand, Petit & Coquot, Eec,
1906, 81.— Marchand, Petit & Pecar, ibid., 1907, 25.— Peter, B. t. W., 1898, 505.—
Petit, Bull., 1906, 85. — Eoth, tilier eine intrakran. Dental-exostose usw.. Diss.
Zurich, 1888.— Schenk, W. f. Tk., 1906, 705.— Sehmey, A. f. Tk., 1910, XXXVI,
121. — Wetzstein, Studien iib. Tuberk. d. Zentr. Nervensvstems, Diss. Ziirich, 1907
(Lit. on cerebral tuberculosis).— Wolff, A. f. Tk., 1906, XXXII, 363 (Lit.).
*See footnote, page 656.
660
Gid.
13. Gid. Coenurosis.
{Drehsucht, Drelikrankeit [German], Tournis [French], Gid,
Staggers, Tuntsick.)
Gid is a chronic disease of ruminants, and especially of
the sheep, and is caused by the Coenurus cerebralis, the cystic
stage of the Ttenia coenurus. In addition to other symptoms
indicative of cerebral disturbance there are very frequently
forced movements.
Historical. The Coenurus cerebralis was first recognized as the
cystic stage of a tapeworm by Leske in 1780, and the nature and etiology
of the disease by Kuchenmeister in 1853. This was confirmed by other
authors at a later date (Haubner, May, Gurlt, Gerlach, Leuckart, Baillet,
Flirstenberg), and the Coenurus cerebralis was recognized as the cystic
stage of the Taniia coenurus.
Occurrence. The disease is
known in all countries. The sheep
is most commonly attacked, and
the disease occurs more rarely in
cattle and still more rarely in the
goat. It is only exceptionally that
the disease is met with in the
horse, camel, dromedary, ante-
lope, rabbit and hare. In wet
seasons, the disease among sheep
may amount almost to an epi-
zootic. Trinchera observed out-
breaks among calves, and Bauer
among calves and adult animals.
Etiology. The Coenurus cere-
bralis is a single cyst wdiich may
be as large as a hen's egg and is
filled wdtli a colorless or pale yel-
low liquid. Through the delicate
translucent wall one can dis-
tingiiish small white specks, the
size of poppy seeds or smaller, each of which is an invaginated
scolex. These are, as a rule, arranged in smaller or larger
groups (fig. 91).
01. Cwinirus cerebralis
iiral size.
Nat-
The cysts develop from embryos set free in the stomach from eggs
of the taenia. Having bored their way through the wall of the stomach
or intestine by means of their hooks, the embryos are apparently car-
ried by the blood-stream to the cranial cavity of their new host, where
they lose their hooks and become converted into small cysts. Excep-
tionally, they are carried into the vertebral canal. Witli further devel-
opment the scoHces are formed, thus producing the typical cysts.
Occurrence. 661
An embryo in the central nervous system reaches the size of a pea
in about 24 days, and scolices are first found about the 38th day. About
three months are required for the full development of the cyst.
Views are somewhat divergeut regarding the migrations of tlie embryos. One
view is that the embryos provided with booklets migrate into the connective tissue,
probably around the blood vessels and enter the cranium by the foramen lacerum.
This view is supported by the fact that after experimental infection minute tracks
are found in the loose tissues of the thoracic and abdominal organs (Baillet) and
also the fact that the first symptoms make their appearance after a week. As an
explanation as to why the cysts principally develop on the upper surface of the
hemispheres one must suppose that the emljryos are able to develop more easily
there because the furrows between the convolutions are deeper and the pressure is
less. According to the other view, which is especially upheld by Moller, the escape
of the embryos is by way of the blood stream. The occurrence of cerebral em-
bolism due to worms, the' absence of perforations or inflammatory changes at the
base of the brain or in the dura mater support this view. The latter view is prob-
ably correct since there are other examples of the escape of worms from the intes-
tine by way of the blood. .
The power of resistance of the eggs of the tapeworm is apparently gi'eat,
since eggs remain alive after the disintegration of the proglottides provided that
the superficial layers of the ground or the grass are sufficiently moist. Gurlt saw
a case of severe infestation after three weeks. The eggs do not resist desiccation
for long and according to Roll desiccation for two weeks in the open air kills
them Experience shows that infestation is rare in animals that are stall ted,
because there is little opportunity for the contamination of food or drinking water
with the feces of dogs under these circumstances. The resistance of the cysts is
still less. According to Perroneito they are killed by raising the temperature to
38° to 41° C. and then cooling.
Natural infection is due to the ing-estion of grass or water
contaminated either with the proglottides passed out with the
feces of a dog or with eggs of the Taenia coenurus after the dis-
integration of the proglottides. The disease attacks sheep and
other herhivora. The' shell of the egg is dissolved by the gas-
tric juice, and the liberated embryo commences its migration to-
wards the central nervous system. The tapeworm develops
principally in the intestine of sheep dogs, owing to the culpable
habit of shepherds of giving the brains of diseased sheepto
the dogs, and the carcasses of sheep that have not been buried
properly are also dug up by the dogs.
The occurrence of the disease is naturally bound up with
the number of dogs, but the state of the weather, especially m
rainy springs and autumns, is also an important factor, because
the dampness favors the vitality of the embryos. Infection
through contaminated water may take place throughout the
year (Moussu). According to Diem, experience shows that the
disease occurs more frequently among the animals of farmers
whose meadows are close to the road where dogs can deposit
their feces.
Susceptibilitv. The sheep is the most susceptil^le of all,
cattle and other' ruminants being more rarely affected. The
horse and many wild herbivora are only slightly susceptible. The
disease generally occurs in young animals, the sheep being at-
fected up to one vear old and cattle up to two years. Even
experimental infection fails in older animals save in exception-
al cases. The ox is an exception in that infection is not abso-
662 Gid.
lutely rare in older animals. The increasing resistance offered
to the disease with advancing- age in all probability is connected
with the greater delicacy of the tissues in young animals, this
favoring the migrations of the parasites.
According to tlie older authors ca'iiurus oysts are exceptionally found in
lambs at the time of birth or a few days after (Simonds, Hering). If these obser-
vations are correct tlie embryos must have entered the body of the fetus by way
of the placental blood vessels.
Pathogenesis. The oncospheres reach the cortex by way
of the blood vessels of the pia mater and may penetrate into
the medullary substance. During their passage they make
tracks, and set up inflammation in the immediate neigiil)orhood.
This circumscribed inflammation causes no disturbance of the
functions of the brain, provided the inflamed areas are few in
number; l)ut where the parasites are numerous, there may be
severe disturbances, owing to the larger number of small cen-
ters. The development of the embryos into cysts increases the
intracranial pressure in proportion to the size of the cysts, this
pressure causing atrophy of the nervous tissue in the neighbor-
hood and in more remote parts of the brain. As a result of
this destruction of nervous tissue, both general and local symp-
toms make their appearance.
Anatomical Changes. In the sheep in the acute stages one
can see small tracks in the cortex of the upper portion of the
hemispheres corresponding with yellowish purulent streaks in
the arachnoid, while the inner surface of the dura may be cov-
ered with a purulent layer. One can also see green or greenish-
yellow Ijladders containing pus-like material contained within
translucent membranes. These vary in size from a pin's head
to a linseed and they are surrounded by a layer composed of
the remains of destroyed tissue and calcified granules, Avhile
there may be small hemorrhages round about. The fluid con-
tained in the ventricles may be increased in amount and turbid,
especially if, as is exceptionally the case, the small cysts have
invaded the venous plexuses.
In the chronic stage, as a rule, only one or two and more
rarely as many as six cysts may be found. Ilink records a
case in which there were 17 and Huzard even 30. Sometimes
small granules, the remains of dead embryos, can be recognized
in the membranes. The larger cysts are generally found on
the convex surface of the brain or in the hemisphere, but they
may be occasionally found in connection with the cerebellum,
or the base of the brain. Their connection with the pia mater
is generally easily discovered. The brain tissue appears atro-
phied and anemic, and in the immediate neighborhood of the
cysts is converted into a reddish granular mass, or in some
cases it may have a viscid consistency. In the great majority
of cases one, and more rarely both, the hemispheres are de-
Anatomical Changes. Symptoms
663
stroyed, and tlie basal ganglia flattened. In some cases, one
hemlpl ere may be entirely replaced by a cyst. Exceptionally,
rhyda'id is q'^nte free in the excess of flnid m the lateral ven
tricle( Bering 'Hntvra & Marek) and may pass from there
throngh tlie fommen of Monro into the ventricle of the opposite
side o'r into the third ventricle. +i,^ ^lo
Cvsts on the surface of the hemispheres may canse the de-
strnction of the roof of the craninm immediately over them
tvo cases Hntyra & Marek), and even of other por ions, gener-
a Iv the frontal or parietal bones. In sncli cases the bone be-
comes as thin as paper and qnite translncent, or tj- >one tissne
mav quite disappear over a circular area, leaving the cyst cov-
ered only by the membranes of the bram, the periostenm, and
the soft tissues over the cranium.
Out of 100 cases Kolb found the cyst in 32 cases on the left side, 68 on the
right, and in 5% of cases in the cerebellum.
In rare cases, the cysts develop in the vertebral canal (see
compression of the spinal cord).
In cattle the cysts sometimes attain the size of an orange,
and there may be a number present (Vollrath found twenty-
three, and Pfab sixty). They may be the cause of exactly sim-
ar iLsions of the brain and also of atrophy of the roof of the
cranium. If they are situated under the frontal bone in calves
fhev n ay perfo/ate the still single layer of bone; but m older
an'mals, the inner layer is forced outwards and the frontal
mis is'completely obliterated. The outer wall may also appear
to bulge outwards (Greve), or may even be atrophied over a
circular area (Pfab).
In the horse, as a rule, only single cysts are found, either on
the upper surface of one of the hemispheres, or ma lateral
wntricle. They have been found in one case between the hemi-
spheres and the cerebellum, and in one case m both hemispheres^
In animals that have been ill for some time, symptoms ot
anemia and cachexia are generally seen. Sometimes, one sees
in t^e thoracic or abdominal wall, or in the oose connective
tissue small rounded greenish-yellow nodules about the size ot
a pea On section these are found to contain a pu p-hke mass
enclosed in a membranous envelope which in all Probability rep-
resents the remains of dead embryos (Roll, Neumann) l^xcep-
tionally well-developed hydratids ^-^y^l^^-^l^^l^^.^^^^.f;^^!^
taneous connective tissue (Natlmsms, Eichler), m the thyioid
and in the muscles (Rabe).
Symptoms. In the sheep two stages separated by a long
interval are recognizal)le during the course of the disease. The
first stage is cerebro-meningitis, set up by the migrations ot
GCA
Gid.
Uie (Miibryos, and tlio second is indicated l)y symptoms due to
pressure on the brain.
During tlie tirst stage wliicli sets in ten to fourteen days
after infection there are symptoms of a general nature indicat-
ing inflammation of the brain and its membranes. As a rule,
these symptoms are so slight that they escape the notice of the
shepherd ; it is iu a proportion of cases only, according to Mol-
ler about one-tifth, that the symptoms are sufficiently pronouuced
to be observed. The diseased sheep are left behind by the
flock, m.ove as if giddy, cease feeding and stand with heads
droyjped, and vacant expression. In some cases, but not very
often, the animals make forced movements.
In somewhat more severe cases, the symptoms of inflam-
mation are more pronounced. The head is hot and painful, the
¥i<^. 9:2. Brain of a sheep with Ccenurus eerebralis. (1) Cyst in the left hemi-
sphere. {'1\ lliglit liomisphere forced to tlie right by the left hemispliere. (3)
I'osition of ])erforation (5) in the frontal bone. (4) flattened convolutions of the
loft hemisphere.
vessels of the conjunctiva are dilated, the expression wild, and
in some cases there is obliquity of vision. There is acceleration
of the pulse, the neck is twisted to one side, owing to muscular
spasms, and in some cases, there is a full flow of saliva and
grinding of the teeth. Many animals jump up suddenly, rush
about, stumble, and fall down, showing spasms of certain groups
of muscles or of the whole body. In a proportion of cases (5
per cent, Moller) the diseased animals are absolutely unabh'
to rise. In such cases, death usually takes place from four to
six days after the appearance of the first symptom. In other
cases, the acute stage varies in duration, according to the sever-
Symptoms.
665
ity. It may be anything from two to six or eight to ten days,
after which the symptoms, having reached a certain stage, grad-
ually disappear, and the animals apparently recover.
The second stage is preceded by a latent period of three to
six months, and as a rule in flocks of sheep no symptoms are
observed during this period. Now and then, the disturbances
of the functions of the brain are indicated by a certain dullness,
especially when the weather is warm or in damp sheds. After
the latent period the symptoms which are characteristic of the
second stage, gradually develop.
Disturbances of consciousness are prominent among the
general brain symptoms. The animals remain separated from
the flock, move with unsteady gait, the feet being lifted high.
They stumble along with the head depressed or held high. As
a rule, the head is turned around to one side (see flgs. 94 and
95) and the animals wdiile standing still, allow the head to drop,
or they stand with the
forehead pressed against
the wall (fig. 93). There
is a vacant expression
and the appetite is vari-
able. Finally the giddi-
ness, which results in a
stumbling gait, must be
referred to disturbances
of consciousness.
In many cases there
are convulsions. Indi-
vidual groups of muscles
may be involved, for ex-
ample, the muscles of
mastication, causing the
animal to grind its teeth
and the saliva to froth.
In other cases, there may be epileptiform seizures. Forced
movements may be produced by the disturbances of conscious-
ness. These, however, are not constant in nature, and conse-
quently are of no value for determining the situation of the cyst.
The types of movement vary from case to case. There may be
movements in circles, rotation at one place, stumbling, falling on
one side, forwards or backwards.
The veins of the optic disc and the surrounding tissue ap-
pear very congested, the arteries on the other hand are con-
stricted. There is sometimes edema of the optic nerves and a
diffuse cloudiness of the optic disc indicating neuro-retinitis
(Bouchut).
Among the focal symptoms there is sometimes observed
squinting, resulting from compression of the nerves of the mus-
cles of the eyes, and there are also forced movements which
are constant.
666
Gid.
The following are some of the forced movements observed:
Movements in circles, the circles varying in size. As a rule, the
diameter of the circles decrease in size until tinally the animal goes
round and round on a very small space, and then loses its balance and
falls down. Exceptionally, the circles described remain the same size
for a. long time, and even get larger, until the animal finally stands
still.
Rotation movements. In these the animal rotates alwut one fore
or hind foot as a fixed point with the head and neck dropped.
When animals press forwards the head is in most cases sunk do^^^l
on the breast, and the legs are lifted high ; but exceptionally, the head
is bent over backwards and the animals stumble and fall down.
In animals that fall backwards, the head is bent backwards; and
there are tonic spasms of the muscles of the neck.
Rolling is only rarely observed and lasts only for a short time.
Falling on the side is somewhat more frequently seen. (For the
diagnostic importance of these movements, see page 670.)
In many cases only certain groups of muscles are involved
in tlio toiiio-clonir spasms (Jacksonian epilepsy), but in others
they liegin in the same
group of muscles, but ex-
tend to the rest of the body.
In the somewhat more
advanced cases, there may
be appreciable yielding on
pressure of the roof of the
cranium, and it is usually
over the frontal or parietal
bone that this can be felt.
If there is a complete re-
moval of bony tissue from
the place, there is actual
fluctuation. Pressure on
such places sometimes
causes the animal to col-
lapse, or there may be mus-
cular spasms or epilepti-
form seizures. The soft area does not always mark the position
of the cyst, for, as Hutyra & Marek have shown it may be found
on the opposite side (fig. 92). Percussion of the area not rarely
gives a more hollow sound than the surrounding parts that have
not undergone a process of thinning.
In the final stage of the disease, the animals are very ema-
ciated and lie motionless on the ground, respond to no stimuli,
take neither food nor water, and finally die, the respiration
having become of the Cheyne-Stokes type.
In cattle the onset of the disease is marked by loss of appe-
tite, dullness, gradually progressive giddiness, and blankness
of expression. The neck may be extended or even rigid. There
is a tendency to collapse, the head may be supported upon the
manger, held obliquely or it may show pendulum movements.
Fiff. 94. Gid.
Symptoms.
667
Animals sometimes move in circles, first in one direction, and
then in the other. This, according to Diem, is seen particular-
ly early in Simmenthal cattle. As the disturbances of con-
sciousness become more marked, there is developed a condition
resembling staggers. This stage is especially marked in young
animals in whi'ch the symptoms are striking, but in older ani-
mals, it often escapes observation.
The second stage sets in in from three to six months (Pfab)
but it is not sharply marked off. The symptoms presented
closely resemble those observed in the sheep. Many affected
animals cannot find their places in the shed, especially if this
lies in the opposite direction to that in Avhich they tend to move
Fig. 95. Lateral llexioii of tlie head in gid.
when at pasture (Cruzel). It is very difficult to turn affected
animals or move them backwards; they cannot see objects m
their way and fall over them (G. Lovy). In one case recorded
by Trinchera, in which there was a hydatid in_ the neighbor-
hood of the corpora quadrigemina on the right side as large as
a hen's egg, there was in addition to movements in circles, par-
tial paralysis and atrophy of the limbs of that side.
Eder is inclined to refer the paralysis of the fore-limb seen
in a calf affected with staggers to the presence of the cyst in
the brain. Simultaneous with the movement m circles, there
is a tendency to hold that side of the head which is turned
668 Gid.
towards the interior of the circle lower than tlie other side. Not
rarely and especially" in the later stages of the disease tliere is
extension of the head (Albrecht).
The frontal and parietal regions, and the roots of the horns
feel warmer than normal and exceptionally the frontal region
may bnlge forward (Greve). In animals np to one to one and
one half years old, percussion of the cranium, provided the cyst
is superficially placed, gives an unusually hollow sound, sim-
ilar to that obtained by percussion, immediately below the horn
core (Albrecht, Merkt). At the same spot the resistance is
elastic. Now and then the roof of the cranium is yielding (Al-
brecht), and in many cases the use of the percussion hammer
produces sjaiiptoms of pain.
For percussion of the cranium Albrecht uses a light hammer, but Diem pre-
fers one that is fairly heavy and has one end round and the otlier square. Pfab
has recently constructed a useful hammer for this purpose. Percussion hammers
of the usual type are useful for the discovery of quite superficial cysts. The whole
of the frontal region should be percussed with the head extended after the hair
has been clipped off.
As the appetite falls off tliere is gradual emaciation, and
if the animal be not slaughtered in time, it finally gets into a
condition of complete cachexia.
In the isolated cases that have been ol)served in horses, the fnnc-
tional disturbances have been somewhat severe. In a case recorded by
Schwanefeld, there were symptoms of acute cerebro-meningitis (the
cyst being on the upper surface of the hemisphere). Frenzel observed
emaciation and dilatation of the pupils, and from time to time, circu-
lar movements. In Gotteswinter's case, the horse which was previously
quiet, became excital)le and vicious, and later showed symptoms of
sleepy staggers. In Ziindel's case the disease which lasted four months,
started with amaurosis. Later there were attacks of giddiness, while
the horse was at work, the head being held to the left and the animal
going in the same direction. It was found to be impossible to turn it
the other way. The cyst was found in the right hemisphere under the
frontal lobe. In addition to these symptoms, rotation, backing and
sleepy staggers have been observed,
Course. Apart from those cases in which the animals die
showing symptoms of acute encephalitis at the time of infec-
tion, the disease tends to be chronic and last for months. In
a proportion of cases, symptoms make their appearance ten to
fourteen days after infection, the condition lasting sometimes
for a week. These symptoms then disappear, and the charac-
teristic symptoms set in after three to six months. In the
majority of cases, the disease tends to begin with s^^nptoms in-
dicative of pressure on the brain. The length of the interval
between infection and the appearance of tlie characteristic
symptoms depends upon the severity of the infestation, but the
situation of the cysts is not without some influence on this. The
subsequent course of the disease depends upon the same factors.
There are cases in which the symptoms develop rapidly and
Diagnosis. 669
increase in severity so qnickly that the animal dies in the course
of a few days. This stage, as a rule, lasts from two to six
weeks, but it may extend, and especially in cattle, to two to
three months, or even longer. Gieres records a case in which
it was eight months; and Pfab, one in which it was more than
a year.
Death is generally due to weakness and anemia, but it is
sometimes quite sudden and resembles apoplexy.
Diagnosis. During the acute stage the symptoms are those
of acute cerebro-meningitis, and during the chronic stage those
of increased intracranial pressure. An option as to the cause
of the increased pressure may be based upon the local symp-
toms, the examination of the roof of the cranium, and the fur-
ther course of the disease, provided the preliminary enquiry
affords exact information. In the absence of such information,
diagnosis passes beyond the bounds of possibility, although in
practice the disease is generally easily recognized, and espe-
cially in the sheep, on account of its frequent occurrence and
still more from the postmortem examination of some of the
animals.
In connection with differential diagnosis, sunstroke and
acute meningitis must be taken into consideration. Apart from
the sudden onset of the disease, these cause severe depression
from the outset. Forced movements and particularly move-
ments in circles are only rarely observed. There is congestion
of the mucous membranes of the head, and the course is very
acute. When the disease occurs enzootically among sheep, it
may be confounded with infectious cerebro-spinal meningitis,
especially when housed animals are attacked. Apart from the
diagnostic symptoms of meningitis, a diagnosis may be always
based upon a postmortem examination. Severe cerebral symp-
toms may be caused in sheep by the larvas of the CEstrus ovis.
In such cases, there are only symptoms of acute inflammatory
disease of the brain and its meml)ranes without forced move-
ments, and besides valuable information is furnished by the ca-
tarrh of the nasal cavities and sinuses which is present at the
same time. One must not lose sight of the fact that both dis-
eases may exist at the same time. Errors should scarcely be
made in other cases of catarrh of the nose and sinuses.
Tumors of the brain, tuberculosis of the brain, or its mem-
branes in cattle and in particular echinococcus cysts may set
up similar sjmiptoms.
In such cases the possible presence of similar tumors, tu-
berculosis, or parasites in other organs, aifords a certain
amount of information, although this does not enable one to
make a certain diagnosis. With regard to tuberculosis, the
presence of lesions in the eye is decisive. For the rest, atten-
uation of the roof of the cranium has not up to the present
been observed in anv other disease of the brain. In the horse
670 Gid.
chronic dropsy of the ventricles must be considered, but in this
case differential diagnosis may be based on the absence in ccen-
nrosis of the acute attacks that not rarely occur in internal
hydrocephalus. There is a possibility of confusion with epi-
lepsy in those cases in which occasional attacks of general
spasms occur, but in epilepsy there is complete absence of any
evidence of brain trouble in the intervals between the attacks.
A local diagnosis is only possil)le when there are pro-
nounced localized symptoms (movements in circles always in
the same direction, cerebellar ataxia, rolling, functional disturb-
ances of certain cranial nerves, Jacksonian epilepsy), and there
is compressibility of the roof of the cranium at one particular
spot, or percussion yields a hollow sound, but as mentioned
above, the spot does not always mark the seat of the cyst.
The connection between the nature and direction of the forced
movements and the situation of the cyst, is seldom so intimate that the
situation of the cyst can be determined without further investigations.
This is true, lioth for the cases in which there is a single cyst, and in
eases in which there are large numbers. Comparison of large numbers
of results gives the following points as being common to the minority of
cases. In most cases, the cyst is in that half of the brain towards
which the forced movements are made. In cases in which the animals
move in circles, the cyst is situated in that half of the brain which is
turned towards the center of the circle and is situated close to the roof
of the cranium. Rotation about a tixed point indicates the presence of
a cyst in the depth of the opposite hemisphere, or in the floor of the
lateral ventricle, in which case the corpora quadrigemina are subjected
to pressure. In some cases movement in circles towards the sound side
is seen. When animals force their way forwards with the head de-
pressed, the cyst is as a rule, in the frontal lobes directly in front of
the corpus striatum ; while in cases in which there is rolling, it is situated
at the base of the cerebellum or on the pons. If the cyst be in one of
the hemispheres of the cere])e]]um, the vermiform process, or the occip-
ital lobe, there is evidence of great giddiness and a staggering gait. In
cases in which the head is drawn forcibly backwards, the cyst is usually
to be found in the neighborhood of the tentorium cerebelli between the
cerebrum and cerebellum.
In 76 animals that were trepanned or examined postmortem Selioltz found
the cyst in 17 cases on that side of the brain that was turned towards the center
of the circle.
Prognosis. The disease may terminate at the stage of ex-
citement, owing to the death of the embryos (about tw^o per cent
of cases, Ziirn), but prognosis is unfavorable, even in the early
stages. In the second stage, prognosis may be made more or
less favorable by surgical interference. Results obtained up to
the present show that provided the operation be done in time
about a third of the number of sheep, and in cattle under favor-
able conditions, not rarely a half or even two thirds of the ani-
mals, may be saved.
Treatment. 671
Treatment. In the first stage cold applications to the head
and purgatives are indicated to alleviate the symptoms pro-
duced by the inflammation.
In the second stage only removal of the cyst by trepanning
can lead to recovery.
Under the following circumstances surgical interference is indi-
cated: a superficial and accurately localized situation of the cyst, the
appetite maintained to some extent, and the animal in satisfactory
condition, the absence of spontaneous convulsions, and finally, when
slaughter is not desirable. In connection with the operation in cattle,
the breed of the animals must be taken into consideration. Results
obtained by a number of Bavarian veterinarians (Imminger, Braun,
Diem) show that trepanning is attended with great difficulty in the
case of Simmenthal cattle on account of the extraordinary thickness
of the cranial bones, the tough structure of the cysts ; and finally, the
special susceptibility of the animals to the operation. Diem's results
(87% of cures) indicate that, provided certain precautions are taken
(ligation of blood vessels, the cyst be not probed about or infected, the
wound be thoroughly cleansed and washed out after operation) as
good results may be obtained with this breed as with others. The
species of the diseased animals should also be taken into consideration.
Sheep are of less value than cattle, and not infrequently they harbor
a large number of cysts, points which are opposed to the operation
being undertaken, and to its success. In cases in which the symptoms
indicate the presence of cysts, but their exact situation cannot be de-
termined, it is advisable to wait for two to eight weeks in the case of
cattle so that the chance of localizing the parasite may be increased.
According to Diem, pregnancy is no liar to the operation.
In operating, the entire cyst should be removed, the results
following removal of the contents only being less favorable.
As a general rule, it appears to be advisable to remove the
liquid slowly and with pauses as a sudden alteration of in-
tracranial pressure may cause fatal paralysis or general con-
vulsions and hemorrhage.
The seat of operation depends upon the case and especially upon the local
lesions presented by the cranial wall (see pages 666 and 667). If such indications
be absent the operation should be undertaken only at the special desire _ of the
owner. With experience the cyst will in most cases be found, and especially if
the animals have shown symptom of moving in circles or forwards. In horned
breeds of sheep the middle portion of the occipital lobe lies 12 mm. in rams and
16 to 20 mm. in ewes behind the middle point of the line joining the horn cores,
and the frontal lobes immediately behind the inner portion of the horn or the
horn core. In hornless breeds the following are the guiding points: The area
included between lines joining the bases of the ears and the eyes and lines joining
the base of each ear with the eye on the same side is divided medially by a vertical
line, and the operation is carried out at the mid-point of the areas so marked out.
In cattle the proper seat of the operation is at a point 4 cm. above a line joining
the brows of the eyes and 1.5-2 cm. from the middle line (Albrecht). In any case
the middle line must be avoided so as to escape injuring the longitudinal sinus.
More exact directions will be found in text books on surgery, and references to
the operation in cattle will be found in the publications of Merkt, Albrecht, Diem
and Pfab.
In cases in which the operation is successful and recovery
is going to take place, there is a striking improvement in the
672 Gill. Otlicr Parasitc-s oh' \\w Brain.
aiiimars condition within llie next few days; the depression dis-
appears; there are no forced movements, the appetite retnrns
and in a week or two, the animal appears to have recovered.
Cattle as a rnle recover more slowly. For the first few days
after the operation, they are so weak that they have to be fed
artificially. Recovery generally takes two or three weeks, but
there are many exceptions to this. If, after the operation, symp-
toms make a fresh appearance and are associated with fever,
encephalitis or meningitis must be suspected, and the animal
slaughtered as soon as possible. The same holds good for
those cases in which symptoms appear after a longer interval,
l)ecause it is obvious that in such cases one or more cysts re-
main behind in the cranium. Now and then, a second operation
leads to a definite recovery (Renner).
The proportion of recoveries following operation is of course very variable.
In sheep Scholtz records a ])ercentage of 25, Demann 33'/f , Kiihlmann 25 to 35%,
while in cattle Diem had 91% of recoveries in 24 animals operated upon and Pfab
59% of 58 cases. Half of Merkt's cases and all of Renner 's recovered. These good
results are quite the exception, accidents being recorded in the majority of cases
(Vollrath, Brauu).
The only other method of treatment that will be mentioned here is that ad-
vised by Hartenstein and used by Nocard with good results in two cases. The
sheep is enclosed in a box with its head extended through a hole of suitable size
and, with the excei)tion of feeding times, the head is subjected to a stream of cold
water which is supplied through a rubber tube from a vessel fixed at a height.
The irrigation must Ije continued for three days and then repeated at longer in-
tervals until all symptoms disappear. Postmortem examinations have shown that
under such treatment the cysts die. De Mia effected cures in two calves up to a
year old by applying ice compresses to the head for 12 days.
Prophylaxis. Efforts must be made to protect sheep and
cattle from infection from dogs. In this connection a reduc-
tion in the number of sheep dogs is indicated, and tapeworms
should be expelled from the dogs every two to tliree months.
During treatment the dogs must be isolated and their feces
burnt or buried deeply. Care must also be exercised that the
dogs are afforded no opportunity to get hydatids from animals
that have died or have been slaughtered. This is best accom-
plished by burning or cooking the affected brains. If certain
fields are known by experience to be dangerous, the young cat-
tle which are more susceptible, should be kept off them, es-
pecially during wet weather.
Literature. Albrecht, Monh., 1S94, Y, 337.— Bauer, W. f. Tk., 1901, 15.—
Braun, ibid., 1906, 441.— Diem, il)id., 190G, S81.— Gotteswinter, ibid., 1894, 378.—
Greve, Mag., 1835, 23.— Hering, Eep., 1855, 20; 1859, 247.— Kunz, Schw. A.,
1893, XXXV, 62.— Leblanc & Freger, J. Vet, 1907, 193.— Lovy, Vet., 1895, 222.
— De Mia, N. Ere, 1904, 109.— Moller, D. Z. f. Tm., 1875, I, 425.— Pfab, Miinch.
t. W., 1910, 73 (Lit.).— Eenner, W. f. Tk., 1878, 174.— Schmid, ibid., 1906, 706.
—Scholtz, Pr. Mt., 1869-70, 147.— Schwanefeldt, A. f. Tk., 1885, XI, 230.—
Trinchera, Clin. A^et., 1893, 485.— Vollrath, W. f. Tk., 1905, 791.— Zimmermann,
Vet., 1901, 689.— Ziirn, Tier. Parasiten, 1882, 139.
Other Parasites of the Brain, In the pig, and more rarely in the
flog, the Cysticercus cellulosse develops in the ])rain, and the Cysticercns
bovis has been found in calves by Deleidi & Reggani. Lesbre records
Acute Bulbar Paralysis. 673
the occurrence of the Cysticercus pisiformis in the brain of a dog.—
Echinococcus cysts have now and then been found in the brain of the
horse (Oeltjen, Boschetti, Dollar, Giitzloff, Glokke), and in cattle (de
Angelis, Reaii, Laszlo). The alfected animals either showed simply
symptoms of dullness, or there were attacks of mania; the head was
held obliquely, and percussion of the cranium yielded a hollow sound
(Reali). — The larvae of sclerostomes sometimes occur in the brain of
the horse, and may give rise to an acute hemorrhagic meuingo-encepha-
litis, and possibly also to dilatation of some of the arteries of the brain
(Abilgaard, Le Bihan, Albrecht, van Heill). The occurrence of the
larvae of Gastrophilus has been recorded (Dieckerhoff, Lindstrom, Sie-
damgrotzky, Johne). The penetration in all probability took place via
the Eustachian tube or from the gutteral pouches through the foramen
lacerum. As a rule, they remain in the base of the brain and cause
an acute rapidly fatal meningo-encephalitis. On a few occasions the
larvae of the Hypoderma bovis has been found in the horse (Boas, Poul-
sen, Segelberg, Railliet), and on one occasion in Hungary, in the ox.
The ajiimals showed symptoms of a rapid and acute meningo-encepha-
litis. Widakowich found a sexually mature roundworm in the enlarged
pituitary body in a cat, and Lafargue in a horse showing symptoms of
meningitis two amphistomes in a subarachnoid hemorrhage.
Apart from cysticercosis, no case has been recorded of parasites
causing functional nervous disturbances during life.
Literature. De Angelis, N. Ere, 1903, 62.— Lafargue, Eee. d'Hyg. et de
Med. Vet. Mil., 1909, X, 705.— Martin, Eev. Vet., 1907, 741.— Eailliet & Diicasse,
Eec, 1901, 207.— Eeali, Clin. Vet., 1900, 2.59.— Siedamgrotzky, S. B., 1884, 15.—
Widakowich, Cbl. f. Bakt., 1905, XXXVIIT, 447.
14. Bulbar Paralysis. Paralysis bulbaris.
(Paralysis glosso-lahio-laryngea.)
Bulbar paralysis is the term used to indicate combined pa-
ralysis of the cranial nerves arising from the floor of the
fourth ventricle (sixth to twelfth pairs). The disease may be
uncomplicated, or it may accompany other diseases of the brain
(meningitis, encephalitis, hemorrhage, contusion).
(a) Acute Bulbar Paralysis.
Paralysis of the nerves arising from the medulla oblongata
may be caused by hemorrhage that is limited to the medulla,
plugging of the vessels, or inflammation. In this connection,
encephalitis comes into consideration first. In many cases of
encephalitis due to distemper, and in the majority of cases due
to rabies, the disease sets in with bulbar paralysis. So far, no
anatomical reason has been found for the cases of infectious
acute bulbar paralysis observed in the cat and dog in Hungary
(see Vol. I), although Marek records a perivascular infiltration
in cattle that have died of the disease. Finally, poisoning by
bunt and rust in some cases causes symptoms of bulbar paraly-
Vol. 2-43
674 Progressivi' Bull)ar Paralysis.
sis (see page 215). All these forms have been dealt with in th-e
chapters devoted to the particular subjects.
There appear to be other diseases than those mentioned
above that occur in animals, and are associated with bulbar
paralysis. Stietenroth observed a bulbar paralysis terminating
fatally in seven to twelve days in three horses, the exact nature
of which was not determined. Thomassen mentions the occur-
rence in Belgium and Holland of a contagious disease among
young horses associated wdth suddenly occurring difficulty of
masticating and swallowing, and paresis of the limbs. Histo-
logical examinations revealed no alterations save that there
was a reduction in the number of ganglion cells in the neigh-
borhood of the nuclei of the hypoglossal, glosso-pharyngeal and
vago-accessorius nerves and there was chromatolysis, vacuoli-
zation and marginal disposition of the nuclei. Thomassen iden-
tifies the disease with the progressive bulbar paralysis ob-
served in Belgium, but owing to essential differences in the
course of the disease, it should not be considered as the same.
From time to time, cases are recorded in which paralysis of the
nerves of the bulb is an outstanding feature. Little definite
information can at the present moment be given with regard
to these and similar diseased conditions. The principal con-
ditions included under the term are enceplialo-myelitis of va-
rious types, diseases of the peripheral nerves, and poisoning.
Literature. Dexler, Ergebn. d. Path., 1896, III, .507 (Lit.).— Doderlein,
W. f. Tk., 1905, 83.— Stietem-oth, B. t. W., 1899, 265.— Thomassen, Monh., 190.3,
XIV, 1.
(b) Progressive Bulbar Paralysis.
Occurrence. There are observations to show that progres-
sive bulbar paralysis occurs in the horse as an independent
condition (Lagrange, Stockfleth, Gerard, Degive, Cadeac, Tho-
massen, Frohner). The disease appears to have a tendency to
break out sporadically every year in the northern parts of
Belgium. Isolated cases have been recorded by Cadeac in
France, Frohner and Rosenfeld in Germany.
Etiology. Belgian authors and Thomassen are inclined
to think that the cause of the disease is an intoxication due to
white beets, there being no evidence that it is due to an infec-
tion. It is still unknown whether the disease actually involves
the medulla oblongata or the nerves originating from it.
Symptoms. Clinically, the disease is characterized by a
gradually progressing bilateral paralysis of the bulbar nerves.
There is difficulty in swallowing in every case. The animal
takes food greedily, chews it for a long time, but swallows only
a part or none at all, the food returning partly through the nose
Sj'inptoms. Course. Diai;n«)sis. Treatinoiil. 075
and partly tlirougli the iiioiith. Illuiiiiiuitiou of the interior of
the pharynx may show it adhering- to the posterior wall of the
cavity. If there is simultaneous paralysis of the esophagus
food may remain here. Drinking appears to be little disturbed
at the outset. The secretion of saliva is increased. Paralysis
of the larynx causes whistling or roaring and finally aphonia.
As a result of paralysis of the tongue, swallowing is rendered
still more difficult and the food collects in the mouth. This
greatly interferes with drinking, and in many cases the
horses try to get water into the upper part of the esophagus
by suddenly lifting the head after having taken water into the
mouth in a manner resembling that seen in the goose. The
tongue undergoes a process of atrophy and its upper surface
appears wrinkled. Evidence of paralysis of the nerves of the
face soon makes its appearance and, owing to paralysis of the
lips, food is prehended with the incisor teeth. Finally, there
is paralysis of the muscles of mastication. In exceptional cases
the paralysis is more pronounced and more extensive on one
side than on the other. In a case of bulbar paralysis observed
by Frohner there was pronounced atrophy of the muscles of
the back and croup.
Course. The disease lasts for five or six months or more,
the animals becoming very emaciated owing to difficulty of
swallowing. Debility or pneumonia due to the passage of food
down the esophagus finally bring the disease to a fatal termina-
tion.
Diagnosis. Diagnosis is based upon the exclusion of ab-
scesses in the pharynx, neoplasms, impaction with foreign
bodies and diseases of the esophagus.
Treatment. The administration of thin pultaceous foods
is indicated throughout the course of the disease, a stomach
tube being used if necessary (see page 123). If the disease is
not checked it appears advisable to consider the value of the
animal as early as possible.
Literature. Cadeae, J. Vet., 1902, 519.— Degive, Ann., 1883, 12.— Frohner.
Monh., 1905, XVI, 550.— Eosenfeld, Z. f. Vk., 1905, 26.
Section II.
DISEASES OF THE SPINAL CORD.
1. Acute Inflammation of the Membranes of the Spinal Cord.
Meningitis spinalis acuta.
Under this term are inchided acute inflammations of the
membranes of the spinal cord which commence either in the
dura mater, the epidural tissues or the pia mater, and as a
rule, spread to the other membranes and even the spinal cord
itself, causing the production of a serous, sero-fibrinous, or
suppurative inflammatory exudate.
Occurrence. Apart from cerebro-meningitis, the disease
is of rare occurrence in the domesticated animals, Imt among
tbem the majority of cases occur in the horse.
Etiology. Inflammatory conditions of the membranes of
the spinal cord are always due to an infection. Now and then,
cases occur as a result of influenza, strangles, pyemia, or sep-
ticemia. Hess records a case of purulent meningitis of the
Cauda equina in an ox that was associated with purulent cere-
bral meningitis. Apart from some calcified tubercles in the
mediastinal gland and worm nodules in the small intestine,
there were no lesions in the internal organs. Injuries such
as blows on the vertebral column, docking the tail too short,
are sometimes causally connected with the disease, in that they
allow of the access of bacteria. Finally, in England, there is
a contagious disease of the sheep characterized by a pyemic
inflammation of the membranes of the cord which is known as
''loping ill" (McFadyean).
By Frohner, Cadeac and others distemper is thpujj^ht to he causally related
to an acute and clinically recogniyable spinal meningitis, because in this disease
there is an accumulation of a large (|uantity of clear liquid in the inter-meningeal
spaces (hydrorhachis). The authors have never observed any clinical evidence of
spinal meningitis in the many hundreds of cases of distemper that have come under
their notice.
Not rarely the inflammatory processes spread to the mem-
branes from surrounding tissues. This is especially the case
in caries of a vertebra, the rupture of an abscess in the neigh-
676
Pathogenesis. Anatomical Changes. Symptoms. 677
borliood of the vertebral canal (Decosse, Ohm, Frohner), or in
cases of suppurative inflammation in the mediastinum or neck.
According to Trasbot, inflammation may extend along the
course of nerves from nerve plexuses to the membranes of the
cord. This has been proved by Homen and Laitneu by the
injection of streptococci into the sciatic nerve; the meningitis
observed in one case of dourine may have been caused in this
way. The circumscril^ed spinal meningitis which often devel-
ops is not of much clinical importance as it is obscured by the
myelitis which develops at an earlier stage.
Pathogenesis. The nerve terminals in the membranes, the
cord, and the nerve roots passing through them are irritated by
the hj^eremic dilatations of the vessels and the serous-celled
infiltration which soon follows. In the later stages the con-
ductivity of many of the nerve roots is lessened or even de-
stroyed. In addition to this, there is an extension of the in-
flammatory processes from the membranes to the superficial
layers of the cord itself. Intermixing of the toxic material with
the cerebro-spinal fluid, generally causes the extension of the
inflammation over a large area.
Anatomical Changes. In addition to the marked conges-
tion of the vessels there is an exudate in the intermeningeal
space which is turbid or even mixed with flocculi of fibrin. The
vessels of the membranes may be surrounded by layers of fibrin
of variable thickness, producing an appearance of streaks of
pus. In many cases, the exudate is actually purulent. Not
rarely the fibrinous or purulent exudate involves the nerve
roots connected with the spinal cord.
The presence of a clear serous fluid between the membranes is in itself no
proof of the existence of spinal meningitis. In animals in an advanced stage of
emaciation there are often large quantities of clear fluid in the subdural space,
but this is accounted for by the decreased resistance owing to the disappearance of
the epidural fat.
Symptoms. The first symptom is increased sensibility
of those parts of the body, the nerve trunks of which pass
through the diseased membranes. As a result of this, the gait
is particularly cramped and cautious, and the animals liold the
vertebral column as motionless as possible and stiff. The sen-
sibility of the skin (hyperalgesia) is further shown by the
symptoms of pain exhibited if the skin be pinched or rublied
with the flat of the hand, especially in the direction opposed to
the lay of the hair, or if a sponge soaked in warm water be
placed in contact with the skin. The back is arclied, and the
animals become very restless, snap at the hand, and utter cries
of pain. Similar symptoms are exhibited if pressure be exert-
ed upon the muscles. In some cases, accurate investigation
shows that this increased sensibility is restricted to certain
parts of the body, a quarter, one half or a third of the body
578 Acute luflamniatiun of the Membranes of the Spinal Cord.
(Spinola and Trasbot). In all probability, animals suffer pain
without any interference from without, in that they, and espe-
cially dogs, often utter cries and moans, and persistently rub
some part of the body and even bite it until the blood comes.
The painfulness of the vertebral column is shown by percussing
the spinous processes and during passive movements.
At this stage there are momentary spasms, fibrillar twitch-
ings or cramplike contractions of the muscles. These contrac-
tions occur principally in response to external influences, and
in some cases in response to the lightest contact with the skin,
but in others as a result of heavier blows, pressure, or attempts
to move the animal. In one case observed by Frohner this
caused a horse to rear. If the contractions of the muscles are
persistent and involve the muscles of the back, the back is
arched and the muscles are as hard as wood. Spasms of this
kind frequently occur in the muscles of the limbs at the same
time, and if the inflammation has extended to near the medulla
oblongata the neck muscles may be thrown into spasm. Should
the contractions involve the muscles of respiration and the ab-
dominal muscles, respiration becomes hurried and superficial,
the abdomen is tucked up; and there is retention of feces and
urine, probably owing to contraction of the sphincters of the
anus and bladder. In other cases, urine is passed frequently,
the passage being associated with pain. Now and then, pri-
apismus is observed in male animals. In the early stages, both
kinds of reflex are exaggerated in the hyperalgesic area.
After the motor nerves have been deprived of part of their
conductivity, paralysis of individual muscles or groups of mus-
cles in the hyperalgesic area is observed, associated with re-
duction or complete loss of the previously exaggerated reflex
irritability. At the same time, or more usually at a later stage,
there is a reduction, but rarely a complete loss of sensibility
in those parts of the body that were previously painful. These
symptoms, as a rule, remain confined to a small area so long as
the spinal cord appears to be uninjured.
Extension of the inflammation to the cord or compression
of the cord by the exudate is rapidly followed by extensive and
progressive paralysis and anesthesia of all portions of the body
posterior to the most anterior limit of the area involved in the
inflammation; in a word, there are s^^nptoms of inflammation
of the spinal cord. As a result of the paralysis, the gait
becomes uncertain and in a short time the animal can no longer
stand, bedsores very promptly appearing on prominent parts
of the body, especially in large animals.
There is frequently elevation of temperature, and in many
cases the onset of the disease is marked by high fever.
Exceptionally the course of the disease may differ from that described. There
may be loss of sensibility from the outset (Hutyra & Marek) or there may be
paralysis at once (Frohner), and especially if the cord is affected from the com-
mencement.
Course. Diagnosis. Treatment. 679
Course. The disease, as a rule, terminates fatally within
a week, death being due in most cases to disease of the spinal
cord. There are cases in which circumscribed inflammation of
the meninges may persist for months.
Diagnosis. There is no special difficulty in making a diag-
nosis when the symptoms can be observed to make their appear-
ance in the order given, but systematic observation is essen-
tial. S>Tnptoms that are of particular value are the gradual
disappearance of the irritability of the nerves, which is present
in the early stages, until there is complete paralysis, and the
forward extension of the inflammatory processes. With refer-
ence to the course taken by this disease, injuries to and com-
pression of the cord are easily excluded. — Pachymeningitis
ossificans may be distinguished by the chronic course and the
slightness of the initial symptoms. — Acute muscular rheuma-
tism may be differentiated by the painfulness of the muscles,
while the sensibility of the skin remains normal, and the nor-
mal condition of the reflexes, tetanus by the trismus, and the
absence of sensory disturbances ; acute inflammation of the
brain and its membranes by the pronounced dullness and the
paralysis of the cranial nerves. — Polyneuritis sometimes oc-
curs in animals, but in this condition there is exaggerated sen-
sibility, but there are no muscular spasms. — In many cases, the
differentiation of transverse or diffuse inflammation of the cord
may be associated with difficulty. The chief distinction is that
in spinal meningitis there is severe pain and muscular spasms
over large areas. In inflammation of the cord there is at an
early stage extensive sensory and motor paralysis, and dis-
turbance of defecation and micturition are more frequently ob-
served. Finally, experience shows that in cases in which the
disease is confined to the cord there are no objective symptoms
of pain.
Treatment. The increased excitability and reflex irrita-
bility seen in the early stages make it essential that the animal
be placed in a quiet, clean box and provided with a soft bed,
because bedsores are easily produced in cases of this kind. The
affected parts of the body should be injected or rubbed several
times daily with alcohol containing camphor or turpentine, and
parts that are already partly paralyzed must be kept clean.
Large animals should be placed in slings, should the increased
irritability permit of it, and paraplegia has not become com-
plete. Should the animal go down, the parts must be washed
several times a day with a disinfectant and sprinkled with a
disinfecting powder.
Cold applications should be used to oppose the inflammatory
processes, and this is particularly the case in small animals in
wdiicli the thin layer of muscles does not offer much opposition
to the effect of the cold on the vertebral canal. India rubl)er
680 Ossifying' Inflaniniatiou of the Dura Mater of the Spinal Cord.
bottles of siiita])le shape, wliicli should be filled with ice or with
cold water which is chanoed at frequent intervals during the
day, may be laid along the course of the vertebral column.
Thick layers of tow may be used, ice water being used to sat-
urate them at short intervals. After the disappearance of the
symptoms of excitement, Priessnitz poultices may be applied.
Internally sodium salicylate (15 to 20 gm. for large animals,
and 1 to 2 gm. for small), or calomel (2 to 4 gm. or 0.05 to 0.4
gm. per diem except to ruminants) may be given.
If there are painful or tetanic contractions of the muscles,
alleviation may be obtained by the administration of narcotics
(chloral hydrate, potassium bromide, morphine).
Tn ilofis hiinbar puncture as described by Sabrazes and Muratet may be re-
sorted to with the object of removing a portion of the cerebrospinal tiuid.
Literature. Frohner, Monh., 1907, XVllI, 142.— Johne, S. B., 1896, 66.—
Le Maitre, Rec, 1900, 529.— Marchand, Petit & Coquot, ibid., 1906, 5.— Sabrazes
& Muratet, Eev. Gen., 1906, VIII, 633.
2. Ossifying Inflammation of the Dura Mater of the Spinal
Cord. Pachymeningitis spinalis ossificans.
There not rarely occurs in the dura mater of the spinal
cord of dogs a peculiar inflammatory process resulting in the
formation of plates of bone of various sizes which cause tear-
ing and crushing of the roots of the spinal nerves, and even of
the cord itself, and in addition may compress the cord.
Historical. Primary ossifying inflammation of the dura of the
cord was observed by Mauri in 1878, Bonnet in 1881, Kitt and Stoss
in 1883, and Frohner in ]893. The specific nature of the disease was
established by Dexler in 1893 and 1896 as a result of extensive clinical
and microscopical examinations.
Occurrence. The disease is of comparatively frequent oc-
currence in dogs, but more rare than degeneration of the inter-
vertebral discs. In three years, Dexler saw nine cases of this
disease, and eleven cases of intervertebral enchondrosis. Sin-
gle plates of bone, which caused no functional disturbance were
found ])y Dexler in about ten per cent of adult dogs upon which
postmortem examinations were made.
Siedamgrotzky found hard nodular elevations of a yellow color in the inner
surface of the spinal dura mater of a tiger that was affected with paraplegia.
Etiology. No definite information can be given regarding
the causes of the disease. Experience indicates that sex, age
and breed have no influence on the occurrence of the disease,
and at the most it appears to be more common in the larger
breeds of dogs. As already indicated by Dexler, the actual
cause should be found in the pronounced curvatures of the spine
Pathoaenesis. Anatomical Changes. Symptoms.
681
tliat are sometimes present. In one case the disease was com-
plicated with diffuse ossification of the vertebrae from the mid-
dle of the dorsal region to the sacrum, but there were no adhe-
sions between the bones and the dura mater (Hutyra & Marek).
Pathogenesis. The hemorrhages and dilatation of the ves-
sels found by Kitt and Stoss, and
Cadeac, indicate that the disease is of
an inflammatory nature. The plates
of bone that are formed, press upon
the motor and sensory nerve roots in
their immediate neighborhood and,
owing to the increase in thickness of
the membranes, pressure may be ex-
erted upon the spinal cord itself. They
also hinder the free movements of the
cord in the vertebral canal during
changes of position of the body, and
consequently there is a chance that the
nerve roots', and even the spinal cord
may be torn in the early stages of the
disease. In time, the mechanical irri-
tation in the cord and nerve roots sets
up a chronic inflammation.
Anatomical Changes. Scattered
along the dura mater from the cervi-
cal to the lumbar portions of the cord,
and often in other parts, there are
white or dark l)luish-red plates of bone
which by fusion may form quite large
bony patches. In very severe cases,
the dura may be converted into a hard
tube. The majority of the plates are
to be found on the ventral surface
where they are almost exclusively
situated in the early stages (fig. 96).
Fig. 96.
meningitis, (a) Inner surface
of the dvira mater in the lum-
bar and sacral portions of the
cord, (b) Sensory (c), motor
nerve roots, at places sur-
rounded by bony plates, (d)
Plates of" bone' in the dura
mater.
The plates develop on the inner surface of the membrane and are covered on
the inner face with a thin layer of endothelium and on the outer with a thick con-
nective tissue layer. They are composed of genuine bone tissue and show no
tendency to unite with the vertebra?. There is an increase m the amount of con-
nective tissue in the nerve roots and degeneration of the nerve fibei-s, while the
lesions in the cord are less pronounced, but in severe cases are those of myelitis set
up by pressure.
Symptoms. A variable length of time elapses before clin-
ically recognizable s^auptoms make their appearance. Accord-
ing to Cadeac, this may be as long as one to two years after
the onset of the disease. The first symptom observed is usu-
allv evidence of pain owing to the stretching of the sensory
682 Ossifying luiiamuiation of the Dura Mater of the Si^iual Cord.
fibres with every movement of the vertebral colmnn. Animals
sometimes cry out without any apparent cause, and still more
when getting up, lying down, or making other movements.
About the same time, but sometimes earlier, and at other times
later, motor disturbances are observed. These may for a com-
paratively long time be due simply to pain or to muscular
spasms caused by pain. The animal is easily fatigued, is un-
willing to go up or down stairs and does so with difficulty, lies
down cautiously and is very averse to moving the head or neck.
During movement, the limbs are not flexed as much as normal,
the gait is consequently more or less stiff, and in exceptional
cases the animal may walk on its fore legs only. These symp-
toms may persist for a variable length of time or they may
completely disappear, the animal appearing perfectly healthy
Fig. 97. Maximal extension of the hind legs in ossifying spinal meningitis. (The
sijecimen shown in fig. 9G was obtained from this animal.)
There may, however, be more striking symptoms. The
muscular contractions become exaggerated, and owing to the
increased tension of the extensors and adductors, the limbs are
held in the position of maximal extension and adduction (fig.
97), and passive movements are possible to a limited extent
or not at all. As a result of the compression of the motor
nerve roots, and even of the cord itself, the symptoms of paraly-
sis become more pronounced until in almost every case there
is paraparesis or paraplegia, the paralysis being either sjonmet-
rically bilateral or appearing to be more severe on one side
than on the other. The paralysis is most severe in the hind
quarters, but in rare cases, it affects the fore quarters, but to
a less extent. Paralysis limited to the fore limbs is possible
Symptoms. 683
if the compression involves the brachial plexus only. The pa-
ralysis in most cases develops slowly, the first symptoms be-
ing a certain weakness of the hind quarters. This increases
with periods of improvement until there is complete sacral
paralysis, in which case the hind legs are dragged along. On
the other hand, the case may get worse so rapidly that the
animal appears to become paralyzed suddenly, but in such
cases, the atrophy of the muscles indicates the slow develop-
ment of the disease.
As the paralysis increases, the muscular tone decreases,
and there is a rapidly progressive atrophy of the muscular
tissue. If the paralysis is due to compression of the cord, the
motor nerves remaining uninjured, there is no loss of muscu-
lar tone. In many cases there is a decrease in the suscepti-
bilitv to electricity.
The hyperalgesia which, at the commencement, is evidenced
by subjective symptoms, for a time increases as the motor
disturbances progress. Light contact with the hair or a tap
on the skin, etc., may cause symptoms of severe pam, while
in other cases animals, which are obviously restless owing to
paresthesia, bite their limbs until they are sore. Passive move-
ments of the spine or percussion of the spinous processes m
some cases cause symptoms of pain, but the position of the
pain cannot be localized. In the later stages, the hyperalgesia
may be replaced by hyperesthesia or complete anesthesia over
limited or large areas.
At the onset of the disease all reflexes appear to be exag-
gerated. In many cases, muscular contractions may be caused
by quite slight contact with the skin, scratching with the point
of a needle, etc., and these may also involve the opposite side
of the body. If the sole of the foot be scratched there is not
simply a sudden flexion of the phalanges, but also an active ex-
tension of the whole of the opposite limb. Among the tendon
reflexes the patellar reflex is most frequently increased, but
in a large number of cases, active and very rapid contractions
of the particular muscles are caused by percussion of the tendo
Achillis, of the extensor tendons in the lower third of the fore
arm or in the metacarpal region, the tendon of the tibialis ant-
icus, the flexor metatarsi, and the distal tendons of the anco-
neus muscles. The priapismus which is sometimes observed
affords further evidence of the increased reflex irritability, an
erection being easily induced bv rubbing the skin of the abdo-
men the prepuce or the urethral bulb. If the finger be intro-
duced into the rectum, the sphincter is thrown into repeated
contractions and, as in stimulation of the abdominal skm, there
is an involuntary and full flow of urine. This symptom must
not be attributed to paralysis of the bladder.
In the later stages, reflexes disappear m those parts m
which the motor and sensory nerves have lost their conduc-
tivity, while in cases in which there is compression of the cord
684 Ossify
iiig luflanmiation of the Dura Mater of the Spinal Cord.
and the conductivity of the sensory and motor nerves is not
destroyed there are active reflexes. In view of the fact that
the process of ossification rarely extends backwards from the
himbar region to any marked degree, the reflexes in that por-
tion of the hind quarters are often exaggerated in the later
stages of the disease.
Incontinence of urine and involuntary discharge of feces is
rarely seen in cases where the nerve roots of the bladder and
rectum are involved, but somewhat more frequently if the cau-
dal portion of the cord be compressed. Retention of both
urine and feces is far more often seen. The digestive func-
tions remain undisturbed for a long time, but finally nutrition
suffers, and the animal becomes emaciated. In many cases,
there are bedsores which render the animal liable to a gen-
eral septic infection. Death is due either to an infection of
this kind, to hypostatic congestion of the lungs, or to collapse.
Diagnosis. A suspicion as to the existence of the disease
is raised if a dog occasionally, when changing its position or
sometimes without obvious cause, utters cries. The following
sjanptoms are characteristic of the disease : circumscribed but
asymmetrical hyperalgesia of the skin, muscular spasms of the
same and other parts of the body caused by passive move-
ment of parts of the spine, symptoms of pain, the exact seat
of which cannot be localized, in the later stages, loss of sensa-
tion in those parts which were previously hyperalgesic, paraly-
sis of the muscles originally in a condition of spasms, ill de-
fined areas that are in a condition of anesthesia, and, finally,
symptoms indicative of pressure upon the cord.
The disease is most likely to be confounded with compres-
sion of the spinal cord, due to intervertebral enchondrosis, and
as pointed out by Dexler a differential diagnosis is not always
possil)le. The most important differential symptom is that in
the last named disease the symptoms are localized up to the
time of death, and indicate compression of the cord from the
outset. In the ossification of the membranes, there is a grad-
ual extension of the disease, and at first only individual nerves
are involved, but later symptoms of chronic meningitis make
their appearance. Compression of the cord is indicated wlien
the area of sensory and motor paralysis is sharply circum-
scribed from the start, and the gait is consequently very un-
steady; the paralysis in such cases is supranuclear. On the
other hand, primary ossifying degeneration of the dura is in-
dicated under the following circumstances : the reflexes which
at the outset are very active, become gradually weaker, the
muscular spasms which rapidly increase in severity are fol-
lowed by relaxation and atrophy of the muscles, the area that
is devoid of sensation is ill defined, and the disease is obviously
progressive in character. Taking these and other points into
consideration, it is quite possible to exclude spinal pressure.
Prognosis. Treatment. 685
Formerly, the disease was very frequently confoi-incled with
muscular rheumatism, but the distinction between the diseases
is very striking in that in rheumatism there is no muscular atro-
phy, the reflexes are not affected, and the sensibility of the
skin is normal. The disease may be distinguished from tetanus
by the absence of trismus and spasms of the muscles supplied
by the facial nerve. In spinal meningitis there is an absence
of obvious objective pain, and owing to the more rapid develop-
ment of the disease, muscular contractions are not observed.
The course of transverse or diffuse myelitis is much more rapid.
Prognosis. When symptoms are already clinically recog-
nizable, the condition ])ecomes aggravated either gradually or
suddenly until there is complete paralysis. In some cases,
temporary improvements are seen.
Treatment. The anatomical alterations that are the cause
of the disease exclude the possibility of radical treatment.
Treatment can only be directed towards alleviating the pain,
and where possible delay, the appearance of fatal symptoms.
Literature. Bonnet, Miineh. Jhb., 1880-81, 109.— Dexler, Ergebn. d. Path.,
1896, III, 2, Abt., 516 (Lit.) ; Die Konipressionsmyelitis des Hundes, 1896.— Kitt
& Stoss, D. Z. f. Tm., 1883, IX, 142.
3. Injuries to, and Concussion of, the Spinal Cord. Contusio
et commotio medullae spinalis.
Etiology. The spinal cord may be injured by the penetra-
tion of pointed objects entering the vertebral canal through
interverteliral spaces, an accident which is especially likely to
happen in the cervical region. An accident that occurs far more
often is the crushing of the cord through dislocation of the
vertebrae, owing to some violence, such as falling, being run
over, collisions, etc. In many such cases, there is some frac-
ture of the bones, the cord being injured by dislocation of
the pieces or by splinters. In horses, and especially in well-
bred animals, fracture of vertebrae occurs without any external
violence, owing to severe muscular contraction, e. g., in jump-
ing, kicking and galloping, or in attempts to get free after
being cast. In many cases the resistance of the bones is de-
creased. Jacoulet and Vivien proved the existence of osteopo-
rosis in two cases of fractured vertebrae, and in many cases of
fracture of other bones. Decreased resistance of the bone tis-
sue must be assumed to be the immediate cause of fracture in
cases in which there is osteomalacia, or loosening of the inter-
vertebral joints owing to enchondrosis of the intervertebral
cartilages. According to the observations of Frohner, Flatten,
Nielsen, Pallain, and others, the injury causes only a splitting
of the bone, the complete fracture developing after some time,
generally some weeks.
686 Injuries to, and Concussion of, the Spinal Cord.
Vertebral fraetui'e occurs most frefjucut ly in the horse,
and more rarely in other si)ecies. Tapkeii records several
cases in cattle. The cervical vertebrae are most commonly in-
volved, then the anterior Inmbar l)ones, dorsal fractnre bein*;-
somewhat rarer. Powerful muscular contraction nsually
causes fracture of the lumbar or the most posterior dorsal ver-
tebrjp.
Dislocation and fracture of vertebrae cause liemorrlia,i>-es
between the membranes (intermeningeal hemorrhage), and in
many cases, as o])served by Schlesing-er, hemorrhage into the
tissue of the cord itself (hematomyelia). Similar hemorrhages
may be caused l)y external violence bringing about no actnal
injury to the bone.
In rare cases, traumatism causes lesions which are only
detectable by microscopic examination.
Pathogenesis. If the cord be crushed or subjected to pres-
sure by extra va sated blood, conductivity is destroyed both in
the central and peripheral directions from the seat of the lesion.
The conductivity may he destroyed completely, it may affect
only one half of the cord, or a single column; nerve function
will be abolished in the neighborhood of the lesion. The asso-
ciated nerve roots are stimulated or destroyed by dislocation
of the bones, and also by intermeningeal hemorrhage, which in
some cases involves a large section of the cord.
Symptoms. In cases of complete cross section of the cer-
vical portion of the cord an\^vliere between the medulla and
the point of origin of the fifth and sixth pairs of cervical
nerves, the animal dies in a few seconds, owing to the cessa-
tion of respiration, because the respiratory center is cut off
from the nuclei of the nerve, supplying the muscles of respira-
tion. During the brief period elapsing between the section of
the cord and death, only the muscles of the head are moved. If
the cord is not completely destroyed, the animal may remain
alive for some hours, and exceptionally for several weeks, de-
pending upon the extent of the injury. The s;^anptoms presented
are those of injury to the inferior segment of the cord and also
in some cases l)ulbar symptoms (difficulty of swallowing, slow-
ing of the pulse). The body temperature may be elevated
(Schlesinger).
Total destruction posterior to the cervical thickening of
the cord (posterior to the origin of the phrenic nerve) causes
paralysis and loss of sensation in the extremities, body and
tail. During inspiration, the thorax is not expanded, the ribs
are motionless, and the respiratory movements are limited to
the diaphragm, and through this the abdominal wall and the
hypochondriac region (diaphragmatic respiration). In the
fore quarters, the reflexes are destroyed but they persist and
are even exaggerated in the posterior parts of the body. In-
Syiuptoms. (587
voluntary passage of feces and urine, without incontinence, in
other cases persistent retention of feces and urine, and some-
times priapismus may be observed. The pupils are equally or
unequally dilated, but they react to light.
Injury to the dorsal portion of the cord leads to paralysis
of the posterior half of the l)ody. The reflexes are either nor-
mal or exaggerated, and the same disturbances of function of
the bladder and rectum are observed as in the previous case.
In exceptional cases, the contusion is limited to the anterior
portion of the dorsal cord, in which case there may be dia-
phragmatic respiration.
Injury to the anterior portion of the lumbar segment of
the cord causes paralysis and anesthesia of the croup, hind legs
and tail. If the injury be in the middle portion
of this region the symptoms are the same except that
there is no patellar reflex owing to injury to the nucleus of
the femoral nerve; the reflexes of the paralyzed portions
of the body posterior to this are normal or increased.
The same alDnormalities with regard to the passage of urine
and feces are observed as before. Destruction of the pos-
terior third of the lumbar portion of the cord is generally
associated with injury to the sacral cord and results in sensory
and motor paralysis of the area supplied liy the sciatic nerve,
the nerves of the croup and tail, and the nerves supplying the
sphincters of the anus and bladder. The anus remains open
and stimulation of the sphincter does not close it. The urine
trickles away.
At the moment of the injury^ there are observed convulsive
muscular spasms, which at first pass off very rapidly, but af-
terwards the contractions persist for a somewhat longer time.
These are obviously due to a stimulation of the central motor
path immediately before it is divided. Muscular contractions
are observed either continuously or at intervals in the neigh-
borhood of the injury owing to stimulation of the nerve roots,
but in cases of extensive meningeal hemorrhage the contrac-
tions are for the most part observed in various parts of the
body and the limbs.
In small animals, there is frequently demonstrable painful-
ness of the spine, in the larger animals, however, this is not
as a rule observed. In cases of extensive meningeal hemor-
rhage, the areas showing increased sensibility vary in size be-
cause the sensory nerve roots are stimulated by the extravasated
blood and the stimulus is carried towards the center by the
uninjured cord. In a proportion of cases, there is a circum-
scribed swelling and crepitation, and very slight passive move-
ment of the vertebra can be noticed.
In the very rare cases of unilateral injury to the spinal
cord, there is motor paralysis on the same side as the injury
and sensory paralysis on the other.
688 Injuries to, and Concussion of, the Spinal Cord.
Tn many cases the sjniiptonis differ from those described. Tn some the paraly-
sis ami in others the anesthesia is less pronounced, or the reflexes posterior to the
scat of injury are obliterated. Balint's investii^ations and the observations of
Hutyra & Marek on horses killed by pithing showed that the reflexes disappear
behind the seat of injury if the roots or cells of the nerves in question were in-
jured. In one horse that had fractures of the first and second lumbar vertebrae
there was in addition to -the symptoms due to the contusion great restlessness and
difficulty of respiration, the cause being the simultaneous existence of an incar-
cerated diaphragmatic hernia.
Course. Even in those cases in wliicli the injury does not
cause the immediate death of the animal, death is the usual
sequel. The larger animals die, as a rule, within one or two
days, seldom more, hut death is generally delayed somewhat
in small animals, and results from l)edsores, hypostatic con-
gestion of the lungs or cystitis. Occasionally it happens that
animals, and especially small ones, survive for a longer time,
the s;ymiptoms persisting unaltered, or in cases where hemor-
rhage is the only lesion, gradually ahate. S^anptoms may dis-
appear rapidly. The possibility of recovery does not appear
to be excluded in cases in which the injury causes only hemor-
rhage or only slight lesions of the cord.
In some cases, the animals show no disturbance or only
a slight paresis for some time, which may amount to weeks,
after the occurrence of the injury, but then by some compar-
atively slight influence there is caused displacement of the ends
of the bones and complete paralysis results.
Diagnosis. As in most cases there is an obvious connec-
tion between the symptoms of paralysis and some wound or
injury, diagnosis usually resolves itself into determining
whether the s>anptoms are due to some injury to the cord itself,
or whether they are caused by hemorrhage. A point that is
of value in coming to a decision is that disturbances due to
hemorrhage only tend to improve with time, and also hemor-
rhage is indicated by a paralysis that is somewhat slow in de-
velopment.
Dogs are often said to have been run over, when careful
enquiry elicits the fact that the animal's movements were not
quite perfect previously, and that there is either an ossifying
inflammation of the dura, or there is some compression of the
cord. In the differential diagnosis in horses the principal con-
dition that is likely to be met with is paralytic hemoglobinemia.
In this condition the paralyzed muscles are hard, the urine fre-
quently contains blood pigment, and the sensibility of the skin
is normal. In cases of pelvic fracture, there is no loss of sen-
sibility of the skin, defecation and urination are not disturbed
and there are symptoms indicating fracture of the bones.
Treatment. Improvement is only to be expected when
there is simply contusion of the cord, owing to tearing of the
membranes or intermeningeal hemorrhage. If in the larger
Spinal Hemorrhage. Inflammation of the Spinal Cord. 689
animals tliere is no improvement within a day or two, and if
in the small animals there is an actual fracture or luxation of
a vertebra, it is advisable to have the animal killed or sent to
the butcher. If treatment be undertaken, the first essentials
are perfect quiet and a soft bed. After some days, treatment
may be commenced with systematic massage, followed by cau-
tious movement, and, finally, electrical stimulation may be em-
ployed.
Literature. Arndt, Ergebn. d. Path., 1903, IX, 1, Abt., 427.— Balint,
M Orv. Arch., 1903, 1.— Dexler, Ergebn. d. Path., 1900, VII, 466 (Lit.).— Knud-
Fen, Maanedsskr., 1909, XXI, 33.— Nielsen, ibid., 1907, XIX, 1.— Pallam, Vet.
Jonrn., 1905, 259.— Petit & Desonbry, Bull., 1905, 117.— Pilwat, Z. f. Vk., 1902,
321— Eoder, S. B., lcS96, 137.— Tapken, D. t. W., 1907, 489.
Spinal Hemorrhage. {Apoplexia Spinalis, Hcematomijelia.) Hem-
orrhages of the spinal cord are generally due to inflammatory condi-
tions or to injury, and consequently do not come in for further consid-
eration here. There are very few references to spontaneous hemor-
rhage in the spinal cord in the domesticated animals ; and they have no
special clinical significance. Thomassen & Hamburger record a case
in a horse in which there were small hemorrhages in the cervical and
lumbar portions of the cord, and in which nficroscopical examination
showed dilatation of the neighboring capillaries. This particular horse
showed symptoms of paralysis which had disappeared the next day:
but three weeks later there was paralysis of the bladder, tail and nerves
of the face. The cause of the disease was in all probability inflamma-
tory. Dernbach observed intermeningeal hemorrhage in a case of pur-
pura. A case that was diagnosed as hematomyelia on purely clinical
grounds by Lellmann was, judging from the manner in which it showed
itself, and from its course, nothing but a case of pressure on the spinal
cord.
4. Inflammation of the Spinal Cord. Myelitis spinalis.
Under this term are usually included inflammatory con-
ditions of the cord which may or may not be associated with
softening, and which lead either to an infiltration with Avhite
corpuscles or to actual hemorrhage within the affected part of
the cord.
Occurrence. The disease occurs most frequently in the
dog, less commonly in the horse, and very rarely in the other
species. In the dog the majority of cases occur in association
with distemper, in the horse with influenza, apart from the so-
called infectious spinal paralysis, which is probably inflamma-
tory in origin (see page 697). Marchand, Petit & Bredo have
recorded a case of cervical myelitis in a cock.
Etiology. Inflammation of the spinal cord is caused by
viruses and bacterial toxins, and possibly also by other intox-
ications. The viruses of influenza, distemper, and rabies, often
690 Inflammation of the Spinal Cord.
cause inflammation of the spinal cord as lias been frequently
demonstrated in encephalitis. In very rare cases there de-
velops simple tuberculous myelitis. It is remarkal)le that there
is scarcely any tendency to purulent myelitis in the case of
strangles. There are also other unknown causes. In a case
recorded by Dexler, a dog, eight years old, had got loose one
cold night a month and a half previously and was found the
next morning half numb. The dog showed symptoms of mye-
litis which were referred by Dexler to an infection of some
sort. The same author observed a case of hemorrhagic inflam-
mation involving the spinal cord as well as the brain in a
horse. Marek records two similar cases in dogs, and one in
a horse. Myelitis of unknown origin has been recorded in the
horse by Weber and Barrier, Lienaux and Hendricks, Le Calve,
Watson, and Savary. Hutyra & Marek have on one occasion
observed inflammation of the dorsal portion of the cord in
a horse used for the preparation of diphtheria serum. Ceni
and Besta produced chronic diffuse m^^elitis in a dog by feed-
ing it on maize contaminated with the aspergillus fumigatus.
The paralysis-like weakness observed in fowls by Wilke, and
described by him as anterior acute poliomyelitis was probably
a disease of the bones resembling rickets.
Marek found a diffuse iuflanimatiou of the spinal cord in four dogs ex-
tending- over the greater part of the cord, and in all the cases there was extensive
hemorrhage and necrosis of the cord, but he was unable to discover the cause of
the condition. The possibility of its being distemper was excluded. In three of
the cases extensive hemorrhagic enteritis was found at the postmortem, but it re-
mained undecided whether the myelitis was a sequel to the enteritis or the enteritis
a complication of the myelitis. Brown & Ophiils observed four cases similar to
the above in dogs, but there was no enteritis.
As already mentioned, inflammatory processes involving
the membranes frequently extend to the neighboring parts of
the cord. The same thing happens in epizootic cerel)ro-spinal
meningitis. On the other hand, diseases of the vertebrae and
surrounding tissues rarely extend to the cord.
Some authors state that myelitis may be caused by cold or
over-exertion, but these can only be considered as predisposing
causes. Excessive use of animals for sexual purposes plays
no direct part in the production of the disease.
Anatomical Changes. Macroscopic lesions are not always
present. In cases of distemper-myelitis there are no hemor-
rhages or very slight ones, and usually also no softening, con-
sequently the condition is often overlooked. In other cases,
the inflamed parts of the cord are obviously altered. In recent
cases they are softer, and in older cases, firmer. They are very
rarely thickened, but more frequently become thinner. After
section the substance of the cord generally runs out ; the differ-
ence in color between the gray and white sulistance is indis-
tinct, or there may l)e none. In acute cases the softened cord
Auatuiuioal C'lianges. 691
substance appears moist and gliatening, reddish in color and
may be beset witii liemorrliagic points. In certain cases (Brown
and Opliiils, Plutyra & Marek) the cord substance is converted
into a grayish-red pulp-like mass in which there is discover-
able a reddish-brown track composed of extravasated blood.
This can also be seen in neighl)oring parts that are apparently
altered to a slight extent only. Pus is found very occasionally
only in the cord, and when present it is generally the result of
a direct injury. In acute cases there are often sharply circum-
scribed areas of hyperemia in the membranes, and even inflam-
matory alterations. In chronic cases there may be thickening
of the membranes.
Errors of diagnosis are possible if a thorough examination of the cord is
undertaken, and principally because, however carefully it may be taken out, it is
scarcely possible to avoid cutting it and the cuts which pass unobserved cause a
softening of the substance of the cord and this may be thought to be due to in-
flammation.
Information as to the nature and extent of the lesions can only be obtained
by histological examinations. In acute eases the blood vessels appear to be dilated
and there is a cellular and in some cases a fibrinous exudate round about them.
In many cases the hemorrhagic character of the inflanunation is pronounced, the
perivascular spaces being occupied by large groups of red corpuscles, or, as in the
cases of diffuse hemorrhagic myelitis observed by Brown & Ophiils and by Marek
in the dog, masses of red cells are visible occupying large sections of the cord,
the surrounding nerve tissue appearing necrotic. In the nerve cells are to be
found all stages of chromatolysis, peripheral disposition of the nucleus, shrinking
and disappearance of the cell processes, and even of the cells themselves. There
may also be varicose swelling of the axis-cylinder processes, degeneration and de-
struction of the medullary sheaths. The diseased parts are rich in cells containing
fat. At places where the nervous tissue is destroyed there may be a proliferation
of the neuroglia, but in chronic cases there may be a production of fibrous con-
nective tissue and a thickening of the vessel walls.
In cases in which the inflammation involves the whole thickness of the cord
the centripetal paths (posterior columns, lateral cerebellar tracts, Gower 's tract, in-
dividual fibers of the lateral tract) undergo degeneration towards the brain, and
in the centrifugal paths (central motor paths, and, as shown by Dexler and
Lienaux, Schultze's tract in the basal portion of the posterior columns) the de-
generation proceeds in the opposite direction. In cases in which the inferior cornua
are diseased the inferior nerve roots and the motor fibers of the nerves involved
also degenerate.
The disposition and extent of the lesions varies from case
to case. The spinal cord may be involved through its entire
thickness, or for a short distance only (myelitis transversa-
lis), or it may be very extensively diseased, and in still other
cases there may be large inflamed areas which do not involve
the whole thickness of the cord. In such cases, the lesions are
scattered through the tissue (myelitis disseminata). It is very
exceptional to find a single inflammatory center (myelitis fo-
calis).
Symptoms. In cases of myelitis transversalis the nerve
cells at the seat of the inflammation are killed and the tracts
which pass through it on both sides of the cord are inter-
rupted. Consequently, there is a peripheral paralysis in the
part of the body involved and a central paralysis in parts
lying posterior to it, associated with loss of sensation (par-
aplegia, para-anesthesia). It is easily understood that the
69:
Inflammation of the Spinal Cord.
peripheral paralysis is only recognizable in cases in which the
inflammation is somewhat extensive; not rarely only the cen-
tral paralysis is observed. The anterior limit of the area that
is devoid of sensation coincides with the anterior limit of the
inflammation, bnt it appears to be displaced a little posterior-
ly owing to the distribution of the sensory nerves, the displace-
ment being greater the more posteriorly placed the inflamma-
tory lesion is. The numbed area is generally separated from
tlie normal tissues by a zone of varying width that is in a con-
dition of hyperesthesia.
The sensory and motor disturbances reach their maximum
after some hours, days, or even weeks. At first, the only symp-
tom is that the animals tire rapidly, they lie down frequently
and remain lying for
long periods, and rise
with difficulty. Very
soon the gait becomes
trailing, the joints of
I the limbs give way and
\ are placed sometimes
in positions of abduc-
tion and sometimes in
positions of adduction.
The body is not brought
forward sufficiently and
sways about. After a
time there is complete
paralysis. When this
lias occurred, the animal
can no longer get up or
move his limbs. Small
animals drag the hind
quarters along on the
extended hind legs (fig.
98), provided the seat
of the inflammation be
posterior to the cervical
thickening of the cord.
When the myelitis transversalis develops rapidly, the muscles
of the paralyzed parts of the body are relaxed, but if the course
of the inflammation be slower, there is a certain amount of
muscular rigidity in those parts of the body that are posterior
to the seat of disease.
The tendon and skin reflexes in those parts of the body
that are involved in the supra-nuclear paralysis, are as a rule,
exaggerated. But if the myelitis be more extensive, the re-
flexes at the anterior limit of the paralyzed area are either
reduced or completely absent. The muscles in this area re-
spond to a sudden blow with a slow and sluggish contraction
Fig. 98. Spinal meningitis with complete p
ralysis of the hind (punters.
Symptoms. 693
(mechanical reaction of degeneration), wliicli is freqnently ab-
sent if the blow be repeated a number ot tmies, bnt alter a
pause reappears.
Provide.! the intra-nniscular nerves remain intact they respond to mechanical
stimulation of the muscle belly with a contraction caused ^y/neir excitability it
there is already degeneration of the nerve, especially after destruction ot the cells
of the infeiim horns or of the peripheral nerves, their excitability is lost and under
these circunsauces the muscle fibers which are extremely excitab e will give only
a Jow contraction which is due exclusively to the mechanical stimulation and is
produced entirely without nervous influence.
In cases where the spinal cord exclusively is involved,
there is no pain. In exceptional cases, the insensitive area is
margined by a hyperesthetic zone, this is due to secondary
spinal meningitis. i i ^
As a rule, there is no ataxia. One can only conclude from
the severe disturbances of locomotion, which are not propor-
tional to the paresis, and which increase with the loss ot the
power of vision, that there is simultaneous ataxia, provided
that there is no great loss of muscular power.
If the disease involves the sacral portion ot the cord, the
urine trickles away, and there is involuntary defecation but it
the disease affects higher portions of the cord retention ot
urine and feces is observed, copious discharges of urine taking
place at times. ,, . i i + .^
Among the trophic disturbances the simple muscular atio-
TDhv which is caused by persistent supranuclear paralysis, must
be mentioned. Towards the end of the first week there may be
muscular atrophy associated with degeneration reaction m the
area involved in' the nuclear paralysis, provided the mliamma-
torv changes are extensive (Hutyra & Marek). In some cases
there is edema, and now and then, localized sweating is observed
The symptoms of inflammation of the various portions ot
the spinal cord agree in the main with the symptoms produced
by contusion of the same portions (see page 686). It the m-
flmnmation extends to the medulla and if the connection between
the brain and the respiratory center is not completely inter-
rupted, serious symptoms may make their appearance,^ such
as difficulty in swallowing, irregularity of the heart, which is
sometimes 'accelerated, and sometimes slowed, irregular respi-
ration, etc., and finally, death may occur suddenly owing to
paralysis of the respiratory center.
Diffuse myelitis generallv involves a circumscribed portion
of the cord and extends rapidly either upwards or downwards
(Mvelitis ascendens, M. descendens). In occasional cases, the
area originallv involved is large. In the majority of cases it
commences in "the more posterior parts of the cord, and withm a
short time paralvsis and loss of sensation of the tail, the^ croup,
and the hind legs occur, associated with incontinence ot urine,
involuntary defecation and relaxation of the sphincter ot the
594 Inflatumatioii of the Spinal ("ord.
aims. Tlie anterior limit of tlie affected area soon moves in the
forward direction and readies the abdominal wall, and from
there extends to the thoracic wall, respiration being carried
on solely by active contraction of the diaphragm. Shortly after
this there is paralysis of the mnscles of the fore limbs, and
the animals lie on the gromid helpless but perfectly conscious.
Death occurs shortly after, owing to the diaphragm becoming
involved. The groups of muscles Avhich lie immediately in
front of the progressing part of paralysis show, as a rule, fibril-
lar twitchings and even slight clonic and tonic spasms before
they become paralyzed. The animal suffers from hiccoughs
before paralysis of the diaphragm occurs. The paralyzed mus-
cles are in a condition of complete relaxation, and offer no
passive resistance. The reflexes are completely destroyed in
the paralyzed area, but percussion of the paralyzed muscles
produces slow contractions right up to the time of death (me-
chanical degeneration reaction).
If the process starts higher up and spreads further for-
wards or backwards, symptoms of supranuclear paralysis are
observed from the outset in the latter case in the parts of
the body posterior to the seat of the inflammation, this grad-
ually passes into a nuclear paralysis with obliteration of the
reflexes and paralysis of the sphincters. If the process extends
forwards, the original paralysis remains supra-nuclear, but
towards the head the nuclear paralysis involves an ever in-
creasing area.
In myelitis disseminata inflammatory foci occur in both
the white and gray matter of the cord, the distribution and
extent of which are variable, and in consequence the symptoms
vary from case to case. The disease is usually seen in cases
of distemper, and it is apparently not rare to observe hemor-
rhagic myelitis in the horse. In this as possibly also in other
forms of myelitis there may be centers of inflammation in the
brain, in wdiicli case the symptoms would be still more compli-
cated.
In the majority of cases of myelitis disseminata due to
distemper, there are more or less rhythmic contractions which
generally involve the muscles of the extremities, Init more
rarely may affect the muscles of the neck or the abdominal
muscles exclusively. The muscles of the chest and the mus-
cles supplied by the radial and sciatic nerves chiefly are in-
volved. In the majority of cases there is a nuclear paralysis,
and sometimes also a supranuclear paraplegia of certain
groups of muscles of the extremities and of the sphincters.
Charitat observed persistent gnawing of the end of the tail
(automutilatio) in a dog that was fully conscious.
In a case of (li»seniinatefl myelitis in a horse Weber and Barrier observed
a gradually proj^ressive paresis of the extremities and a consequent rapid tirinjj
of the yiatient. Three months later the disturbance was more striking. During
Tiiotiou liotli the fore and hind feet -were lifted jerkily, abducted and advanced with
excessive flexion, adducted and set down clumsily. This was followeil by marked
Symi^toms. Course. Diagnosis. 695
flexion of all the joints under the body weight, the animal stumbled frequently
and staggered to such an extent that it was likely to fall at any moment. Blind-
folding the eyes exaggerated the motor disturbances to a marked extent, showing
that ataxia was also present. That the motor disturbances were not due exclu-
sively to ataxia was shown by the fact that there was also paresis, the horse
being unable to hold back a cart when going downhill. The muscles on the an-
terior surface of the upper arm and the superficial croup muscles were rigid, but the
extensors of the elbow and the posterior muscles of the croup were relaxed. After
having been under observation for nine months the animal was killed. In the
right half of the spinal cord, immediately in front of the seventh nerve there was
an inflamed area about 1^2 cm. in length involving the outer third of the posterior
column, the lateral column, and the greater part of the gray matter. In the left
half of the cord in the lumbar region there were three similar centers situated close
together and involving the greater part of the lateral column and the superior horn.
In a case recorded by Dexler the disease commenced with paresis of the off
hind leg and of the corresponding fore leg, partial facial paralysis, and sharply
defined hyperidrosis of the same side. Two days later there was paresis of the
other legs. The muscles of the off fore leg were rigid and those of the hind re-
laxed. Numerous centers of inflammation were found scattered irregularly in
the white and gray matter in the cervical and dorsal portions of the cord.
In a ease in a horse recorded by Hendricks and Lienaux there was stagger-
ing gait, jerky lifting of the foot as it was brought forwards, dragging of the
wall of the off fore foot along the ground, loss of sensation of certain parts of
the fore and hind legs. Blindfolding did not aggravate the disturbances. In the
cervical region, about opposite the seventh vertebra, there was a sclerotic area with
ascending degeneration of the posterior column. In the dorsal portion of the cord
about opposite the first vertebra some small irregular foci were also found.
In a case of cervical poliomyelitis in a cock Marchand, Petit and Bredo ob-
served paresis and hyperesthesia of the wing, and lateral flexion of the neck during
repose so that the lieak was directed backwards. During feeding there was no ab-
normality of the position of the head.
Course. The duration of the disease is influenced prin-
cipally by the seat of the inflammation and the rapidity with
which it spreads. Both transverse and diffuse myelitis run a
short course especially in the larger animals, death taking
place within a few days or in very rare cases a little longer.
In the case of disseminated myelitis on the other hand, if there
is no extensive paralysis the disease may last for a month and
even longer. In such cases the disturbances become more se-
vere slowly and spasmodically, and sometimes come to a halt,
a condition of chronic myelitis having* been produced in the
meantime. Provided no febrile complications occur, there is
no rise of temperature, even in the acute cases. Death is
caused directly by general sepsis, cystitis or enteritis, and in
many cases by cessation of respiration.
Recovery in the clinical sense of the term is exceptional,
as for example in cases of distemper, in which the inflammation
is not very extensive. Not rarely some improvement is ob-
served, but generally a sudden exacerbation occurs after some
time.
Diagnosis. A diagnosis may be based upon the presence
of the sjanptoms above described, which have no obvious cause
or no association with the diseases mentioned in the paragraph
relating to the etiology, upon the rapid progress of the condi-
tion, and the absence of objective symptoms of pain in the ver-
tebral column and the skin. — The differential diagnosis of acute
696 Inflammation of the Spinal Cord.
myelitis and ossifying myelitis lias already been dealt with
(see pages 679 and 684). — In cases of tramnatism of the spinal
cord, there is in most cases some evidence of the mechanical
interference. Symptoms appear suddenly, and there is often
evidence of pain in a circumscribed portion of the spine, dis-
tortion and crepitation. — Compression of the cord is usually
characterized by a slowly progressive paralysis associated with
active contraction of the muscles; sensation persists for a
longer time, and is not destroyed in the majority of cases even
in the later stages. There may be pain and distortion of the
spine in the late stages. There is great difficulty in ex-
cluding cases of compression of the cord in which the symptoms
of paralysis are actually or apparently produced suddenly, or
in which there is neither pain nor distortion. Eecognizable cir-
cumscribed atrophy of the muscles, the repeated appearance of
these or similar s^^nptoms, stiffness of the paralyzed muscles,
and a disappearance of the paralysis in the later stages contra-
indicate inflammation of the spinal cord. In the dog, compres-
sion of the cord is the most commonly observed disease of that
structure, — Diseases of a general nature associated with pro-
nounced muscular weakness are still often confounded with
myelitis. There is a special tendency for the hind quarters to
appear weak in certain diseases of the intestine or peritoneum
that are associated with pain in the smaller animals and these
symptoms are often said to be due to disease of the spinal
cord without further investigation. In these cases, disease of
the cord can generally be excluded if the sensibility of the skin
and the reflexes are investigated, defecation and micturition are
carefully observed, and a thorough examination of the other
organs is made.
Treatment. Bedsores are avoided by the provision of a
soft bed and the frequent turning of the animal. Frequent
grooming prevents the development of dermatitis. If there
is retention of the urine and feces, the bladder may be evacu-
ated by pressure with the flat of the hand, or by the use of the
catheter, and the feces may be removed manually.
Internally, potassium iodide in doses of ten to twenty and
1 to 2 gm. is administered in most cases, but no special results
follow its use. If muscular atrophy should threaten or be ac-
tually present, attempts should be made to check it by passive
movements of the paralyzed limbs and massage. This treat-
ment promises best in cases of supranuclear paralysis. It is
absolutelv useless to administer nerve stimulants such as strvch-
nine (0.05 to 0.10 gm. or 0.001 to 0.003 gm.), veratrin (0.05 to
0.20 gin. or 0.01 to 0.02 gin.) subcutaneously, arsenic (liquor
arsenicalis 10 to 15 gm. or 2 to 5 drops daily per os). Many
authors have recorded rapid improvements following the sub-
cutaneous injection of eserine, pilocarpine or arecoline in dogs.
It is possible that in such cases the pressure on the spinal cord
Treatment. Enzootic Spinal Paralysis of the Horse. 697
is due to defeneration of the intervertebral discs, a condition
which frequently improves rapidly without any treatment what-
ever In the small animals, electricity may be employed, a large
electrode being placed on each side of the spme, and a strong
galvanic current passed for thirty minutes. The paralyzed
muscles mav ])e stimulated by faradization, or if their sensi-
bility to this be lost, a galvanic current may be used But no
more is to be expected from electricity than from other meth-
ods of stimulating the muscular, nervous and circulatory sys-
^"^^in cases in which anv of the above treatments are without
avail, animals that are fit for food should be sent to the butcher
as soon as practicable.
Literature. Brown & Ophiils, J. of Med. Research, 1901 344.-Le Cah-e^
Eec, 1899, 401.-Cem & Besta, Vet. Jhb., 1906, 140 -Charitat Eec., l^O/' 230-
Dexer, Er'gebn. d. Path., 1896, III, 2 Abt 516 (Lrt.); f 00, VII, 4.1 (L^tO,
KprvPrkrkh d Pferdes, 1899, 78, 81; J. Vet., 189o, .0.5; A. f. Tk 18J», -^f^^>
?7T-^Hlmbi4er D Z. f. Tm. 1895, XXI, 104.-Hendricks & Lienaux Ann
%lo, f.-Marfhancl;^- Petit & Bredo, B^c, 1907, J^^.-Marchanc^ Petit & Coquo^
ibid 1906 .5— Marek, Z. f. Tm., 1904, VIII, 391.— Savary, Eec, 1901, 538.—
Wei^r & BarHer, ibid.,' 1884, 32.-Wilke, D. t. W., 1909, 697.
5 Enzootic Spinal Paralysis of the Horse. Paraplegia en-
zootica equorum.
This is as a rule, an acute general infectious disease char-
acterized bv multiple capillary hemorrhages in the various or-
gans and especially in the spinal cord There is f requen ly a
gelatinous infiltration around the bladder and the genital or-
gans. It is caused by a specific streptococcus and its special
clinical feature is paralysis of the loins.
Historical. The disease was first observed and accurately described
hv Com^nv in France in 1888. Further additions were made to the
hteratnre upon the subject by Mulatte (1897), Grange and Megmn
(1897 Bhn Lambert (1897), and Sorriau (1905). In Germany
it appears to have been recognized as a specific disease by Schm dt
(188"^"^, and by Albrecht (1896). A contagions l^™^;f, P//^^'X'et ol
horse in India (Kumri) ^^^ ^escjibed by Burke (1897) The e^^^^^^^
ogy of the disease was investigated by Schlegel (1906), f^^^^^ Z^^'
and recently bv Perucci (1910). The disease was connected uith para-
??tic hemoglobinemia by Schlegel, as indeed it had already been by
earlier authors.
Occurrence. The disease appears to have a very localized
distribution and occurs only in certain stables. In these sta-
bles, there may be an alternation of contagious cases with cases
that appear to be more sporadic in nature.
Eepeated outbreaks have been observed in Germany by Schlegel, for instance
in PrTissia, Saxonv, Baden, Wvirtemburg, and Hesse.
In France it" has been observed as an epizootic among army horses.
(398 Enzootic S])iiial i'aralysis of the Horse.
Aceoiiliii;^ to DaliJstiuiii a contagious lumbar paralysis has lieeu kuowu in Den-
mark and ISweden for more than 50 years, which is probably the same disease.
Christianssen and Kasmussen observed weakness of the hind quarters in foals
from 1 to 2 years old which lasted for months and even 1 to 2 years.
In Austria a similar disease has been observed among the army horses in
the neighborhood of N'ienna. This was considered by Szerdahelyi to be due to
alkaloid poisoning.
Small outbreaks have been recorded in Italy by Perucci in Bologna.
Etiology. A streptococcus which is noncapsulated has
been described as the cause of the disease by Schlegel, Zwick
and Perucci; and Schlegel has named it streptococcus nielano-
genes. The organism can be found in the blood, parench^ina-
tous organs, bone marrow, spinal cord, the gelatinous infiltra-
tion around the bladder and genital organs and in the urine.
In the circulating blood it occurs either as mono- or diplo-
cocci, or in short chains, but as a general rule the chains are
longer. These long chains are prominent in the acute cases.
Staining. The streptococcus stains easily and well with the l)asic
anilin dyes, and according to Zwick and Perucci, is Grram-positive ; but
according to Schlegel, it is Gram-negative.
Cultivation. The organism is an aerobe and the optimum temper-
ature for growth is that of the liody. The best growths are obtained
on media containing detil)rinated rai)bit or horse blood. In broth col-
onies develop in large numbers in 24 hours. These settle to the l)ottom
or on to the sides of the vessel, the liquid remaining clear. Perucci
observed a rapid decrease in the profnseness of growth in simple broth cul-
tures and also on other media containing no ])lood. In broth contain-
ing ])lood, growth is abundant, and the colonies which fall to the bot-
tom appear brownish-gray in color, owing to decomposition of the blood-
pigment. In agar growth takes place along the needle track in the
form of a fine grayish-white thread with down-like outgrowths. On
l)lood-agar the organism produces pale grayish-white colonies surround-
ed ])y a deep browm zone, resulting from the decomposition of the blood
by the streptococci. Nieter found the last-mentioned characteristic,
common to many other streptococci.
Pathogenicity. The organism isolated hy Schlegel causes a gen-
ci-al infection in the small experimental animals, characterized by pa-
ralysis of the hind quarters, and other lesions similar to those seen in a
natural case in the horse. Perucci, however, was able to infect rabbits
only by intravenous, intraperitoneal, and subcutaneous inoculation with
blood or culture, the inoculation setting up a general disease, associated
■\vith degeneration of the parenchymatous organs. In the horse, Schle-
gel observed only a temporary weakness of the hind cpiarters after the
intravenous introduction of large (juantities of culture. Zwick produced
the typical disease by repeated injections, and Perucci succeeded with
a single intravenous inoculation of 10 cc. of broth culture. The admin-
istration of cultures by the mouth caused only a transitory paresis in
a horse (Zwick), while intraperitoneal inoculation caused a slowly pro-
gressive lumbar weakness without hemoglobinuria, a sero-purulent peri-
tonitis, and lesions similar to those seen in a natural case (Schlegel).
So far the natural infection is not know^n. Schlegel sup-
poses that the streptococci maintain a saprophytic existence in
the intestine of otherwise healthv horses, and under certain
Etiology. Pathogenesis. Anatomical Changes. 599
favorable circumstances, suck as feeding on maize, bran, beets
or potatoes, after overexertion, faulty attention, the presence
of parasites, assume pathogenic properties. The diseased
horses can infect others, because the streptococci which have
become pathogenic are passed out with the feces and urine,
and should these come into contact with food or water
or be introduced into healthy horses in any other way, infection
results. By feeding a horse, a donkey and a male goat on some
suspected hay Zwick succeeded in causing the typical dis-
ease, although under natural circumstances the disease ap-
pears to be confined to the horse. Comeny and Sorriau are in-
clined to think that infection takes place by way of the urethra
and the urinary tract. On the other hand, Kull and Duvinage
observed the disease in connection wdth an infectious catarrh of
the upper air passages.
Pathogenesis. From the experiments that have been made
up to the present the only conclusions that can be drawn are
that the streptococcus causes a general infection, associated
with hemorrhages and parenchymatous degeneration of various
organs. No proof has been furnished as to the inflammatory
nature of the lesions in the bone marrow and the central ner-
vous system. Similar extravasations occur in any case in which
there is dissolution of the blood. An explanation is necessary
as to what extent the symptoms of paralysis are due to the
hemorrhages in the spinal cord on the one hand, or to the lesions
in the long bones and the resulting pain on the other, or whether
they may be caused by the septicemic infection.
Anatomical Changes. The peritoneum shows petechial
hemorrhages. The mesenteric glands are markedly swollen
and infiltrated with blood-stained serum. The spleen is normal
or it may be enlarged three or four times. The liver and kid-
neys are enlarged and show parench5^natous degeneration and
hemorrhages. The bladder often contains urine stained with
blood, the mucous membrane is beset with hemorrhages and
the wall somewhat thickened. In a numl)er of cases the con-
nective tissue around the bladder and genital organs is gelati-
nous and there may be edematous swelling of the lips of the
vulva or of the sheath, and sometimes of the skin of the peri-
neum. The mucous membrane of the vagina is in such cases
studded vritli small hemorrhages. The marrow of the long and
flat bones is stained brown or brownish-red, either diffusely or
in patches, owing to hemorrhages, the appearance resembling
that seen in infectious anemia (see Vol. I). There is a blood-
stained fluid in the epidural and subdural spaces, the arachnoid
and the pia mater are swollen and gelatinous, and the latter
appears to l)e beset w^ith small hemorrhages. In the spinal cord
there are numerous minute hemorrhages and reddish-yellow
softened centers, especially around the central canal, which w^ill
700 Enzootic Spinal Paralysis of the Horse.
probably be onh^ recognized by microscopic examination. Tliere
is no cellular infiltration (Perucci). In some cases there are no
macroscoi^ic lesions.
Symptoms. Clinically the disease, according to Schlegel,
passes through an occult and an open stage, while Perucci dis-
tinguishes between a peracute, an acute and a subacute form.
The subacute form described by Perucci corresponds with the
occult stage of Schlegel.
In the occult stage there is emaciation, weakness, languor
and loss of power in the hind quarters, the gait being uncertain
in consequence. Stumbling, paddling with the hind feet, cramp-
like contractions of the muscles of the loins, croup and a])domen
are observed frequently. In some outbreaks there is slight
edema of the sheath and vulva, in which case there is often a
sediment in the urine.
The open stage commences with collapse of the patient dur-
ing w^ork or movement, or in some cases while the animal is at
rest (peracute form). In many cases the lumbar paralysis de-
velops in stages and is complete wdthin some hours or two or
three days (acute form). The animal is only able to get up with
help or not at all. In cases in wdiich the paralysis is not yet
complete the animals paddle wdth the hind feet, keep getting
up and lying down again, and groan. The appetite is not dis-
turl)ed and, according to Perucci, there is no elevation of tem-
perature. By this time bile-staining of the conjunctiva is
usually recognizable and shortly after a rise of temperature
{4V to 42° C.) and a notable acceleration of the pulse. There
is strangury and the urine often appears red in color and con-
tains albumen, red blood corpuscles and bile pigments. There
are no obvious sensory disturbances and there isno paralysis of
the sphincters; the only authors to record these symptoms be-
ing Duvinage and Perucci. In the later stages of the disease
there is marked emaciation.
In certain outbreaks, inflammatory lesions of the external
genital organs have been observed. The penis hangs out of
the sheath which is swollen and edematous, its outer surface
being beset with minute hemorrhages ; the lips of the vulva gape
and the mucous membrane of the vagina is intensely red in
color. Sometimes the edema extends to the perineal region.
Course. This differs in different outbreaks. The dura-
tion of the disease may vary from one or more days to a week
in some cases, and in others from several weeks to three months,
so that an acute, a sul)acute and a chronic course may be dis-
tinguished. According to Schlegel the disease is fatal in the
majority of cases (70 to 100 per cent), but other authors have
recorded recovery in 50 per cent of cases, especially in the oc-
cult stage of the disease. Convalescence is slow.
Diagnosis. Treatment. Tabes Dorsalis. 701
Diagnosis. A diagnosis may be based upon the symptoms
of jDaralysis nnassociated with any special sensory disturbance,
the maintenance of the appetite for some time, the absence of
hemoglobinuria, the rigidity of the muscles of the quarters, in
many cases the edema of the genital organs, and on the infec-
tious nature of the disease in many outbreaks. In sporadic
cases, and especially during the occult stage of the disease, con-
fusion is possible with other diseases. Whether, as believed by
Perucci, a diagnosis may be based with certainty in such cases
upon the cultural demonstration of the causal organism in the
blood is a matter for further investigation. The conditions
that are likely to be confounded with the disease are infectious
anemia, paralytic hemoglobinemia, piroplasmosis (see Vol. I),
and, in the postmortem room, sclerostomiasis (see page 488).
Septicemic conditions and certain intoxications must also be
excluded.
Treatment. This is useless in cases that develop rapidly.
In less acute cases the treatment advised for paralytic hemoglo-
binemia (see Vol. I) may l)e applied. Symptomatic treatment
and the administration of disinfectants must also be considered.
In a case of the authors, atoxyl produced no satisfactory re-
sults (see page 492).
As prophylactic measures Schlegel advises that a diet con-
taining large proportions of maize, bran, molasses, roots or
potatoes should be avoided, and that the stables should l)e kept
clean and well ventilated. Healthy horses should be separated
from the diseased, and intestinal disinfectants should be ad-
ministered. A change of diet appears to be indicated.
According to Perucci the injection of anti-streptococcic
serum is useful in outbreaks inasmuch as the animals acquire
an increased resistance.
Literature. Albrecht, D. t. W., 1896, 311.— Comeny, Eec, 1888, 230.— Duvin-
age, Z. f. Tk., 1905, 473.— Kiill, ibid., 1904, 473; 1906, 353.— Pastriot, Eev. Vet.,
1906, 488.— Perucci, D. t. W., 1910, 409 (Lit.).; Pr. Vb., 1900-1904.— Schlegel, B. t.
W., 1906, 463 (Lit.); Die infekt. Ruckenmarkenzundimg der Pferde, 1907 (Lit.). —
Schmidt, A. f. Tk., 1885, 407.— Sorrian, J. Vet., 1905, 271.— Zwick, Z. f. Infkr.,
1907, II, 310 (Lit.).
Tabes Dorsalis. Although this disease occurs frequently in man
in connection with diseases of the spinal cord, it so happens that tabes
dorsalis or an analogous disease does not occur in animals. Tabes dor-
salis (progressive locomotor ataxia of Duchenne) is a quite deiinite
chronic disease of the central nervous system, the most striking feature
of which is a degeneration of the posterior cohnnns of the cord, involv-
ing the posterior nerve roots, and also to a greater or less degree the
other centripetal paths. There is also degeneration of certain groups
of fibers in the brain. The disease is systemic and tends to involve
constantly certain groups of fibers.
In veterinary practice, cases have been and are still reported which
702 C.Miii.tvssini, or iliL- Spinal Cord.
ai'c said to })1'ovl' tlu' occiiiTciu-i' oi' lalics ilorsalis in the lower animals.
For a long time trotting disease (Traberkrankheit) of the sheep, and
tlie nervous stage of dourine were thought to correspond with tal)es in
man, until histological examinations finally showed that there is no con-
nection between them. Frohner claims to have seen cases in the dog
exactly simulating tabes, Lienaux and Hendricks record a case in a
liorse that closely resembled ta])es both clinicall}^ and histologically ; and
Hendricks records a case of locomotor ataxia in a dog. Hamburger
found degeneration of the posterior columns in a dog, but the case was
not observed clinically.
These and similar cases do not prove in the least the existence of
tabes or a disease like it in animals. The cases that were observed,
only clinically furnish no proof because the diagnosis was based simply
on the symptoms of sensory disturbance, and sufficient consideration
was not given to the fact that similar disturbances may be caused by
other lesions of the motor paths, as components of the co-ordinating
system (see page 588). Besides the condition of the reflexes is not men-
tioned, and in cases where such examination was made (Hendricks)
they were found to be exaggerated. No histological evidence of the oc-
currence of the disease in animals has been adduced. The degeneration
of the posterior columns observed in sheep by Anacker in cases of
trotting disease have not been found by investigators Avorking with
accurate methods. The case of Lienaux and Hendricks, already men-
tioned, merely shows that in this particular case there was disseminat-
ed myelitis, which happened to produce a lesion in the cervical portion
of the posterior columns with consequent degeneration upwards. It is
merely a case of localized disease of the cord associated with the not un-
usual ascending degeneration. Hamburger's case in the dog Avas similar
in nature. Hutyra & Marek have found pronounced degeneration of
the posterior columns in cases of disseminated myelitis in distemper;
but there was not the slightest resemblance to tabes.
6. Compression of the Spinal Cord. Compressio meduUae
spinalis.
Compression of the cord is caused by a variety of diseases
in wliich tliere is a reduction in the Inmen of tlie vertebral canal.
Etiology. The primary disease may involve either the tis-
sues immediately surronnding- the vertebral column, the verte-
bral column itself, the vertebral canal, the membranes of the
cord, or the cord. The following diseased conditions may cause
compression of the cord.
Degeneration of the Intervertebral Discs (Enchondrosis
interverte1)ralis). Tliis occurs almost exclusively in the dog and
was hrst described accurately, clinically and histologically by
Dexler. Recently two cases have been observed in the pig by
Marek. Nothing definite can he said as to the cause. The fre-
quency of the occurrence of the disease increases with age.
The occurrence of the degeneration in those parts of the spine
that are the most mobile appears to suggest that it may in some
cases be caused hy excessive curving, strain, etc., of the spine,
Etiol.^oy.
703
and especially in breeds of doi>-s in wliicli the spinal colnnin is
too long in comparison with the length of the animal's legs.
This was shown by Jakob regarding the striking disproportion-
ate length of the body and the limbs in the case of dachshunds.
The prejudicial effect of this body-formation is increased by the
weakness of the joints of the limbs. A few observations have
shown that the joints that are affected most commonly are the
tenth and thirteenth dorsal, the first and fourth lumbar, and
somewhat more rarely the second and fourth cervical. It is
very rarely that other joints are
affected. According to Pexler the
cervical vertebraB are involved as
frequently as the dorsal and lumbar
joints, and Cadeac believes that the
disease occurs principally in the
cervical vertebra?. It is rare that a
single joint is affected. In cases in
which the posterior dorsal vertebra^
are involved the lumbar bones are
also affected, and, similarly, disease
in the cervical vertebrae is associ-
ated with disease in the dorsal bones.
The disease is not, as a rule, co-ex-
tensive in all the joints.
Dexler's histological investigations have
shown that the disease begins with the for-
mation of a cellular tissue richly supplied
with vessels in the periosteum of the verte-
bra and the intervertebral di^cs, the tissue in
the latter ease containing islands of hyaline
cartilage. Later the number of vessels de-
creases, the connective tissue shrinks, and the
islands of cartilage increase in size and final-
ly become calcified.
Fig. 09. Projection of the inter-
vertebral discs into the spinal
canal owing to encliondrosis inter-
vertebralis. (a) Between the sec-
ond and third cervical, and (b)
between the eleventh and twelfth
dorsal vertebme. At (a) the dura
was adherent to the prominence.
At the postmortem there are
found, both in the vertebral canal
and also on the outer surfaces of the
vertebrae, white prominences which
at first are soft, but afterwards be-
come bony. In the later stages the bony grow^ths within the
canal, which are boatlike in shape, extend from one vertebra to
the next and form a connection between the two. As a result of
persistent irritation, in cases that have been in existence for
some time a chronic inflammation of the dura is set up in the
immediate neighborhood. This generally leads to the production
of new cartilaginous tissue which calcifies subsequently. In
time the thickened portions of the membrane become joined to
the intervertebral growths and so further reduce the lumen of
the canal (fig. 99).
Whether the process described in the intervertebral discs is actually inflam-
matory or of some other nature is not definitely known, but the inflammatory nature
704
Compression of the Spinal Cord.
of the change is iiiflicated by the histolog-y of the lesion. Tliat the condition is
inflammatory is also indicated by the facts that in some cases there is a sinud-
taneous ulcerative inflammation of some of the joints of the limbs (Hutyra &
Marek), and that Cadcae has observed exostosis-formation in the joints of the
limbs in many cases.
Intervertebral Ossification (Enostosis intervertebralis). In
old horses and dogs there sometimes develop, as a result of an
osteoplastic periostitis in the neighborhood of the intervertebral
discs, growths composed of true bone. These growths var}- in
size and project into tlie vertebral canal and join the opposed
parts of two or more joints by means of closely set toothlike
projections, so firmly that the whole spine with the exception of
the neck is converted into a solid cohnnn. The process occurs
in nine-tenths of the cases in the most mobile parts of the dorso-
lumbar sections of the spine, that is, the parts which are espe-
^
Fig.
^^S!!Sg
100. Vertebral tuljei
vertebra, (b)
j.iii. ,a, 1 ulii-rculous growth in a dorsal
liowing "hour glass" compression.
cially exposed to strains. Similar growths may also result
from fracture of vertebra^ (Cadeac, Dexler, Ryder, Hutyra &
Marek.
Ossifying Pachymeningitis (see page 680). This condition
in some cases leads to compression of the cord.
Tuberculosis. Both in cattle and in the pig tuberculosis is
frequently responsible for compression of the spinal cord. A
similar case has been recorded l)y Megnin in the horse. Tuber-
culosis of the bones occurs most frequently in the dorsal por-
tion of the spine, and more rarely in the cervical and lumbar
regions. Of eleven cases collected by Hamoir, seven involved
the back, two the neck and two the lumbar bones. The disease
leads to the production of softened or caseous centers, or in
some cases to the formation of sarcomalike masses with consid-
erable enlargement of the verteliral bodies, or more rarely the
Etiology. Parasites. 705
vertebral arches (see fig. 100). Tuberculous meningitis is usu-
ally seen in the dorso-lumbar portion of the cord, and more
rarely in other parts, or even throughout the length of the cord.
This leads to the production of a varying number of tuberculous
nodules of different sizes with caseous centers. Round about
these nodules there are often lesions of a more acute nature.
Tuberculosis of the spinal membranes is of very rare occurrence,
and so far has been observed in the form of caseous or calcified
centers in the lumbar portion of the cord only (George and
Johne, Kitt, Steuding, Schmidt, Hamoir). One case has been
observed in the dog by Poulin and one in the pig by Vogt.
In a few cases actinomycosis of the membranes has been
observed in cattle (Mathieusen, Koorevaar, Poes). In such
cases there was enlargement of the vertebrae with the formation
of cavities full of pus. According to Mathieusen the lesions are
found in the anterior parts of the neck and back.
Neoplasms are rarely the cause of compression of the cord.
In many cases they develop in the neighborhood of the verte-
bra and, penetrating through the intervertebral foramina, or
through the vertebrae themselves, gain access to the canal (Dorr-
wachter. King, Hertwig, Petit, Hutyra & Marek). In other
cases they develop in connection with the bones, the membranes,
and, in very exceptional cases, the cord itself. In cases of general
melanosis in the horse, and especially in gray horses, melano-
mata develop in connection wdth the vertebrae, and m very oc-
casional cases, exclusively in the meninges. These growths ap-
pear to be found most commonly in the dorso-lumbar region.
Sarcomata have been met with in the horse, ox and dog, gho-
mata and glio-sarcomata in cattle, (Kitt and Dorrwachter),
papillomata and sarcomata occasionally in the horse, lipomata
principally in cattle, cholesteatomata in the horse and^ dog
(Dexler), and finally, chondromata in horses. From a clinical
point of view, inflammatory tissue produced by injuries (hem-
orrhages, fissures in bone; Frohner, Rubay and Navez) is as
important. Exceptionally aneurism of the aorta causes ero-
sion of the bodies of the vertebrae, and compression of the cord
(Schmidt). In one case recorded by Jakschatsch, there was
cystic dilatation of the canal of the cord at the level of the
seventh dorsal vertebrae of a calf showing pronounced symp-
toms of paresis.
Parasites. The Coenurus cerebralis frequently penetrates
into the lumbar portion of the cord in sheep and cattle, and
exceptionally also in the horse, and develops into cysts between
the membranes that are elongated in shape and about the size
of a finger (socalled lumbar staggers). Echinococci and Cysti-
cerci occasionally occur (in the pig and dog), and Echinococci
occasionally develop in the bones themselves (Feuereissen
Goldmann and Stroh). According to Hinrichsen, Brauer, and
706 I'oinpressioii of the Spinal Cord.
Homo, the liypoderiiia lineata occurs comparatively frequently
in the second stage of its development in the epidural fat in
cattle (according to Hinrichsen in forty to fifty per cent of
slaughtered cattle). Symptoms are produced very rarely be-
cause they leave the cord before their development is complete.
Abscesses have been observed very rarely in the spinal ca-
nal (one case, Raoul). The penetration of pus through the
intervertebral spaces from abscesses in the immediate neigh-
borhood of the vertebrae is observed somewhat more frequently.
In some cases, pus enters the canal by extension of suppura-
tive processes involving bone as in the case of glanders (Chauv-
rat, Decoste, Anbury, Boisse, Stanton, Tapken).
Pathogenesis. Any of the primary conditions mentioned
may lead to a gradual reduction in the size of the vertebral
canal, the result being that the cord and nerve roots are sub-
jected to pressure. This occurs earliest in the dorsal region
where the canal is comparatively small, and latest in the pos-
terior half of the lumbar portion. Many processes cause a
local edema of the spinal cord owing to obstruction of the
blood or lymph circulation. Hard growths lying outside the
cord hinder its motility and consequently tend to cause tearing
or crushing of the cord and nerve roots. Degeneration of the
intervertebral discs, or caries of the bone, are likely to lead to
excessive curvature of the spinal column at the diseased part,
dislocation, or fracture of individual bones (Lienaux), and thus
lead to compression of the cord or nerve roots. Finally, chronic
inflammation of the cord is set up by the persistent mechanical
irritation.
According to Jakob degeneration of the intervertebral discs plays a primary
part in the paraplegia which frequently occurs in dachshunds, but in some cases a
secondary part through excessive flexion of the spine. Paraplegia is caused far
more frequently by stretching and tearing of the peripheral nerves, and particularly
at their point of exit through the intervertebral foramina. The correctness of this
idea, which is not based upon an analysis of the clinical aspect of the disease, is
opposed by the fact that the paraplegia involves all the nerves of the hind parts.
This usually indicates supranuclear paralysis and is associated with incontinence of
urine and feces.
Anatomical Changes. In addition to the lesions of the
spine and memln-anes already mentioned, the cord is reduced to
about a third of its normal thickness at the point where the
pressure has been applied. The consistence is often reduced,
but in rare cases that have been in existence for some time,
it may become more dense. The appearance of the surface on
cross section is asymmetrical, the shape of the gray cornua and
of the inferior fissure being altered. In very exceptional cases
there are no visible lesions of the cord, although the animal has
shown severe symptoms during life.
Exhaustive histological examinations were carried out by Dexler in eases in
which the compression of the cord was due to enchrondrosis, enostosis, or neoplasms.
At the point where pressure had been exerted and for a certain distance on each
Symptoms. 707
side the nerve fibers were destroyed, the vessel walls were thickened, and their
sheaths were infiltrated with round cells. The nerve cells were more or less de-
generated, and, in cases that had been in existence for more than a year, the tissue
of the cord was invaded by a fibrous tissue that was poor in cells but which con-
tained here and there a few unaltered fibers or groups of nerve cells. In some
cases the fibrous tissue contained numerous cavities containing a serous fluid (great-
ly dilated lymph spaces). In the other parts of the cord there were degenerations of
a secondary nature. Above the seat of tlie compression the posterior columns de-
generate as far as the nuclei in the medulla as do also the lateral cerebellar tracts
and Gower's tract. The motor tracts and the comma tract of Schultz degenerate
in the caudal direction. At the seat of the compression the nerve fibers contained
in the nerve trunks originating from the degenerated motor nerve roots may also
be in a condition of degeneration.
Symptoms. A common symptom is tlie evidence of pain
wliicli sometimes precedes the other symptoms by long periods.
The pain may be either constant, in which case the animal holds
the spine rigid and somewhat arched, or it may be intermit-
tent and manifest when the animal gets up or lies down, and
during movement or jumping, causing the animal to cry out.
Owing to the pain, movements are executed with care. In some
cases in which the cervical portion of the spine is involved, the
animal may be unable to take food from the ground or to
graze.
Motor disturbances may be observed in some cases simul-
taneously with the appearance of sjanptoms of pain. In other
cases they appear later, but they may be observed without any
preliminary symptoms indicative of pain. These disturbances,
as a rule, first affect the hind quarters irrespective of the seat of
the disease, owing to the fact that the muscles of the hind
quarters play a greater part in the execution of body move-
ments than those of the fore limbs, and consequently any weak-
ness in them is observed sooner. It is only in exceptional cases
that the weakness sets in in all four limbs at once, and it scarce-
ly ever happens that the fore liml)s are affected more severely,
or exclusively so. As a general rule, the loss of power is
bilateral, but in some cases this is not so, and the difference
may be so pronounced between the two sides that a superficial
examination may lead one to think that the paralysis is unilat-
eral or involves "a single limb only. In exceptional cases, if for
example only one side of the cord is subjected to pressure, there
may be a true unilateral paralysis or monoplegia (Brown-Se-
quard type). Goldmann records a case in which a pig showed
sensory and motor paralysis of one hind leg, owing to an echino-
coccus in one of the dorsal vertebras.
In typical cases, motor disturbances are observed in the
larger animals. The animals rise slowly and with caution, cat-
tle get up like horses, or remain sitting like dogs for a long
time. In some cases, they lower themselves on their hind legs
while urinating, in the manner frequently observed in puppies
(Hamoir and Stenstrom). In such cases, weakness of the hind
quarters is always observable and especially when the animal is
turning. Small animals, and especially dogs, are no longer able
to jump up or to stand on their hind legs.
- 708
Coniiiressioii of the S]»iiuil Cord.
Both large and small animals lie down a lot, are easily
fatigued, and during movement it is quite olwious that the
limbs are neither lifted nor flexed as much as usual. The lat-
ter is especially obvious in the hind limbs, but sometimes also
in the fore limbs. In consequence of this abnormality of move-
ment, the hoof wall in the large animals, and the toes in the small
are dragged along the ground, especially if the ground be un-
even. In dogs the dorsal surface of the toes may be sore.
In the later stages, animals walk on the dorsal surface of the
phalanges or all the joints knuckle over at the moment when
Fig. 101
alysis of the hind quarters.
any weight falls on the limb. In still later stages, this symptom
is observed ^vhile the animal is standing still, or during the pas-
sage of urine. After a variable interval, the paralysis pro-
gresses to such an extent that the animal can no longer get up
or walk. Pressure upon the croup is sufficient to cause them to
show signs of falling, and in small animals pressure upon the
sacrum causes them to fall powerless to the ground. Finally,
in some cases in which there is no paralysis of the fore legs,
the animals tend to drag the paralyzed hind quarters after them.
Associated with the gradually progressive symptoms of pa-
Symptoms. 709
ralysis, and the slowly increasing but slight atrophy of the
affected muscles, there is in some cases an active rigidity of.
the muscles in the portion of the body posterior to the seat of
compression of the cord. This rigidity is evidenced by a firmer
consistence and an increase in the passive resistance offered by
the muscles, and also by extension and even crossing of the par-
alyzed limbs. This is especially obvious when the animal is
sitting or lying down (fig. 101). In consequence of the rigid-
ity of the muscles, which in some instances is pronounced while
the paresis is still slight, the gait is spastic, the joints are
scarcely flexed, and the feet are dragged along the ground.
Dogs walk on the tips of their toes (fig. 97, page 682), slip up
on smooth surfaces and fall over if they attempt to jump upon
anything. In many cases, on the other hand, the feet are lifted
backwards and quickly put down again.
In numerous cases that have been examined no actual ataxia has been dis-
covered either 1)y Dexler or Hutyra & Marek. The very variable symptoms are
entirely caused by loss of muscle power or by the muscular cramp.
In addition to the pain already mentioned, sensation be-
hind the seat of compression appears to be decreased or even
quite lost, but not rarely, and even when there are pronounced
symptoms of paralysis, there may be very slight disturbances
of sensation or none at all. The insensitive area is not
rarely limited anteriorly by a hyperalgesic zone which corre-
sponds with the area supplied by the sensory nerves, the roots
of which are subjected to pressure. The pain may be so severe
that the animals bite the affected part until they draw blood.
If there is tumor-, callus-formation, or luxation, the spine
shows a circumscribed swelling, and in many cases of caries
there may be a recognizable excrescence. In small animals,
there may be evidence of pain if the superior spines be struck
or subjected to pressure and even during passive motion. Ex-
ceptionally, it is possible to determine pronounced passive
mobility of some part of the spine.
Posterior to the seat of compression, the reflexes are ex-
aggerated, but in parts where the compression is somewhat
more extensive, there may be a complete absence of reflexes.
The frequent erections of the penis which are easily caused by
stimulation of the skin of the abdomen, of the prepuce or the
penis are the result of the exaggerated reflex irritability.
Abnormalities of function of the bladder and rectum are
frequently observed. In view of the fact that tlie compression
is usually situated in the middle of the lumbar portion of the
cord, there is, as a rule, retention of urine and feces. In many
cases, the animals are unable to pass urine or feces voluntarily.
In a greater proportion of cases there is an involuntary dis-
charge of urine and feces at long intervals. This discharge
can also be induced by external influences, such as pressure on
the wall of the abdomen, or the region of the bladder or peri-
neum. Urination takes place at very short intervals, sometimes
710 Compression of the Spinal Cord,
even on extremely slight irritation, and consequently it appears
as if the urine were trickling away owing to paralysis of the
sphincter, but that this muscle is uninjured is rendered obvious
by the fact that urination ceases when the pressure is removed,
and also that large quantities of urine collect in the bladder
during complete rest. In very rare cases of compression
of the lumbar portion of the cord there is observed paraly-
sis of the sphincter of the bladder and dribbling of urine, re-
laxation of the sphincter of the anus may also be seen. The
distribution of the motor and sensory disturbances according
to the position of the part of the cord that is sul^jected to
pressure, has been dealt Avith in connection with contusion of
the cord (see page 686).
The occurrence of atypical cases is not rare. In some such
cases symptoms of paralysis follow disturbances which are in-
considerable, and which possibly have very little local effect.
It happens now and then that some intraspinal growth for a
long time causes no obvious symptoms and is then the cause
of the sudden onset of symptoms. In both cases the deviation
from the usual course of events is caused by crushing or
stretching of the cord or some of the nerve roots through
some sudden movement or excessive flexion of the spine, thus
causing either a unilateral traumatic lesion or probably some
interruption of conductivity due to a local disturbance of cir-
culation.
Course. Corresponding to its nature the condition runs a
chronic course. In typical cases the disturbances increase until
there is complete paralysis which may be gradual, or there maj''
be times at which the disease is at a standstill, or possibly
there may be some improvement. In other cases some slight
disturbance is followed by severe or complete paralysis, or
tliere may be severe symptoms of paralysis which are not pre-
ceded by any obvious disturbance. In cases of this kind in
small animals, the condition may abate for a certain lengih of
time or even completely disappear, but as a rule, after some
weeks, it makes its appearance again, and this may occur re-
peatedly. In exceptional cases the improvement is maintained
so long that from a clinical point of view the animal may be
said to have recovered. In the large animals such improve-
ments are not observed because of the development of bed-
sores or of hypostatic congestion of the lungs.
In the majority of cases the disease terminates fatally, and
usually owing to complications. Bedsores develop quickly in
the larger animals, but are not absent in the later stages in
small animals. As a rule these lead to a general infection. The
rapid course of the disease in the larger animals is referable
to this and also to hypostatic congestion of the lungs. In com-
paratively rare cases tliere is catarrhal inflammation of the
urinary tract.
Diagnosis. 711
Diagnosis. Diagnosis is associated with little or no diffi-
culty in cases in which there are the following symptoms : very
slowly progressive paraparesis and para-anesthesia, local
swelling and pain of the vertebral colmnn, evidence of spon-
taneous pain, a girdle-like area that is hyperesthetic, and dis-
turbances of micturition and defecation. An error of diagno-
sis is far more likely to be made in those cases in which the
paralysis appears to set in or actually sets in suddenly. The
presence of more or less pronounced atrophy of the muscles
and spastic movements of the paralyzed portion of the body
lead one to suspect that certain motor disturbances have been
in existence for some time. Possibly also there is a history
of the occurrence of rheumatic pains and stiffness of gait.
The points that are of importance in the differential diag-
nosis of compression of the cord, ossifying meningitis, contu-
sion of the cord, and myelitis, have already been dealt with
under these diseases. Muscular rheumatism with which the
disease may be confused owing to the evidence of pam, is
easily distingaiished by the facts that there is no loss of mus-
cular power," rigidity of the muscles is absent, the sensibility
of the skin is increased and the reflexes are normal. In the
horse, thrombosis of the branches of the posterior aorta might
be confused with the disease, but this is distinguished by the
fact that the paralysis which is observed during movement
rapidly disappears when the animal is left at rest, and rectal
examination enables one to establish the diagnosis.
The seat of the compression can only be determined accu-
rately in cases in which there is some distortion of the body;
there is local pain of the vertebrae, a hyperesthetic zone can
be demonstrated, the extent of the paralysis and loss ot sen-
sation, the condition of the reflexes, and the functions ot the
bladder and rectum also afford information. In other cases
one can do no more than determine the approximate seat ot
the lesion, and in some cases this amounts only to deciding that
it is situated in the cervical, dorsal, lumbar or sacral sections
of the spine.
The cause of the compression can m some rare cases be
accurately determined. In this connection, the following points
must be taken into consideration. In the ox and pig, tuber-
culosis is the commonest cause of compression of the cord, m
the sheep coenurosis, in the dog disease of the vertebral joints.
Tuberculosis of the internal organs strongly suggests the pos-
sibility that this is the cause of the trouble, the presence ot
gid in a flock suggests the parasitic nature of the condition,
the presence of neoplasms in other parts of the body, and
especially in the neighborhood of the vertebral column is more
suggestive of a growth in the canal being the cause ot a re-
duction in its lumen. If the symptoms of compression set m
during the course of a suppurative disease the probability is
that the cause is an abscess.
712 Compression of the Spinal Cord.
Prog-nosis. This, as a general rule, is unfavorable, and
especially in large animals which are alreadj' unfit for work,
owing to somewhat severe motor disturbances, and in which
dangerous complications are likely to occur early. In the small
animals a complete recovery is not to be expected. Not rarely
the animals improve and the SJ^nptoms of paralysis disappear,
but the disappearance is only temporary, and, inasmuch as
the possibility of a regeneration is not to be expected, a re-
covery in the clinical sense cannot be hoped for. On the
grounds of the symptoms presented one cannot say whether
there is likely to be an improvement later or not, for this pur-
pose the animal must be under observation for a week or two,
during which time in favorable cases some improvement will
be noticeable.
Treatment. No satisfactory treatment can be advised in
the case of the large animals. They should be slaughtered as
soon as possible. In the small animals the extirpation of neo-
plasms may be attempted, but in the majority of cases radical
treatment cannot be adopted owing to the impossibility of ex-
actly localizing the disease. In such cases there is not rarely
some improvement and even a complete disappearance of
symptoms if all movement be avoided and the animals kept in
a condition of complete rest. The animal's position should be
changed from time to time, and the urine and feces should be
removed. If the animals can move moderately well, slight move-
ments and massage of the muscles may be useful. Some au-
thors have observed improvement follow the injection of eserine
and pilocarpine, but such improvement might have happened
without any such treatment.
Literature. Barrier, Bull., 1906, 283.— Dexler, (3. Z. f. \Ts., 1896, VII, 1;
Krgeb. (1. Path., 1896, III, 2, Abt., 516 (Lit.); 1900, VII, 479 (Lit.); Nerven-
krkh. d. Pferdes, 1899, 87 (Lit.).— Feuereissen, Z. f. Flhyg., 1905, XV, 86.—
Frohner, Monh., 1899, X, 123.— George & Johne, S. B., 1885, 40.— Goldmann, Z. f.
Flhyg., 1907, XVIII, 35.— Hamoir, Ann., 1904, 627; 1906, 332.— Haugmeier, Rep.,
1853, 112.— Hink, D. t. W., 1899, 4.— Hinrichsen, A. f. Tk., 1882, XIV, 219.—
Jakob, M. t. W., 1910, 305.— Jakschatseh, B. t. W., 1899, 455.— Kammermann,
Schw., A. f. Tk., 1888, XXX, 205.— Nocard, Bull., 1885, 80.— Petit, Rec, 1906,
470.— Poes, Ann., 1902, 89.— Poulin, ibid., 1906, 687.— Rubay & Navez, ibid.,
1902, 629.— Schmidt, A. f. Tk., 1889, XV, 295.— Stenstrom, Z. f. Tm., 1906, X,
113.— Tapken, D. t. W., 1905, 482.— Teetz, Z. f. Flhyg., 1905, XV, 60.— Wilson,
J. of comp. Path., 1904, 332.
7. Syringomyelia.
This name is applied in human medicine to a condition in which
there is an increase, and later a destruction of the neuroglia tissue with
the production of cavities, the Avails of which are formed of neuroglia
tissue. The cavities that are formed by dilatation of the lymph spaces,
or to softening of the tissues, observed in cases of myelitis, due to pres-
sure and in other forms of myelitis, are not included under the term.
There are only two records of the occurrence of syringomyelia in
Syringomyelia. 7]^ 3
the lower animals. One is recorded by Roger as occurring in the guinea
pig; and the other in the dog by Lienaux. These two cases, and the
histological examinations made by Lienaux do not definitely settle the
question whether the condition found in these animals exactly corre-
sponds with the condition found in man, as Lienaux supposed in his
ease. In this case symptoms of posterior paraparesis gradually devel-
oped in a two-year-old Newfoundland. After four months, there was
loss of sensation in the hind quarters, and later there were clonic con-
tractions of the digastric muscle which caused occasional opening of the
mouth. In the sixth month, the gait was unsteady, the croup was
sunken owing to excessive flexion of the joints of the legs; and, owing
to paralysis of the muscles on the left side, there was lateral curvature
of the spine the convex side of the curve being on the left. By this time
the animal only got up to feed or when told to do so, but soon lay dowTi
again powerless. From the scapular region backwards the left half of
the body was completely insensitive ; while there was marked hyper-
esthesia of the right side. The patellar reflex which, at the outset w^as
normal, was exaggerated on both sides. Later the area of anesthesia
spread to the neck. There was no disturbance of micturition or defe-
cation.
At the postmortem, there was found a cavity extending the whole
length of the cord, the walls of which were covered with ependyma, and
which in the dorsal and lumbar portions of the cord, communicated with
small cavities scattered through the gray matter. "Wlien cut into, a
clear serous fluid escaped from this cavity. Microscopic examination
showed atrophy of the nerve cells, increase of the neuroglia cells, slight
unimportant perivascular infiltrations, and a secondary degeneration
extending up to the medulla.
Literature. Lienaux, Ann., 1897, 486.— Lefebure, Eec, 1906, 516.
Section III.
DISEASES OF THE PERIPHERAL NERVOUS
SYSTEM.
General Etiology and Symptomatology of the Diseases of the
Peripheral Nerves.
A variety of causes are responsible for diseased condi-
tions of the peripheral nerves.
Traumatic injuries are frequent causes of such conditions.
In the first place a superficial nerve may be crushed between
the underlying bone and some hard object, or more rarely be-
tween a muscle in a condition of powerful contraction and the
bone. In a number of cases nerves are injured by blows, or
penetrating wounds, but tearing of a nerve owing to sudden
excessive extension of a limb is observed only very occasionally.
Solution of continuity of the nerves is rarely met with in cases
of wounds of the surrounding soft tissues or fractures of bones.
Compression of nerves may result from the development of
neoplasms either around the nerve, in its immediate neighbor-
hood, or even in the nerve itself. Neuromata occur almost ex-
clusively, but with moderate frequency in the ox. It is only
exceptionally, however, that they give rise to any svmptoms
(Zietschmann, S. B. 1900, 234; Detroye, Rev. Vet. 1907, 408).
As a rule, several nerve trunks of the head, trunk and limbs
are involved simultaneously, and they also occur on connec-
tion with the fibers and ganglia of the sympathetic. They are
composed of fibrous and gelatinous tissue and arise in connec-
tion with the interstitial tissue of the nerves, the nerve ele-
ments remaining uninjured. In some cases, amputational neu-
romata develop after neurotomy has lieen performed, and they
are the cause of severe pain.
Nerves may suffer compression owing to the existence in
their neighborhood of enlarged and indurated hmiphatic glands,
effusions of blood, abscesses, foreign bodies, parasites (larva?
of TTypoderma), dislocations of bones and calluses resulting
from fractures of bones.
714
General Etiology of the Diseases of the Peripheral Nerves. 715
Neuritis. Recent investigations have furnished evidence
that neuritis is by no means an uncommon disease in the do-
mesticated animals. The explanation of the scanty records of
the occurrence of neuritis in the older literature is that in
those times it was the central nervous system that was princi-
pally examined in cases in which there were nervous disturb-
ances, the peripheral nervous system receiving no attention at
all or a mere naked-eye inspection. Consequently, the inflam-
matory changes in the nerves which are only recognizable on
microscopic examination passed unnoticed.
There is no doubt that cases occur in which the neuritis is
due to chilling, but in what manner the effect is produced is not
accurately known. There is but little information as to the
alterations that occur in nerves as a result of cold, and it can
only be maintained with a certain amount of probability that
they are of an inflammatory nature. In the vast majority of
cases neuritis is due to an infection. The inflammation in such
cases is set up by microorganisms or, as appears to be more
commonly the case, by their toxins. At the present time,
the causes of dourine, strangles, and influenza are known to
be capable of setting up neuritis. The results of more recent
investigations have shown that certain poisons may cause neu-
ritis, provided the animals survive sufficiently long, as in the
case of chronic poisoning, or after recovery from a not very
severe poisoning. Thomassen furnished experimental proof
that lead possesses the power of causing neuritis in certain
nerves. Up to the present no evidence has been adduced with
regard to other poisons, but it appears to be probable that the
same holds good for mercury and arsenic. Many vegetable
poisons of known and unknown composition appear to be cap-
able of setting up neuritis. Satisfactory and conclusive experi-
ments and observations have been made regarding the neuritis
caused by polished rice. Mechanical influences (stretching,
blows, pressure, etc.) set up chronic inflammation in the con-
nective tissue of nerve trunks, especially if they are slight and
are in action for a long time, or affect one nerve repeatedly.
Finally, some cases may result from the extension of inflam-
matory processes that are going on in the neighborhood of the
nerve, for example, pleurisy may involve the recurrent nerve,
the glosso-pharyngeal nerve, may be affected in pharyngitis or
disease of the pharyngeal organs, and severe inflammation of the
lymphatic glands may involve any nerve that is near.
Lesions that are visible to the naked eye are found in only
a small proportion of cases, and then only in cases in which the
inflammation has led to the production of a large amount of
connective tissue, pronounced degeneration, or atrophy. The
gelatinous appearance of the perineural connective tissue in
animals that are greatly emaciated must not be considered as
an inflammatory condition, since the gelatinous infiltration is
716 General Etiology of the Diseases of the Peripheral Nerves.
simply the result of the removal of a considerable quantity of
fat. Definite results can be obtained only by microscopic ex-
amination which reveals, in acute cases, dilatation of the ves-
sels, cellular infiltrations, small hemorrhages in many cases,
in chronic forms an increase in the amount of connective tissue,
and in both cases degeneration and disappearance of the nerve
fibers extending in the peripheral direction from the seat of
the disease. If the seat of the inflammation is on the central
side of the spinal ganglia or the ganglia of the cranial nerves,
the degeneration is found in the sensory roots of the spinal
or cerebral nerves and in the posterior columns of the cord
or in the sensory root of the trigeminal nerve. As a rule the
lesions do not involve the Avhole cross-section of the nerve trunk
to the same extent.
If the inflammation starts in the connective tissue sur-
rounding the nerve it is known as perineuritis, but if it has its
starting point in the intraneural interstitium it is called in-
terstitial neuritis. The term parenchymatous neuritis is re-
served for those cases in which the primary lesion is a degen-
eration of the nerve filler.
Diseases of the central nervous system and its membranes
frequently cause paralysis and other functional disturl)ances
of the peripheral nerves, but, strictly speaking, these do not
belong to the diseases now under consideration. On practical
grounds it appears to be advisable, however, to refer to them
while the subject of the diseases of the peripheral nervous sys-
tem is under discussion.
Diseases of this kind involving the purely motor nerves
abolish the conductivity of the affected nerves, either entirely or
in part, either through the entire cross-section of the nerve or
in a part only. This results in an infranuclear (peripheral)
paralysis of the muscles supplied by the nerves in question.
In mixed nerves the conductivity is preserved for a time,
and not rarely till the time of death in the sensory nerve fibers
which are apparently more resistant, provided the nerve be not
completely severed or crushed. In view of the fact that the
sensory nerves are stimulated more easily by various influences,
disease of a portion of a mixed nerve, as a rule, leads to pain
through the whole lengih of the nerve and throughout the
area supplied by it. The contractions and spasms of ttie
muscles concerned and the exaggeration of the reflex irrita-
bility which is observed in rare cases are due to stimulation of
the sensory fibers. The reflexes persist so long as the conduc-
tivity of the motor nerves is not destroyed. As the motor
nerves which are very easily injured lose their conductivity
right from the start or very soon after, muscular spasms and
exaggeration of the tendon reflexes are very rarely observed
in diseases of the peripheral nerves, except in disease of the
membranes, in which the entirely different mode of development
Paralysis of the Nerves of the Eye. 717
often produces the opposite effect. Infraiiuclear paralysis is
often associated with the loss of conductivity in the motor
fibers in a mixed nerve. Sensation persists in the paralyzed
area, and it may be either exaggerated, but it is diminished or
completely lost if the conductivity of the sensory nerves has
been destroyed by some very severe inflammation.
1. Paralysis of the Nerves of the Eye.
Etiology. Paralysis of the III, IV and VI pairs of cranial
nerves is generally due to some intracranial disease (menin-
gitis, concussion of the brain, encephalitis, tumors), and is of
fairly frequent occurrence under such circumstances. (In a
case recorded by Zschokke, the abductor nerve was subjected
to pressure by an intracranial angioma.) There are no cases
on record of extracranial disease of these nerves, but injuries
might occur through fractures of Ijone in their immediate
neighborhood, or through the presence of exostoses or tumors in
the depth of the orbit.
In cases of torsion of the eyeball recorded in horses by Bal-
langee and Bayer, Clerchet, Fayet & Nicolas, the cause was not
discovered.
Symptoms. Paralysis of the oculo-motor nerve is observed
most frequently, the condition l)eing more rare in the abduc-
tor and trochlear nerves. In cases of paralysis of the oculo-
motor the upper eyelid is dropped (ptosis), the animal is nn-
able to open the eye, but is able to lift the upper lid to a certain
extent by powerful contraction of the corrugator supercilii,
which is supplied by the facial nerve. The bulb of the eye
is directed outwards and its outer half somewhat upwards
(strabismus divergens). The pupil is dilated and does not
react to light. On pressure the eye is not retracted into the
orbit and the membrana nictitans is consequently not seen.
Paralysis of the external rectus muscle, wliich is supplied
by the abducens nerve, causes the eyeball to turn inwards
(strabismus convergens), while paralysis of the trochlear nerve,
which supplies the superior oblique muscle, causes the eye to re-
volve with its onter part downwards.
Dexler has repeatedly observed exophtliahinis in cattle, also convergent squint-
ing, and functional disturbances of the muscles of the eyes associated with secondary
catarrh of the conjunctiva. The cause was in all probability an increase in the
intraorbital fat.
Prognosis. Improvement is scarcely to be hoped for, but
it depends upon the nature of the primary disease. Exceptions
to this rule are many cases of concussion of the brain or rota-
tion of the eyeball' without other disturbances (Ballangee).
718 Paralysis of the Trigeminal Nerve.
Treatment. In view of the fact that the origin of the dis-
ease is as a rule central, treatment should be along the lines
laid down for diseases of the brain or its membranes.
Literature. Ballangee, A. f. Tk., 1906, XXXII, 103.— Clerehet, Fayet and
Nicolas, Bull., 1909, 490.— Zschokke, Sehw. A., 1885, XXVII, 174.
2. Paralysis of the Trigeminal Nerve.
Occurrence. This paralysis has up to the present been ob-
served in the horse and dog, and Reuschel claims to have
seen it in a cow. (Hintze found degenerative atrophy of the
infraorbital nerve in a pig aifected with rickets of the jaw.)
In the dog, the disease is not rarely observed, even if cases of
rabies, in which it is common, and cases of distemper, in which
it is infrequent, are excluded.
Etiology. The principal causes of paralysis of the tri-
geminal nerve in the dog are rabies and distemper, but among
other causes may be mentioned inflammation of the brain in the
neighborhood of the pons (Mathis), concussion of the brain
(Hutyra & Marek), the development of a neoplasm around the
intracranial root (Gratia, and Cadeac & Roquet, a gliosarcoma
and an endothelioma) and, under certain circumstances, squeez-
ing of the motor branch through powerful contraction of the
muscles of mastication (laying hold of some heavy object, bit-
ing a hard bone, etc.).
The crushing of the motor branch lietween the niasseter and temporal muscles
is explained by supposing that the nerves mentioned are pressed against the condy-
loid process during active contraction of the temporal muscle. This is particularly
the case when a dog forcibly closes its widely opened mouth or is holding a heavy
object in its mouth. A consideration of the anatomy of the part is sufficient to
convince one that a crushing of the motor branch only, and one that is as a rule
bilateral, is quite possible, and it is not necessary to suppose that the cause is
either rheumatism or some intoxication, as Cadiot and Almy assert. The sudden
onset of the disease contraindicates this.
The disease is met with only very occasionally in the horse.
In a case recorded by Lydtin, the cause of the paralysis was
a fibrosarcoma in the immediate neighborhood of the Gasserian
ganglion, and a growth of the same nature close to the temporo-
maxillary joint is recorded as the cause by Tempel. Meyer,
in one case ascribes the paralysis to the presence of an angioma
in the cranium, and neuritis is said to be the cause in cases
mentioned by Roll, Liipke, Dexler and Marek. Sometimes tri-
geminal paralysis appears to be due to concussion of the brain
(Berton, Pr. Mil. Vb.).
Symptoms. In cases of paralysis of all three branches of
the trigeminal nerve both, disturbance of mastication and loss
of sensibility are observed. If the first branch (ophthalmic
Symptoms. 719
branch) be alone affected the skin over the forehead up to the
level of the ears (tig. 102), the eyelids, the nasal mucous mem-
brane, the surface of the eyeball and the cornea are insensitive.
Pressure on the cornea does not cause closure of the lids nor
retraction of the eye. Particles of dust and dirt settling on the
surface of the eye are not perceived and consequently not re-
moved. As a result of this the cornea becomes cloudy and soon
ulcerates, thus allowing the inflannnation to spread to deeper
parts of the eye (ophthalmia neuroparalytica).
If the second branch be paralyzed (the superior and in-
ferior maxillary branches) there is loss of sensation of the skin
of the face, of the dorsum of the nose, the cheeks and lips and
the mucous membrane of the tongue on the diseased side (fig.
102). The tongue is injured during mastication without the
animal feeling it. The upper lip on the diseased side is drawn
towards the opposite side owing to loss of muscular tone, while
the insensitive half of the lower lip moves slowly. Simultane-
ous paralysis of the vaso-motor nerves maj^ cause intense red-
dening of the mucous mem-
branes. In cases of paralysis
caused by compression the an-
esthesia is always preceded by
hyperesthesia.
Disease of the lower branch
causes also paralysis of the mus-
cles of mastication (masseter,
temporal, internal and external
pterygoids). The animal mas-
ticates with the sound side only,
the teeth of the opposite side
scarcely coming into contact Fig. 102. Paralysis of the trigemin-
with each other. One can easily f ^ "«^^^, ^^^ *« contusion of the
-,„„,,., ,, • brain. The dark line indicates the
convince Oneselt Ot this by allow- upper and posterior line of the anes-
ing the animal to chew some thetic area,
hard object. The lower row of
incisors is pulled away from the paralyzed side and a narrow
space is left between the upper and lower rows. The teeth on
the paralyzed side do not wear properly and particles of food
collect between the cheek and the teeth owing to the insensitive-
ness of the mucous membrane. If the hand be placed on the
temporal region or on the masseters during mastication it can
be noticed clearly that while the muscles on the sound side con-
tract, those on the opposite side remain quiescent. In time
the paralyzed muscles undergo atrophy.
In dogs paralysis of the trigeminal nerve resulting from
crushing by the contraction of the muscles of mastication tends
to be bilateral and involves the motor branch only. The mouth
is held open and the lower jaw is dropped, but it is easily raised.
The tongue is dry and hangs out of the mouth, there is a flow of
saliva (fig. 102), food and water cannot be taken, but food
720 Paralysis of the Trigeuiinal Nerve.
placed uijon the tongue is gulped down with some effort. In
some cases rabies, and exceptionally distemper, may be accom-
panied by bilateral paralysis.
Paralysis due to diseases of the brain is in many cases only
partial, the loss of sensibility is often limited to one or the other
branch of the nerve, while a partial disease of the long tri-
geminal nucleus or the root appears to be quite possible.
In many cases facial paralysis follows paralysis of the trigeminal nerve
(Dexler, Tenipel and Marek), or there may be sjTiiptoms of bulbar paralysis. In
a ease of paralysis caused by a subparoti- are sufficient to cause a much more audible
Symptoms. 733
sound. Now and then, cases are met with in which the partic-
ular sound is audible even while the animals are at rest, or from
the slightest stimulation of any kind. Cases are very rare in
which owing to bilateral paralysis there is a sound during
expiration due to stenosis of the glottis. It is easy to prove
that the sound is influenced by the quantity of air entering the
trachea and the rapidity mth which it is taken in. If one
nostril of a roarer be closed or both of the nostrils are par-
tially closed the noise due to the stenosis disappears immedi-
ately. In this lies the explanation of the fact that the sound
ceases immediately after the animal stops, or at the latest with-
in 5 to 8 minutes after.
Respiration is more or less difficult during severe exertion.
Simultaneously with the appearance of the sound, symptoms
of dyspnea set in, the nostrils are opened out in a trumpet-like
manner, the ribs are raised spasmodically, the flexible por-
tions of the chest wall sink inwards at each inspiration, and
the anus moves in and out with each inspiration and expira-
tion respectively. If the work be continued there may, in severe
cases, be s;^anptoms suggestive of suffocation and the horse
may fall down. The difficulty of respiration soon disappears,
and within one to five minutes after the animal stops, there
may be only as much deviation from quiet respiration as is
seen in sound horses under the same conditions.
During rest symptoms are either very slight or quite ab-
sent. In somewhat more advanced cases it is often difficult to
make animals cough, but the cough in such cases is deep, pro-
longed and rattling. This is proof that the glottis cannot be
closed and the paralyzed and relaxed vocal cord makes slow
oscillations. So long as the vocal cord is sufficiently tense to
allow of closure of the glottis the cough does not show the
characters described. In many cases the neigh is more hoarse.
Since the irritability of the sensory nerves tends to be exaggerated before
conductivity is lost there is a dry cough which is not associated with any discharge
from the nose before the onset of paralysis and for some time after. This cough
can be caused far more easily than normally. Some authors have observed catarrh
of the larynx before the onset of symptoms of paralysis.
In many cases the arytenoid cartilage of the left side can
be pressed more easily into the cavity of the larynx, by palpat-
ing the larynx, causing a whistling or rattling inspiration.
Palpation of both sides frequently reveals atrophy of the
muscle on the left side.
Examination of the larynx with the laryngoscope shows
that one vocal cord, generally the left, moves only slightly
during respiration, or remains motionless in the middle line,
or in cases in which the dilator alone is paralyzed it remains ver-
tical. In cases of bilateral paralysis both the vocal cords move
sluggishly or remain motionless. In view of the fact that with
the laryngoscope a bird's-eye view of the larynx is obtained,
slight dropping of the arytenoid cartilage cannot be deter-
734 Paralysis of the Kecurreiit Xerve.
mined, but it may )je suspected in many cases, owing to asym-
Pietry of tlie larynx, the ary-epigiottic fold appearing shorter
and curved in its hinder part.
Immobility of the vocal cords caused by paralysis must not be confused with
the position occupied by them during prolonged inspiration, for in the former case
they are unable to make any movement, while in the latter pressure on the nasal
septum, blowing into the nose, drawing one or two straps tight round the thorax
are sufficient to set the vocal cords in motion again (Malknuis).
According to Bassi the condition of the vocal cords in horses can be ex-
amined by introducing a brilliant light into the posterior portion of the widely
opened mouth. This plan, although useful in small animals is impracticable in the
horse, the different portions of the larynx not being visible owing to the length of
the soft palate.
Course. In the great majority oi ^ases the disease is
chronic. It is only very occasionally that the condition appears
suddenly with pronounced symptoms of illness, persists for
several weeks and then gradually disappears or becomes chron-
ic. Such cases have been recorded by a number of authors
(Giinther, Lies, Vollers, Alberts, Albrecht, Malkmus, Friis,
Miiller and others). Malkmus, from the findings in one case
carefully examined with the laryngoscope, describes a complete
bilateral paralysis as opposed to the usual nnilateral chronic pa-
ralysis, in which there is a possibility of recovery. With the
exception of these very rare cases the progress of the disease
is slow. S^^nptoms appear at the most four to six weeks after
the commencement of the disease process and reach their
maximum after a long time, sometimes one to two years.
Sometimes paralysis makes its appearance ten to eleven days
after the appearance of the primary disease (Rosenfeld, Froli-
ner). The sound due to stenosis increases from this time on-
wards, in constantly shorter intervals during work, until a few
paces are sufficient to cause a loud roaring and s^miptoms of
dyspnea.
Diagnosis. Paralysis of the vocal cords or their muscles
can l)e determined with certainty only by examination with the
laryngoscope, and in small animals by direct inspection. If it
is possible to press the arytenoid cartilage easily into the
larynx or if atrophy of the muscle on the outer surface of the
cartilage can be detected one may form the opinion that the
disease is in existence, but this can only be done in advanced
cases, and the possibility of error is not excluded. Coughing
is of only slight value from the point of view of diagnosis be-
cause it is difficult or impossible to make many sound horses
cough. If parah^sis exists already, the cough may not be spe-
cially characteristic, and on the other hand, there may be the
peculiar type of cough in other diseases of the larynx.
With a probability that amounts almost to certainty the
disease may be diagnosed when some other disease is or has
lieen in existence which experience has shown may be followed
by paralysis of the recurrent nerve (strangles, pneumonia,
neoplasms, aneurism, etc.). In the absence of such information
Diagnosis. Projinosis. 735
and without inspection of tlie interior of the larynx one can
diagnose with certainty only some stenosis of the npper air
passages or larynx, generally termed roaring, but only a con-
ditional opinion can be expressed as to whether paralysis of
the recurrent nerve is the cause of the condition. According
to Cadeac and Fleming, whistling and roaring are caused by
paralysis of the recurrent nerve in 95 to 99 per cent of cases.
Whistling and roaring during work may be due to stenosis
of the upper air passages from other causes. Neoplasms in
front of or in the larynx (tumor-like growths of a glanderous
nature, Dexler), dilatation of the guttural pouches, curvature
of the trachea, proliferations of the laryngeal mucous mem-
brane, may cause exactly similar symptoms, as may also ste-
nosis of the pharynx or posterior portions of the nasal fossas.
While the last named type of stenosis, and that due to curva-
ture of the trachea or larynx can be detected by careful exam-
ination of the exterior, this is not so in the case of stenosis of
the larynx.
Stenosis of the larynx may occur in acute diseases, and
especially in acute edema of the glottis, or owing to acute
swelling of the mucous membrane. If the stenosis is only
moderate, roaring and dyspnea are observed during work only.
In such cases a diagnosis may be based on the history of the
case, the course of the disease, and especially the alternation
of exacerbations with improvements.
Temporary paralysis of the recurrent can only be differ-
entiated from the chronic progressive form of the disease by
observation of the course taken by the process.
The best method of testing a horse as to whether he is a roarer is to gallop
it in a circle on a lunging rein with its head held in and turned slightly to the
right. If results are not obtained, saddle horses may be galloped or ridden at
a fast trot and harness horses may be driven. If possible the ground shouhl be
Boft in order to cause violent inspirations and to avoid masking the sound by the
noise made by the cart or by the horse's feet. The head should be held well in
because this puts the muscles of the larynx in an unfavorable position (Giinther)
and consequently the noise is appreciable earlier. In view of the fact that under
Buch conditions many sound horses breathe noisily in fast paces, particular atten-
tion must be paid to the nature of the sound produced. It is only a high-pitched
whistle or a deep roar that indicates stenosis. A sound of this type is never pro-
duced by a sound horse.
Further investigations are necessary to decide how often individual muscles of
the larynx are paralysed, and whether the nmscles other than the dilators are
sometimes alone involved. Thomassen's observation that many horses show dis-
turbance of neighing before there is any whistling appears to indicate that the
constrictors only may be affected for a time.
Prognosis. Laryngeal paralysis due to some infectious
disease or intoxication not rarely disappears within some
weeks or months, while the apparently spontaneous disease, or
paralysis due to compression of the nerve is constantly pro-
gressive and is associated with a decreased power of work or
loss in value. The question as to the extent to which the dis-
ease affects the animal's capabilities solely depends upon the
type of work done. Whereas, a saddle horse is rendered use-
73f) Paralysis of the Recun-ent Nerve.
less by a moderate severity of the condition, a draught horse
or one that is used at slow paces may last for years.
In the early stages of the disease difficulty of respiration
appears even with severe work only after a long time, thor-
oughbreds are capable of running short races without distress.
Thomassen's investigations have shown that age is a factor
that comes into play, for disturbances are more severe in young
animals, presuming the extent of the disease of the nerve to
be the same, and also in addition to the paralysis of the mus-
cles, marked distortion of the whole larynx is more likely to
happen in young animals.
Treatment. In cases that set in acutely anti-rheumatic
treatment or treatment designed to combat acute catarrh of
the air jiassages appears to be indicated.
For the chronic form of the disease, Levi advises intrach-
eal injection of strychnine (0.01 to 0.05 gnn. in increasing doses
two to three times daily), or Lugol's solution (20 to 30 gm.), but
others have not had any results from this treatment. The
same applies to the internal administration of preparations of
iodine and arsenic.
Lindemann claims to have had recoveries in many acute
cases obtained by repeated partial closing of the nostrils, caus-
ing more powerful contractions of the dilators of the larynx.
In six cases, Tagg united the recurrent nerve with the vagus and
in three cases the roaring disappeared.
Giinther practiced resection of the sunken arytenoid and
of the vocal cord, an operation which was afterwards modified
by Stockfleth and Moller. Good results with this operation
have been recorded repeatedly, but in a proportion of cases
(according to Hirscli in 50 per cent) constriction of the larynx
reappears owing to contraction. Hirsch describes arytenoid-
ectomy as a very dangerous operation, and one to be consid-
ered only when it is a matter of lessening the dyspnea suffi-
ciently to permit a horse to carry out its usual work, but it
does not do away with the loud respiration. More recently,
Blanchard has practiced cricotomy or cricoidectomy, and has
cured seventeen animals out of thirty-six.*
Draught horses may be rendered serviceable by perform-
ing tracheotomy and inserting a tube, and this plan may be
applied to advantage even to race horses. Tracheotomy also
appears to have a beneficial effect upon the disease (Albrecht).
Bridles which partly compress the nostrils are not to be ad-
vised for although they tend to prevent the noise they impair
the animal's power.
If exact observations provide actual proof of the trans-
mission of the predisposition in special cases, it is advisable
to cease breeding from the animal transmitting it.
*Recently the Williams operation for roaring appears to give very good results and
extensive statistics show that about 70% of recoveries follow the operation. Hobday reported
140 cases operated upon with about 75 permanent recoveries. — (Editors' note.)
of the Larynx. Paralysis of the Suprascapular Nerve. 737
Literature. Agonigi, N. Ere, 1900, 305.— Albreeht, W. f. Tk., 1905, 305,
343._Beckniaiin, Z. f. Vk., 1891, 253.— Cadeac, Jouni. Vet., 1909, 30.— Dexler,
Nervenkrkh. d. Pferdes, 1899, 34 (Lit.); Ergebn. d. Path., 1900, Vii, 459 (Lit.).—
Friis, Maauedssk., 1905, XVli, 265. — Frohner, Monh., 1908^ XIX, 123.^Giittniann,
Z. f. Vk., 1908, 80.— Harms, B. t. W., 1906, 97.— Hirseh, Uber die Arytiiiiektoniie
usw. Diss. Leipzig, 1908 (Lit.).— Labat, Rec, 1900, 155.— Malknuis, D. t. W.,
1897, 19.— Moller, Das Kehlkoi)fpfeifen d. Pferde, 1888 (Lit.).— Miiller, S. B.,
1892, 25; 1893, 21.— Prietscli, ibid., 1905, 77.— Rosenfeld, Z. f. Vk., 1895, 161.—
Tayg, Journ. of comp. Path., 1904, 156.— Thomassen, Monh., 1904, XIV, 193,
289; Monatssehr. f. Psych, ii. Neurol., 1903, 423 (Lit.). — A'errier, Rec, 1883, 657.
— Vosshage, D. t. W., 1900, 209.— Walther, S. B., 1902, 167.
Spasm of the Larynx. (Spasm of the Glottis.) References to
spasm of the larynx in literature are very scant (Giinther, Gerlach,
Leblang, Ebinger, Dieckerhotf ) . Hutyra and Marek recognized one
case in a foal by examination with the laryngoscope. In one case
recorded by Degive it is probable that the stenosis was due to a growth
in the pharynx. The disease is very rare in the horse. Bedel has
recorded one case of spasm of the glottis in a dog.
The cause is (luite unknown, but it does not appear to be improb-
able that the condition occurs under the same circumstances as paraly-
sis of the larynx. The condition might he due to some nervous disorder
which does not lead to loss of conductivity of the motor nerves. At the
present time there are no facts to support the idea that the spasms may
be due to a neurosis.
The symptoms agree in the main with those of paralysis of the re-
current nerve, only the noise is in many cases quite unconnected with
movement, and may even disappear after long and vigorous exercise
(Gerlach). During an attack, closure of the rima glottidis can l)e discov-
ered with a laryngeal mirror. Hutyra & Marek are of the opinion that
this occurs only in horses that have had tracheotomy performed (Au-
thors' case).
In the differential diagnosis of the condition neoplasms of the lar-
ynx and pharynx and laryngeal paralysis must be taken into consider-
ation.
In the treatment of the condition an effort must be made to lessen
the nervous irritability by means of narcotics (morphine and chloral
hydrate). If there be great dyspnea, tracheotomy must be performed.
7. Paralysis of the Suprascapular Nerve.
Occurrence. Up to the present time this disease has heeii
observed almost exclusively in horses, but in these animals the
condition is not very rare. A case in a dog has been recorded
by Zimmermann, and a few cases in cattle by Kovacs, Bru and
Szekely.
Etiology. Paralysis of the suprascapular nerve is gener-
ally due to mechanical injury in the neighborhood of the
slioulder. It is caused principally by colliding with some ob-
ject or another horse, the nerve being injured where it turns
round onto the outer surface of the shoulder blade, and is
placed practically superficially an inch or two above the
Vol. 2-47
738 Paralysis of (he Suprascapular Nen'e.
shoulder joint. The nerve may he injured hy falling, slipping,
when an animal is cast, or through fracture of tlie scapula.
The superficial position of the nerve at the point where it turns
round the edge of the hone renders it possible for an injury
to happen in any position of the limb, and not, as supposed by
Moller, only when the leg is not bearing weight. Zimmermann
observed the paralysis in a dog associated with paralysis of
the anconeus.
Symptoms. Paralysis of the suprascapiilar nerve causes
paralysis of the supra- and infra-spinatus muscles, the deltoid
and teres minor. The result of this is that the leg moves
backwards and outwards when weight is put on it, and
especially when the weight first falls on it. During the
whole of the period during which the leg supports weight
a gap of variable size is left between the shoulder and the chest
wall. The horse is unable to abduct the paralyzed limb and
consequently is nnal)le to move over towards that side. While
the weight is upon both limbs, no abnormality may be visible.
In exceptional cases the paralysis is bilateral. Bru records the
occurrence of dropped shoulder in a cow associated with flexion
of all the joints below the elbow. At the onset the cow moved
on three legs.
The paralyzed muscles degenerate and undergo atrophy
about the second w^eek, and this atrophy may be so marked
that the muscles are reduced to soft, thin structures, the spine
of the scapula becoming very prominent. Experience with
peripheral paralysis in other parts permits one to conclude
that an electrical and a mechanical degeneration reaction should
be demonstrable in the more severe cases.
Diagnosis. In the diagnosis of this condition, rupture of
the muscles involved or of their tendons must be excluded as
these conditions cause similar symptoms.
Prognosis. Contrary to the opinion expressed by the ma-
jority of authors, who l)elieve that a larger percentage are in-
curable (Friedberger and Frohner 75 per cent) or are curable
only after several months, Schimmel ])elieves that in the ma-
jority of cases a cure can be effected. A general rule can
scarcely be laid down in this connection because the injury
received by the nerve varies from case to case. Recovery ap-
pears to be possible in many cases, as is seen in traumatic pa-
ralysis of peripheral nerves in general, but this rarely occurs
within a few days or weeks, it is generally only after a period
running into months or even a year that recovery is complete.
In some cases, the motor disturbances disappear with time,
but there is always a certain amount of atrophy remaining. No
opinion can be formed at the commencement of the disease as
to the result, it depends npon the further course taken by the
Treatment. Paralysis of the Kadial Nerve. 739
disease. The more rapidly the atrophy makes its appearance,
and the more rapidly it progresses, the later will be the cure,
or there may be no recovery. The animal will only be pre-
vented from moving at a fast pace, walking is not much
affected.
Treatment. Schimmel's treatment appears to be rational
and to have yielded very good results. His treatment consists
in massaging the aff'ected muscles for the lirst two weeks, pas-
sively moving the leg after the first fortnight, by extending
and flexing it, adducting and abducting, and then from the third
or fourth week, giving the horse systematic exercise. Elec-
tricity may sometimes be used with advantage, but the various
stimulants (strychnine, veratrine, etc.) appear to be almost
useless. As a general rule paralysis of peripheral nerves tends
to recover without treatment, provided the lesion is not suffi-
ciently severe to exclude the possibility of regeneration.
Literature. Bru, Eev. Vet., 1908, 741.— Kovacs, A. L., 1907, 495.— Maschke,
S. B., 1904, 181.— Sehimmel, O. M., 1900, 120 (Lit.).— Szekely, A. L., 1909, 040.—
Zimmermann, Vet., 1897, 576.
8. Paralysis of the Radial Nerve.
Occurrence. Paralysis of the muscles supplied by the
radial nerve is seen with comparative frequency in the horse.
In other animals it is far more rarely met with, but neverthe-
less it does occur, and principally in the ox and dog.
Etiology. The radial nerve is easily injured by traumatism
at the point where it is almost immediately under the skin, and
turns round the bone to reach the outer surface. This point
is just above the lateral epicondyle. In horses and cattle the
nerve may be crushed through ipalling, heavy draught, kicks,
or blows with the shaft, collisions, etc. Slipping backwards or
sprawling the leg forwards may cause injury to the radial
nerve. (Nietzold, Castagne.)
In many cases the paralysis appears to be partly due to
cold. Brauer records the occurrence of the condition simul-
taneously in three horses which were exposed to a cold wind
while w^et, but the s^anptoms rather appear to suggest that
the condition was one of muscular rheumatism. On the other
hand, there is sometimes radial paralysis after influenza. Froh-
ner and Moller have observed the condition in the dog, prob-
ably resulting- from distemper. Scoffie and Seres ascribe the
paralysis to neuritis resulting from inflammation of the axil-
lary gland. Hebrant records a case in which the radial nerve
was compressed by an enlarged axillary gland. Hansen ob-
served a case in an ox following the injection of tuberculin.
The cause is in some cases situated in the spinal cord. A
740 Paralj'sis of the Radial Nerve.
case in a liorse is recorded by Kutzner in wliicli there Avas si-
multaneous paralysis of the left radial nerve (associated with
paralysis of the anconeus) and of the crural nerves.
Frohner is of the opinion that the cause of the condition lies in the nmseular
tissue and that myositis leading to atrophy and paralysis result from excessive
strain of the muscdes. Tlie occurrence of muscular paralysis in the horse cannot
be denied and the credit of having adduced proof of this principally belongs to
Frohner, but the conclusion must not be drawn from observations in which no ex-
haustive investigations of the nerves were made that this kind of paralysis is of
more frequent occurrence than that of nervous origin. The superficial situation
of the radial nerve at the point indicated make it extremely probable that, in the
horse particularly, pressure on the nerve is of comparatively common occurrence.
Symptoms. In view of the fact that radial paralysis is
generally due to an injury of the lower portion of the arm,
and that in this situation there is only that part of the radial
nerve which supplies the muscles below the elbow joint, trau-
matic radial paralysis usually shows itself in a paralysis of
the extensor muscles lying on the forearm. It is only excep-
tionally that the sensory fibers supplying the outer surface of
the forearm or the motor fibers of the extensors of the elbow
joint are involved. If the injury is inflicted at a still higher
level, about the level of the shoulder joint or in the vertebral
canal, the paralysis involves the anconeus group of muscles.
During rest the shoulder and elbow joints are held ex-
tended and the rest of the joints flexed (fig. 106). If the limb
be forced back by pressure on the carpus, the weight is borne
by the limb and the position does not differ from the normal,
but if the animal moves the joints are flexed again and the
animal cannot straighten the limb. If the animal be made to
walk the limb is advanced by means of the extensor muscle
of the shoulder until it is vertically under the body or a little
further forward, the hoof wall being dragged along the ground.
Directly the w^eight is put upon the limb all the joints are
flexed, because the foot is not properly placed owing to loss of
power of the extensors. It is very difficult for the animal to
get up and sometimes quite impossible. The extensor muscles
are in a condition of relaxation both during movement and
rest, and in somewhat more severe cases atrophy soon sets in.
The elbow joint is somewhat lower than on the sound side
(Plosz). The sensibility of the skin and the distribution of
heat are not in any way abnormal. In some cases there is loss
of sensation or evidence of pain in the parts where the nerve
ramifies (Bossi, Hebrant).
If the extensors of the ell)ow are paralyzed at the same time
the motor disturbances are much more striking and these mus-
cles are also relaxed and atrophy soon occurs.
If the paralysis is incomplete the motor disturbances are
less ol)vious. During rest the animal may, for example, be able
to extend the limb to some extent so as to be able to bear some
part of the weight on it, but during movement the animal keeps
SymiJtoms. Diagnosis. Prognosis. Treatment. 74I
on stmiibliiig with the affected limb or advances it by jerks at
each step. If the paralysis be only slight the motor disturb-
ances are most obvious when the animal is made to move over
uneven ground.
In a case observed by Moller a horse lay down much of the time owing to
unilateral paralysis of the radial nerve and paralysis of the opposite side devel-
oped. Friis records a case in which there was radial paralysis on one side and
sciatic paralysis on the other, and Flohil and Kntzner have observed simultaneous
paralysis of the radial and femoral nerve in a horse.
Diagnosis. The condition is easily differentiated from pa-
ralysis caused by thrombosis of the axillary artery by the
facts that the pulse can be felt in that vessel and that tlie paraly-
Fig. 1U(). Paralysis of the radial nerve (Plosz).
sis is present during both rest and movement. Rupture of the
extensor tendons of the forearm can be excluded without
difficulty.
Prognosis. In the majority of cases the animal recovers
and sometimes within a few days, but if the paralysis has been
in existence for several weeks and there is already considerable
atrophy of the muscle recovery is still possible, but paralysis
is often persistent in such cases.
Treatment. Recovery may be hastened by applying the
treatment already mentioned on page 739.
Literature. Albreeht, W. f. Tk., 1903, 594 (Lit.).— Brauer, S. B., 1S90, 74.
— Castagne, Pr. Vet., 1905, 387.— Cinotti, N. Ere, 1905, 266.— Diem. W. f. Tk.,
1906, 503.— Flohil, Tidsskr., 1904, 486.— Frohner, Monh., 1897, VIII, 499.— Hebrant,
Ann., 1905, 417.— v. Kukuljevic, B. t. W., 1905, 714.— Kutzner, Z. f. Vk., 1904,
492.— Lutz, Monh., 1903, XIV, 532.— Nietzold, S. B., 1904, 79.— Williams, Vet.
Journ., 1906, 703.— Wyssmann, W. f. Tk., 1904, 645 (Lit.).
742 Paralysis of the Brachial Plexus.
Radial Cramp. This condition is fre(iuently seen in dogs that
have suffered from distemper. The muscles supplied l)y the radial
nerve show more or less rhythmic contractions. In one particular case,
the nerve was surrounded hy a callus involving both the bones of the
forearm at the distal end. In a condition of rest the toes were extended
and the slightest movement caused an exaggeration of the extension,
and rendered the outlines of the tendons clearly visil)le. An animal
which had ankylosis of both elbow joints fell down every time it tried
to move, and held the fore-legs extended downwards from the elbows.
There Avas no muscular atrophy; and the radial nerve was not painful
on pressure.
9. Paralysis of the Brachial Plexus.
Occurrence. Paralysis of all the nerves of the brachial
plexus is a very rare condition in the lower animals, owin,i>' to
the protected position occupied by it. It is seen most frequently
in the small animals.
Etiology. In the carnivora and the ax)es injury to the
brachial plexus is likely to happen when the animal is jumping
downwards, the axilla coming into contact with some rigid ob-
stacle. In a case recorded by Bayer in which the paralysis was
preceded by chorealike spasms, the paralysis was probably of
spinal origin. The disease is seen exceptionally in the large
animals (Frohner, Lanzilotti-Buonsanti), and, as in the case of
the small animals, may he caused by injuries to or bruising of
the shoulder, fracture of bones in the neighborhood, inflanuna-
tory conditions of the subscapular connective tissue, or by
neoplasms.
Symptoms. In cases in which the paralysis is complete
the affected limb hangs like a lifeless mass from the body and
is trailed along during movement. If the paralysis be incom-
plete the activity of all or of the majority of the nmscles is
affected to varying degrees. Passive movements are easily
carried out. Sensation is lost either in the entire limb or mark-
edly decreased, or it may be lost only in the areas supplied by
certain nerves, but it may be quite normal or even exaggerated.
Prognosis. Paralysis due to injury in small animals is
likely to be recovered from, but in the case of large annuals a
cure is rendered impossible owing to the fact that the animals
frequently lie down or remain lying down for long periods, and
also owing to complications.
Treatment. Treatment follo\vs the same principles as that
laid down for paralysis of the individual nerves of the brachial
plexus.
Literature. Frohner, Mouh., 1901, XIT, 210.
Etiology. Symptoms. Treatment 743'
10. Paralysis of the Sciatic Nerve.
Etiology. The following causes have been recorded : Kick-
ing (Albert), punctured wounds, falling from a height (Hol-
ler), falling (Polfiorow), and myelitis due to distemper. Pa-
ralysis of the sciatic nerve associated with paralysis of the fore
limb of the opposite side has been observed by Friis in the
horse and by Moller in the dog. In a case recorded by Labat the
l)aralysis was due to rupture of a pelvic abscess, and in one by
Cadeac to pressure on the nerv^e by a sarcoma. The disease is
observed frequently in dourine owing to neuritis.
Symptoms. In complete unilateral paralysis of the sciatic
nerve there is loss of power in the lower portions of the biceps
femoris and the semitendinosus, and of all the muscles below
the stifle joint. The animal is unable to flex the stifle joint, nor
can it flex or extend the hock or joints of the foot. In the con-
dition of rest the leg hangs relaxed, but if placed in the proper
position is able to support the body because the stifle joint is
fixed by the extensors attached to the patella and consequently
the lower joints are fixed. There is always marked flexion of
the hock. During movement the foot is dragged along the
ground and the weight of the body is borne by the toes in the
position of plantar flexion. In consequence of this the skin
covering the toes becomes abraded. There may be loss of sen-
sation in the portion of the limb below the stifle, but on the other
hand there may be hyperesthesia.
If the paralysis be bilateral the picture presented resem-
bles that seen in lumbar paralysis, but differential diagnosis may
be based upon the absence of functional disturl)ances of the
bladder and rectum, the normal sensilnlity of the inner sur-
face of the thigh, the active movements executed by the tail and
the hip joint. Atrophy tends to appear early in the paralyzed
muscles, as in all cases of peripheral paralysis.
Treatment. A cure may at most be looked for if the par-
alysis be due to an injury. The treatment indicated is that
advised by Schimmel for supra-scapular paralvsis (see page
739).
Literature. Cadeac, J. Vet., 1907, 396; Pr. Mil. Vb., 1901, 104.
Sciatica. In the neighborhood of Saglio in Italy, Giovanoli has
frequently observed in goats and cattle, a condition resembling sciat-
ica, due to an inflammation of the sciatic nerve. The condition was
thought to be due to cold and badly constructed staliles. The stalls
which were paved Mith stone were too short and were provided be-
hind with open drains that were too deep, -with the result that when
the animals were lying down, the hip joints were snlije; ted to great
pressure against the sharp edge of the stalls. In spite of the
fact that similar stable construction Avas found in other places,
744
Paralj'sis of the Sciatic Nerve.
no similar symptoms were observed. Serini records the occurrence of
a condition resembling sciatica in the dog.
Cattle that are so affected hold all the joints of the diseased limb in
a position of moderate flexion, and from time to time draw it slowly
up to the abdomen as if trying to ease the pain. They look round
at the belly at times, and start at every sound. An attempt is made
to prevent passive movements, and if one succeeds in extending the
limb passively the animal is likely to fall. Turning round is avoided
as much as possilile. During movement, the animals hop on the sound
limb, the diseased leg being dragged along cautiously. There is pain
on pressure along the course of the sciatic nerve. (Giovanoli, Schw.
A., 1891, XXXIII, 181.— Serini, 0. M., 1893, 316.)
Paralyis of the Tibial Nerve.
Paralysis of the tibial nerve alone is a
very rare condition. Only a small
number have been recorded, a few in
the horse (Moller, Pr. Mil. Vb., 1893)
and one in the cow (Schultz).
The animal was unable to extend
the hock, and flex the joints of the foot.
When the hock is motionless, the af-
fected foot is somewhat flexed (fig.
107), but during movement there is ex-
cessive flexion of all the joints ; and the
foot is put do^^^l awkwardly, the move-
ments recalling those of a fowl walking.
It is not impossible for the foot to bear
weight because the hock joint is fixed
by the gastrocnemius tendon. The mus-
cles on the posterior surface of the lower
thigh, and the flexor pedis are relaxed
and soon atrophy.
Cramp of the Muscles of the Tibia.
This condition has ])een frequently ob-
served in the horse (Strauss, Duschanek
and Hauptmann). The affected leg is
extended and directed somewhat back-
wards, and quite immobile. Neither ac-
tive nor passive movements can be made.
The tendo Achillis is tense and hard ;
and there is a deep groove between it
and the gemelli. At best, the animal can take only a few steps with the
other legs. The cramp is accentuated by mechanical and thermal stimuli.
The condition lasts at most from a few hours to a day, but very ex-
ceptionally for longer periods. The condition can easily be confounded
with outward luxation of the patella. (Duschanek, T. Z., 1906, 283.—
Hauptmann, ibid., 1906, 371.)
Paralysis of the External Popliteal Nerve. Paralysis of the per-
oneus is of very rare occurrence. Fillecke saw a case in a cow that had
caught its foot between two boards. Szidon records a case in a dog in
which the nerve was subjected to pressure by a shot, while in one
case in a dog, the paralysis was caused by creeping under the bed.
The condition has been observed in the horse by Darrou, the cause
107. PaiahMs of tlu" ti
neive (MoUei ) .
Paralysis of the Femoral Nerve.
745
being pressure on the nerve by a larval Hypoderma, while in one par-
ticular ease the paralysis was caused by pressure on the nerve by a
loop in a hobble-shank. Uhart believes that in the case in a horse
recorded by him the cause was a false step.
In cases of complete paralysis of the external popliteal nerve the
animal is unable to flex the hock and to extend the other joints of the
limb. When the leg is advanced the toes drag along the ground; and
when weight is put upon the leg, the foot rests with the dorsal surface
of the toes on the ground (fig.
108). If the phalangeal joints
are extended passively, the leg
is capable of supporting the
weight properly. According to
Giinther, the position occupied by
the pastern in the horse is more
vertical. If the paralysis ])e in-
complete, the animal stumbles a
lot during movement, and espe-
cially on uneven ground ; and all
the joints of the affected limb are
flexed at the instant that v/eight
falls on the leg. In the later
stages, in order to avoid stum-
])ling, the foot is intentionally
lifted higher and set do^^^l quick-
ly-
There may be no sensory dis-
turbance but in many cases there
is anethesia of the antero-lateral
surface of the lower thigh and
metatarsus. Atrophy of the mus-
cles and absence of reflexes may
be observed.
Paralysis due to injury gen-
erally disappears within a few
weeks but may persist longer.
Literature. Darrou, Eev. Yet.,
1902, 586.— Meoni, J. Vet., 190-'^,
166.— Szidon, Vet., 1898, 129.— Uhart
Eec, 1905, 291.
Fig. 108. Paralysis of the peroneal
nerve in a case of do urine.
11. Paralysis of the Femoral Nerve.
Occurrence. Paralysis of the femoral nerve in the lower
animals is of very rare occurrence owing to the protected posi-
tion occupied by the nerve.
Occasionally there is paralysis of the quadriceps femoris in the horse after
an attack of hemoglobinuria, which is due to a primary diffuse degeneration of
the muscles. According to Frohuer the majority of cases in the horse described
as paralysis of the femoral nerve are in reality cases of primary muscular de-
generation.
746
Pai-alvsis of the renioral Nerve.
Etiology. Injury to the femoral nerve is generally due to
over-extension wliicli may be due to slipping or falling with
the hind legs spread apart. In exceptional cases the disease
may be due directly to a splinter of bone being broken off, or to
extrava sated blood. Violent kicking may also cause Suretching
of the nerve. Paralysis following parturient paresis may be
due in exceptional cases to stretching of the femoral nerve.
Neuritis is sometimes the cause of the paralysis observed in
cases of donrine. Other causes are abscesses, hemorrhages or
tumors in the psoas muscles.
¥ig. ion. I'ai-alysis of tl
civc will
tVnioris.
irkcd atropliy of tlio quadriceps
Symptoms. Owing to paralysis of the quadriceps femoris
the animal is unable to hx the stifle joint when weight is put
upon the affected leg and the leg gives way in the other joints at
every such attempt (fig. 109). At the same time the stifle joint
is not extended sufficiently and consequently the leg is not ad-
vanced as far as normally. The patellar reflex is either absent
or exaggerated. There is a tendency to loss of sensation of
the skin on the inner surface of the thigh, and if the paralysis
persists there is atrophy of the quadriceps muscles.
Prognosis. If the paralysis is due solely to stretching of
the nerve and there is no atrophy of the muscles, recovery may
Paralysis of the Obturator Nerve. 747
be expected within a few weeks. In other cases animals \q;u\\
after some months to walk with safety, the atrophy of tlio
nmscles meanwhile gradnally disappearing totally or in ])i}vt.
Paralysis dne to pressnre on the nerve tends to persist for Jong
periods.
Treatment. Massage should be practiced and systematic
exercise shonld afterw^ards be given (see page 739).
Literature. Fiohner, Moiih., 1S97, ^'J 1 1, 499.— Flohil, Ti.lsskr., 1904, 4S().~
Grunth, B. t. W., 1904, 93.— Kiitzner, Z. f. Vk., 1904, 492.— Sehininiel, 0. M., 1901,
469.
12. Paralysis of the Obturator Nerve.
Etiology. The cause was not known in two ont of three
cases in horses recorded by Schimmel, while the disease resulted
in a dog that jumped down from a height and fell over back-
wards. Thomassen records one case, and Willis two, in horses
in which the paralysis was due to a callus of tlie pubis, and in a
case recorded by Nocard the nerve was crushed in a fracture of
the pelvic bones. The disease tends to appear in dourine.
Symptoms. During rest the position occupied l)y the limb
may be normal or there is more or less abduction. This abduc-
tion is more marked at a walk and still more at a trot, the ani-
mal hopping on three legs, and holding the affected leg in the
air in a position of abduction. In some cases there is marked
flexion of the hip joint and the stifle moves upwards and out-
wards. The step is shortened and consequently the annual
moves obliquely towards the opposite side. It is very difficult
for the animal to back, the affected leg is moved backwards
with difficulty only and is abducted during the movement. Ad-
duction of the leg is impossible.
The absence of other motor disturbances indicates simple
paralysis of the obturator nerve and subsequent atrophy lends
support to the diagnosis. Up to the present no sensory dis-
turbances have been observed.
Treatment. Recovery may be hastened by massage of the
paralyzed leg, followed by passive movements and systematic
exercise from about the third or fourth week (see page 739).
Recovery almost always occurs unless the nerve be subjected to
pressure.
Literature. Eexilius, Z. f. Vk., 1905, 72.— Schiniiiiel, O. M., 1894, 387; 190?,
242.— Thomassen, Monh., 1901, XII, 367.
748 Paralysis of the Sacral Plexus. Paralysis of the Gluteal Nerve.
13. Paralysis of the Sacral Plexus.
One case each of this kind has been recorded by Thomassen and by
Cadeac in horses in which there was gradual atrophy of the muscles
of the near hind leg, and also very marked atrophy of the muscles of
the left side of the croup. In Thomassen 's case the diseased leg was
lifted quickly upwards and inwards, and put down clumsily, there
being flexion of the fetlock joint. The left half of the croup, the outer
and posterior surfaces of the thigh, and the portion of the leg below
the stifle w^ere insensitive. Electrical and mechanical stimulation of
the muscles were without effect. In Cadeac 's case the animal lay for
the most part on the sound side, or was unable to rise after lying on
the diseased side. Thomassen found marked thickening of all the
nerves of the sacral plexus, an increase in the amount of epi- and
perineural connective tissue, with atrophy of the nerve fibers. These
lesions were probably caused by over-stretching of the plexus. On the
other hand Cadeac showed that the plexus was enclosed in a sarcoma-
tous growth. Giinther states that he has seen several cases of paraly-
sis of the sacral plexus in the horse.
Literature. Cadeac, J. A'et., 1907, 39G.— ThomaKsen, Monli., 1901, XII, 145.
Paralysis of the Gluteal Nerve. Subsequent to a difficult parturi-
tion, Cuny (J. Yet., 1907, 652) observed rapidly progressing atrophy
in the area supplied by the superior gluteal nerve in a mare. The
author believed that it M^as due to crushing of the nerve during the
parturition. There was no evidence of motor disturbance.
Paralysis After Parturition. This condition is most often ob-
served in cows from five to eight years old. According to Hess, it oc-
curs more fre(iuently in spring and summer and is intimately con-
nected vrith the parturition. According to this author, it occurs usually
after easy and rapid parturitions, while other authors associate it with
difficult parturition, supposing that the paralysis is due to compres-
sion of the sacral plexus, the sciatic, and obturator nerves, caused l)y
luxation of the sacro-iliac articulation. On the other hand, Franck
and more recently Hess, state that the paraparesis is produced re-
flexly by an injury of the genital passage. This view is supported by
the fact that a similar condition can be produced in the rabbit by
compression of the uterus. Possibly the paralysis may be caused by
luxation or contusion of the hip-joint and also by exhaustion (Hutyra
& Marek). The cases occurring after easy parturition, and uncompli-
cated cases, are scarcely distinguishable from parturient paralysis ; or
they may be the same thing (Hess, Albrecht, Zehl).
The first symptoms make their appearance either directly after par-
turition or towards the end of the first day. In exceptional cases their
appearance may be delayed beyond this. There is weakness of the hind
quarters, and the animals lie down. Once down, they are unable to
rise again. Otherwise the animals appear normal.
Treatment. If the animal does not get up of its own accord by the
fourth or fifth day, it may be made to rise by rubbing its tail between
two round pieces of wood, pouring water in its ear, hoisting it up with
Paralysis Before Calviiig. Paralysis of the Pudic Nerve. 749
hay-hands, hy pushing hay or faggots under it. If convenient, slings
may he used! Hess, Alhreeht, Zehl and others have fonnd inflation of
the udder with air, useful.
Literature. Albrecht, W. f. Tk., 1906, 741 (Lit.).— Hess, Schw. A., 1905,
XLVII, 279.— Zehl, B. t. W., 190S, 117.
Paralysis Before Calving-. This is a symptom of weakness, and
is seen in old cows that are in poor condition, or in cows that are weak
through long retention in stalls. It may be the result of fractures,
luxations, bruising, brittleness of the bones, or infiltration of the
muscles of the croup or pelvis.
14. Paralysis of the Pudic Nerve.
Occurrence. Paralysis of the pudic nerve appears to be a
very rare condition and it occurs exclusively in the horse.
Etiology. Paralysis of the penis may be due to traumatism
(a. kick in the perineum, bruising- against the bale, etc.), more
frequently it is associated witli influenza (Barrier, Frohner,
Scliulze). In some cases the cause cannot be discovered. In
one case Barrier observed, in addition to bruising of the peri-
neum, signs of chronic interstitial neuritis in the pudic nerve.
Frohner is inclined to attribute the paralysis following in-
fluenza to a disease of the spinal cord. In a proportion of cases
the cause of the paralysis appears to be in the muscles.
Symptoms. Owing to paralysis of the retractor penis which
is supplied by the pudic nerve there is protrusion of the penis
which later becomes edematous because of the obstacles offered
to the flow of blood and lymph.
In some cases recovery takes place w^ithin a few weeks or
months. In a case recorded by Roder recovery took place with-
out any treatment after five years. In the majority of cases
the paralysis does not appear to regress.
Diagnosis. Protrusion of the penis owing to surgical con-
ditions must be excluded before the disease is taken to be of
nervous origin.
Treatment. If the paralysis does not disappear after
several months amputation of the penis is indicated. This is
often followed by stricture of the urethra.
Literature. Barrier, Eec, 1899, 70.— Boos and Eomer, D. t. W., 1899, 348.
—Frohner, Monh., 1898, IX, 1; 1904, XV, 217.— Hoeg, Maanedsskr., 1899, XI, 209.
'50 C.mhinc.l ]\inilysis ..T tlic Tail and ..f the Spliiiicli
15. Combined Paralysis of the Tail and of the Sphincter.
In the horse a condition is sometimes observed whicli is
characterized hy paralysis of the spliincters of the anns and
bladder with simnltaneons paralysis of the tail. The canse of
this condition is a chronic interstitial nenritis of the canda
eqnina.
Occurrence. The disease, which has been known for a lon^sf
time, is confined to the horse. Marek's observations do not con-
firm those of several anthors who state that the disease occnrs
most frequently in mares. In Marek's observations 50% of
the cases were in mares.
Etiology. Chronic inflannnation of the canda eqnina is
caused by mechanical inflneuces. This may be severe and act
only once, or it may be slight and be in action for long periods
or come into action repeatedly, and may involve the mobile
candal vertebrae or even the sacrnm.
Wolff has frequently seen the condition result from fracture of the caudal
vertebrae and Marek has seen one similar case. Jn a case reported by Eubay fracture
of the sacrum led to chronic inflammation of the eauda equina, and in one ob-
served by Kuske and ]\Iarek the horse received an injury to the croup during trans-
port by rail. Marek observed the occurrence of the disease in a mare shortly after
copulation, in two horses after falling on the buttocks, and in a further case a
horse that was in somewhat poor condition had to l)e helped to rise by lifting on
the tail. In a case observed by Mayerstrasse there was also facial paralysis but
this in all probability was due to bruising while the animal was down.
Injuries to the croup or tail may obviously lead to bruising and consequent
temporary paralysis of the caudal nerves or may lead to the i)roduction of clinical
symptoms of neuritis of the cauda equina.
Anatomical Changes. The nature of the disease was eluci-
dated by the thorough investigations of Dexler and his results
have been confirmed completely by other authors (Cadeac,
Raymond, Rubay, Hutyra and Marek). According to these in-
vestigations the nerve roots in the vertebral canal posterior to
the end of the spinal cord and outside the dura mater are em-
bedded in a fibrous connective tissue which takes the form of
an elongated and often asymmetrical swelling, filling up the
sacral canal (figs. 110-111) and which extends into the inter-
vertebral spaces. In many cases one or more nerve trunks
leading to the brain are wholly or partly free but appear much
thickened. As a rule the inflammation does not extend further
forwards than the second or first sacral nerve roots, but in a
few cases the last two lumbar nerve roots were involved. Ex-
ceptionally the process involves the subdural section of the
nerve roots and even the pia mater of the cord. In recent
cases the connective tissue appears gelatinous, red in color or
beset with numerous hemorrhages (fig. 110).
Under the microscope it is seen that the nerve fibers are closely surrounded
by newly formed connective tissue. This tissue is very finely fibrolated and at
Anatomical Changes. Synii
751
places, especially arouinl the vessels, the walls of which are much thickened, it is infil-
trated with cells. In most of the nerve fibers the medullary sheath is degenerated
and in many bundles no fibers can be
made out. The cells of the spinal
ganglia show various stages of chroma-
tolysis and destruction of the nuclei.
The spinal cord appears normal and in
a single case only could ascending de-
generation of the posterior column lie
made out with certainty where the pro-
cess involved the intradural portion of
the nerve roots and the last two lum-
bar nerves were also diseased.
The muscles of the tail appear
for the most part degenerated and in
more advanced cases somewhat similar
lesions have been found in the mus-
cles of the croup. Of the peripheral
nerves the following are usually in a
condition of degeneration; the nerves
of the tail, the pudic nerves, the sn-
perior^ and inferior gluteal nerves, the
posterior cutaneous branches of the
dorsal branches of the sacral plexus
and the posterior hemorrhoidal nerve.
Symptoms. In the early
stages tlie sensory nerves are
stimnlatecl by the connective
tissue which gradually increases
in amount and contracts around
them, with the result that the
skin of the tail and the peri-
neum are hyperesthetic. In
consequence of this the animal
rubs these parts against any
rigid object and, finally, there
are symptoms of great restless-
ness. In a case recorded by
Dexler the onset of the disease
was marked by severe and per-
sistent priapism. The attend-
ants do not as a rule notice this
and the rubbing of the tail is
put down to other causes. The
matted condition of the hair on
the root of the tail indicates
that the animal has suffered
from severe irritation. In one
case (Hutyra and Marek) spas-
modic contractions of the
gluteal muscles were observed
if a loud noise were made or a
person approached the animal.
The other symptoms are
far more noticeable. The most
prominent is paralysis of the
Fig. 110. Terminal portion of the spinal
cord with the cauda equina from a case
of paralysis of the tail and sphincters.
L;)-LG last two lumbar nerves. S1-S5
sacral nerves, of wliich numbers 4 and
5 are enclosed, together with the first
two coccigeal nerves. C1-C2 and the
filum terniinale, in an elongated, thick-
ening which is much larger on the right
side. Between S5 and C2 there was
marked congestion and some hemor-
rhages were also present. The speci-
men was obtained from the horse shown
in fig. 112.
751
Combined Paralysis of the Tail and of the Sphincter.
tail. At the trot this hangs lifeless between the buttocks
and swings from side to side. At rest it is quite motionless or,
if the paralysis remains nnilateral for a time it may be moved
to one side only. During defecation and urination it is not
lifted. As a result of atrophy of the muscles, the tail appears
thinner than normal and in the later stages there is a depression
between the posterior and upper gluteal regions. As a rule the
atrophy is not symmetrical on both sides of the body. The tail
offers little or no resistance to passive movements to one or both
sides. The paralyzed muscles show electrical degeneration re-
action or the absence of electrical or mechanical irritability
(Dexler).
There is usually loss of sensation of the skin, the joints
and muscle of the tail, the perineum, root of the tail, posterior
gluteal region, mucous membranes of the rectum and vagina
on both sides, though perhaps not to the same extent. One side
alone may remain insensitive
for a time (figs. 112-133).
Pricking the muscles or
twisting the tail causes no
reaction. Similarly, heat,
cold and electrical stimula-
tion are without effect. In
the later stages there is
usually a narrow hyperes-
thetic zone bounding ante-
riorly the anesthetic area
(Hutyra and Marek), or
there may be circumscribed
hyperesthetic areas. This
hyperesthetic zone gradual-
ly advances with the exten-
sion of the area of anes-
thesia in the forward direction. The anesthetic area merges
into the area that is hyperesthetic or of normal sensibility in
many cases through a very narrow zone that is hypoesthetic.
There is marked retention of the feces and defecation may
be impossible. As a rule balls of feces are passed only during
exercise. The anal region is soiled with feces and in the case
of mares with urine, the sphincter is relaxed, the posterior
portion of the rectum is widely dilated and packed with feces.
Masses of feces project from the anus and after these are re-
moved fresh masses are pushed on from the anterior portion
of the rectum and again fill up the dilated portion (figs. 112
and 113).
For a time micturition is quite normal, but in the later
stages there are abnormalities in the manner in which the urine
is passed. Both during rest and movement it may be passed
in small jets without effort or it may be passed continuously in
Fig. 111. Combined paralysis of the tail
and sphincters. Cross section through the
Cauda equina shown in fig. 110 after fixa-
tion in Miiller's solution. Tlie dark areas
mark the position of the nerve fibers which
are surrounded by a large amount of con-
nective tissue.
Symptoms.
753
drops. Any increase of intra-abdominal pressure or move-
ment causes larger amounts to escape. Pressure on the bladder
causes a larger quantity to be ejected in a stream and when
the pressure is removed the stream ceases. In this case both
the sphincter and the detrusor urinae are paralyzed. In many
cases there is difficulty of micturition due to paralysis of the
detrusor urinae. The disturbances of micturition may in time
cause cystitis or may lead to the formation of calculi, which
may prove fatal.
There are no sensory disturbances and the appetite re-
mains normal. It is only when large quantities of feces collect
Fig, 112.
Fio-. 112.
Fig. 112. Combined paralysis of the tail and spliincters. The area marked with
horizontal lines was in a condition of anesthesia, while that marked with vertical
lines was markedly hyperesthetic. The anus was open and packed with feces. The
specimens shown in figs. 110-111 were obtained from this horse.
Fig. 113. Combined paralysis of the tail and sphincters. There was complete
anesthesia in the shaded area. The anus was relaxed.
in the rectum that the animals may show slight symptoms of
colic and these disappear when the feces are removed. If the
masses of feces are not removed the obstruction may be a
source of danger.
As a rule there are no motor disturbances, but in excep-
tional cases in which the process involves the anterior sacral
and the posterior lumbar nerves there are symptoms of lumbar
paralysis (Hutyra & Marek).
754 CumbiiK'd Paralysis of the Tail and oil llic Sphincter.
A case is recorded by Holterbach in which a calf showed severe periotbca!
restlessness and gnawing at the root of the tail. In this case the nerves of the
tail were compressed by a fibroma.
Course. The course of tlie disease is chronic. The first
symptoms generally escape observation, but within two or three
months they become pronounced and in many cases remissions
are observed. In some cases the s^anptoms may be fully de-
veloped within a month (Marek). With careful treatment the
animal may remain useful for a year or more, but it frequently
liappens that the animal dies before that from cystitis, or there
may be lumbar paralysis.
Diagnosis. In well developed cases the disease is easily
recognizable owing to the characteristic nature of the symp-
toms. The slow development is sufficient to distingiiish it from
contusion of the cauda equina or of the posterior part of the
sacral portion of the cord (fracture of the sacrum), and the
presence of the zone of hyperesthesia distinguishes it from
other diseases of the spinal cord. The condition is differen-
tiated from that caused by compression of the cauda equina
(Petit) by the discovery of a neoplasm (melanoma) in the sacral
portion of the spinal canal.
Treatment. The diseased process within the vertebral
canal is uncurable and consequently the symptoms due to it
cannot be removed. With careful treatment, however, an ani-
mal may be able to work for a long time. The masses of feces
which collect in the rectum must be removed by hand at least
twice a day, and the anal region must be kept clean. Suitable
treatment must be applied to the catarrhal condition of the
l)ladder.
Literature. Dexler, Z. f. Tm., 1897, I, 273 (Lit.) ; Nervenkrkh. d. Pferdes,
IsitO. 4-2 (Lit.).— Holterbach, B. t. W., 1904, 788.— Kiiske, Z. f. Vk., 1904, 389.—
Marchand & Alix, Eec, 1906, 353.— Marek, Z. f. Tm., 1909, XIII, 33.— Mayer-
strasse, B. t. W., 1898, 85.— Petit, Bull., 190r., 266.
16. Polyneuritis.
Under this term are included inflammatory conditions of
the nerves which involve several nerve trunks, either simul-
taneously or one after the other, but which are due to the same
internal cause.
Etiology. Investigation of a number of cases of dourine
(Marek) showed that the symptoms were due to an interstitial
inflammation of the nerve trunks which extended as far as the
dura mater of the cord (see Vol. I). The investigations of
Thomassen showed that in chronic lead poisoning in the horse
there is parenchymatous inflammation of various nerves. The
Etiology.
755
nerve that is iirst affected is the vagus and its branches. The
sympathetic suffers to a less degree, and in the nerves of the
extremities the lesions are very slight and cause no functional
disturbance. Vachetta observed polyneuritis in a fowl as a re-
sult of lead poisoning, but ]\Iarek was unable to produce the dis-
ease by introducing large quantities of lead into the crop. In
dourine it is principally the proximal portions of the nerves that
are affected, but in lead poisoning it is the distal segments.
An error will scarcely be made if it be supposed that there are other causes
of polyneuritis in the domesticated animals. The nervous symptoms seen in chronic
mercury poisoning are probably due in part to a polyneuritis, but the question
-yO^
Fif,^. 114. Cross section of the femoral nerve of a fowl affected with jjolyneuritis.
(a) Extensive infiltration of the endoneurium with mono-nuclear cells. (b) Scat-
tered i^ersisting nerve fibers, (c) Cross section of blood vessel, (d) Slight cellular
infiltration of the perineurium abutting on the epineural tissue.
whether mercury and other metals and viruses can cause polyneuritis cannot at
the present moment be answered with certainty. In a case recorded by Lellmann
as ' ' infectious polyneuritis ' ' the symptoms were in all j)robability due to chronic
ossifying pachymeningitis of the cord.
In Batavia, Eykmann observed a disease resembling beri-beri in
fowls after feeding with cooked rice. The disease had an incubation
period of three to four weeks or more, and on the grounds of histolog-
ical examination he stated that it was a polyneuritis. The disease could
be produced experimentally in fowls by prolonged feeding with de-
corticated rice; birds of prey and apes were refractory.
756
Combined Paralysis of the Tail and of the Sphincter.
The raw iinhusked rice Avas Avithout effect, but decorticated rice
warmed to 125° set up the disease just as is the case with rye.
From this fact Eykmann concludes that the husk of the rice and rye
contains some protective material which paralyzes the toxic power of
the decorticated grains in some way or other. Maurer and Treutlein
think that this kind of polyneuritis is due entirely to a chronic poisoning
with oxalic acid, large quantities of this acid being produced during
the fermentation of the rice in the crop, and this cannot be neutral-
ized by the husk, owing to tlie absence of calcium salts. In order to
produce the disease, the feeding must be continued for several weeks.
For this reason the condition described by Kellermann, which was pro-
duced by a single meal of rice was certainly not polyneuritis.
yO^
]iiis. 759
Ihere is severe parenehyniatous iiiflainniatioii of the smallest ln-anches of the periph-
eral nerves, destruction of the processes of the axis cylinders and of the nerve
sheath, while the nerve tnmks and the spinal roots are uninjured. A more or less
extensive chromatolysis of individual motor nerve cells was the only lesion that
could be demonstrated in the cord. Cassirer on the other hand was unable to fintl
any lesions in either the central or perijiheral nervous system, and is consequently
inclined to classify the condition as a functional nervous disease and connect it
with Westphal's "pseudosclerosis," a disease of the human subject.
No exact knowledge as to the nature of the disease is availal !e at the present
time owing to the variable or negative results of experimental investigations. Tak-
ing the general nature of the disease into consideration it appears to le most likely
that it is a polyneuritis. The negative results of the careful investigations of
Cassirer are not compatible Avith this supposition.
Symptoms. The most striking syniptoiiis in the early stages
are, as a rnle, excital)ility and fright. The animals have a
scared look and the approach of a person or animal is snfficient
to so frighten them that they stand and tremble. The appear-
ance of a dog may canse collapse and epileptiform seiznres. If
a hold be taken of an animal many of the mnscles are thrown
into a state of spasmodic contraction. It is especially the mns-
cles of the neck that are so affected, the head being drawn back
in consequence. On warm days in summer the ears hang down
and tremble, there is nodding of the head, and there may be
dilatation of the pupils and nystagmus. The animals appear
dull and depressed to a certain extent.
Gradually motor disturbances develop. Within one or two
months from the onset of the disease, and it is usually earlier
in warm than in cold weather, there is weakness of the quarters,
the gait becomes uncertain and at the same time peculiar trot-
ting-like movements are seen. The neck is extended and the
head dropped, the hind feet are separated widely from each
other, and very short, quick, tripping steps are taken, the joints
being flexed to a very slight degree. In exceptional cases the
feet are lifted very high and the animal walks like a fowl.
Owing to the weakness of the quarters the animal cannot move
quickly, much less jump over mounds or ditches. In the later
stages the fore limbs become weak, the animals stumble along,
keep falling down, rising being accomplished with great diffi-
culty. Pressure on the back causes it to sink. If an animal he
raised and set on its feet the joints are flexed or it falls on its
knees. Defecation and urination are normal up to the end. Ac-
cording to Cassirer the reflexes and sensibility to electrical
stimuli are normal.
In the majority of cases paresthesia and severe pruritus
are present. In the early stages the animals gnaw at the root
of the tail, the gluteal region and croup, and later the hind and
fore legs, or they rub these parts of the body against the wall.
In some cases they sit like dogs so as to be able to reach the ir-
ritating parts better with their teeth. The l3are patches pro-
duced by the rubbing and gnawing become inflamed, the skin
being reddened and thickened and covered with thick crusts.
According to Funke a scratching or pricking of the affected por-
tions of skin causes pronounced reddening.
760 Trotting Disease.
Ill spite of the fact that the appetite remains good up to
the end, emaciation, anemia, or hydremia, becomes more and
more pronounced. Finally the weakness of the hind quarters
becomes so great that the animals lie on the ground as if para-
lyzed, and emit hoarse groans. There is an offensive discharge
from the nose and mouth, but they still gnaw places that they
can reach. Finally they die from complete exhaustion.
Course and Prognosis. In the great majority of cases the
onset of the disease is insidious and its progress slow. There
may be apparent improvements from time to time, but the
disease terminates fatally in two to four months. In very oc-
casional cases the animals are in a condition of utter prostra-
tion within four to six weeks. The course of the disease tends
to be more rapid in summer than in winter, and in young ani-
mals than in adults.
Eecovery is very exceptional and when it occurs it is in
the early stages of the disease.
The disease spreads very slowly, but in some cases the
spread has been so rapid that in the course of a few years the
profits have been out-balanced by the losses sustained, so that
continued occupation of the farm becomes impossible.
Very occasionally there is a sudden outbreak of the disease
on a farm previously free and within a short period great losses
may be experienced, especially among the young lambs.
Diagnosis. Timidity, motor disturbances and especially
the peculiar gait, and the intense pruritus combine to form a
characteristic collection of symptoms.
The cardinal symptoms mentioned are not presented by
every case, but since a number of animals are always affected
at the same time the incomplete series of symptoms presented
by any individual animal can often be completed by examina-
tion of other animals. Diagnosis is most difficult where only a
few animals are affected, as in the case of newly purchased
rams, and when the symptoms presented by such cases are not
characteristic. More extensive observations will furnish evi-
dence as to the nature of the disease.
The disease may be distinguished from other diseases char-
acterized by pruritus, and in particular from scab, by the fact
that the skin appears to be healthy save for the lesions caused
by the rubbing. In other diseases no motor disturbances are
observed. Canurosis has often been mistaken for this disease,
the development of cysts in the vertebral canal sometimes caus-
ing sacral paralysis, but in coenurosis there is never any timid-
ity, trembling or pruritus.
Treatment. Up to the present no satisfactory treatment
has been devised, and the animals should be slaughtered as
early as possible.
Treatment. Prophylaxis. 761
Prophylaxis. A rational plan of breeding must be adopted
and all pampering of the animals must be avoided. The great-
est care must be exercised in the matter of the purchase of
fresh animals as these may be the source of infection to the
whole flock.
After symptoms have made their appearance it is a matter
of the greatest difficulty to check the spread of the disease.
The affected sheep and those that have been in immediate con-
tact should be isolated, and the remainder of the flock should
be removed to a high-lying district.
Literature. Besnoit, Eev. Vet., 1898, 397.— Besnoit & Morel, ibid., 1899,
265.— Cassirer, V. A., 1898, CLIII, 1.
Section IV.
FUNCTIONAL DISEASES OF THE NERVES.
{Neuroses ivltho'iit Known A)iatoniical Basis.)
In contradistinction to the ori>anic diseases of the nervons
system the nenroses may be classified with those aihnents which
are not associated with any visible anatomical changes in the
nervous system and which, besides, arise as independent clinical
forms of illness.
Owing to lack of research in nervous diseases, a proper
division cannot yet be made in veterinary medicine between ac-
tual neuroses and those affections causing- similar swiptoms, but
which are due to organic diseases of the nerves or to other dis-
orders of an organ of the body.
1, Megrims. Vertigo.
By megrims one understands a conflict arising between
the sensations of movement and position causing a loss of
equilibrium and a sense of dizziness. This sensation causes in
man a feeling as if his own body or, on the contrary, the neigh-
boring ground moved in a certain direction; immediately the
sense of equilibrium becomes uncertain and finally the conscious-
ness is affected and swooning occurs. The subjective sensa-
tions of animals under such circumstances are withheld from our
innnediate notice, but animals are sensible to these disturbances
of movement and, the nature and manner of innervation in
them being similar to those in man, it may with justice be as-
sumed that attacks of vertigo in animals mil be accompanied
by similar false sensations.
Since the wliole of the or^^aiis of sense are more or less concerned in the sensa-
tions of movenient and position, certain functional disturbances of one particular
organ of sense can cause vertigo, yet the vestibular or the apparatus of vision includ-
ing their central areas are chiefly concerned because they especially enable one to see
and find one's way about.
Since one only has knowledge of the final sequel of vertigo, in animals, that is
of the disturbance of equilibrium, he is comiielled at i)resent to ascribe the vertigo
to a transitory derangement of consciousness and not to consider it a real vertigo
due to disturbance of equilibrium.
762
Occurrence. Etiology. 763
Occurrence. Attacks of vertigo are chiefly noticed in
horses and dogs. Generally it is, with very few exceptions,
that draught horses fall ill, whereas blooded horses and those
of the hardy country type are seldom afflicted.
Etiology. In the domesticated animals megrims scarcely
ever occurs as an independent affection (vertigo idiopathica s.
essentialis), but as a rule as a secondary ailment (vertigo
symptomatica).
Brain diseases may above all form the basis of megrims.
Hyperemia, hydrocephalus, tumors, parasites, contusion and
hemorrhage into the brain, emboli of the cerebral vessels, in-
flammation of the brain and its coverings come under this cate-
gory in about equal proportions. Also diseases of the cerebel-
lum and its adjoining parts of the brain are, in all probability,
often accompanied by true vertigo.
Sometimes vertigo is associated with defects of vision.
Observations of attacks of megrims through disturbance of the
motor power of the eye muscles have not been recorded but it
is certain that suitable external irritation of the organs of
vision can produce attacks of staggers, as many observations
prove. Thus horses are at times attacked with vertigo when
travelling on unequally lighted highways, between two rows of
trees, or when moving quickly under a rising or setting sun,
when running round in a circle for a long time, or when objects
move quickl}^ before their eyes as in railway journeys. Besides
many authors blame the glistening inner surface of the blink-
ers which reflect rays of light for causing attacks of vertigo.
Of diseases of the organ of hearing, affections of the laby-
rinth or of the n. vestibularis may occasion megrims (compare
Meniere's disease).
Disturbances of circulation may result in vertigo (n. car-
diaca) such as every form of heart weakness, compression of
the veins, pericarditis, growths inside the pericardium or in
the neighl)orhood of the base of the heart. In this connection,
compression of the superficial veins in otherwise healthy horses
may be noted; this may be due to parts of the harness (the col-
lar or throat latch) or to the head being pulled and held in (in
draught horses). Far more readily may cerebral anemia cause
attacks of megrims.
Of the diseases of the digestive organs, intestinal catarrh or
helminthiasis (v. verminosa) sometimes lead to attacks of dizzi-
ness.
Violent irritation of the skin may occasion an attack es-
pecially if occurring on the injured skin; Guibert has seen an
attack of vertigo after simply brushing over a short clipped
fetlock.
Finally megrims occurs as a symptom of acute poisoning
and indeed as a result of a direct eff'ect of the poison on the
central nervous system. Such an effect is produced by alcohol
764 Megrims.
and by the other narcotics, as also by some poisonous plants
(Solaniim, Equisetum, Lolium temulentiim and reed, Phrag-
mites communis, etc.).
Symptoms. Horses are attacked chiefly when at work. The
animal suddenly manifests a staggering, slackened or uncertain
gait or it suddenly stops, nodding or shaking the head, snorting
conspicuously, pulls back in its harness, leaning against the
pole or the neighboring horse, after stopping they spread the
feet apart, the head is held sideways, the horse sways in the
direction of the inclined head, or presses with uplifted head
backwards or with sunken head forwards. These disturbances
of equilibrium sometimes last only a few seconds and the at-
tack is soon over so that after a short time the animal can con-
tinue its work. In other cases the animal completely loses its
equilibrium, loss of consciousness occurs and often also nystag-
mus, the animal collapses, falls (vertigo cadnca), and remains
for a long time lying quietly, then it commences to kick, suddenly
stands up, shakes itself and appears all right again. If the
attack occurs in the stable, the horse staggers to and fro with
outspread limbs, holds its head up or to one side, hangs on the
halter strap, or leans against the partition or wall and suddenly
falls to the ground. The course of vertigo runs similarly in the
other species of animals.
At the beginning of an attack the animal shows great anx-
iety, its gaze is fixed, the pupils are dilated, respirations are
quickened and sweating is general all over the body. Dogs fre-
quently vomit and at times urinate and defecate involuntarily.
Individual attacks last barely for one or two, exceptionally
up to five minutes, but recur at varying intervals of time. Horses
that are subject to vertigo are most frequently attacked during
work and in warm weather, whilst in winter they are seldom
affected. When being led or ridden, horses subject to vertigo
are seldom attacked.
The name vertigo abdominalis was formerly applied to a disease i)ecidiar to
horses. Its symptoms on the one hand were severe tligestive disturbance (diminished
appetite, colic, tympanitis) and on the other great dullness and possibly also forced
movements and great excitement. Such attacks were repeated, and finally after some
hours or days the patient recovered or at times died. It is very probable that this
affection was due to poisoning by plants.
Seasickness causing a dizzy feeling is occasionally seen in animals. Damoiseau
saw it in an Arab horse transported from Syria to France. On the first day, the
animal was depressed, alternately bending and stretching his head, neighing often,
trembling all over his body and vomiting after each feed for four days ; in eight days
he had recovered. Bering has repeatedly seen the same illness in dogs.
Diagnosis. Vertigo may at all times be mistaken for epi-
lepsy; it is differentiated, however, from this affection by the
absence of convulsions. Restiveness and fright are scarcely
noticeable since in these the disturbances of equilibrium are
Meniere's Disease. Paralytic Vertigo. 765
absent. The cause of vertigo is hard to establish and its dis-
covery is especially necessary in newly bought horses.
Treatment. At the beginning of an attack of megrims the
horse should immediately be unharnessed and by supporting the
head and shoulders the animal is prevented from collapsing.
Covering up the eyes, and cold douches to the head, also exercise
a favorable influence. If the fall cannot be avoided, one must
at least take care that the animal does not injure itself. After
the passing of an attack, a judicious rubbing of the body and
limbs has a good effect.
The treatment is directed to the cause of the vertigo and if
this can be ascertained complete recovery may be expected. By
judicious care and cautious use of the animal, by removal of the
disturbing blinkers, as well as by the employment of proper
harness, the best results will be attained.
Literature. Dexler, Nervenkrkh. d. Pferdes, 1889, 231.— Guibert, Eec, 1899,
725.— Hering, 8pez. Path., 1858, 658.— Lustig, D. Z. f. Tm., 1878, IV, 17.
Meniere's Disease. (Vertigo ab aure laesa, V. labyrinthina.) By
this is understood in human medicine, vertigo, caused by a neurosis of
the nerves of hearing and which is accompanied by strong buzzing in the
ears. The affection is often caused by disease of the arched passages of
the membranous labyrinth which is well known to play an important part
in the preservation of equilibrium.
A similar morbid condition was noticed by Fleming in several
horses with the following symptoms : The animal suddenly shook one ear,
bent its head to the same side, moved in a circle or pushed to one side,
had a fixed gaze and finally fell on the side on which it shook its ear;
after a time it stood up but remained excited for a long time. — Similar
cases have been noticed in horses by Frohner, and Lellmann saw one in a
cat which afterwards became deaf. — (Fleming, The Vet., 1891, 466. —
Lellmann, B. t. W., 1902, 776.)
In chicken pest similar attacks of vertigo (twisting of the head, nod-
ding of the head, circular movements, rolling) have been noticed in hens
(Centanni, Ostertag & Wolffhiigel), and oftener in geese, further in arti-
ficially infected young pigeons (Vol. I). The authors saw similar symp-
toms in two hens affected with purulent otitis or purulent inflammation
of the petrous temporal bone.
Paralytic Vertigo. (Vertigo paralysans.) Gerlier noticed in the
Canton of Geneva among laborers and herdsmen repeated peculiar
attacks of vertigo with passing paralysis of different muscles, occurring
as an epidemic. He also saw similar attacks in the same neighborhood in
several cats. The symptoms were as follows : the animal stopped suddenly,
shook its head often to one side, and finally bent it until its nose
touched the ground. In severe cases, the animal fell on its belly, and re-
mained a few minutes lying motionless on the ground. After the passing
of the attack the animal stood up again and moved about in a normal
way. Many times on account of the relaxation of the muscles dramng
down the lower jaw pseudotrismus was observed. During the attacks the
animal did not see although consciousness persisted. The attacks were
766 Epilepsy.
ivpcated at intervals and always during walking or wlien partaking of
food. Hitherto such attacks oidy came under notice in winter and in
such cats as persistently stayed in a warm place, for instance near an
oven. Gerlier assumes an infection. The ilhiess lasted only a few weeks
and then ceased entirely. (Gerlier J. vet., 1891, 507.)
2. Epilepsy. Epilepsia.
{FalViug Siclxurss; Morbus cad}(C}(S, MoiIjus saccr.)
Epilepsy is a clironic illness occiirrins' periodically niaiii-
festiii.^' itself by severe (leraiigemeiit of consciousness accom-
panied by tonic-clonic spasms.
From true epilepsy (epilepsia vera s. idiopathica s. genuina), which
is characterized by the chronic course and its hereditary transmission, one
should separate epileptiform spasms (epileptoid conditions) [Weygandt,
Dexler, Sarbo]). These occur from time to time in certain organic
diseases of the brain, further as a reflex effect in painful affections of
other organs or of the peripheral nerves and are generally kno\ni as
symptomatic epilepsy (epilepsia symptomatica s. secundaria) or as reflex
epilepsy. Since however little consideration has been given to this dis-
tinction in animals a separation of the two forms has not been accom-
plished in practice, and therefore the last mentioned cases have been
considered here.
Occurrence. In the domestic animals true epilepsy prob-
ably occurs only very seldom (Lafosse noticed 4 cases in 130,000
horses examined, and Dexler none in 25,000). No great reliance
can be placed on the records of older authors in which true epi-
lepsy often figiires, because they did not distingTiish the reflex
epilepsy which more frequently comes under notice in the do-
mestic animals. Secondary or reflex epilepsy is most frequently
met with in clogs, less often in cattle and swine and only excep-
tionally in the horse, it is not uncommon in parrots, canaries and
turkeys.
Lafosse found 22 epileptic subject^ ..i..oiig 130,001) liorses, 7 anionic IG.oiui
cattle, a7ie frightened to death from quite trivial causes (?). According
to Dexler these cases are due to pathological and degenerative peculiarities of an
hereditary nature similar to the sensory disturbances in dancing mice and albinotic
deaf animals.
Literature. Besnoit, Eev. vet., 1901, 349.— Castelet, D. t. W., 1900, 312 (Eev.).
—Dexler, B. t. W., 1908, 970.— Soulet, Eev. gen., 1905, VI, 471.— Tapken, D. t. W.,
1899, 353.— White & Plaskett, Am. v. Eev., 1904, 1167.
4. Puerperal Convulsions.
{Eclampsia puerperalis.)
In connection with parturition there occurs a peculiar con-
vulsive illness chiefly noticed in bitches, but occasionally in other
female animals. In the course of an attack consciousness does
not, as a rule, appear to be visibly disturbed. The last men-
776 Puerjieral Convulsions in Bitches.
tioiied circiuiistaiice and the fact that the trouble is associated
with i^artiiritioii distinguishes the affection both from epilepsy
and eclampsia, and appears to justify its separate treatment.
(a) Puerperal Convulsions in Bitches.
(Socalled Eclampsia of Bitclus.)
Etiology. The affection, al)out the character of Avhich
nothing is known, is noticed most frequently in pampered pure
bred bitches.
The localization of the irritation which produces the spasms may be in the
cerebral cortex, in the subcortical motor centers, or in the anterior horns of the spinal
cord, but as consciousness is undisturbed until the end it is probable that the two
last structures are concerned most often. In view of the fact that similar convulsions
are observed in strychnine poisoning and in tetanus it is not out of the way to
assume that the spasms are due to the direct effect of some toxins which are formed
somewhere in the body, possibly in the organs of generation, and act on the motor
cells of the anterior horns of the spinal cord. This view is more credible than the
hypothesis of Friedberger & Frohner, who believe that the immediate cause is to be
found in a peculiar reflex irritation arising in the udder or uterus and bringing about
anemia of certain centers of the brain. Eeul sees a certain etiological similarity
between this disease and parturient paresis. It cannot be wholly rejected that the
affection represents, as do puerperal convulsions in general, an anaphylactic phe-
nomenon brought about in the course of pregnancy by the homogenous, specific
placental albumen, so that after the absorption of considerable quantities of placental
tissue anaphylactic symptoms arise. The eclampsia of lying-in women is nowadays
considered in many cases in the nature of anaphylactic shock.
Yassale produced eclamptic attacks in three pregnant bitches by extirpation of
the parathyroid glands, and these could be brought to a standstill by the administra-
tion of large doses of parathyroidin. On this account he assumes that in a latent
parathyroii(l., 185.3-54, 101.
794 Spasm of the Nerves of the Diaphragm.
8. Spasm of the Nerves of the Diaphragm.
{Spasui of the diaphragm, socalled ahdomiual piilsatiou;
choree du diaphragme [French].)
Spasm of the nerves of the diaphragm consists in twitch-
ing of the muscles of the diaphragm.
History. The condition which prodnecs convulsive jerking of the
body was for a long time attributed to palpitation of the heart or to in-
creased pulsation of the aorta, but recent observations have shown that
it is due to muscular spa.sms which are even at this time very often mis-
taken for spasms of the abdominal muscles. With the aid of a consider-
able number of available observations Thomassen made a careful study
of the illness, and more recently Ziirn has undertaken an analysis of
the symptoms in two cases.
Occurrence. Spasm of the diaphragm is not uncommon in
horses, but is observed exceptionally also in cattle (Paimans,
Bach, Lucet) and also in dogs (Marek). The greater number
cases described under this name belong without doubt to
spasm of the abdominal muscles.
Etiology. Rather often digestive disturbances, or acute
stomach ailments precede spasm of the diaphragm or it occurs
as an accompanying complaint to intestinal catarrh or stoppage
of the bowels. In these cases the spasm is probably a reflex
condition being produced by an irritation occurring in the
mucous membrane of the stomach and intestine being communi-
cated through the n. vagus to the medulla oblongata, and from
there to the diaphraginatic nerves, and possibly also to the
nerves of other muscles. The effect of chemical substances ab-
sorbed from the intestinal canal does not appear to be excluded,
in fact, it appears probable in many cases.
In some cases the spasms are not dependent on digestive
disturbances, but may arise after excessively severe work or
after psychic excitement. In these cases Haubner & Siedam-
grotzky believed that the diaphragmatic nerve was irritated
by the agitation due to strong beating of the heart, or that for
some reason the nerve had become more irritable. Thomassen
and Langendorf on the contrary believe that the nerve w^hich
passes over the heart muscle is irritated l)y the electrical current
generated at every systole, the irritation being capable of caus-
ing a spasm only in a nerve that had become irritable.
The connection between the heart movements and the
spasms of the diaphragm is indicated by the fact that the num-
ber of the two contractions in many cases coincide, or in cases
where the contractions of the diaphragm occur less frequently,
these immediately follow upon the heart beats.
But even if such a connection exists, the spasm of the diaphragm cannot be
attributed without further evidence to the heart action, as is shown by a case of the
Symptoms. Diagnosis. 795
authors in a dog. In this dog, which was suifering from catarrh of the stoiaach and
bowels, spasms of the diaphragm occurred in equal number to the heart beats and
immediately following these; besides spasms were observed, far less often and at
quite irregular periods of time, in different muscles at the head, neck and limbs.
The common origin of the spasms was plain enough here, and yet the contractions
of the diaphragm followed the heart beats.
At times the spasms are observed in acute inflammatory
diseases of the thoracic organs, especially of the serous mem-
branes or of the pleurae. Finally myelitis in the neighborhood
of the center of the diaphragmatic nerves may occasion spasm
of the diaphragm (personal observation).
Symptoms. The disease is manifested by peculiar rhyth-
mic jerkings of the body, which are strongest along the arches
of the ribs, and at first sight give one the impression of very
strong heart beats. At each convulsive movement there is a de-
pression in the neighborhood of the costal arch, whilst at the
same time the portions of the abdominal wall, which are situ-
ated further back, especially in the region of the epigastrium
the flank, bulges out somewhat; the intercostal spaces on the
contrary, along the whole extent of the lower part of the chest
or only in the posterior third of the chest show spasmodic re-
traction. With the flat hand one can distinguish short power-
ful beats in the region of the lower ribs, and these become
gradually weaker in all directions.
The number of impacts may coincide with the heart beats
and then the convulsive jerkings immediately follow upon the
heart b,eats. With an accelerated heart action the movements
become more frequent; far more often, however, the number
of pulsations is higher or lower than the heart beats, or no
regular relation between the two can be established. In two
cases of the authors the spasms of the muscles of the
back ceased for a short time on percussion of the back. From
the nasal orifices one may distingaiish a sound similar to that
of a sol)bing, but it must not be mistaken for that which is
caused in clonic spasm of the abdominal muscles, by the jerky
and short expirations. The animals appear restless and gener-
ally show no appetite. The condition hardly ever lasts longer
than two days.
Diagnosis. The only characteristic signs of spasm of the
diaphragin are the bulging out of the epigastrium and flank,
which are synchronous with the convulsive jerkings, and at the
same time the simultaneous retractions of the intercostal spaces.
In doubtful cases the hand introduced into the rectum up to
the place where the diaphragm is attached will immediately
detect the convulsive movements of the latter. The clonic
spasm of the abdominal muscles may be distinguished in that
one can see the contractions of the abdominal muscles, or feel
them with the hand placed in the flank, and moreover a retrac-
796 Local SpasQis in the Muscles of the Head, Body and Extremities.
tioii of the epigastrium and a bulging* out of the intercostal
spaces occurs svnchronoush" with the convulsive movements.
Treatment. The increased irritability of the diaphragmatic
nerves and the spasms themselves may disappear without any
treatment. Only Perrin noticed a fatal result in the horse. As
a rule it is sufficient to keep the animal ciuiet, yet one can hasten
improvement by subcutaneous injections of morphine (0.30-0.50
gm. for horses, 0.01-0.02 gm. for dogs), because the spasms cease
entirely in half to one hour after a single injection. Any digestive
disturbances that are present must of course be remedied
(change of food, internally neutral salts).
Literature. Dupas, Eev. vet., 1906, 548.— Klingberg, Z. f. Vk., 1906, 23.—
Perrin, Bull. spec, des vgt., 1906, 49.— Thomassen, Ann., 1892, 17 (Lit.). — Ziiru, D.
t. W., 1905, 25.
9. Local Spasms in the Muscles of the Head, Body and
Extremities.
(Tic.)
Clonic spasms or twitchings occurring in the muscular tis-
sue of different parts of the body are characterized by the fact
that they are never associated with disturbances of conscious-
ness, they are limited to single muscles or to the territory sup-
plied by single nerves, and that a certain uniformity and regu-
larity may be observed in this case, or even when several parts
of the body are affected. These peculiarities distinguish this
form of spasm on the one hand from epilepsy and eclampsia,
and on the other from chorea, for which it is frequently mis-
taken. Most cases recorded in literature under the name of
chorea belong to this category.
Etiology. In certain cases which need here not be consid-
ered in detail, the cause of the spasms lies in organic disease of
the central or perhaps exceptionally the peripheral nervous sys-
tem. As neuroses the convulsions may be occasioned by poisons
which are not known exactly. This must 1)e considered when
the spasms are due to intestinal inflaimnation, catarrh, diges-
tive disturbances or to other diseases, as is the case not infre-
quently (in one of the authors' cases purulent pleurisy). In
many cases, however, they are perhaps due to reflex causes.
Thus Lienaux noticed extensive spasms after opening an ab-
scess on the neck of a dog, but they ceased after packing of the
abscess cavity. A similar occurrence was noted by Krammel
after docking the tail of a horse. Gunning saw the occurrence
of such spasms in a horse after castration (after separation of
the spermatic cord recovery resulted), whilst in Bartolucci's
case spasms limited to one-half of the body were occasioned by
Symptoms. Prognosis. 797
a trauma. In a considerable number of cases the causes re-
mained unknown (as for instance in cases described as chorea
by Anacker, Schleg", Albrecht and Besnoit).
Symptoms. The spasms occur ahnost exchisively in tlie
form of twitchings, with which only very rarely short tonic
spasms are associated. The number of twitchings is very vari-
al)le and may be equal or different in all the involved muscles.
Rather often the twitchings are more or less plainly rhythmic;
quite irregular contractions, now in this and then in that muscle,
as in chorea, are never ol)served. The spasms usually continue
during rest, but as a rule occur less often, and are less power-
ful, than when some external influence arouses the attention
of the animal. They are usually transient and disappear after
a few days or several weeks. With the exception of those
spasms that arise from severe basic diseases they occasion little
or no disturbance of the vital functions of the animal, and do
not impair their working power unless they involve a consid-
erable area.
The clinical picture varies according to what muscles aie
attacked, and how many are affected. Spasms in the region
of the facial nerves will draw the lips back by jerks and close
the eyelids, etc. Uni- or bilateral spasm of the muscles of
mastication will cause gritting of the teeth, which may be
audible some distance away (Dexler, personal observation). If
the neck muscles are attacked the head nods or moves convul-
sively to one side, whilst spasm of the back muscles causes curv-
ature of the back upwards, downwards, or to one side. Bilat-
eral spasm of the oblique abdominal muscles causes contrac-
tions of the abdominal wall, depression of the epigastrium, and
a visible bulging of the intercostal spaces, or also an upward
curvature of the loin region; a unilateral spasm on the con-
trary produces a curvature of the body to the same side besides
contractions of the abdominal Avail on the affected side. If the
extremities are included in the attack then the joints are bent
at times or are extended by jerks, whereby peculiar dancing
movements are produced so that the animal lies down frequent-
ly or constantly. Contractions of the muscles of the skin coin-
cide with those seen in getting rid of flies. In given cases the
spasms occur in manifold combinations. In one case in a horse
the authors succeeded in relieving the spasms of the muscles
of the back for a short time by tapping the liack.
Prognosis. In spasms arising from organic disease of the
nervous system or from deep seated inflammation of the diges-
tive organs, the prognosis is unfavorable in accordance with
the nature of the primary disease, but convulsions from other
causes mostly disappear after a short time, at the latest after a
few weeks.
798 Tetany. La Teial)ladera. Basedow's Disease.
Treatment. Al)ove all one should endetn'or to find out the
cause of the complaint. Besides, irrital)ility of the nervous sys-
tem may be counteracted with narcotics (bromine, chloral hy-
drate, opium, morphine). The spasms generally disappear,
however, in time without any treatment.
Literature. Kramell, Z. f. Vk., 1905, 498.— Lieiiaux, Ann., 1897, 479.— Polil,
Z. f. \k., 1909, 22.5.— Villeinin, J. vet., 1905, 601.— Ziirn, D. t. W., 1905, 25.
Tetany. (Tetania, Tetanus intermittens.) As tetany one desig-
nates in human medicine, according to Striimpell, attacks of tonic and
generally painful spasms which in most cases occur symmetrically on
])oth sides, and which preferably affect the flexor muscles, whereas the
body, neck or head muscles are seldom attacked. In the intervals be-
tween the spasms, the electric, and especially the galvanic, as Avell as
also the mechanical irritability of the peripheral nerves is increased.
A further important diagnostic sign is that the spasm can be lirought
on ])y pressure on the trunks of the great arteries and nerves. The out-
come of the disease is usually favorable. This neurosis has hitherto been
noticed chiefly in nursing women, further in connection with certain
acute diseases, as well as freiiuently after the extirpation of goitre, and
in dilatation of the stomach.
Gunning (Am. v. Rev., 1895, No. 12) claims to have noticed tetany
in a recently castrated horse in which adhesion had occurred between the
spermatic cord and the scrotal wound ; the tetany disappeared immedi-
ately on separation of the adhesion. Since the horse Avas not examined
for the characteristic symptoms of tetany the case cannot be accepted as
proving the occurrence of tetany in animals.
La Tembladera. This is an intoxication disease occurring very fre-
([uently in herbivorous animals in the Argentine Republic. According
to Rivas & Zanolli this disease is brought about by a thread fungus para-
sitic on Festuca Hieronymi, but indigenous animals are immune. Six to
ten hours after eating the plant fibrillary spasms arise in different mus-
cles, likewise dullness and roughness of the coat. After a few hours
swaying movements of the whole body occur both laterally and length-
ways. At first these convulsive movements are but slight, but after a
day or more they become so strong and occur so suddenly that the ani-
mal can only preserve an upright position with great difficulty, and
at times falls dovai. After a further 2 to 7 days the patient remains
lying down but shows spasms or nuiscular stiffness in the neck and ex-
tremities. After a decided rise in the pulse rate the liody temperature
sinks as low as 34° C. and in 4 to 14 days the animal dies, unless ap-
propriate treatment (employment of purgatives, pilocarpine, arecoline,
eserine) is undertaken. (Rivas & Zanolli, La Tembladera, Revista de
la Fac. de Agron. y Veter., 1909, V.)
10. Basedow's Disease. Morbus Basedowii.
{Goitre ophtliahnique [French] ; Grave's disease; Exophfhahn'w
Goitre.)
History. In veterinary literature there are few references to this
disease since it was first ol)served in man by Basedow in the year 1840.
Jewsejenko, Cadiot, Marek, Ries have noticed a similar kind of iHness
Etiology. Syniptoiiis. Trealnient. ^99
in the horse Roder and Gorig each in a cow, and Jewsejenko and Son-
nenberg each in a dog Even if all these cases do not exactly con^spond
^Inf rl''* i^^^^^T^^^'" ^ ^^^^^^«^' y^^ a ±'^^^' aiid especially the case
Etiology. In recent times disease of the thyroids has been
Tontl"'^ "' ^'''IT '''''Y'^' ^' ^' ^ primary affection since
/LnP.t!^"''''^^ of hyperplasia they secreted more abundantly
(hypeithyrea) and perhaps also produced a toxin (dystliyrea')
Wnv rl-^f If aterial on circulating in the blood, caused vaso-
motoi disturbances (Mobius). According to this view, there-
fA^r fi" • • ^^*^V'^|^i«/- according to this view, tliere-
toie, the illnes^s is an intoxication brought about through an
abnormal function of the thyroid glands". This theory which
as the most adherents is still further supported by the fact
that loss of the thyroids causes an exactly opposite clinical
picture (cachexia strumipriva).
Symptoms. The disease is characterized by three cardinal
F?^fTh T^"^' '^™"' exophthalmus and tachycaiSa!
fnnlril T ^If ^^g'^^^^^^\^?f the thyroids is said to make its
appeal ance. In the cases hitherto observed, one or the other
or both lobes of the thyroid gland were enlai'ged to twLe t eh'
size and more, smooth, of firm consistence ami tense; the en-
larged lobe may reach to the middle line, and may extend well
backwards Albrecht found on dissection three supplementary
glands which were united to the enlarged thyroids ) ^
Ihrough exophthalmus (protrusion of the eyeballs) the ex-
fhrnHfi./'Tff ^^""''^'^^y staring and anxious. This causes
the oiifice of the eye to be opened too widely, and conse-
quently the hds close less frequently and incompletely. Be-
sides, a flow of tears is noticed, and on raising the head the
l3hn 'V'f ^^^S^;^".^)^ }^'' movements of the eyeball (Al
biecht). Roder and Gong have observed a marked ^strabismus
convergens m cows which, however, indicates the presence of
an organic brain disease.
Palpitation of the heart may generally be noticed from a
the wW'/r7 ^''f'^ Yf* '^^"^"^8- ^^'' ^^f^ «i^^^ «f the chesl or
1 1 of +1 ^^ noticeably; sometimes one sees besides a pulsa-
tion of the superficial arteries (Cadiot)
These symptoms are not always present in like degree,
the exophthalmus, and still more the palpitation of the hear
disappearing altogether temporarily, taie' rapid and paroxis-
mal onset of the disease may be accompanied now and then bv
othei symptoms, such as timidity, trembling and languor. ^
r)it.tTnr*?!!f''*' il^'^'r ' •? r ^PPli^^tions to allay the heart pal-
p tation, internally digitalis or narcotic agents may be em-
ployed. In obstinate cases partial extirpation of the thvroid
glands may be tried, which experience shows has repeatedly
800 Enzootic Cretiuisiii in Animals. Psychoses.
given good results in man and is also without danger in ani-
mals as a case of llies's pro\es.
Literature. Albrecht, W. f. Tk., 1895, 233.— Bircher, Ergeb. d. Path., 1894,
I, 1, Abt. 5.— Cadiot, Bull., 1892, 138.— Gorig, D. t. W., 1898, 306.— Marek, Vet.,
1894, 310.— Eies, Eec, 1899, 145.— Roder, S. B., 1890, 77.— Sonnenberg, B. t. W,,
1906, 554.
Enzootic Cretinism in Animals. In regions where endemic cretin-
ism occurs in man (especially in the enclosed valleys of the Alps,
Pyrenees, in Franconia and in the Palatinate) frc(iuent cases of cretin-
ism were also observed in dogs, and were investigated by Cerletti &
Pernsini, v. Wagner and by Uexler. The disease may possibly occur in
the other domestic animals also, although the cases hitherto described
under this name probabl}^ l)elong to chondrodystrophy (socalled fetal
rickets). Von Ilansemann saw a case of cretinism in a jackal.
The cause of cretinism is found in a congenital complete failure of
the function of the thyroids in consecjuence of disturbances in develop-
ment or disease of the thyroid gland under the influence of unknown
local injurious factors. Disturbances of metabolism thus caused re-
sult on the one hand in anomalies in the growth of the bony system
aiid the soft parts, and on the other hand in disturbances of the de-
velopment of the brain, and pyschotic symptoms due to them.
■ The symptoms consist usually in a moderate enlargement of the
thyroid glands, by a short and compact spinal column, with a large
and short skull ; the extremities are short and clumsy and the neck is
short and thick. Rolls of skin are seen, especially on the head and
neck, which cause the anterior part of the body to seem developed ex-
cessively in comparison to the hind part. Such animals frequently
suffer from digestive troubles. Psychic abnormalities are especially
prominent, being chiefly characterized by apathy. Although the senses
are not much impaired the voice of the animal is strangely weak and
it is apathetic, its ability of observation and of association is impaired,
and its whole demeanor stupid, sleepy and lazy (Dexler).
A condition similar to cretinism may be induced experimentally by tliyreoidec-
tomy (cachexia strumipriva), as the exi)eriments of Lanz, and especially those of
Zietzschniann prove. This is true particularly in young animals, whilst adult animals
become ill only after many mouths, and present a somewhat different clinical picture.
By treatment with thyroid gland these symptoms can, as a rule,
])e made to disappear completely or in a great measure. The thyreoidi-
num depuratum (1 dessertspoonful of the solution 0.1:100 internally)
or the thyreoidinum Poeld (0.3-0.6 gm. 3 to 4 times daily) mny be used
for this object.
Literature. Dexler, B. t. W., 10(10, 391, (Lit.).— Zietzschniann, Mitteil, a. d.
Grenzgeb. d. Med. u. Chir., 1908, 353 (Lit.).
11. Psychoses.
As true psychoses (mental disorders) are designated in
human medicine diseases of the cerebral cortex which are
diffuse and usually only functional. They develop independ-
ently, run a clironic and afebrile course and are characterized
Psychoses, qa-i
exclusively or principally by abnormal symptoms of psychic
liie (Psyche). ^ "^
There is no doubt that most organic diseases of the brain, produce seeondarv
psychotic symptoms, if it so happens that the cerebral cortex is involved in sympaSy
with the psychic processes, yet these diseases cannot be reckoned as psyJhoses L an
exact sense, because on the one hand their nature depends on the o r g^^^^^^^^
referred to, and because on the other hand the psychotic syinptoms onlyTrm a part
ance I?7he"'las? n ent' "''f' '"' ''' bodily (somatic) symptoms remai^ n aC
^rr;,.o ^^ il i mentioned eases were considered as true psychoses then most
diseases of the bram must rank as psychoses.
Some veterinary authors have endeavored to prove by
certain symptoms that true psychoses can occur in animals.
-But the question remained unanswered how many of the visible
actions of otherwise healthy animals depend on psychic pro-
cesses or on the contrary on reflexes, automatisms and fatigue,
which ot course have nothing to do with the psychic functions.
J^ mally a new analysis of the observed symptoms was under-
taken. Dexler has shown that only the occurrence of organic
diseases of the brain can be considered as proved, and that
these diseases may be connected with more or less pronounced
psychotic symptoms, which, however, may not be mistaken for
independent psychoses. The study of the symptoms arising in
given cases must be approached circumspectly with proper con-
sideration of the direction advanced by Dexler and of the ele-
ments of comparative psychology and general psvchopathology,
and one must hold strictly to the accepted definitions of psychia-
try if one wishes to avoid confusion in the matter. It is fur-
ther necessary to keep in mind that the nervous system of ani-
mals IS not exposed to nearly so many injurious influences as
IS that of man m whom the various means of enjoyment, also
certain infectious diseases (especially syphilis), affect the ner-
vous system frequently and for prolonged periods on account
ot the comparatively long life. The reaction of civilization
upon the psyche becomes manifest in man in an increasingly
greater degree and no natural selection opposes the extension
of morbid tendencies by heredity, as is usually the case in ani-
mals when certain transmissible anomalies make their appear-
ance. For these reasons true psychoses can be expected in ani-
mals_ only very rarely if they occur at all, and their diagnosis
requires above all the elimination of organic brain diseases by
means of careful clinical and, especially, histological examina-
tions.
The psychotic disturbances which hitherto have been observed in animals have
been taken to correspond with the following psychoses of man.
To Traumatic Early Psychosis (a traumatic dementia) the cases described by
Fierqum (1838; cited by Cadiot) as "accidental dementia" are said to belong
f a young cat after a fall into a well suffered all through its life from weak
mental faculties. A talkative parrot crept into a hiding place during the long con-
tinued thunder of cannons, and when later he was taken out of his hiding place he
had lost his" vocabulary," and during his whole life afterwards could only make an
attempt to imitate the noise of the cannon. In the first case there was probably a
Vol. 2-51
802 Psychoses.
chronic disseminated distemper encephalitis, and in the parrot a traumatic lesion of
the brain, v. Kaliseher has proved experimentally that injury of a definite part of
the mesostriatum in parrots abolishes their power of speech.
In a case observed by Pierquin a previously healthy and very lively young cat
was attacked with something like an "anxiety psychosis"; the animal became as
if fascinated at the first sight of a dog; it watched the dog with anxious look, was
motionless and stupid, and recovered only after several hours, the dog having been
removed in the meantime. In this case there appears to have been simply a violent
fright of a more than usually sensitive animal, similar to that in the so-called ' ' faint-
ing goats" (see page 77.5).
In this category would also belong the mad rush of a herd of animals (taking
fright in a body, stampede, animal panic). But there is no valid reason for con-
sidering these as acute psychoses, because in such stampedes it is less an un-
thinking factor, the sensing of a danger and the transmission of this idea upon
all individuals of a herd, that is here active, but rather reactions to external in-
fluences, based upon instinct (Dexler). Stampedes, especially in horses, and not sel-
dom in cattle, camels and mules are not rare moreover, and may be very fatal in the
course of war or manoeuvres. The impetus to a stampede is apparently always af-
forded by the abnormal excitement of one or several individuals and finally it causes
an unreasoning flight in which the animals run blindly against obstacles or precipitate
themselves into fire or water, etc. A blind, unreasoning flight is now and again
noticed in single animals.
Straaten saw paroxysmal attacks of nervous symptoms in 12 cows of different
herds after a severe fright. These were manifested by shaking of the head, stagger-
ing, falling down, stretching of the limbs, loud bellowing, labored breathing and
diarrhea. In half an hour the attack was over.
To the affective psychoses especially melancholy, a case is supposed to belong
which was observed also by Pierquin in a dog. An old dog went about sorrowfully
after the death of his master, took insufficient food and finally became affected with
marasmus, dying in a few months. Neither during life nor after death were the
various organs examined for any derangement, and therefore internal illness leading
to nutritional disturbances was not eliminated.
The three cases of psychic paralysis in dogs recorded by Aruch (1889) exhibit
a great similarity to disturbances caused by compression of the spinal cord. Nor
can exact proof be deduced from the case of supposed psychic paralysis in an
epileptic horse, recorded by Girotti, since no anatomical examination was made.
Albrecht (1903) reports upon nervous disturbances in a dog whose extensor
muscles of the fore and hind limbs together with the muscles of mastication refused
to act after certain influences. By strong stroking or tapping of the back, the dis-
turbances were made to disappear. When these attacks became more and more
frequent, the dog finally became incapable of standing upright, and fell away rapidly
in condition. As the examination of the brain gave negative results (the spinal cord
was not examined) a psychic illness with pronounced symptoms of inhibition was
supposed to have been present.
Staggers of horses was in many instances mistaken for a kind of "circular
delirium." Gleisberg (1865) says in his text book of Comparative Pathology, that
' ' idiopathic delirium ' ' among animals, especially horses, is represented by staggers ;
he identified the socalled mad staggers with the paroxysms of "idiopathic de-
lirium." On the other hand, Vogel (1888) grouped the maniacal symptoms together
under the name of "mania transitoria" and considered them to be due to organic
disease of the brain, nervous predisposition, sexual excitement and so forth. Ziirn
(1899) agrees with Gleisberg 's view concerning staggers in horses, and Hoffmann
(1899) also classes staggers and restiveness with the mental diseases without, however,
attempting an analysis of the symptoms. Finally, even a prominent psychiatrist like
Ferg (1895) considers that staggers of horses is very similar to the "mental con-
fusion" of man. But if one considers that the circular delirium of man in the ma-
niacal stage is characterized by a hilarious ill-temper and by acceleration of cortical
association, and in the melancholy stage, by morbid primary depression, primary
inhibition of thought and frequently also by motor inhibition (Ziehen), the idea of
allying staggers with the psychoses in man that have been mentioned, will have to
be given up, the more so, as staggers is based upon organic brain disease.
By many authors the disseminated subacute or chronic encephalitis of distemper
has been taken to be dementia paralytica (paralysis progressiva). In a case de-
scribed by Cadiot (1896) in a three year old dog, previously very lively, which had
been forgotten in a railway carriage and in consequence made a journey of 79 hours'
duration, a certain idiocy developed after a few weeks, while a two year old dachs-
hund observed by Nissl, suddenly became ill with nervous symptoms. Both cases
call to mind the appearances of distemper encephalitis, and the histological changes
Psychoses. 803
found by Nissl coincide with those found later by Dexler after a painstaking analysis.
The same applies to the eases of sub-acute meningo-encephalitis of Marchand, Petit
& Peeard, in which the authors draw a parallel between the histological changes
found and those encountered in paralysis progressiva in man. But in reality the
clinical as well as the anatomical changes in dementia paralytica are fundamentally
different from those of the above named forms of encephalitis.
Further hysteria is also said to occur in animals. This was first asserted by
Higier (1898) in connection with his observations in a cat and a canary bird. In
both animals a paralysis arising from traumatic causes disappeared after a severe
fright. The assertion is not supported by detailed clinical evidence, and an histologi-
cal examination which might perhaps have shown evidences of some organic disease
of the nervous system (traumatic lesion) was wanting. In a canary bird Losonczi
noticed a loud chirping and then a lifeless appearance lasting for a short time, when-
ever the cage of the bird was taken down; the first attack occurred, as in Higier 's
case, after a cat jumped at the cage. Grobon likewise claims to have seen
hysteria in cats. The cases of alleged hysteria in dogs reported by Mainzer (1906)
have been criticized by Dexler, and the latter has shown that hysteria in animals
occurs, at most seldom, or not at all, because it is prevented by the specifically animal
mentality, by the inability to coordinate the relations of phenomena one to the other.
Further, motor inhiliition due to strong impression upon the senses, which was
studied carefully by Yerworn and which is quite frequent in animals, may be mis-
taken for motor disturbances that have an emotional basis. Vageler, among others,
even assumed the existence of a supposedly imaginary pregnancy and took it also
to be a sign of hysteria, but Kehrer explains these cases as being due to auto-
intoxication with lutein which after an unfruitful oestrum is formed by the slowly
retrogressing corpus luteum, and after its absorption produces an affection of the
nerves which causes the milk glands to swell and secrete milk, so that the animal
becomes restless and prepares for parturition.
Besides, the sexual perversity which is not uncommon in animals has been fre-
quently attributed to a degenerative psychopathic constitution (psychic degenera-
tion). Thus Cadiot relates that a 1% year old dog used to play with the hens in the
fowl yard, and developed the habit of covering one of the hens (whether immissio
penis occurred into the cloaca is not stated). A similar case was described by
Villemin in a 10 months old dog, which had the habit of seizing a hen, holding its
head fast with its mouth, and attempting to introduce his penis into her cloaca.
The misused hens were killed by this violence; only one hen allowed the rape with
resignation. Finally Holterbach noticed sexual intercourse between a bull and a
mare. The last named author attributed the penetration of the vaginal wall of a
cow by a powerful bull during covering to sadism. It would have to be proved, whether
these and similar abnormalities of sexual life are actually to be considered as
evidences of an abnormal psychic condition, for it is very easily possible that the
perverse sexual intercourse is merely the result of a frequently agitated sexual desire
arising from non-gratification of the normal sexual appetite, perhaps a kind of
onanism or simply a phase of detumescence. In man also all onanists or pederasts
can hardly be said to be mentally deranged or psychically degenerated, for the
sexual perversity can without doubt be the result of psychoses, but it has often been
observed independently of such a cause (Weygandt). Karsch and Lomer have given
numerous examples of abnormalities of sexual life in otherwise healthy animals. In
this connection the observation of Albrecht is also interesting where a dog with
prostatitis which emitted an odor like trimethylamin, was jumped by other dogs or
attracted them in like manner as if he were a bitch in heat.
Enzootic cretinism in animals may be (see page 800) associated with tlie
psychoses of man from congenital defects.
Literature. Albrecht, W. f. Tk., 1900, 161.— Dexler, Ergebn. d. Path., 1900,
VII, 401 (Lit.) ; Monatschr. f. Psychol, u. Neurol, 1904, XVI, 99 (Lit.) ; D. t. W.,
1906, 525; 1908, 289; 1909, 61; Neurol. Cbl., 1907, 98 (Lit.); Die Tierpaniken, A. f.
Psych., 1907, XLII, 2 (Lit.); Zur Diagnostik d. psychotischen Krankh. d. Haustiere,
Prager Med. Wochenschr., 1908-1909, XXXIII (Lit.).— Ebbinghaus, Abriss. d.
Psychologic, 1908.-~Gleisberg, Lehrb. d. vergl. Path., 1865.— Goldbeck, D. t. W., 1902;
201.— Grobon, Eev. vet., 1907, 172.— Hoffmann, O. M., 1899, 1.— Holterbach, D. t. W.,
1905, 519; B. t. W., 1905, 217.— Karsch, Paderastie u. Tribadie bei d. Tieren, 1900
(Lit.).— Kehrer. Die Umsehau, 1909, 171.— Lomer, Neurol. Cbl., 1906, 513.— Main-
ler, ibid., 1906, 438.— Marchand, Basset & Peeard, Eec, 1906, 813.— Straaten,
Maanedsskr, 1905, XVII, 1. — Vageler, Die Umsehau, 1909, 157. — Verworn, Die sog.
Hypnose d. Tiere. Beitr. zur Phvsiol. d. Zentralnervensystems, 1898. — Weston, Bee.,
1905, 180.— Ziehen, Psychiatric, Leipzig, 1908.
Diseases of the Organs of Locomotion
1. Articular Rheumatism. Rheumatismus Articulorum.
{Polyarthritis Rlieumatica.)
Articular rheumatism is a febrile infectious disease in
which several joints are attacked by a serous or sero-fibrinous
inflammation at one time or one after the other.
As rheumatism {ptvixa, flux of the laity, because they believe that
the disease material flows about in the body) acute inflammations of
the serous membranes, synovial capsules, muscles and nerves have al-
ways been designated, which arise from cohl, are accompanied by violent
pains and usually attack several parts of the body at once or in turn.
Recent investigations proved that most diseases called rheumatism re-
sult from infection, cold being at most a predisposing cause, and that
the complaint often occurs without the intervention of cold. While the
name is at present still used generally to denote certain muscular and
joint affections, this is only done in order to indicate the manner in
which the disease extends and also the frequent connection of the attack
with catching cold, but a common cause of the diseases called rheumatism
is no longer accepted.
Occurrence. The disease occurs relatively most frequent-
ly in cattle, very rarely in dogs (among 70,000 sick dogs Froh-
ner found only 92 cases), horses (Pfeitfer, Tetzner, Frohner,
Pancritius, Knabe), swine, goats and sheep; in the last two
species of animals it was noticed as an enzootic (by Greswell
in sheep, by Barthelemy in goats). Among cattle, mostly deli-
cate good milkers become ill, oxen are atfected much less often,
and almost mthout exception only if they are kept in the barn
for long periods, while grazing animals are scarcely ever af-
fected.
Etiology. Improper keeping of the animals, especially
feeding on watery fodder of no food value, appears to exercise
a predisposing effect. A much more common influence in this
direction is exercised by cold, damp air and draughts, especial-
ly if they strike the animal standing in a warm barn. Finally
Etiology. 805
all the external influences which cause chills and colds may be
considered as causes. Consequently the illness is observed
most frequently in the spring and autumn.
Cows may fall ill with symptoms of articular rheumatism
a short tmie, 5 or 6 days, after calving. The disease occurs
especially after calving or after the retention of the afterbirth.
The course of articular rheumatism and its close connec-
tion with various diseases which at present are known to be
decidedly infectious (endocarditis, sero-fibrinous inflammation
of the serous membranes) seem to point to the fact that the
actual cause of joint rheumatism is some infection. In ad-
dition, it must be mentioned, that in connection with infectious
diseases of certain organs (uterus, udder, and so on) an in-
flammation arises clinically, corresponding A\ith articular rheu-
matism, concerning the infectious source of which there can
be no doubt.
The view that articular rheumatism is an infectious disease re-
ceives still more support from the recent bacteriological investigations
on sick persons (Guttman, Petron, Buday) which repeatedly gave posi-
tive results, and according to which the pus producing microorgan-
isms, especially streptococci, play an important role in the production
of articular rheumatism. Wassermann and Meyer express the same
view, while von Striimpell found staphylococci as well, and Thiroloix &
Rosenthal attributed the disease to the bac. perfringens var. rheuma-
tismi._ Considering the great similarity of the symptoms in animals to
the disease in man bearing the same name, there can now scarcely be a
doubt but that joint rheumatism of man is also caused by an infection.
In man articular rheumatism is usually preceded by catarrh of the pharynx.
Meyer cultivated streptococci from the tonsils of persons suffering from articular
rheumatism, and with their cultures he succeeded in producing not only a sero-
hemorrhagic inflanimation of the joints, but also an inflammation of certain serous
membranes, and in some cases even a verrucous endocarditis. Giirich expressed it as
his opinion that a connection between articular rheumatism and angina can no longer
be disputed. ^
Lenhartz indeed claims that in man he has always found the exudate in diseased
joints free from bacteria and considers those cases where streptococci are found in
the joints as not belonging to the category of articular rheumatism. But the negative
findings of Lenhartz do not argue against the infectious nature of articular rheuma-
tism, since bacteria growing in any internal organ can exert an inflammatory effect
m the joints through toxins circulating in the blood stream, or it may be that the
bacteria imprisoned in the articular cavities disappear soon after the onset of in-
flammation.
The results of investigations in man, further the observation that cows fall ill
with symptoms similar to articular rheumatism a short time after parturition, after
an abortion, or if the afterbirth is retained, support the view that articular rheuma-
tism in animals is, in most cases, if not in all, a secondary disease, in such manner
that the infectious material itself or its toxins reach the joints from any, even
slightly diseased, organ by way of the blood stream, possibly with the stimulation of
predisposing causes, and set up an inflammatory process therein. This view is
strengthened all the more by a case of typical articular rheumatism which was recently
observed by Knabe and which had developed in association with a pharyngitis. There
is therefore no ground for separating diseases similar to articular rheumatism from
this disease in so far as they do not represent the partial symptoms of specific infec-
tious disease. Such affections are inflammation of joints, arising bv metastasis after
parturition, in connection with a mastitis, or with other internal disease. Yet many
authors (Hess, Guillebeau, Ehrhardt. Strebcl, Moussu, Loblanc & Bitard and others)
still deem such a separation necessary. It would not have a proper basis even if it
806 Articular Rheumatism.
were established that articular rheumatisni in a number of cases actually does not
arise from a primary disease, because many diseases are known which, although
always caused by the same infectious material, now occur as a primary and again
as a secondary disease.
Anatomical Changes. Yellow gelatinous infiltrations are
formed in the i:>eriarticular connective tissue. The synovial
fluid of the affected joint appears more or less increased, yel-
lowish red and turbid ; it contains at times shreds of fibrin, or is
exceptionally like pus. The synovial membranes appear swol-
len, injected, traversed by small hemorrhages, their inner sur-
face is velvety in consequence of swelling of the articular vil-
losities, the cartilage of the joint is bluish red, and later on
Fig. 117. Arlicular Nltcianatism in a Coir. Inilaniniatioii of Jloth Carpal Joints.
yellow, its surface feels somewhat rough. — In chronic cases the
synovial capsule and the surrounding connective tissue is
lardaceously thickened (tumor albus). — These changes will
generally be found at the same time in several joints.
In addition inflammatory processes will also be found in
the tendon sheaths and sometimes also in some of the internal
organs. When the disease continues for a long time great
emaciation occurs.
Symptoms. The inflammation of the joints, which is char-
acteristic of the disease, almost always sets in suddenly and
affects several joints at the same time or consecutively. The
trouble is rarely limited to one joint. Favorite localizations
Symptoms. Course. 807
are the stifle, carpal, hock and fetlock joints. A prominent
symptom is acute pain, and as a result the animal goes lame
and resents the joint being handled, seeking to avoid its being
subjected to passive movement. On standing at rest the affected
extremity will be bent (Fig. 117) and in case several feet are
affected at the same time the animal remains lying do^vn. The
diseased joint and its neighborhood are swollen, hot and tense,
in severe cases fluctuating in places. The local symptoms of
inflammation become milder after a certain time, generally after
one or two weeks ; they may also disappear within a very short
time, but frequently reappear later on in other joints. In this
way the inflammation may attack most of the joints of the ex-
tremities in succession, while the other joints are affected only
exceptionally; at times, however, the same joint is attacked
repeatedly, and finally deformity of the joint occurs, whereby its
mobility suffers an increasing restriction.
At the commencement there occurs a febrile rise of tem-
perature, and at times the s^aiiptoms of fever precede the local
symptoms.
The rise of temperature is usually considerable (40.5-
41.0° C), and at the same time the breathing is quickened and
shallow, while the number of pulse beats may be double the
normal.
The appetite declines, rumination is suppressed, the dis-
charge of feces is retarded, the urine is dark in color, its quan-
tity is diminished. The milk secretion is likemse lowered or
ceases altogether ; the milk tastes sour and clots easily.
In animals that remain continuously lying down, pressure
necrosis of the skin develops which may be the source of a gen-
eral septic infection.
Complications may occur after a few days in severe cases,
sometimes, however, they commence only during the stage of
improvement. Most frequently inflammation of the serous and
similar membranes is observed (serous inflammation of the
tendons and tendon sheaths, less often verrucous or ulcerous
endocarditis, further pericarditis, sero-fibrinous pleuritis, or
peritonitis, etc.). The development of such symptoms is gen-
erally announced by a more decided rise of temperature and
by general fever symptoms which are followed by the specific
symptoms of the respective local affections.
Course. The separate attacks run an acute course and con-
tinue for 2 or 3 weeks ; occasionally they last, with distinct re-
missions, for several months. The decline of an attack does
not, however, mean a cure of the disease. On the contrary, it is
very frequently noticed that a complete cessation of the symp-
toms occurs, followed after a certain time by a recurrence of
the process in the same or in other joints, and that not only
changes in the joint arise, but also the nutrition of the patient
808 Articular Rheumatism.
suffers. At times catarrh of tlie stomach and indigestion de-
velop, in consequence of which the animal rapidly becomes
emaciated, the milk supply ceases, and the muscles correspond-
ing to the severely affected joints, become atrophied. In this
way a cachectic condition develops, which may, however, be
due partially to certain sequelae, especially inflammatory changes
of other organs (valvular incompetence, growths on the serous
membranes, etc.).
Diagnosis. The diagnosis of articular rheumatism neces-
sitates great caution, since other diseases of the joints produce
a more or less similar clinical picture. — Polyarthritis puer-
peralis as well as joint inflammations sometimes following upon
mastitis or upon inflammations of internal organs, which in
many cases are limited to one joint, especially the hock joint,
can be differentiated positively if the underlying illness can
be determined, or if the complaint occurs shortly after parturi-
tion or abortion. — The other metastatic forms of the complaint
in which frequently several joints are attacked by inflam-
mation are also preceded by primary diseases of certain organs,
and the arthritis in these cases is mostly purulent. — Traumatic
inflammations are followed by feverish symptoms only after
some time, and besides the history usually clears up the cause
of the disease.
Arthrites arising in the course of different infectious dis-
eases generally declare themselves only some time after the
respective diseases have been in existence. In this respect
tuberculous arthritis is not rarely an exception, since according
to Guillebeau it may arise without tuberculous disease of other
organs, and on this account may often be mistaken for joint
rheumatism. In tuberculous inflammations, however, in about
four-fifths of the cases, only one joint is affected, especially
the stifle joint, and tuberculosis of other organs may be estab-
lished at least in many cases. At times the tuberculin test is
serviceable, but it does not always prove absolutely that the
arthritis is of a tuberculous nature.
In an advanced stage the disease may be mistaken for
osteomalacia. In this disease, however, only the phalangeal joints
are usually swollen, and further softness and brittleness of
the bones will be noticed; moreover, in large cattle herds the
spnptoms of licking or gnawing disease are observed. — In
rachitis one finds only the articular ends of the long bones
swollen in addition to rachitic changes in the bony framcAvork;
the articular ends are hard as bone, and only in certain cases
moderately sensitive to pressure, while the capsule as well as
the cavity of the joint itself is unchanged.
Prognosis. This is generally unfavorable, because on the
one hand fatal complications may set in, and on the other hand,
repeated exacerbations greatly decrease the value of the ani-
Treatment. Other Polyarthrites. 809
mal, causing deformity of the joints as well as subsequent
chronic disease. A cure rarely results from treatment and has
been noticed most frequently in dogs and swine.
Treatment. For the acute inflammatory attacks salicylic
acid with its salts, especially salicylate of soda, are said to be
specifics, but now and then they fail, as a case of Frohner
proves. To large animals one may give 30 to 40 gm. 2 or 3
times daily, to small ones 1 to 2 giii. 3 or 4 times daily. (Men-
del and Behr saw quicker effect in man after the intravenous
injection of salicylic acid.) With this treatment the fever
usually declines after the first day and the local symptoms also
improve. In order to assure a favorable result it appears ad-
visable to continue the treatment for a few days. In cases
where salicylic acid does no good other remedies with a similar
action such as antifebrin, antipvrin, salipyrin or salol may be
given a trial.
For local treatment friction of the affected joints with iodo-
form, camphor, carbolic acid or gray mercury ointment may
be administered, followed by warm or Priessnitz poultices or
fomentations with camphorated Burow's solution. At the same
time the animal must, of course, be kept at rest, stabled in a
warm place and bedded on soft litter. If chronic changes occur
they must be treated by massage and absorbents, if for any
reason it seems desirable to keep the animal alive.— If the
origin of the infection is discovered, this must, of course, be
treated at the same time. Cattle are best slaughtered in good
time, before they become emaciated.
Cheuot reports very favorable results in three cases in the horse after
paracentesis of the joint cavities with subsequent aspiration of the fluid exudate and
injection ot a 7 to 10% solution of sodium salicylate into the cavity of the joint.
Literature. Barth^lemy, J. vet., 1894, 276.— Behr, Miinch, m. W., 1904-1908 —
Cadeac, Journ. vet., 1908, 24.— Chenot, Eec. dTiygiene et de med. vet. mil., 1907
IX.— Dammann, Mag., 1871, 296.— Ehrhardt, Schw. A., 1896, XXXVIII, 122 —
Frohner, Monh., 1903, XIV, 448.— Guillebeau, Schw. A., 1898, XL, l.-U^urich
Munch, m. W., 1904, 2089.— Harms, Hann. Jhb., 1871-72, 31.— Leblanc & Bitard j'
vet., 1900, 193.— Pancritius, Z. f. Vk., 1902, 389.^Pfeiffer, Monh., 1899, X 155 —
Strebel, Schw. A., 1903, XLV, 37.— Tetzner, Z. f. Vk., 1899, 53 (Lit.).— Webb
Journ. of comp. Path., 1908, XXX, 350. ' > \ / ,
Other Polyarthrites. Inflammations of joints clinically corre-
sponding with articular rheumatism and more or less similar to it occur
rather frequently in the domestic animals. Polyarthritis puerperahs
is one of the most frequent. It occurs as a serous, fibrinous, or purulent
inflammation arising generally a short time after parturition, especial-
ly if the afterbirth has been retained ; sometimes it does not occur until
some time after a birth, when it is usually due to putrefactive material
in the womb. Under symptoms of fever the hock joint is affected prin-
cipally, and often at the same time the carpal joint; eventually also
other joints are attacked either simultaneously or consecutively. The
810 Infectious Articular Inflammatiou in Young Geese and Ducks.
disease often leads to emaciation, especially if several joints are af-
fected or if an arthritis contiinies for a long time.
Quite similar symptoms of articular inflammation sometimes fol-
low upon mastitis or diseases of internal organs.
In the course of certain specific infectious diseases, forms of poly-
arthritis may be noticed which simulate the acute or chronic forms of
joint rheumatism. Diseases leading to the development of such symp-
toms occur in fowl cholera, influenza of horses, distemper, swine ery-
sipelas, hog cholera, foot-and-mouth disease and glanders. They usual-
ly appear as the disease declines, one or several joints being inflamed.
Infectious Articular Inflammation in Young Geese and Ducks.
(Socalled Lameness of Geese; Osteoarthritis infectiosa.) This affection,
first observed by Prahl and described as ' ' lameness of geese, ' ' was investi-
gated by Lucet and its nature was recently cleared up i)y Freese. It
occurs as an enzootic in geese and ducks 5 to 8 weeks old, and is caused by
the staphylococcus pyogenes aureus. Lucet succeeded in producing arti-
ficial transmission of the disease in young geese by intravenous injection,
and Freese caused it in like manner in young ducks.
The anatomical changes consist in a serous or sero-fibrinous in-
flammation of a joint, a hemorrhagic inflammation of the bone marrow,
and in intestinal catarrh; in case of a protracted course the osteomye-
litis assumes a purulent character.
Symptoms. Clinically the disease occurs in two forms.
In the acute form (peracute form of Lucet) one notices great
apathy, complete loss of appetite, and besides severe lameness in one
or both legs. The hock and single toe joints chiefly are affected, at
times also single joints of the wings, especially the elbow joint; in the
latter case the birds droop the affected wings. If the course of the
disease is very rapid no further changes appear in the joints (Lucet) ;
but in most cases one finds them also swollen, hot, painful and fluc-
tuating. At the same time there is violent diarrhea, and often slight
catarrh of the conjuctivse. Death occurs within 2 to 4 days.
In the chronic form the symptoms of arthritis are most prominent,
while the general symptoms are less pronounced, and diarrhea is no-
ticed only at the beginning of the illness. After a duration of about
14 days death occurs, or the birds gradually recover, but they re-
main stunted and cannot be fattened. Exceptionally an acute relapse
occurs which leads to death.
The treatment consists in the local employment of antiphlogistic or
disinfectant remedies, but Prahl found these useless, while puncture
of the joint cavity and subseciuent fomentations with disinfectant solu-
tions resulted in recovery of the animals in 12 days.
Literature. Freese, D. t. W., 1907, 322.— Lucet, A. P., 1892, 841.— Prahl, Pr.
Mt., 1871-72, 168.
Wing Paralysis of Pigeons. In carrier pigeons an arthritis some-
times occurs, also in conseciuence of infection, which assumes an en-
zootic character (Klee, personal observation). Housing in draughty,
cold lofts predisposes to it.
Wing Paralysis of Pigeons. Muscular Klieumatism. 81.1
It attacks the wing joints exclusively, and principally the elbow
and shoulder joints, usually on one side, causing the bird to droop its
wing and to be unable to fly. Now and then it is only by making the
pigeons move that one can discern that one wing is hanging down. The
affected joint is more or less swollen and painful.
For treatment Klee recommends putting on a woolen bandage and
soaking it every two hours with lead water. By suitable bandaging
and isolation, attempts at flying will be hindered and the joint kept at
rest. After 8 to 14 days painting with tincture of iodine may be re-
sorted to. A cure not infrequently results spontaneously. In a some-
what protracted course caseous masses form in the joint itself and in
the neighboring tissues, which may be removed by operation ; but when
operated on the bird generally loses its ability to fly. (Klee, Gefliigel-
Krankheiten, 1905, 54.)
2. Muscular Rheumatism. Rheumatismus musculorum.
{Myositis Rheumatica.)
Occurrence. Muscular rlieumatism is generally a rare dis-
ease, although now and then it may occur as an epizootic. There
is no doubt that the disease is much rarer than was formerly
supposed where it was often mistaken for other diseases (pachy-
meningitis spinalis; compression of the spinal cord, rachitis,
osteomalacia, etc.). Horses and dogs suffer most frequently,
yet the remaining domesticated animals may not infrequently
be attacked. (Among the horses of the Prussian Army in the
years 1899-1908 only 0.04 per cent of the whole stock on an
average suffered from muscular rlieumatism.)
Etiology. The important role played by cold cannot be
disregarded, but perhaps here also it only acts as a predispos-
ing cause, the immediate cause being probably an infection or
intoxication. To support this view there is the similarity of
the disease to articular rheumatism, as well as the fact that
both diseases occur at times from the same cause and in the
same animal. Magnin repeatedly noticed in horses attacks of
affections similar to muscular rheumatism which developed af-
ter croupous pneumonia or pleuro-pneumonia, as well as in con-
nection with an infectious illness which is not described exactly.
The disease occurs, as a rule, after exposure to damp, cold air
or draught, after sudden wetting through or after a cold bath,
and is observed most frequently in the spring and autumn. In
horses it arises further after long continued railway transpor-
tation as socalled pleurodynia (see page 84), in connection
with hyperemia of the lungs, and perhaps also with fibrinous
pleurisy (Sigl).
Predisposition. Horses and dogs seem most inclined to
muscular rheumatism. Well nourished, pampered animals living
most of the time in warm rooms are especially subject to it.
812 Muscular Rheumatism.
Anatomical Changes. The symptoms of the disease sug-
gest that it is a serous inflammation of the intramuscular con-
nective tissue, in which the muscle fibers may be affected by
cloudy swelling and disintegration. Siedamgrotzky, Bruck-
miiller and Zschokke actually found in the affected muscles dila-
tion of the vessels and sero-gelatinous infiltration of the intra-
muscular connective tissue, granular disintegration, and fatty
degeneration in certain muscle bundles. Schmid found hemor-
rhages in the affected muscles. In many chronic cases the inter-
fibrillary connective tissue was enlarged.
Kitt found at times in hogs diffuse necrotic foci in the muscular tissue, while
according to Glasser, the homogenous, caseous masses in cattle attributed to muscle
tuberculosis are caused by bacteria of the typhus-coli group, and according to
Hungerbriihler are produced by the bacillus pyogenes.
Symptoms. The most prominent sign of muscular rheu-
matism consists in emphatic expressions of pain. AVithin a short
time desided disturbance of motion occurs without any prod-
romal symptoms. In the frequent disease of the muscles of the
loins (lumbago rheumatica) the stiff position of the hind quarter
arouses attention, both while at rest and during motion, and if
at the same time it happens that the croup, thigh, and psoas
muscles are affected, the hind feet are dragged and scrape the
ground. It is only w^itli difficulty that the animals can raise
themselves from the ground, and in very severe cases they can-
not do so at all. Where the shoulder muscles are involved,
which frequently happens, the fore feet are lifted from the
ground only slightly and the step is shortened ; when going up-
liill the disturbances in motion are increased, and a peculiar
cracking of the joints is audible at times. If the muscles of the
back or neck are affected the animal stands stiffly in one place;
with outstretched neck, while on turning the body is held as if all
in one piece and without lateral flexion of the trunk. In simul-
taneous involvement of the muscles of the extremities, a con-
dition similar to that seen in tetanus may arise ; it is, however,
characteristic of muscular rheumatism that the abnormalities of
movement as well as the stiffness gradually diminish with exer-
cise. In lambs the neck muscles are at times affected on one side
only, and the neck is in consequence flexed to the affected side.
Intercostal rheumatism causes superficial quickened breathing
and sensitiveness to pressure on the intercostal spaces (com-
pare pleurodynia, page 87).
A further sjTiiptom which can be observed only on the
superficial muscles is swelling, sensitiveness to pressure and a
firm consistency of the affected muscles. The painfulness is
especially evident in dogs which howl and whine even when
handled gently, or at the approach of anybody, as well as when
trying to move about. Where the abdominal muscles are af-
fected one notices retention of feces, and now and again painful
defecation: where the muscles of mastication are affected this
Course and Prognosis. Diagnosis. 813
process is interfered with. Rather frequently the disease will
jump from one part of the body to another, whereupon the
form of the functional disturbances varies.
The sensibility of the skin remains unchanged as do also the
reflexes, unless the voluntary fixation of certain joints hinders
the releasing of tendon reflexes on account of the pain.
Fever is not usually present in muscular rheumatism ; only
in severe cases where a considerable part of the body is in-
volved there is a rise of temperature of 1 to 1.5" C. On the
contrary one finds the pulse almost always quickened and tense,
and the breathing frequent and superficial. The appetite re-
mains undiminished for the most part.
Complications occur very seldom; only exceptionally an
acute inflammation of the serous membranes and catarrh of the
respiratory or digestive tract follow upon muscular rheuma-
tism, and in horses inflammation of the tendons, laminitis and
possibly arthritis.
In foals Tatray observed acute iritis and choroiditis in
about 5% of the severe cases wdth deposits of fibrinous exudate
in the anterior chamber of the eye. In 90% of the sick animals
the eye trouble disappeared within 6 to 8 days, in 10% attacks
similar to periodic inflammation of the eyes were repeated and
were finally followed by blindness.
Course and Prognosis. The disease usually runs an acute
course and lasts only a few days or at most a week, whereupon
the disturbances in motion disappear completely; sometimes,
however, an inclination to relapses persists, so that the prog-
nosis is somewhat less favoral)le, especially in horses.
Functional disturbances similar to those of muscular rheu-
matism may accompany inflammatory diseases of the tendons
and fasciae and the muscular sensitiveness may be found in
strain, in overextension or in partial tearing of muscles.
Diagnosis. From all these complaints muscular rheuma-
tism may be distinguished apart from the special signs noted
in surgery, especially by its sudden occurrence, often after a
chill, the "firm consistency of the muscles, the gradual decrease
of discomfort in movement and particularly the sudden transi-
tion of the complaint from one part of the body to another. — In
contrast to tetanus only single groups of muscles are usually
attacked in muscular rheumatism, a real trismus is wanting and
the reflex irritability remains unchanged. — Paralytic hemo-
globinemia is distinguished by severe derangement of motion,
lack of pain in the muscles, loss of reflex movement as well as
by the hemoglobin constituents of the urine. — Compression of
the spinal cord and pachymeningitis spinalis were in former
times often mistaken for chronic muscular rheumatism, the oc-
currence of which seems to be doubtful ; but these diseases may
easily be eliminated by a careful examination of the nervous
814 Muscular Klieuinatism, Race-course Disease of Horses.
system, and tlio same ai)})lies to otlier nervous diseases. — Well
defined eases of rachitis and osteomalacia may easily be dis-
tinguished, but where the disease of the bone is not pronounced
the differential diagnosis is sometimes a matter of great diffi-
culty.
Treatment. Muscular rheumatism limited to a small re-
gion is treated most suitably with massage, for which different
stimulating materials (camphor, spirits of soap, mustard oil in
alcohol) or chloroform (e. g. spir. sapon., chloroform aa, or
spir. camph., spir. sapon. kalin. aa 100, ol. thereb. 20.) may
be employed; after massage warm or Priessnitz poultices may
be applied.
The production of diaphoresis is also of good service, and
for this purpose animals should be wrapped up warmly, while
dogs may be placed in a steam or turkish bath ; subcutaneous in-
jections of pilocarpine (0.2-0.5 gm.) may be employed, especial-
ly in horses.
In general muscular rheumatism salicylic acid and its
preparations (see page 809) do good service. Salol, salipyrin,
antipyrin, antifebrin and quinine (according to Caroni 20-40
gm. daily for a horse) are also effective. The combined em-
ployment of morphine and atropine in shoulder rheumatism of
the horse may produce at times dangerous complications (see
page 365). The disease of the eyes needs no special treatment.
Literature. Albrecht, W. f. Tk., 1902, 170.— Hink, D. t. W., 1899, 5.— Hoff-
mann, T. Z., 1901, 424.— Magnin, Eec, 1906, 217.— Sehmid, W. f. Tk., 1901, 148.—
Schwendimann, Sehw. A., 1898, XL, 116.— Siedamgrotzky, S. B., 1874, 43; 1878, 41;
1887, 26.— Sigl, Monh., 1900, XI, 559.— Tatray, Vet., 1894, 209, 264.— Zschokke,
Schw. A. 1898, XL, 97.
Race-course Disease of Horses. After excessive exertion, as for
instance on a long run, stepping high, and on bad, deep, or hilly ground,
after forced runs, in distance riding and on race-courses, perhaps also
after being throwai, a peculiar diseased condition appears in horses
which is commonly called race-course illness. It occurs mostly after
work, but occasionally it may be noticed during the exercise.
The animals become feverish, exhibit great anxiety and seem to
experience pain. Breathing appears labored and copious sweating oc-
curs. The muscles of the thigh, back and neck are at first hard and
stiff to the touch, and twitching as well as quivering of the muscles
may be noticed ; besides there is often retention of urine and of feces.
After one or several days most of the above mentioned symptoms dis-
appear, the animals begin to move about, but great weakness, increased
irritability and timidity persist; the twitchings in different muscles
are noticed for a long time and are increased by external influences.
In the further course the stiffness of the muscles yields to a visible
relaxation, the gait of the animal l^ecoming remarkably languid and
tottering, the feet scarcely being able to support the body. But these
symptoms as well as the twitchings and the irritability disappear grad-
ually, so that the animals recover completely in 3 to 4 weeks, and often
earlier (Kirillow), but at times later (Willielm).
Muscle Degeneration. gir
The basis of these disturbances is probably a myositis caused bv
overexertion or rupture of muscle fibers, although Wilhelm considers
that there is a general disease of the motor nervous apparatus, and at
the same time an inflammatory condition of the muscular tissue
The treatment consists in complete rest, rubbing, massage and
stimulating applications. '
Literature. Kirillow, Yet. Jhb., 1891, 126.— Wilhelm, S. B. 1897 127.
A muscular inflammation after over-exertion ocoins comparatively frequently
m cattle, and develops m the form of a serous iuflammation, especially in the mus-
cular tissue of the shoulder girdle (Marek). Pregnant cows and oxen which are
stabled continuously are especially subject to it after long drives on foot. It does not
appear to be a smiple relaxation of tired muscle as Giovanoli claims; the affected
muscles as well as the intermuscular connective tissue appear to be very much infil-
trated with serum. The affected animals remain recumbent for 4 to 10 days or
longer, are unable to rise on their fore feet, and if by chance they succeed in doing
so there IS a sinking of the vertebra; between the shoulder blades. Generally the com-
plaint disappears of itself, but occasionally it necessitates slaughter. (Giovanoli
Schw. A., 1909, LI, 116.— Marek, Vet. 1895, 308.) ^mo^anoii,
Muscle Degeneration. A pronounced parenchymatous and fatty
degeneration of muscles arises in the course of paralytic hemoglobine-
mia (see Vol. I). Besides cases have been recorded (Frohner, Bartke
Leipziger, Cadeac and others) where the muscle degeneration in horses
manifested itself after throwing, if the animals had struggled violently
Ihe degeneration occurs in those muscles which come into play in the
straining movements against the shackles, that is, the muscles of the
loms and the croup, the anconei and the extensors of the stifle.
This kind of muscle degeneration arises to all appearance in the
same way as m paralytic hemoglobinemia, but there is usually no elimi-
nation of hemoglobin through the kidneys, although this symptom has
ao times been noted (Leipziger). Morel & Vieillard also referred the
fatty degeneration as well as atrophy in the muscular tissue which is
frequently found in horses after being slaughtered, to previous attacks
ot paralytic hemoglobinemia. But it is not impossible that the de-
generation of muscle may be combined with an inflammation caused
by overexertion as occurred in cases of Frohner and Cadeac.
Literature. Frohner, Monh., 1897, VIII, 499; 1898, IX, 489- 189Q X 354 —
Leipziger, Z. f. Vk., 1900, 389.— Poulsen, Maanedsskr., 1897, IX, 305. ^'
Fatty Degeneration of the Muscles in Sucklings. In fine-bred
pigs and lambs, much less often in foals and calves, the muscular
tissue of the whole body undergoes a high degree of fatty degeneration
m consequence of anemia ; the cause of this degeneration is as yet un-
known (hereditary predisposition, too close breeding, excessively high
fat contents of the milk). The muscles appear glistening like 'bacon,
or as if cooked, and a fatty degeneration of the parenchymatous organs
and the lymphatic glands may be recognized. The animals are born
diseased (Furstenberg, Roloff, Repiquet) or the degeneration mav be
seen a few weeks after birth.
The sick animals cease to suck, they are weak, scarcely move about
at all he on the ground almost uninterruptedly (little pigs do not
squeal) and die quietly or after the onset of diarrhea, and perhaps in
convulsions.
816 Pseiuloliypertrophy of Muscles. Trichina Disease.
Medicinal trt-atiiieiit is useless, but the disease is warded off by
the introduction of fresh blood in the l)reeding animals, by exercise
and suitable feeding of the mother animals during pregnancy (Fiirsten-
berg, Y. A., 1864, XXIX, 152).
Pseudohypertrophy of Muscles. This was noticed by Schindelka in a two-
year old Italian greyhound. The superior and lateral muscles of the neck, the
muscles of the shoulder, thigh, back and loin appeared thickened and their outlines
plainly visible. The muscles of the hind quarter were firm to the touch, those situated
more anteriorly, soft, and at the neck as soft as fat. Owing to contraction of the
flexor tendons of the hind extremities, only the points of the toes were brought to the
ground in walking. Weakness and pronounced indolence were noted ; the patellar
reflex was absent. The thyroid glands were plainly atrophied. The administration
of thyroidin tablets caused only a transient improvement. After about 3 years the
previously tractable dog became irritable and vicious and was therefore killed.
(T. Z., 1908, 67.)
3. Trichina Disease. Trichinosis.
History. Trichina were first noticed in the muscles of man by
Paget (1837), although calcified trichinae were found earlier by Hilton
(1832), Tiedemann (1822), and Peacock (1828) (Ostertag). The worm
discovered by Paget was described by Owen and thus became known.
]\Iuscle trichinae in smne were first demonstrated in America by Leidy
(1847). In a postmortem on a girl, Zenker (1860) found a great num-
ber of young trichinae in the muscular tissue, and sexually mature
w^orms in the intestinal canal. He found out afterwards that the girl
referred to had, before her illness, taken ham and sausages containing
encapsuled trichina and that other people had contracted the disease
from the same source. Through the feeding experiments undertaken
with Zenker's material by Leuckart and Virchow, the outbreaks of
trichinosis in Germany were elucidated, and by microscopic examina-
tion of s^^dne flesh the etiology of the disease was clearly established.
Recently Hoyberg and Strose made valuable observations on the mode
of infection.
In Hungary only a few muscle trichina had, until the year 1891,
been found accidentally in human corpses by G^nersich (1867 and
1891), as well as by Bollinger (1875) ; in the year 1891 the disease
was found by Ballagi in living men at the iron works of Diosgyor.
Occurrence. TrichinaB have hitherto been found in tame
and vnM s\vine, in rats, mice, dogs, cats, foxes, martens, bears,
badgers, polecats, etc., and also not infrequently in man.
An exact statistical record of the frequency of trichinosis can evidently only be
compiled in places where trichinae inspection is in vogue. In the German empire
one generally finds more cases in North or East Germany than in the Southern
States. Thus Eulenburg put the percentage in the Kingdom of Prussia in the
years 1876-1885 at about 0.059%. In the years 1890-1895, out of 25,490,339 swine
examined, 7,897 or 0.03% were trichinous; in the years 1897 to 1903 out of 64,648,755
swine 7,694 or 0.011%; in the vear 1904 on the contrary only 0.005%; in the year
1905, 0.007%; in the year 1906, 0.006%, and in the year 1907, 0.005%. In the
Kingdom of Saxony in the years 1899-1902 out of 11,029,467 swine examined 1161
were found to be trichinous, or a percentage of about 0.01%, while in the years 1903
to 1905, the percentage was similar to that in the Kingdom of Prussia; in the year
1906 it was only 0.003%. In Prussia as well as in Saxony there has been a gradual
decrease in the number of cases. In Bavaria in the year 1906, there was a percentage
of 0.001%.
Occurrence. Etiology. 817
According to the investigations of Tenipel and otliers, trichina; occur in some
neighborhoods to a greater extent in slaughtered dogs (in four years on an average
1.11%), than in swine (of 289 slaughtered dogs Tempel found four with trichinae
[1.4%-]). In the year 1906 trichinosis was found in 0.222 7o of slaughtered dogs.
In swine imported from Hungary into Saxony trichinae were found in
0.011% in 1893; in 1894, 0.009%; and in 1895, 0.024% (Ostertag) ; recently
imported from Austro-Hungary have been found to be more subject to trichinae
than the native breeds (Edelmann).
Trichinosis is much more frequent in North America. Thus Billings found 4%
and Salmon 2.7% of swine in Boston to be affected with trichina?. In the year
1874 the percentage in Indiana was l(i..3, later 6.5 ; in Chicago, in the year 1878,
8%; in 1883, 2.4%; in 1881, in New Orleans, 0.4%. According to Hamel-Eoos, in
Boston, from 1886-1890, out of 3,064 swine examined, the boars were infected in
14.87% of cases, and the sows in 10.61%.. Of American hams and other pig
products imported into Germany, an average of 2-3% (maximum 8%) were found to
be trichinous (Friedberger & Frohner).
Etiology. The Trichina spiralis (Trichinella spiralis) is a
small nematode belonging to the family of Trichotrachelides
(see page 487) which occurs in the body of susceptible animals
and of man and causes the disease. It occurs in a sexually
mature state in the intestinal canal, and as larvae in the muscu-
lar tissue.
The intestinal trichina is barely visible to the naked eye as a very fine, thread-
like, yellowish white worm, whose straight anterior end becomes gradually thinner,
while the blunt hind end appears bent. The surface of the body is flat with fine
cross stripes; the male 1.4 to 1.6 mm. long, 0.04 mm. thick; the female 3 to 4 mm,
long, 0.06 mm. thick. From the fertile eggs, with a diameter of 0.02 mm., embryos,
about 0.12 mm. long, develop in the uterus of the female. They break through
the eggshell in the uterus and are born alive. The male dies after copula-
tion, but the female remains alive until after the birth of the embryos; her average
duration of life is 5 to 8 weeks.
The muscle trichina at first lives free inside the sarcolemma of the muscle
fibres, then rolls up and becomes enclosed in a lemon-shaped capsule. It is 0.7 to
1.0 mm. long, its head end forms a point, and its hind end is blunt.
The development of trichinae occurs as follows : After the eating
of flesh containing the encapsulated, living muscle trichinae the capsule
is dissolved by the gastric juices within 18 to 20 hours, and the liber-
ated larvae reach the small intestine after 30 to 40 hours; they grow
quickly, and in about 2i/'o days become sexually mature. Five days
after copulation, after the female has been pressed into Lieberklihn's
glands along with the male, she deposits living embryos in the interior
of the glands. During a residence of 5 to 8 weeks a single female can
produce, according to Braun, 8.000 to 10,000, and according to Neu-
mann 15,000 embryos.
From Lieberklihn's glands the young trichinae reach the lymphatics
on the seventh day, according to the investigations of Cerfontaine, Geisse,
Askanazy, and especially Graham; from there they pass to the tho-
racic duct and finally reach the blood stream, where they are deposited
by the capillaries in different tissues, and there become arrested. Since
the trichina embrj'o has been observed to have a spike-like process at
the anterior of its body, Hoyberg considers that it is capable of wan-
dering actively from the intestine. As soon as the embryos reach the
tissues of a convenient organ they develop there further if the con-
ditions are favorable. The socalled wandering trichina going with
the lymph stream into the lymphatic glands, and with the blood stream
into ^ the rest of the organs soon perish, but those reaching the
striated muscles which contain sarcolemma persist. The wandering
818 Trichina Disease.
trichinae bore through the sarcok^nuna of the striated muscle and
localize in immediate contact with the plasma. They grow here in
about 3 weeks to a length of 0.7 to 1.0 mm., curve up usually in the
form of a sickle and eventually assume a spirally t\nsted shape. After
the immigration of the young trichinae degeneration of the muscle
plasma sets in, the fibers of the interfascicular connective tissue be-
come hj'pertrophied until finally, through the perforated and thickened
sarcolemma and perhaps through connective tissue cells that have wan-
dered through these inlets (about 2 months after migration), a long
lemon-shaped capsule is produced with a diameter of 0.08 to 0.05 mm.
In this capsule there is generally only one, more rarely there are 2 to
4 and occasionally 7 trichinae.
In the capsule and the granular mass situated therein lime salts
are deposited about 1 to 114 years after migration. Notwithstanding,
it is possible for trichinae to remain alive for a long time (in swine
over 11 years, in man over 30 years) and to be capable of producing
infection. On the contrary non-encapsuled trichinae are incapable of
causing infection, because they die in the stomach.
Natural Infection. S^^ine infect themselves by eating the
flesh of trichinous pigs, from the excrement of trichinous swine
and the ofTal, further by eating rats and mice, and also, ac-
cording to Hojdjerg, by taking np the dejecta of rats and mice.
The last mentioned mode of infection is, however, denied by
Strose. With regard to rats Lenckart has proved that they
are very susceptible to trichinosis and in fact are very frequent-
ly trichinous. Thus Heller found muscle trichinae in 8.3%,
Groker in 5%, Frank in 6.9%, Fessler in 50% and Billings of
Boston in 100 7o of rats examined. It has further been noticed
that most trichinous rats are found in the neighborhood of
knackers' yards, slaughter houses and shambles, where they can
easily be infected by the offal of dead and slaughtered swine.
Johne proved the very frequent occurrence of trichinae in rats
in the zoological gardens in Dresden. In any case the spread
of trichinae results among rats through eating and devouring
rat flesh.
According to Hoyberg rats and mice are rarely caught by swine under the pres-
ent conditions of breeding, and in consequence infection does not often arise in
this way. Infection happens much more frequently by the eating of food soiled by
the excrement of rats and mice. Hoyberg found in his experiments that after the
taking up of muscle trichinae, the feces of rats contain embryo-bearing trichinae for
10 days, and the embryos preserve their vitality for four weeks in a sufficiently damp
medium. After entrance into the stomach many embryos are killed by the destruc-
tive action of the hydrochloric acid; but many escape destruction, the more so as
they are protected in a manner by the bodies of the females, which they inhabit.
Klihn asserts, on the contrary, that the pig is an able rat catcher, and this
opinion is supported by Strose, who did not succeed in finding trichinae in the excre-
ment of artificially infected rats, or in transmitting trichinosis to rats by feeding
them with pregnant trichinae, as well as with the intestines of freshly infected rats.
For this reason Strose agrees with earlier observers who consider that the excrement
of animals containing sexually mature trichinae is of no importance in the spread of
trichinosis, but that, for the transmission of the disease from animal to animal,
only muscle trichinae in an advanced stage of growth are effective. Nor could Strose
confirm the results of Staubli, according to which rats are not of actual importance
as intermediaries for successive generations of trichinae, because they usually Buccumb
to intense intestinal trichinosis.
Suscei)til)ilily. Anatomical riian^es. 819
Dogs wliicli also frequently suffer from trichinosis in-
fect themselves by eating rats which they catch. The same is
true of polecats, while the infection of wild swine, foxes, bad-
gers, hedgehogs, martens and marmots takes place by eating
mice.
Susceptibility. In respect to susceptibility there is no dif-
ference between the various breeds of pigs. The spread of
trichinosis, however, varies greatly in different neighborhoods,
and in this respect the breeding and management of animals
has a great influence. Infection through trichinous swine flesh
and through rats occurs very easily where no great importance
is attached to cleanliness and the burying of dead animals is
not carried out immediately, where, further, parts of the bodies
of dead swine are fed to others. At the same time there is more
opportunity for infection where the swine are not reared in
the open air and in large herds, but are kept in sties in the
neighborhood of dwelling houses.
Many other animals are also susceptible to trichinosis,
such as the wild hog, mice, dogs (Tempel found trichingB in the
flesh of slaughtered dogs as often as in that of swine), cats,
wolves, bears, badgers, etc., horses, cows, sheep, rabbits, guinea
pigs and hares can be infected artificially.
The susceptibility of differeut species of animals is not equally great. Mam-
malians are the most susceptible, while in birds only intestinal trichinae develop, but
the young trichinae soon disappear in the intestine. Genersich accounts for this dif-
ference by the fact that the chemical- composition of the intestinal contents are
always alkaline in rabbits, and frequently so in man, rats and mice, especially after
hunger, while in dogs and birds (ducks) the intestinal contents show an acid re-
action. It follows that the susceptibility of warm-blooded animals is in inverse
ratio to the acid reaction of the intestinal contents.
Anatomical Changes. After the first week only a certain
watery consistency of the muscular tissue is found; besides
the cut surface appears somewhat cloudy, its color pale and
transparent gray. From the fifth to the tenth week the muscle
fibers, when cut in their long direction, show very fine gray or
yellowish streaks, while somewhat later one sees very small
yellowish gray, or grayish white little specks thickly clustered
together or strewn about, which stand out sharply defined when
examined against the light. The respiratory muscles such
as the diaphragm and intercostal muscles are attacked most
severely, also the muscles of the neck, larynx and tongue.
(According to Bohm the muscles whose activity is the most
intense are attacked most severely.) Within the muscles the
trichinae are found in greatest numbers in the superficially situ-
ated fibers and in the neighborhood of tendons, while the tendons
themselves remain quite free from the parasites. In the heart
muscle and in non-striated muscular tissue trichinae never occur
(no sarcolemma!).
820 Trichina Disease.
For the certain recognition of trichinae, niicroseopic examination is essential.
According to Johue, this may lie undertaken in fine oat-grain-sized pieces of muscle
which, after the addition of water or common salt solution (O.T'/c), or acetic acid
(0.1 to O.o'/c), have been pressed together between two glass plates (the best form is
the socalled compressorium). Ten, or at most 40 to 50 diameters of magnification are
sufficient. By this means, free parasites or non-t-alcified capsules, enclosing young
trichina^, may be recognized very easily, while after calcification in a transparent
light only tlie black, characteristic lemon-shaped capsules are visible. After addi-
tion of dilute hydrochloric acid the lime salts dissolve out, whereupon the trichinie
inside the capsule, which has now become transparent, appear in view. For examina-
tion the above named muscles are best adapted.
For scientific examination Tikhomiroff recommends the following procedure:
The small-cut pieces of muscle that are to be examined are for half an hour put
into a mixture of nitric acid (4 parts) and chloride of potassium (1 part), and
then carefully shaken in distilled water, whereby the muscle is made to separate into
fine fibres. Minute swellings may be perceived in the fibres with the naked eye;
under the microscope the eneapsuled trichinae may easily be seen. Close puts a small
piece of the suspected muscle in a conical glass containing a mixture of hydro-
chloric acid and pepsin. The separated trichinae sink to the bottom and can easily
be removed with the pipette.
As additional anatomical changes one finds, before encap-
sulation, only hyperemia of the lung and parenclmiiatous de-
generation of the internal organs, further, acute intestinal ca-
tarrh and acute swelling of the mesenteric hmph glands, es-
pecially during the residence of trichinae in the intestine.
Mature trichinae are found 4 to 6 weeks, at latest 8 weeks, after infection in
the anterior part of the small intestine, seldom in the large bowel. To discover these,
the intestinal contents are diluted with water when the trichina may be recognized
with the naked eye as very fine, short, whitish threads. Yet it is more suitable to
put a drop of the mixture between the slide and cover glass and examine it with
a magnification of 40 to 50 diameters.
Symptoms. In living swine trichinosis has not yet been
diagnosed, although there is no doubt that after intensive in-
fection symptoms of disease arise, but these are ascri])ed to
other affections. The symptoms of trichinosis in s\\dne have
therefore been observed only after feeding experiments.
The disease of the intestine mostly declares itself 3 or 4
days after infection, at the latest towards the end of the first
week. The animals suddenly become ailing, take no food, vomit
at times, crouch in the straw and move about unwillingly with
arched backs. Obstinate diarrhea is hardly ever absent ; at first
the feces are pultaceous, then watery and ill smelling, and the
animals also show sjonptoms of colic. After an extensive in-
fection the animals rapidly lose condition and sometimes die at
the end of the second week, in other cases the s^Tiiptoms of an
attack of muscular disease manifest themselves.
The second stage generally sets in towards the end of the
second week, and in the meantime the animal rubs itself on
hard objects, moves about stiffly and later lies motionless in
one place with outstretched or bent extremities. Breathing be-
comes very painful and superficial. Huskiness also is seldom
absent. If the disease involves the muscles of mastication,
chewing is hindered, and occasionally total trismus may arise,
while the affection of the throat muscles causes difficulty in
Diagnosis. Prophylaxis. 821
swallowing. Some authors liave also noticed circumscribed
edema of the eyelids and feet. The temperature rises chiefly
at the time of the migration of the trichinae.
Recovery is the rule; only after a very intense infection
is the result fatal. The symptoms continue on an average 4 to
6 weeks, that is, until the encapsulation of the young trichinae,
and then gradually cease. The encapsuled trichinae, which are
present in great numbers in the muscles, do not destroy the
function of the muscles in any way, and the animals eat and
grow afterwards just like healthy pigs.
In dogs the symptoms are quite similar to those of trichinosis in
man (Dlugay). Dobbertin noticed severe eosinophilia in the blood,
which had arisen at the cost of the neutrophile leucocytes and occurred
at the beginning of the migration of the trichinae; the migration had,
however, outlasted it.
Diagnosis. It was stated previously that trichinosis by
natural infection had hitherto never been diagnosed in living
swine, since the s}^nptoms are not always characteristic, and
besides other diseases with similar symptoms occur. In this
connection muscular rheumatism may be called to mind, but
here no signs of a violent intestinal affection precede the mus-
cular complaint. The diagnosis is facilitated if an infection
can be shown to have occurred. At times the affected muscle
may be harpooned or excised and may afford material for
examination. Since sexually mature trichinae occur in the
feces of infected animals, the feces should be examined micro-
scopically in suspicious cases.
Prophylaxis. The carcasses of swine dead of trichinosis
should be destroyed by industrial processes, and the living
animals housed in places from which rats and mice are far re-
moved. In knackers' yards and slaughter houses the keeping
of swine should be forbidden where infection may arise through
offal and rats or mice. The annihilation of rats and mice is an
important factor in avoidance of the disease.
Literature. Babes, Cbl. f. Bakt., 1906, XLII, 541.— Bahr, Z. f. Infkr., 1906,
TI, 62. — Dobbertin, tJber d. A^erhalten d. weissen Blutkorp. b. Hunde, tisw., Diss.,
Leipzig, 1907.— Edelniann, Lehrb. d. Flhyg., 1907.— Hoyberg, Z. f. Tm., 1907, XI,
299, 455; 1908, XII. 26. — Joliiie, Der Tric-hinenschaner, 1907. — Ostertag, Biblio-
graphic d. Fleischbeschau, 1905 (complete Lit.).; Fleischbeschau, 1904. — Strose, Arb.
d. G.-A. 1909, XXXIII, 109 (Lit.).
Trichinosis in Man. Man is infected by the use of raw or under-
done pork, or by dog flesh and, according to the number of trichinae
reaching his intestinal canal, either slightly or so severely that in certain
endemics 30% of cases may end fatally. The symptoms are for the
most part similar to those seen in experimentally infected animals.
Here also the disease begins in the second half of the first week, at
times earlier after infection, with acute catarrh of the stomach, the
patient suffering from loss of appetite, nausea and diarrhea, accom-
822 Measles.
panied by colicky pains and at times vomiting. At the time of the
migration and encapsulation of young trichinae one notices swelling,
increased consistency and painfulness of the muscles, and accordingly
superficial painful breathing, hoarseness of the voice, difficulty in swal-
lowing and pain in masticating. More or less characteristic are the
circumscribed edema of the eyelids and joints, severe perspiration,
fever similar to that of typhoid fever, and finally lying with the ex-
tremities drawai up under the body. Hemorrhages into the mucous
membrane and skin, prurigo, pustules, furuncles and severe perspira-
tion may also be noticed. Mild cases last 3 to 6 wrecks, severe ones for
many months.
The diagnosis is supported by severe gastric disturbances which
are followed by the peculiar muscular affection and by edema of the
eyelids. It will further be strengthened by proofs of severe eosinophilia
in the blood, which occurs at the earliest eight days after the use of
trichinous flesh. The diagnosis becomes certain by the demonstration of
trichinae in an excised piece of muscle, or in the initial stage, in the
blood ; for this purpose the latter is mixed with acetic acid, centri-
fugalized and stained according to Giemsa (Stiiubli).
Endemios of trichinosis have occurred pretty frequently since the discovery
of the parasite. Of a great number of outbreaks and cases of death the following
may be related: at Hedersleben, in the years 1863 and 1864 out of 2,000 inhabitants,
337 cases of trichinosis and 16 deaths; at Linden, in the year 1874, 400 cases, 40
deaths; at Emerslebeu, in the year 1883, 403 cases, 66 deaths. Johne recorded
in Saxony, between the years 1860 to 1889, no fewer than 109 endemics of
trichinosis with 3,402 cases and 79 deaths. Since the year 1902 there have been
annual endemics in Bavaria; in the year 1906 in Ingolstadt 8 cases; in the year
1908 in Eothenburg about 100 cases; in the year 1909 in Lorenzen 10 cases; in
Markterlbach and Wilhelnisdorf about 50 cases. According to Friis the disease
has been observed in Denmark on fifteen occasions. In Hungary the first outbreak
was observed by Ballagi (1891) in the ironworks at Diosgyor, where 26 persons
were taken ill after eating sausages which came from Debreezen, and after suffering
from one to four weeks all eventually recovered.
Literature. Merkel, Handb. d. ges. Theraine von Penzoldt-Stintzing, 1909, I,
Bd., 353. ^' > >
4. Measles. Cysticercosis.
{Ladrerie [French]; Finiioikrcuilxheit [German].)
History. Measles in swine was known in olden times to the Egyp-
tians, Jews and Greeks, but it was first recognized as being due to a
parasite by Hartmann in the year 1682. The connection of the disease
with a tapeworm was suspected by Fabricius at the end of the eighteenth
century, but the history of the development of the parasites was first
recorded by van Beneden and Kiichenmeister in the year 1850. Feed-
ing experiments leading to like conclusions were further undertaken
by Siebold, Haubner and Leuckart.
In cattle Leuckart produced measles artificially by feeding with
the proglottides of Taenia saginata, and similar results were ob-
tained by Gurlt, Gerlach, Ziirn, Kiichenmeister, Leisering, Haubner;
Hertwig, Ostertag, Breuer, etc., furnished further contributions to the
knowledge of the disease in cattle.
Occurrence. The frequency of the disease stands in re-
lation to the conditions of barns and houses in the affected re-
Occurrence. Etiologj-. §23
gions. Where the animals are kept near dwelling's, about which
bad hygienic conditions prevail, it occurs more frequently than
where the collection and removal of excreta are well attended to.
Consequently measles is generally much more frequent in the
East than in the civilized countries of Europe where the fre-
quency of cysticercosis has fallen to an inconsiderable per-
centage, especially in recent years. Swine are affected much
more frequently than cattle, and the pigs of small farmers more
frequently than the herds on large estates.
Measles was found in Germany, in the Kingdom of Prussia, in the years 1890
to 1895 on an average in 0.15% of 25,490,339 pigs examined; from 1897 to 1905
among 64,648,755 swine examined 0.05% were diseased; in 1904 to 1906 the per-
centages averaged 0.03, 0.025 and 0.04%,. In the eastern provinces swine measles is
much more frequent than in the western (Ostertag). In Saxony, in the years 1897
to 1902, the percentage varied between 0.01 and 0.04, the lower percentages applying
to the last years; in 1906 a percentage of 0.01 was announced.
In Hungary, in the Budapest slaughter-house, in the years 1897 to 1901, out of
474,401 swine examined (many having come from Servia), an average of 1.08%
were found to be measly. In the Budapest fattening establishment (Kobauya)
Servian swine examined during life in the years 1895 to 1905 were found to be
affected to the extent of 0.5%, (v. Kukuljevie.)
Cysticercosis of cattle was found in the Kingdom of Prussia, in the years
1897 to 1901, in 0.55% of slaughtered cattle; in the year 1904 in 0.32%; in 1905
in 0.34%- ; and in the year 1906 in 0.37%. In Bavaria the percentage in the year
1906 was estimated at 0.06, and Zagelmeier found in the slaughter-house at Niirn-
berg 1.48%- and 1.58% of cattle affected. In the Kingdom of Saxony, in the
years 1897 to 1902, there was an average of 0.37% of slaughtered cattle diseased,
whilst in the year 1906 the percentage was 0.22. In Augsburg, Stroh found measles
in 0.04% of slaughtered calves.
In Hungary, Csaky and Breuer were the first to find cysticercosis in cattle.
In Budapest, in the years 1897 to 1907, an average of 0.21 to 0.45% of slaughtered
cattle were diseased, and in the last four years the percentages varied between 0.30
and 0.42.
In Switzerland, France and Italy cattle measles has also been noted, and
especially so in Italy, and also in Tunis where, according to Alix, about 5% of the
slaughtered cattle are found to be measly.
Etiology. Measles of swine is caused by the Cysticercus
cellulose, the larval form of Taenia solium. This occurs as
a cyst about the size of a lentil or small bean, round or oval in
shape with a thin wall on whose internal surface a milk-white
point may be seen; this is the invaginated scolex and is ex-
truded on pressure upon the vesicle. Under the microscope one
sees four suckers on the scolex, and between these a rostellum
carrying 24 to 32 booklets.
The measles of cattle is due to the Cysticercus bovis s.
inermis, the larval form of Taenia mediocanellata s. saginata;
it is similar to the cysticercus of swine, but it has a more longish
oval form, appears somewhat reddish in color, and there is no
rostellum on the scolex; one finds four suckers at the anterior
end of the head, and a depression which corresponds to the ros-
tellum.
The development of cysticerci occurs when proglottides, which
get into the open with human feces, or eggs which have been liberated
by the destruction of the proglottides, are taken up by swine or cattle.
When the eggshell is dissolved by the digestive juices, the liberated
onkospheres bore through the stomach wall and are carried by the
824 Measles.
blood stream into different organs but especially into the muscular
tissue. The onkospheres noAv change into simple vesicles or cysts, on
whose wall small nodules arise later, and from these the heads of the
future tapeworms develop.
The development occurs rather slowly. In 20 days the Cysticercus cellulosse
is about the size of a pinhead and the head is visible as a small white point; after
40 days it appears as Ing as a mustard seed and the head may be plainly seen, but
it has neither suckers nor hooks; after 60 days the cyst is as big as a pea, with
suckers and hooks but no neck; after 3 months the bladder worm is fully developed
and liehind the scolex the transversely striped neck may be seen (Hosier). The
growth of Cysticercus bovis occurs still more slowly. After 60 days the head appears
as large as a pinhead with plainly visible suckers; the visible depression at the
anterior end of the head develops in the sixth month, when the cyst has already
reached the size of a small bean, but later it develops further and grows to a length
of 12 mm. Hoefnagel & Reeser found cysticerci, 5 mm. in length, after 45 days, in
a calf used for experimental infection.
Natural infection occurs by food or water wliicli is con-
taminated by human feces containing the proglottides or liber-
ated eggs, and is eaten by animals. Swane are attacked especial-
ly easily because tliey root about in dung heaps and in the neigh-
borhood of latrines and sewage deposits, and because they root
up soiled earth. Consequently the disease frequently occurs
in such swine as move about freely in peasants' yards or in
the neighborhood of sties Iniilt near dw^elling houses, while the
large herds which are mostly kept in a state of freedom are
seldom attacked. The infection in cattle probably results pri-
marily from food or drinking water contaminated by human
fecal matter, but it is not eliminated on pastures if persons
with tapeworm deposit their feces there, or if during floods the
contents of canals have been carried to the pastures. Contami-
nation of the drinking water is easy, as brooks frequently are
found in the immediate neighborhood of latrines or manure
heaps. It is also to be considered that eggs of the tapeworm
are viable on damp ground for a very long time, and conse-
quently even one infested man may infect the ground for a long
time with the enormous number of deposited eggs (one prog-
lottis contains about 30,000 eggs), (van Beneden found that
eggs kept by him in alcohol for a year could still develop em-
bryos.)
Susceptibility. Young animals under 2 years of age are
especially susceptible. The disease does not occur in sucking
animals, because generally no opportunity occurs for infection.
Exceptionally, however, quite young animals fall ill; thus
Deleidi and Noack found some ca seated cysticerci in sucking
calves under t^vo months old and these must have been taken
up shortly after birth. In these cases it was supposed that
the infection had been caused through hens' eggs given to the
calves by an attendant affected with tapeworm, whose hands
were soiled. In older animals the toughness of the tissues is
much less favorable for the migration and further growth of
onkospheres.
Anatomical Changes. Symptoms. 825
Anatomical Changes. In the presence of cysticerci in the
striated muscle of swine tlie muscles appear otherwise healthy.
Only after very severe invasion the muscle is pale, reddish gray
and soft, and the increased connective tissue is serously in-
filtrated. The number of cysts varies in different cases; thus
Kiichenmeister found in one case 133 in 17 grammes of flesh,
and this number corresponds to 80,000 cysts in one kilogramme
of muscle. The cysts are easily removable from the muscle
and leave a visible cavity behind ; when present in large numbers
they are of different sizes and partly shrivelled or calcified.
They occur most frequently in the neighborhood of the shoulder
or in the deep muscles of the shoulder and chest, in the ab-
dominal muscles, in the nape and neck muscles, in the dia-
phragm, in the intercostal muscles, and in the adductors of the
thighs, further also in the muscles of tongue and heart ; in more
severe cases they may be found in the other muscles, further,
in the brain, eyes, liver, spleen, lungs, lymphatic glands and in
the fat.
In cattle the cysts occur chiefly in the internal and external
muscles of mastication and in the heart muscle ; more rarely in
the muscular tissue of the tongue, of the neck and chest, and
only exceptionally in the intestines. Their number is usually
small, and only very seldom do cases occur where the muscular
tissue contains numerous cysts throughout. (Hertwig once
found 300 in half a pound of flesh.)
Symptoms. In swine cysticerci cause pronounced s\Tnp-
toms only after a very severe invasion or after localization in
the eye or brain. The greater number of measly swine appear
quite healthy. The disease usually is recognized only if an
organ that can be examined directly is affected. Thus one
finds the cysts now and then under the conjunctiva of the eye,
on the bulbus, or on the inner surface of an eyelid in the form
of a bluish, transparent elevation. Sometimes, however, they
are situated in the interior of the eye, in the anterior chamber
of the eye, in the lens, where they can be recognized with the
naked eye. But if they localize behind the lens, as happens
rarely, they can be seen only with the ophthalmoscope. In the
tongue cysts are to be felt with the hand, mostly at the edges,
on the under surface or in the frsenum. If the cj'sticerci are
numerous, the tongue may be almost paralyzed, and in conse-
quence the animal is unable to eat (Sobotta). Much more rare-
ly cysts occur under the mucous membrane of the anus, where
they may also be recognized by palpation.
In order to examine the tongue for cysticerci the pig is laid on one side by
an attendant, and the mouth pried open with a stick. The veterinary surgeon
passes the index and middle fingers of both hands into the mouth, and on drawing
his fingers over the tongue and lingual ligaments, the cysts may be felt as firm
nodules the size of a lentil or pea. The examination is of value only when a
positive result is obtained. Small cicatrices in the above mentioned positions
incline one to suspect that cysts have been cut out at some time. (^A detailed
description of the method of examination has been given by Kukuljevic.)
826 Measles.
Other symptoms are faulty appetite, progressive anemia,
edematous infiltrations leading to caeliexia, and complete ex-
haustion. At times the body is not sufficiently supported on
account of the disease of the muscles of the chest, consequently
the anterior part of the chest between the shoulder blades sinks
somewhat lower, and the movements of the anterior extremi-
ties become stiff and cramped (Delpech). In other cases hoarse-
ness arises in consequence of involvement of the laryngeal
muscles, and this is especially evident when the annual is
caught. At the same time a short hollow cough will be noticed,
particularly during quick movements (Trasbot), also difficulty in
breathing may be present. In some cases the animal squeals
aloud when rooting about owing to the tenderness of the snout,
later on rooting ceases entirely and the animal takes grain food
very carefully by elevating the upper lip and snout (Greve) ; the
snout is also sensitive to pressure, Cysticerci in the brain may
cause restrained movements, dizziness, epileptoid attacks, arch-
ing of the back (pleurosthotonus, opisthotonus) or the symp-
toms of an acute cerebritis ; occasionally death may follow un-
expectedly from apoplexy.
In cattle one very seldom notices any symptoms of disease
after a natural infection. Flemming relates that examination
of the tongue may also lead to a positive diagnosis in cattle.
Severe cysticercal lameness was noticed by Ciga in an ox, while
Schmidt found in a cow a cyst, the size of a pea, in the anterior
chamber of the eye. In a 10-year-old cow with severe cysticer-
cosis Ottle noticed high fever (41° C), rapid pulse, quickened
and labored breathing, groaning and intense itching at the
head; the animal had to be slaughtered. The disease is often
established after the slaughter of an animal, although it has
been unsuspected during life.
Symptoms of illness were often absent after intense artificial infection, but
now and then transient indisposition, fever and muscular quivering were observed,
while in other cases, in addition to symptoms of an acute general illness, the disease
was accomijanied by pain in the thoracic and abdominal walls, stiffness on motion,
difficulty in breathing and weakness of the heart; finally exhaustion or j^aralysis of
the heart led to death (Leuckart, Ziirn).
Ostertag showed that cysts in cattle could be a])sorbed after previous caseation.
This explains the fact that measles are found much more rarely in old cattle.
In dogs the bladder worm of Taenia solium occurs only ex-
ceptionally. Symptoms of illness hitherto have been noticed
only when the brain has been affected more severely, and they
consisted chiefly in excitement, restrained movements, dizziness
in one case (Vogel), in blindness, and deep lethargy. In one
case of Trasbot & Eailliet where the muscles were infected by
numerous cysts, a marked hyperalgesia of the whole body
arose, which was visible on the slightest disturbance or move-
ment of the limbs, and as a result the animal scarcely moved
at all.
Sufifran saw the development of cystic formations in the subcu-
taneous connective tissue of a dog affected with eystieercosis, while
Prophylaxis. Sarcosporidiosis. 827
afterwards small and somewhat painful nodes appeared under the skin,
and these developed in three or four months to cysts as large as hens'
eggs. They contained at first a reddish, and later on a sero-purulent
fluid in which the cysticerci were suspended; later on the cysts broke
spontaneously and fistulous openings occurred in their places. Among
other symptoms, dejection, fever and loss of appetite were noticed.
In deer, measles (Cysticercns cellulose) have often V)eeu found during meat
inspection (Borehmann, Agerth).
Prophylaxis. The occurrence of the disease in swine can
be prevented by removing, the animals far away from manure
heaps, latrines, cesspools and drains. In the case of cattle the
stalls must be kept clean, and the owners and attend-
ants must 1)6 informed as to the nature and origin of the
disease, and must be told not to deposit their feces in such
places, in stalls (calf pens) or out in the open, where they will
be accessible to domestic animals. The contents of privies
should not be put on meadow and pasture land, but only on
arable land that is not used for the growth of green fodder. A
self evident prophylactic precaution is that persons affected with
tapeworm should immediately submit to medical treatment.
Literature. Agerth, Z. f. Flhyg., 1906, XVI, 419.— Borehmann, ibid., 1905,
XV, 39.— Ciga, ibid., 1905, XV, 118.— Deleidi, Clin, vet., 1903, 273.— Edelmann,
Lehrb. d. Fleischbeschau, 1907.^ — Guustow, Z. f. Flhyg., 1906, XVI, 419. — Hoefnagel
& Keeser, Holl. Z., 1905, 351.— Kukuljevic, B. t. W., 1906, 626.— Noack, ibid., 1906,
348. — Ostertag. Bibliographie d. Fleischbeschau, 1905 (complete Lit.)j Fleisch
beschau, 1904.— Ottle, Miinch. t. W., 1909, 306.— Eepiquet & Salvatori, J. vet., 1906,
220.— Schmidt, S. B., 1900, 270.— Stroh, Z. f. Flhyg., 1907, XVII, 78.— Suffran,
Eev. vet., 1909, 401.— Trasbot, Diet., 1880, XI, 327.
Sarcosporidiosis. The order of sarcosporidia is represented only
by a single species of sarcocyst whose young form of development is
found in the muscle fibers, and constitutes the socalled Miescher's or
psorosperm sacs. They occur especially in s^nne, sheep, horses, cattle
and goats, and in swine most frequently in the abdominal muscles and
diaphragm, in sheep in the skin and abdominal muscles, in horses in
the neck and muscles of the throat. Miescher's sacs are always longi-
tudinal in shape and contain numerous half-moon or kidney-shaped
bodies (sporozoites) ; the protoplasm of the infested muscle fibers show
uninjured striation. In case of calcification one still sees the kidney-
shaped bodies around the calcified S-shaped formations. Their hard
white capsule dissolves after the addition of potassium hydrate solution
(which does not occur in the case of trichinas). In their further de-
velopment and growth the protoplasmic bodies of the muscle fibers dis-
appear completely, so that the sarcosporidium is alone present in the
widely dilated sarcolemma, and lies imbedded in the intra-muscular
connective tissue. These little psorosperm sacs are very often encoun-
tered in the esophagus of sheep, goats, horses, buffaloes and deer. They
seldom occur in the muscles of the larynx, chest or belly, or in the heart
muscle. They appear as yellowish white cysts, of millet seed to hazel-
nut size, with pus-like contents.
There is no ground for separating the order of Sarcosporidia into the two
classes of Miescheria and Balbiana depending on their presence in the muscle fibres
or the intramuscular connective tissue respectively, since they only represent diiferent
forms of growth of the sarcocyst (Bertram, v. Katz). There also occurs in the
g28 Sarcosporidiosis.
horse the Harcocystis Bertrami; iu cattle and iu buffaloes the S. Blauehardi; in sheep
the S. Teiiella, iu the pig the S. Miescheriana, aud in the hen the S. Horvathi.
Infection with sarcosporidiae occurs through the iutestiual canal,
as the iuvestigatioiis of Smith, M. Koch, Negre and Negri prove. Negri
observed that the morphological peculiarities of the same kind of sar-
eosporidia differ according to the species of the experimental animal.
Sarcosporidiffi were found in the muscular tissue of a llama (Eievel & Behrens)
which contained a toxin having a paralytic action on the central nervous system,
whilst Laveran &; Mesnil have recovered a poison called sarcozystin from sarcosporidsp.
Lindner raises the question whether Miescher 's sacs are not simply encj'sted
vorticellary or eolpidium protozoa which have been taken up with the water from
pools. On the other hand Watson recognized a great similarity between the growing
spores of sareosporidia and the little bodies seen growing in trypano^onies, and
considers that mistakes and failures in diagnosis may thus arise.
S3anptoms. Sareosporidia cause no disturbance of health except
in the case of horses in which symptoms of illness due to sarcosporid-
iosis are often exhibited. Difficult respiration was noticed in a sheep
and a goat (Dammann, v. Niederhausern), in an ox stiff gait (Brou-
wier, Tokarenko), in a pig paralysis of the hind quarters (Virchow),
in two pigs painfulness of the nuiseles, hoarseness, fever (Brschosniow-
ski), iu a horse hardening of the tongue (Hoflich) or of the tongue and
the lips (Hendrickx & Lienaux), and as a result of this, nutritional
disturbances. In one of these cases prominent nodes were found on
the swollen, hardened tongue of a horse. Moussu & Co(iuot saw a
hard diffuse swelling of the head in a horse similar to that seen in
purpura, further urticaria-like swellings on the sides of the body, neck
and under the chest, and also a diffuse swelling under the bell.y and
on the sheath, as well as "wooden tongue" with small, yello-\nsh red
nodes on the under surface of the tongue. All these swellings were
firm, of the consistence of cartilage, and situated under the skin ; micro-
scopic examination of an excised node showed the existence of sar-
cosporidiosis. The taking of food and water was made difficult by the
changes caused, and movements were executed painfully aud slowly.
In another case noticed by Lienaux similar swellings were present, and
lameness first in one leg, then another, and then in several legs; in
the extirpated pieces of muscle sareosporidia were found. Watson saw
dejection, aimless wandering about with slow step, swelling of the
bones of the skull. Sabrazes, Marchal & Muratet noticed fibrosarcoma-
like swellings on the lower chest, and a considerable hard swelling of the
metacarpal and metatarsal bones A\'itli formation of numerous exostoses,
further, progressive anemia and emaciation leading to cachexia. In
cattle with generalized sarcosporidiosis, Watson saw the following
symptoms : Emaciation, freciuent stretching of the head and neck with
spasmodic quivering of the affected muscles, especially the muscles of
mastication during the taking of food which was badly interfered with.
The treatment is not promising; a systematic trial might be given
to potassium iodide, since i\Ioussu & Co(iuot saw a lessening of the
swellings and greater freedom of motion after its use.
Literature. Betegh, Cbl. f. Bakt., 1909, LIT, Orig., 566.— Edelmann, Lehrb.
d. Fleischbesehau, 1907.— Hoflich, Miinch. Jhb., 1896-97, 75.— Lienaux, Ann., 1907,
594._Lindner, A. f. Tk., 1907, XXXIII, 432.— Michael, B. t. W., 1906, 619.—
Moussu & Coquot, Bull., 1908, 445.— Negri, Cbl. f. Bakt., 1908, XLYII, Orig., 612.—
Ostertag, Bibliographie d. Fleischbesehau (Lit.). — v. Eatz, Allattani, Kbzlemenyek,
1909, VTTT, 1.— Eievel & Behrens, Cbl. f. Bakt., 1905, XXXV, Orig., 341.— Sabrazes,
Marchal & Muratet, Eev. gen., 1910, XV, 177.— Watson, Journ. of comp. Path., 1909,
XXII, 1.
Diseases of the Skin
1. Itching of the Skin. Pruritus Cutaneus.
{J uchhranklieit .)
An anomaly of function of otherwise apparently healthy
skin which manifests itself by continuous or temporary itching
of a more or less severe character is known as pruritus
cutaneus.
This definition of itching does not apply to the cutaneous pruritus arising in
diseases of the skin connected with anatomical changes (eczema, nettle-rash, etc.),
or to the itching caused by animal or plant parasites.
Neither does the name apply, strictly speaking, to the paresthesia similar to
itching which is seen now and again iu certain diseases of nerves, especially in
affections of the peripheral nerves.
Etiology. General itching of the skin is ol)served at times
as a symptom accompanying chronic inflammation of the kid-
neys (Schindelka), chronic digestive ailments (Haubner, Schin-
delka) exceptionally also in jaundice, more frequently in dia-
betes melitus (Schindelka) as well as in shedding of the coat
(Haul)ner). In one horse it arose after an attack of influenza
(Pr. Mil. Vb.). Long continued feeding with maize and vetches
as well as the prolonged use of caffeine may cause a general
pruritus (Uebele). Further, according to Schindelka, it is not
rare in marasmic dogs. In cases noticed in dogs by Eberhardt
and by Frohner there was no primary disease.
In opposition to the effect seen in human medicine, the prolonged use of arsenic
seems to produce hyperesthesia of the skin rather than pruritus if the employment
of the drug is interrupted periodically (Mayer).
Certain organic diseases cause a local itching of the skin.
Thus pruritus ani is frequently due to the presence of intes-
tinal worms (tapeworms, oxjmriasis, gadfly larvae) in the rec-
tum of horses and dogs, while nasal itching results from pentas-
tomes and oestri. Finally Schindelka noticed pruritus of the
point of the tail in dogs without visible cause, while Frohner
saw obstinate itching on the left side of the lower jaw in a
horse.
Pruritus localis appears also as a symptom in certain paresthesias such as
at the ])lace of the bite in hydrophobia, in acute infectious bulbar paralysis at the
829
830 Syinptonis. Diayuosis. Trealuieiit. Excessive Sweating.
poiut of infeetiou, in trembles oeueraUy in the liind (|narters, in dourine at
times in tlie region supplied ))y certain nerves, in combined tail and sphincter paraly-
sis at the root of the tail. It arises usually as the result of a disease of the
sensory nerves.
Symptoms. Itching- occurs either in paroxysms or con-
tinuously, and causes the animal to gnaw, lick, ruh or chafe the
affected pnvt of the body, so that sometimes sores develop on
the skin.
Diagnosis. Skin diseases due to anatomical changes and
especially scab must be differentiated. It must, however, not
be forgotten that in consequence of rubbing, etc., changes may
eventually be produced in the skin even in pruritus. As far
as possible one should determine whether the trouble is due to
some organic disease.
Treatment. Applications, with friction, of cold water, of
alcohol with 1 to 3% salicylic acid, carbolic acid, thymol, cam-
phor, naphthol or tar are indicated, also compresses soaked in
hot water or alcohol (Schindelka). Eberhardt saw^ good re-
sults from applying sulphuric ether while Schindelka records
onl}^ temporary improvement wath this and also with sapolan
(together with lead water, aa). In other cases anesthetizing
drugs give transient or permanent results. Some of those used
successfully were an ointment of two parts of cocaine, 5 parts of
borax, and 200 parts of lanoline; the application of a powder
composed of 3 parts of orthoform and 100 parts of d;sanal on, the
skin previously cleansed wdtli warm creolin solution and cotton
soaked in benzine; also anesthesin in the form of a 10% oint-
ment.
Literature. Frohner, Monh., 1903, XIV, 459; ,Pr. Mil. A^b., 1901, 162.—
Schindelka, Hautkrankheiten, 1908, 6.S.— Schlesin^er, O. M., 1908, 391.— Strebel,
Schw. A., 1889, XXXI, 12.5.
2. Excessive Sweating. Hyperidrosis.
(Epidrosis, Dysidrosls.)
Excessive sweating denotes a functional disturbance of
the sudoriferous glands, in consequence of which, without any
external cause or in certain internal diseases, the whole surface
of the body or the greater portion of it (hyperidrosis univer-
salis), or only some portions of the body appear continuously
wet.
Etiology. General hyperidrosis usually develops as a sec-
ondary affection. It is seen when carbonic acid accumulates
in the blood as a result of certain diseases of the respiratory
or circulatory organs, in collapse, in the quick decline of fever
(socalled critical perspiration), in the course of uremia, in
generalized muscular spasms, in corpulence, and now and again
Etiology.
831
also 111 certain diseases of the brain, for example, after con-
tusion of the brain (noted by Barbey in a dog). As a distinct
disease it occurs very seldom. Hyperidrosis was noticed by
Pott m horses after feeding on pumpkins.
Local or partial hyperidrosis also occurs chiefly as a sec-
ondary affection and is usually caused by traumatic lesions or
by compression of the peripheral nerves or the s^^ipatheticus,
and more rarely hj traumatic or inflammatory diseases of the
spinal cord.
The known eases of partial hyperidrosis which have been reported so far
occurred as the result of traumatism at the neck (Dupas), front of the chest or
Fig. 118. Hyperidrosis localis in a horse. The dark stripe correspoiuls to the sweating
intercostal region ; at the upper end of the stripe there is a fracture of the rib.
shoulder region (Eiehter), also after fracture of the ilium (Delacroix), of the rib
(personal observation), and after a trauma the nature of which is not stated
(Dexler). Forgeot noted sweating appearing regularly after subcutaneous injec-
tions of ether, and limited to the point of injection; it lasted several days to three
months. Local sweating occurs pretty frequently in inflammatory diseases of the
pharygeal region (Schindelka, Dexler, Dupas), while in one of Schindelka's cases,
m a horse with pleuro-pneumonia, almost the whole of the anterior half of the body
was affected. Compression of the peripheral nerves or of the sympathetieus through
tumors or swellings now and again causes sweating (Kerlirzin, Dexler), while in
pertain cases of fractured vertebra3 (Eoder, Emshoff) the onset of girdle-like hyper-
idrosis commencing at the fracture has been noticed. Bielefeld saw a circumscribed
sweating in the region of the forehead of a horse suffering from neuralgia of the
trigeminus. Finally a case of unilateral hyperidrosis was noticed by ~ ^
mally
horse with disseminated encephalo-niyelitis. '
noticed by Dexler in a
832 Excessive SAveating.
Tn a few other cases of hyperidrosis no manifest cause could be discovered.
Thus it occurred iu a dog after catching cold (Holter])ach) and in a horse after
feeding too largely on clover (Dages).
Symptoms. Single parts of the body of the resting ani-
mals appear saturated on one or both sides, and in consequence
the hair appears darker. Sometimes the sweating is so severe
that the animal appears to steam and the sweat forms in drops.
The limit of the sweating region is generally sharply defined
in the middle line of the body; on the under parts of the body
it appears somewhat less sharply limited because the sweat
flows on to the other half of the body. While movement gen-
erally causes more secretion of sweat, it may occasionally cause
it to cease temporarily (Dupas). The disturbance is, as a
rule, limited to the region that is affected originally, but now
and again it may extend and involve further parts.
In the region of excessive sweating there is often a lower-
ing of sensation in the skin, but sometimes on the contrary
hyperesthesia is noted.
Course and Prognosis. Hyperidrosis is usually a transi-
tory affection which disappears of its own accord in a few
■weeks or months. At times it persists but is not prejudicial to
the health of the animal (Schindelka).
Treatment. Fomentations and frictions mth alcoholic
solutions and repeated subcutaneous injections of atropine may
be employed, but as a rule they do not visibly influence the
hyperidrosis. Kerlirzin saw a cure in a horse after treatment
with potassium iodide (6 gin. per day) for 6 days.
Literature. Bielefeld, Pr. Mt., 1856-57, 103.— Brummel, Vet., 1900, 161.—
Dages, Bull., 1894, 441.— Delacroix, Rec, 1901, 17.— Dexler, Nervenkrkh. d. Pferdes,
1899, 2.38.— Dupas, Bull., 1904, 523; Eev. Vet. 1906, 398.- Emshoff, S. B., 1906,
184.— Forgeot, Bull., 1906, 597.— Holterbach, B. t. W., 1906, 282.— Kerlirzin, Rev.
vet., 1883, 114.— Richter, S. B., 1905, 331.— Roder, ibid., 1896, 137.— Schindelka,
Hautkrkh., b. Haustieren, 1908, 66.
Blood-sweating. (Il^matidrosis.) Blood-sweating occurs as a
result of hemorrhage into the sudoriferous glands, whereby the blood
becomes mixed with sweat. In diseases with hemorrhagic diathesis
(purpura, ejc.) this anomaly occurs now and then (personal observa-
tion), although in these diseases it is due more to oozing of bloo '
through the skin after loss of epidermal substance than to an actual
]3erspiration of blood. Recently (B. t. W., 1907, 954) in a two weeks'
old calf von Milbradt noticed a trickling of clear red drops of blood
from the blo6d pores.
3. Falling Out of Hair, Wool and Feathers. Alopecia.
{Hairlessness, Baldness, Calvities.)
Any falling out of the hair or a loss of hair in any part
of the ])ody other\\ise covered with hair is known as alopecia
when the trouble is not due to any organic or parasitic disease
Etiology. 833
of the skin. Alopecia is thus, as a matter of fact, the result of
nutritional disturbances of the skin.
Etiology. Alopecia seldom occurs as an independent dis-
ease and has in this form been noted hitherto onlj^ in horses,
dogs, and cattle where otherwise apparently healthy skin has
been permanently denuded of hair in large patches (alopecia
areata, Area Celsi). The symmetric occurrence of the affec-
tion may have a nervous cause or be due to some influence of
the trophic nerves. Thus Joseph saw the affection in a charac-
teristic form after section of the second nerve of the neck, while
Trendelenburg noticed falling out of the feathers in pigeons
after section of the sensory roots of the spinal cord. On the
other hand in spite of negative microscopic findings, the action
of parasites is not excluded with certainty.
Holborn found a fission fiingns very siniilai- to the Trieopbyton tonsurans;
Sabaroud believes that the falling out of the hair is caused by a microbaeillus multi-
plying in the hair bulbs.
A congenital baldness (Atrichia, Hypotrichia, or incor-
rectly Alopecia adnata) is seen affecting the whole surface of
the body in foals (Gherardi, Roder), calves (Laurent, Schaar),
and dogs (Corniea). This condition occasionally stands in re-
lation to a faulty growth of hoofs, claws and teeth (Bonnet),
but many a time it is inherited. Such animals usually die after
a short time, occasionally, however, the falling out of the hair
only begins 1 or 2 years after birth.
Andre noticed general loss of hair in 11 foals of one mare, and in 8 of
another the hair fell out, especially on the feet and on the lower parts of the trunk,
near the second year of life. Roller savr a foal born without any hair, whose mother
had lost her hair during pregnancy.
In by far the greater number of cases the falling out of
the hair is a secondary affection (alopecia symptomatica). It
occurs commonly in general derangement of nutrition, such as
feeding with fodder of bad quality, when the animals are fed
insufficiently, also as a result of intestinal catarrh (Duschanek)
or of wasting diseases such as fluke, husk, etc.; on the other
hand it may occur in the course of certain infectious diseases
(purpura, strangles, influenza, swine plague and hog cholera),
in which an injurious effect on the hair papillae is probably pro-
duced by toxins circulating in the blood. It is more difficult
to explain those cases in ewes, mares and bitches, where the
wool or hair fall out at the end of pregnancy or during the lac-
tation period (Hering," Spinola), also cases in horse« after se-
vere sweating and in individual horses as well as in large studs
where during several succeeding winters or summers frequent
cases of alopecia have occurred (Werner, Fomin, Andre). Ex-
834
Fallias- Out of Hair, AYool and Feathers.
ceptionally continual cold may, in horses, cause falling out of the
hair (Hering, Kohlhepp). Wellach observed sudden baldness in
young geese. In cage birds falling out of the feathers is often
connected with the presence of iVlood-sucking parasites (Der-
manyssus) in the neighborhood of the animals.
Symptoms. Symptomatic alopecia usually affects the
whole body, at most the mane, tail and lower parts of the
limbs escaping. At first one only has the impression of a more
Zl_A
> /
Fig. 119. Alopecia Symptomatica.
active shedding of the coat, but later the hair coat is very much
thinner, and eventually irregular spots become quite hairless;
as these rapidly increase in size, the whole of the surface of
the body becomes denuded and hairless (Fig. 119). In a por-
tion of cases the falling out of the hair is preceded by edema-
tous infiltration under the chest, under the belly and at the ex-
tremities, or by difficulties of digestion which may, however, ac-
Diagnosis. Treatment. g35
company the process at a later stage. After a few weeks the
points of fine little hair emerge from the denuded dark colored
skin, causing the skin to feel downy, until finally the hair re-
turns completely.
The general nutritional disturbances may in such cases
become evident by the occurrence of transverse grooves on the
matrix of horns, hoofs, claws and toes.
Alopecia areata appears in the form of small, scattered
round spots on which the hair falls out, and which gradually
increase in size, but for some time preserve a s;^anmetrical
round form, until finally large, irregular bald spots arise by
coalescence of neighboring spots. The loss of hair may be ex-
tensive, but a general alopecia as in the before-mentioned cases,
does not occur ; on the other hand, the complaint is remarkably
obstinate, and occasionally will not heal. The skin appears in-
tact, and as a rule darker in color ; at the edges of the spots the
hair may easily be pulled out.
Roll & Siedamgrotzky found atrophic skin in their cases in the cells of the
Malgighian layer, and very numerous pigmented bodies in the cells of the hair bulbs
and sebaceous glands, while Schindelka found atrophy of the hair bulbs and of the
fatty tissue and a diminution of pigment; microorganisms could not be found by
him.
Diagnosis. Independent or congenital as well as secon-
dary alopecia are distingaiished by the healthy state of the skin,
and by the great extent of the bald spots caused by tissue
changes in the skin.
The round spots in alopecia areata appear very similar to
those seen in herpes tonsurans, but in this latter one can often
feel or see hair stumps, the surface of the skin is covered with
fine scales and thread like fungi, and spores may be found in
the hairs. — Not infrequently acariasis runs for some time a
course similar to alopecia areata, but it may be differentiated by
finding acarus mites under the microscope, and by the fact
that serous fluid comes from the hair bulbs when a fold of the
skin is pressed, although in many cases several examinations
are necessary to establish the diagnosis. Alopecia due to
acariasis occurs much more frequently in dogs than true alope-
cia, with which it has undoubtedly often been confounded.
Treatment. Since symptomatic general falling out of the
hair heals as a rule of itself after a few weeks, the metabolism
will most properly be stimulated by better nourishment, good
care of the skin, by washing with soap, soap and alcohol mbs
(pure rectified spirits, spirits of camphor). A similar procedure
may be adopted in alopecia areata, but owing to the possibility
of an infection, disinfectants (2% corrosive sublimate, 10%
balsam of Peru, 5% pyrogallic acid) may be employed in ad-
dition to the removal of the loosened hair; as a matter of fact
S;}(j Tric'linn-lioxis Nodosa,
even this treatment Mill pi-ove successful only after a lon.i;"
time and sometimes not at all. Uehele claims to liave obtained
excellent results in making the hair grow by energetic daily
applications by friction of nafalan.
Literature. Tieslik, B. t. W., lOOfi, 233.— Katzke, Z. f. Vk., 1898, 289.— Kett-
ner, ibid, 1905, 122.— Roller, Eep., 1842, 306.— Krait, Eev. vet., 190.-), 634.— Kriiger,
Z. f. \k., 1893, 252.— :\roussu, Rec, 189S, 81.- Rodev, S. B., 1903, 296.— Eiiegg,
8ehw. A., 1890, XXX, 124.— Tveiidelenburg, Xeiirol. Cbl., 1906, 386.
Trichorrhexis Nodosa. Tliis aft'ection which is not uneoinmon in
the heard and hair of the head in man occurs also in horses, where it
is seen generally as an enzootic. Exceptionally it may occur in swine,
and Schindelka succeeded in observing the characteristic changes in
the bristles of a shaving brush. On the tail and mane of horses, and oc-
casionally also at one or several places on the hairs of the body, ball
or spindle-shaped swellings occur in the hair which give it the appear-
ance of being infested with white nits. Even on slight pulling the hair
breaks at these places, and when the break is examined with the naked
eye or better under a low power, a brush-like unravelling may be
noticed. If many hairs close to one another are affected, and if the
free ends are broken off during grooming, the hair becomes rough and
it looks as if it had been singed ; even at a distance the lustre of the af-
fected spots is seen to be dulled ; the tail may come to look like a rat tail.
Contrary to what has been noticed hitherto, Bronec found in an en-
zootic, circumscribed swellings in the sheath of the hairs of the tail
only, while on the rest of the l)ody, chiefly in the mane and forelock,
the tips of the hairs were split in the manner of a brush. The skin
appeared rough, but itching was absent. The development always
proceeds slowly and may require a year.
The cause of the disease is unknown at present. IMedical men
ascribe it to a disturhance of nutrition of the hair roots, or to intense
rubbing of the skin, while Hodara asserts a parasitic cause, having found
various shaped bacteria in the hair. The fact that many horses are
affected, and the spread of the disease in a stud seem to indicate
the infectious nature of the disease.
Steiuhardt ohserve('' the spread of the infection from a few horses in a bat-
tery to almost all the horses of the regiment in 1 to 4 weeks; a similar observation
was also made bv Schindler & Moser. In Schindelka 's and Tennert 's cases, men
were infected. According to Schindelka the disease may be transmitted to cattle
by inoculation. .Jakob and Gross, however, did not succeed in proving the presence
of micrococci in the hair.
The disease o])stinately resists the different methods of treatment,
])ut it disappears spontaneously after 3 or 4 months and then loses
at the same time its infectious character ; relapses, however, occur
pretty frequently (Steinhardt).
For treatment it seems most suitable to clip the hair and to cleanse
the skin thoroughly with disinfecting fluids. Trofimow found a mix-
ture of oil of turpentine with tincture of eantharides most effective,
Kalkoff a 5% watery solution of pyrogallol. Schindelka arrested the
disease by clipping and washing the skin thoroughly, and then by long
continued lotions of 1-2% sublimate solution, followed by sublimate
compresses applied for one day. Bronec also succeeded with this
inethod. but after drying the hair he rublied in creolin and linseed oil.
Dandruff. 837
Kutziier & Reichert recoiumend washing the skin with 2-3% luke-
^val•n^ soda solution, and after it is dry, painting it with a 1%
solution of pyoetaninuni coeruleuni. The last mentioned method was
found ett'eetive by Schindler & JMoser if a 3% solution was applied
vigorously.
By way of prophylaxis the stables and curry coml)s, as well as the
brushes should be disinfected.
Literature. Bronec, T. Z., 1908, 45.— Kalkoff, Z. f. Yk., I,s92, 43; 1899, 263.
— Kutzner & Reichert, ibid., 1898, 223.— Eoiiier, D. t. W., 1899, 216.— SeluBdelka,
Ilautkrkh., 1908, 532.— Schindler & Moser, O. M., 1906, 193.— Teuuert, Z. f. Yk.,
1902, 361.
4. Dandruff. Seborrhoea.
The excessive formation of sebum arises, according* to
Scliindelka, from a superficial inflammation of the skin ^\ath
hypersecretion of the sebaceous glands, on which account fluid
or oily secretions are excreted in considerable amount (sebor-
rhoea oleosa) or scales form on the skin consisting of fat and
the horny layer cells (seborrhoea sicca s. pityroides). The
trouble may aifect circumscribed places or develop all over the
body (seborrhoea universalis).
Occurrence. These skin anomalies are chiefly observed in
sheep, horses, asses, dogs, and at times also in cattle.
Etiology. The exact cause of the disease is not yet known.
Only so much is known that anemic animals, or those suffering
from internal diseases, are affected more frequently than healthy
ones, and that not infrequently certain skin diseases (eczema,
scab, acariasis, sclerodermia), severe infections, as well as
digestive diseases form the basis for an attack of seborrhea.
Very frequently no assignalile cause can l)e discovered.
Symptoms. In horses the disease chiefly occurs on the
neck, rump and face, but exceptionally the whole surface of the
body may be attacked (Perrin). It occurs as seborrhoea sicca,
and is also called exfoliating herpes or rash. In cleaning the
animal mealy or bran-like scales are removed together w^itli
much hair. The coat appears dry, dull and as if filled with dust
(pityriasis seborrhoica), l)ut in addition bald spots form (alope-
cia seborrhoica s. furfuracea? s. pityroides) which alwaj^s in-
crease very slowdy. In other cases white, and later dirty gray,
fatty, thick crusts form Avitli a rancid smell, which in case of
an extensive involvement emanates from the patients them-
selves (Eoder). The skin appears either normal, reddened or
sometimes eczematous.
In dogs sel)orrhoea sicca occurs mostly behind the ears, at
the neck, on the shoulders and tail, whence it may spread to ad-
joining parts of the body. Aside from mealy or bran-like
838 Dandruff. Erythema.
scales, a greasy mass surrounds tlie origin of the hair shafts,
which now and again mats several hairs into a tuft. Slight
itching may at times be present, and eventually the hair ^\'ill
fall out.
Seborrhoea oleosa develops, as a. rule, on parts of the body
that are thickly covered with hair, but at times also in groin, in-
side the thighs or inside of the ears (Schindelka). The skin feels
greasy or an oily substance may be scraped from it. The fatty
substance, which is secreted copiously, dries to yellowish gray
crusts under which the skin appears otherwise unchanged.
In sheep the neck, back, shoulders and sides of the breast
are attacked mostly by seborrhoea sicca (socalled false scab),
which form into small or large whitish yellow and later brown-
ish yellow greasy scales or lamellae (socalled tallow scab). Fall-
ing out of the wool occurs later. Itching does not occur, but the
animals tear out the wool at the affected spot (Haubner).
Seborrhoea oleosa occurring on parts not covered with wool
exhibits similar s^Tiiptoms to those seen in the dog.
Course. The disease runs a rather slow course and unless
treated does not improve except with some moderation in sum-
mer. Suitable treatment causes it to decline after the lapse of
several months. In horses it sometimes leads to exhaustion of
the patients.
Diagnosis. Seborrhea may be distingiiished from eczema,
scab or acariasis, because in these affections the skin itself is
more or less changed, and scab is associated with evident itch-
ing. Scab and acariasis occur moreover often at first on dis-
tinct parts of the body, and on microscopic examination the
mites are to be found there.
Treatment. Good nourishment, care of the ski'^i, and if
necessary, clipping of the hair, and the removal of any under-
lying disease, if such be discovered, usually lead to recovery.
In dry seborrhea applications of vaseline or lanoline are indi-
cated as well as washing with alkaline solutions or, in case of
considerable itching, dressing with glycerinated salicylic acid
(1 part of salicylic acid, 3 parts of glycerine, 60 parts of alcohol
[Frederiks]). In other cases the disease is influenced favorably
by the empio^mient of a 5 to 10% resorcin or salicylic ointment.
In obstinate cases the treatment must be continued for a month
or over.
Literature. Dorst, Z. f. Vk., 1906, 437.— Moussu, Eec, 189S, 81.— Eossi, D.
t. W.. 1004, 104 (Eeview).— Roder, S. B., 1903, 293.— Schindelka, Hautkrkh., 1908,
70 (Lit.).
5. Erjrthema.
By erythema is understood a reddening of the skin through
a copious filling of the blood capillaries of the superficial layers
Etiology. Symptoms. Treatment. 839
of tlie coriiim and especially of the papillary bodies, but without
any iniportant change of the tissue structure (Erythema con-
gestivum) or at most with a slight serous infiltration of the skin
(E exudativum). The redness of the skin is thus, as a matter
of fact, the first stage of an inflammation of the skin.
Etiolog-y. Primary erythema (E. idiopathicum) develops
under the influence of external irritants. The causes may be
trauma, for instance, pressure, friction, blow, bite, etc. (Ery-
thema traumaticum) ; thermic influences, such as scalding, burn-
ing, freezing, heat of the sun (E. caloricum and E. solare) ; al-
so chemical agents, namely, sharp, irritating substances like
vesicants (mustard, cantharides), volatile oils, mineral acids
and lyes in not too strong concentration, further the irritating
excretions of beetles and wasps (E. toxicum, s. E. venenis ab
acribus). In new-born dogs and cats, Schindelka has noticed
erythema lasting for several days (E. neonatorum).
Secondary erythema (E. s^onptomaticum) is seen chiefly
ill the course of general infectious diseases, as in swine ery-
sipelas, swine plague and hog cholera, in distemper of the dog,
in smallpox, in foot-and-mouth disease. In those cases in which
erythema occurs after feeding on certain fodder, especially
clover, buckwheat, distillers' grains, lucerne, a pathogenic
effect on the cutaneous blood vessels is produced by a poison
absorbed from the digestive tract.
Symptoms. Erythema is characterized by an increased
redness of the skin, and for this reason the disease is recog-
nized only in animals with unpigmented skin, namely, in sheep
and swine, and also on uncolored, white-spotted parts of the
skin of dark-haired or gray animals. The redness frequently is
seen only in spots as large or somewhat larger than a lentil (ma-
culae, roseolae) or in the form of larger congested spots which feel
hot and at the same time are pink; in both cases the redness dis-
appears under pressure from the finger but returns again soon.
If serous infiltration exists, the affected part of the skin appears
slightly swollen and eventually may show a yellowish color. In
many cases the development of erythema is accompanied by
itching, and then the affected parts of the skin are also slightly
painful.
In most cases erythema lasts only a few hours or at most
a few days, and then disappears without leaving a trace. If
in exceptional cases it continues a longer time, the skin may
desquamate as it becomes paler. If, however, the erythema
occurs as the first symptom of an eruption or of a skin inflam-
mation, then the respective symptoms (nodules, vesicles, etc.)
usually develop as early as the second day.
Treatment. Interference is necessary in erythema only
exceptionally, especially when it is accompanied l)y violent itch-
840 Nettlerash.
ing and pain. In this case compresses of cold water, lead
lotion or Goulard's extract, or applications of alcohol seem
most suitable; neutral dusting powder or simple drjdng oint-
ments (lead or zinc oxide ointment) may also be employed.
6. Nettlerash. Urticaria.
{Quaddelausscldag, Nesselsuchf [German]; Echauhuulure
[French].)
Nettlerash is characterized by roundish shallow elevations
on the skin which, in consequence of serous infiltration (of in-
flammatory origin) of the papillary bodies and of the Malpi-
ghian layer, develop very quickly and mostly disappear com-
pletely after a short time.
Etiology. As a primary disease (Urticaria idiopathica)
nettlerash develops in a portion of the cases from the effects of
irritating chemical substances. Among these must be men-
tioned first of all the irritating juice of the stinging nettle (Urti-
caria urens and U. dioica) which may come in contact, especial-
ly with the bodies of horses and dogs while moving, rolling, or
lying on fields overgrown with stinging nettles (Eohr, Nicolas,
Brisavoine, Holterbach). A similar effect is produced by the
secretion of flies, ants, some caterpillars (processionary moth;
cnethocampa processionalis), the Kolumbcics fly, further by
drugs, such as oil of turpentine, carbolic acid, etc. In many
animals rubbing or scratching causes a similar eruption. Fi-
nally violent cold or cool wind exerting its effect on a heated or
sweating skin can cause urticaria, hence its frequent occurrence
in spring and autumn.
Nettlerash is also due to certain chemical substances when
it follows the ingestion of food stuffs (Urticaria ex ingestis).
Thus one observes it in connection with feeding on green rye,
potato leaves, leguminosae, and in dogs at times after eating
chocolate or certain kitchen waste. A quick change of food can
also give rise to the trouble. Some individuals show a remark-
able hypersusceptibility (idiosyncrasy) in this respect, and as
a result they become ill regularly after partaking of certain
food stuffs, although these substances are harmless for most
animals. In all these cases the absorption of heterogenous
proteid substances appears to play the principal part, especially
if this material has caused an hypersusceptibility of the system
by its repeated absorption (see serum disease).
Secondarily nettlerash develops rather frequently in con-
nection with acute gastro-intestinal catarrh and constipation
(Urticaria s^^nptomatica), especially in horses, more rarely in
dogs. Schindelka also saw nettlerash in one bitch at the time of
Etiology. Symptoms. 841
heat, and in another following upon a vaginal catarrh, while
Houllier & Delannoy saw such cases follow the stoppage of the
milk secretion, especially in market cows. Finally nettlerash
may appear some hours after squeezing out the warbles in
cattle affected with larvae of the gadfly (Strose). All these cases
probably represent phenomena of hypersusceptibility to the
absorption of heterogenous proteid matter, which gains access
to the blood from the intestine in digestive disorders, or from
other organs. Probably the homogenous proteid which has ex-
uded into holloAV organs acts like heterogenous proteid after
undergoing certain changes.
Toxins of specific microorganisms are evidently of im-
portance if the affection arises in the course of infectious dis-
eases: for instance, in dourine (see Vol. I), in swine erysipelas,
the mild form of which runs a course similar to nettlerash
(Backsteinblattern) (see Vol. I), in purpura in which the edem-
atous swellings sometimes develop from nettlerash; further, in
influenza and in strangles where nettlerash is noticed rather
frequently, especially in the convalescent stage ; finally, it occurs
in many animals after injections of mallein or tuberculin.
Both the primary as well as the secondary urticaria occur
most frequently in horses, although cattle and swine may also
be affected and more rarely dogs.
Symptoms. Nettlerash is sometimes preceded by indiges-
tion, debility and a fever temperature (nettle fever, urticaria
febrilis, febris urticata). Eggeling observed fever in cows up
to 40.9' C, while feverish s^^nptoms were observed by Perkuhn
and Karpe in horses at the onset of the disease. The eruption
occurs, however, mostly without these prodromal s^inptoms.
Prominent swellings from pea to almond in size, hard, flat or
half round, appear here and there on the skin, over which the
hair appears somewhat ruffled. The swellings on the skin pre-
serve these characteristics until they disappear, or they
broaden on the surface and sink in at the center becoming-
ring shaped (IT. annularis) ; by contact Avith one another sev-
eral of these rings may form wave-like figures (U. gyrata s.
figurata; seen especially well in horses suffering from dourine).
On the skin of swine the swellings are at first of a reddish
color, later they increase in size and fade in the middle (U.
porcellanea), the progressing edge forming a red seam. If
the affection is caused by the direct action of acrid substances,
there exists in most cases a more or less intense itching, which
otherwise is absent as a rule.
The development of the eruption may take place so quickly
that within 5 to 30 minutes almost the whole surface of the
body may be covered with elevations (Mecke, Jost). They last
generally a very short time, a few hours or 1 to 2 days (in
swine 4 to 6 days) and disappear without leaving a trace, after
the swellings have become flattened (U. ephemera) ; occasion-
842 Nettlerash.
ally so miicli serum collects between the corium and the Mai-
pigiiian layer that vesicles form (U. vesiculosa et bullosa, Pom-
phosis) wliich later on burst and heal with scab formation.
It is also exceptional (e. g., in purpura) that urticaria attacks
the mucous membranes of the eyes, nose, vagina or rectum ; the
elevations in the nose may temporarily hinder respiration. Now
and then edematous swellings also arise at the same time. In
general the disease is quite benign and assumes greater impor-
tance only if it often recurs in an animal (U. chronica, IJrti-
catio).
In cows nettlerash develops occasionally owing to food of bad
quality or after a sudden change of food. It is then usually very ex-
tensive, affecting the body, lips, wings of the nostrils and eyelids as
well as the neighboring mucous membranes of the natural openings of
Fig. 120. Xettlerash.
the body and the larynx. In the neighborhood of the perineum knotty
doughy swellings arise, which may hinder defecation more or less.
While these swellings develop, the animals may be restless and constantly
shift their weight from one foot to another. In conse(iuence of the
laryngeal involvement the animals may die of suffocation, while otherwise
the attack rarely lasts more than 5 or 6 hours (Lucet, Tapken, Albrecht,
Schleg, Wyssmann). Concerning the symptomatology of the mild form
of erysipelas in swine see Vol. I.
In urticaria caused by stinging nettles one notices severe itching, and as a
result restlessness or licking and rubbing of the affected parts of the body. In
dogs severe rhinitis, stomatitis and pharyngitis may develop. Several dogs died
from thes-e affections. Holterl)ach believes that the cause of the fatal termination
is found in the absorption of toxic substances, similar to snake venom, from the
nettle hairs, and not in local inilanunatory procesf-es as is assumed by Rohr.
Treatment. Serum Disease. g43
Treatment. Acute urticaria usually heals spontaneously
witlim a short time and calls for no special therapeutic meas-
ures ; still, fomentations with cold water or friction with vinegar
or alcohol have a good effect. For the treatment of stine:ing
nettle poisoning Holterbach recommends stimulating drugs
(camphor) with permanganate of potash. If recurring attacks
are the result of acrid substances, parasites etc., these must be
Fig. 121. Nettlerash in the doe, Fig. 122. Ihe same dog as in 121 af-
with diffuse swelling of the skin of *^^' disappearance of the urticaria,
the head.
removed, while the presence of intestinal catarrh must be treat-
ed with aperients (neutral salts, castor oil) and disinfecting
applications.
Literature. Albrecht, Monh., 1900, XI, 24.— Bartels, D. t. W., 1909 485 —
Bnsavome, Eec, 1908, 104.— Haag, W. f. Tk., 1907, 967.— Holterbach, D t W
1908, 297.— Houillier and Delannoy, J. vet., 1903, 352.— Jost, Pr. Mt., 1856-57
143.— Lange, S. B., 1906, 75.— Leibenger, W. f. Tk., 1907, 622.— Meeke Pr Mt '
1852-53, 64.— Nicolas, Bull., 1907, 471.— Perkuhn, Z. f. Vk., 1904, 487.- Pourquier'
Eec, 1877, 51.— Bohr, Bull., 1906, 154; 1907, 476; Eev. gen., 1907, X, 521.— Eudolph
b B., 1902, 170.— Tapken, Monh., 1899, X, 166.— Torok, Hautkrankheiten, 1907.—
Wyssmann, Schw. A., 1905, XLVII, 34.
Serum Disease. This phenomenon which sometimes occurs as a
result of serum treatment has been known in human medicine since
the introduction of the treatment with the diphtheria and the scarlet
fever serums, and has recently been noticed also in animals, for example
after the employment of anthrax imnuine serum in cattle and horses
(Kovarzik, Zinner, Alexandrescu), of Gans's polyvalent pneumonia
serum in two cows (Kovarzik), of "Willerding's influenza serum in 30%
of the inoculated horses (Bartels), and of septicidin in swine (Listo,
Garaguso).
Essentially the serum disease consists in a hypersensibility (an-
aphylaxis) of the animal organism to heterogenous proteid sub-
stances. This hypersensibility may be due to the fact either that the
organism is especially intolerant of certain products of the dissociation
of albumins, which may be a normal condition (idiosyncrasy; natural
anaphylaxis of Detre), or that it contains certain substances which
cause a rapid disintegration of the ingested proteid material lead-
844 Serum Disease.
ing to the formation of toxic products (artificial anaphylaxis of Detre).
The natural hypersensibility shows considerable individual variations
as regards the quantity and derivation of heterogenous proteid. Some
anaphylactic animals are made ill only by considerable quantities of
an alien proteid, while others react with severe symptoms of disease,
even to small amounts of alien proteid (blood serum). The symp-
toms occur in all cases of natural anaphylaxis either immediately or
soon after the ingestion of the respective proteids.
Artificial anaphylaxis, on the other hand, only develops subse-
quently to the introduction of certain proteid substances. It may
indeed happen that the organism, being under the influence of some
proteid (usually infectious substances) becomes intolerant to other
heterogenous proteids just as in natural anaphylaxis; but usually, and
in a typical manner, the hypersensibility develops after the animal has
been treated with blood serum (serum anaphylaxis) or other heter-
ogenous albumins. After a single injection under such circumstances
the symptoms may occur only after 8 to 14 days (normal serum disease),
after a sufficient amount of antibodies with the power of dissociating
proteids have formed in the organism which was not originally hyper-
sensitive, and these then cause a rapid disintegration of the heter-
ogenous proteid substances which are still circulating in the blood.
On the other hand, even very small amounts of serum will give rise to
these symptoms only after one or several reinjections and then only in
a portion of the animals. The symptoms either follow immediately
(immediate reaction or serum disease) in cases in which the second
injection was made after about 10 days, or only after 1 to 3 to 6 days
if the interval was longer (hastened reaction). In the last two cases
the anaphylaxis is strictly specific and occurs only in response to those
substances with which the animal had been treated previously; it may
also be transmitted passivel.v to other animals, or by pregnant animals
to the young (passive hypersensibility). Animals usually become an-
aphylactic primarily and exclusively in response to heterogenous
proteids, but occasionally a homogenous proteid may give rise to serum
disease as was shown by the observations of Lorenz and Bartels. In a
case of the authors a healthy horse acquired serum disease after having
been vaccinated with the serum of a healthy horse.
It may here be mentioiied by the way, that it has been possible to render
experimental animals anaphylactic (Rosenan, Anderson) by feeding lilood serum
or meat from healthy horses. This fact opens the way for an explanation of those
cases of urticaria which occur occasionally after the ingestion of certain food
stuffs.
The serum disease is only one form of anaphylaxis which includes among
others the allergy of tuberculous or glanderous animals to tuberculin or mallein
(see Vol. I).
Symptoms. The symptoms occur in domestic animals usually as
soon as 5 to 30 minutes to 3 hours after a first serum injection; only
Kovarzik saw the occurrence of serum disease delayed until after the
second injection which was administered seven days after the first.
In horses there may be only a nettlerash with severe pruritus, which
may involve the entire body (Bartels), or edematous swellings form,
either alone or in association with the urticaria, affecting especially the
head and the point of injection (Zinner). In cattle the most striking
phenomena consist in a generalized urticaria associated with severe
pruritus, and in edematous swellings which are sometimes severe and
affect principally the head and the perineum. In addition one may
observe great restlessness, pain at tlie point of injection, salivation,
Symptoms. Treatment. Eczema. 845
trembling, generalized iniiseular wealiness, dyspnea, bloating and oe-
casionally a febrile rise in temperature. Not infre(|uently laryngeal
edema may develop and may cause asphyxia. Some animals cough
from the connnencement and may continue to do so for weeks (Kovar-
zik). In hogs, Listo and Garaguso observed high^ fever, inappetence
and very decided muscular weakness.
These symptoms are often severe ; in domestic animals they usually
disappear after a few hours or at most within a day without leaving a
trace, a fatal outcome occurring only very rarely, mostly from asphyxia-
tion. It is different in case of the anaphylaxis produced in small ex-
periment animals by reinjections, in which the serum disease often
ends with the death of the animal. In infected herds the disease may
become important insofar as it diminishes the resistance of the organism
to infectious substances for the time of its duration and may therefore
give rise to the activation of some latent infectious disease.
Treatment. The treatment is similar to that employed in urti-
caria. The animals must be watched so that, in case of severe laryngeal
edema, tracheotomy may l)e done in good time. In the employment of
immune serums one should avoid wherever possible the use of heter-
ogenous serum, and if the injections are to be repeated, this should be
done at intervals of not more than 1 to 6 days or serums of different
derivation should be injected: finally it is well to inject serums of as
high a potency as possible so that comparatively small amounts of
serum will suffice. The frequency and severity of the serum disease
stand, other things being eciual, in direct relation to the quantity of
serum injected. The same serum has a stronger effect after intravenous
than after subcutaneous injection.
Literature. Bartels, D. t. W., 1910, 48-5.— Detre, A. L., 1910, 85.— Kovarzik,
ibid., 1909, 147, 563. — P. Th. Miiller, Vorles, iiber Immun. und Infektion, Jena,
I909.^r-Wolff-Eisiier, Klin. Immunitatslehre und Serodiagnostik, Jena, 1910. — Zin-
ner, A. L., 1909, 636.
7. Eczema.
Eczema is an acute or, mostly, chronic inflammation of
the papillary bodies and of the superficial layer of the
corium of the skin associated with hyperemia, profuse exuda-
tion and itching. In the course of the inflammation, nodules,
vesicles and pustules develop diffusely in the inflamed and
swollen skin, leading to quick scaly excoriation of the integu-
ment and causing it to be moist and covered with crusts.
Etiology. The most frequent causes of eczema are found
in external agencies acting on the skin. If the skin is neg-
lected the dirt lodged betw^een the hairs is balled, together with
desquamated particles of epidermis upon the skin and begins
to decay under the influence of dampness, the process being
aided later on by the maceration of the corium. The quite juicy
young epidermal cells of the Malpighian layer in this way come
in direct contact with the decomposing seal), and are exposed to
the influence of the schizomycetes present there, and also to the
injurious action of the products of decomposition. Eczema
846 Eczema.
consequently occurs mostly in those parts of the body that are
most subject to soiling, or which the animal is not able to clean
thoroughly. Accordingly those parts of the body are affected
principally which are covered with long hair, such as the tail
and mane in horses where the dirt collects in large quantities at
the roots of the hair, and on the back which is a favorite locali-
zation of the trouble in long-haired dogs.
Dampness also plays an important part, insofar as by
softening its horny layer, it deprives the skin of its natural pro-
tection, and at the same thne it promotes a firmer sticking of
particles of dirt and the proliferation of fungi on the skin, and
also a closer contact of the superficial with the deeper layers.
For this reason the disease occurs in sheep after continuous
rainy weather, affecting the back and croup, especially if the
fleece is very close. In dogs eczema occasionally results from
over-frequent washing, especially with green soap, which be-
sides a loosening effect also exerts an irritating action on the
skin. On the fetlocks of horses and cattle, pasturing on dew-
covered meadows may give rise to eczema. Eczema (Sudamina)
also develops in long continued diarrhea in the neighborhood
of the anus, in dribbling of urine in the neighborhood of the
urethral opening, further, on parts of the skin that sweat pro-
fusely, especially between the folds of thin skin; but in this
case the excretions or secretions with their irritating constitu-
ents and products of decomposition are important factors. The
continued effect of dampness and dirt must be held responsible
for the eczema occurring on the fetlocks of horses and cattle,
but seldom on those of sheep ("Mauke").
Mechanical influences, such as insect stings, rubbing, pres-
sure, bites, may easily cause eczema if frequently repeated or
if the skin sweats and is dirty. In the presence of animal para-
sites (flies, lice, ticks) not only the stings but also the factors
already mentioned, and the prevailing uncleanliness are to be
considered as immediate causes, the same being true in the
case of eczema accompanying scab and in eczema at the root
of the tail in the presence of oxyuris eggs. In working animals,
especially in horses, the disease occurs especially at those parts
of the body which are subject to the pressure and the chafing
of the harness or saddle, and here again constant intense sweat-
ing plays a part. The simultaneous effect of chafing and sweat-
ing may finally be seen in eczema occurring on parts of the skin
that come in contact and rub on each other between the thighs,
at the root of the tail, and in eczema occurring at times around
the anus (E. intertrigo). The mechanical influences are further
of importance in that they create a loss of substance in the epi-
dermal layer of the skin, and render possible the penetration
of microorganisms into the tissue of the cutis.
The influence of great heat may cause an eczema on the un-
pigmented portions of the skin (E. caloricum), and the same can
develop on spots that are exposed for a long period to the hot
Etiology. Pathogenesis. 847
rays of the sun (E. solare), especially if the skin has previously
been damp. In these cases the ultraviolet rays of the sunlight
cause the inflannnation.
Different chemical substances that cause loosening of the
epidermal layer or irritate the skin may cause eczema, even if
only used once. This may occur, especially after the applica-
tion of gray mercury ointment (Eczema mercuriale), mustard
oil, cantharides, croton oil, tartar emetic, iodine, balsams, pe-
troleum, carbolic acid, tar, etc. ; the affection also arises after
the prolonged internal use of these drugs, and this is especially
so in the case of mercurial eczema.
Of internal causes, diseases of the digestive organs are first
to be considered (E. symptomaticum). Catarrhal diseases of
the stomach and intestine especially, exert such an influence,
for abnormal products of fermentation which are absorbed,
probably affect the blood vessels of the skin or reduce its power
of resistance to external injuries (autointoxication).
Weakening and exhausting diseases (fluke, verminous
bronchitis, rickets, diabetes, etc.) cause a predisposition to
eczematous affections. Other diseases of the skin, especially
scab, also produce a decided predisposition to eczematous in-
flammation, but especially to moist eczema in the dog. Very
fine skinned as well as old and fat animals, especially dogs,
show a marked tendency to this disease, and individual and
racial differences are evidently of importance in this respect
(among dogs the pug dog, the poodle, the bull dog and the
Leonberger [this is a breed of dog originally bred by Herr
Burger of Leonberg, Wiirttemberg. Trans.] are subject to the
disease).
Schindelka repeatedly saw an eczematous skin disease, and finally nephritis,
developing in consequence of constipation in the dog. He considers it probable that
the toxins absorbed frona the intestine irritate the skin on the one hand and the
kidneys on the other.
The mode of origin and the course of eczema render it very probable that
microorganisms, especially schizomycetes, are of importance. Hardly any experi-
ments have been made in animals in this direction, and up to now those under-
taken in humans have produced no conclusive result. Unna, who like Niemeyer,
considers eczema to be a catarrh of the skin, found a species of cocci in the vesicles,
scales and sections of skin, and also observed the development of eczematous patches
after experimental inoculations with these cocci. Ravolgi found staphylococcus
pyogenes albus, Bernheini the same coccus, and likewise the staph, citreus as well
as the diplococcus albicans tardus ; Scholtz found the st. citreus, Veiel found pyogenic
staphylococci. According to the last named author the bacteria pass through the
spaces between the epidermal cells into the skin and into the lymph spaces, and
in this way cause the inflammatory process. Probably different kinds of bacteria
exert a similar effect on the skin or on the tissue of the cutis. In one case of tail
eczema in the horse, Casper proved the streptococcus pyogenes to be the cause of
the disease ; Baer on the contrary in eczema rubrum of a dog, found a micrococcus
as the causal factor.
Pathogenesis. Eczema is essentially an inflammation of
the superficial layers of the skin, in the course of which the blood
vessels of the papillary bodies dilate and the non-pigmented
848 Eczema.
portions of the skin become reddened, whereupon a serous in-
tiltration also forms (stadium erythematosum ; s. Eczema
erythematosum), the celhilar infiltration being at this time quite
inconsiderable or completely absent. In consequence of the
serous and later the cellular infiltration, single groups of papilla^
swell and are raised above the adjacent tissue in the form of
small nodules (Eczema papulosum).
If the cellular infiltration becomes more intense, the hTiiph
spaces between the cells of the Malpighian layer widen, and
small vesicles are formed, up to lentil size, which are filled with
a clear serous fluid, the outer (Unna) walls of which are formed
by the horny layer, while the base is in the rete mucosum or the
stratum germinativum (Eczema vesiculosum). It is generally
supposed, however, that the vesicles may also form by liquefied
prickle cells, but this is denied by Unna. White blood corpuscles
rarely enter the interior of the vesicles in sufficient quantity to
give to the contents a purulent nature (Eczema pustulosum).
If the numerous contiguous vesicles burst by rubbing, are
torn by scratching, or if the horny epidermal layer of the dis-
eased skin becomes chafed, then the corium, scarcely covered by
1 or 2 layers of epidermis cells, becomes exposed and oozing
serum appears on its surface, in consequence of which its red,
fine grained exterior becomes very moist (Eczema rub rum et
madidans). (After isolated vesicles have burst spots form
in size up to that of a lentil, which are moist but not red. They
may be found in ev^ery stage of eczema but are not an integral
part of weeping eczema.)
In consequence of desiccation of the oozing serous fluid or
of the pus, yellow or brown crusts form which soon are loosened
or become thicker by coagulation of the fluid which continues to
be secreted (Eczema crustosum). If as a result of more inten-
sive inflammation many white corpuscles emigrate, a green
layer of pus is formed under the scabs or on the bare skin
(Eczema impetiginosum). With the cessation of the inflamma-
tion the exudate lessens, a layer of epidermis cells consisting of
several series forms under the protection of the dry scab, and
in course of time the crusts fall off.
The inflammatory process may be arrested in any of the
above mentioned stages, but healing only occurs by the inter-
mediation of one of the subsequent stages. But to wjiatever de-
gree the eczema may have developed, the skin remains hyperemic
and scaly for some time before it heals completely (Eczema
squamosum). If, however, vesicles or moist spots have formed,
then the stage of desquamation will in every case be prefaced
by the formation of crusts.
In this form the disease may last for 3 to 6 weeks (E,
acutum). After an inflammation continuing for more than 3 to
6 weeks, the papillae increase in size, the lymph spaces remain
distended, the connective tissue proliferates and becomes harder,
often the layer of prickle cells thickens, in other cases the horny
Symptoms. 849
layer is markedly so, the sweat and fat glands l)ecome atrophic,
and the skin, which has in the meantime become rough, is only
capable of incomplete improvement (E. chronicum).
Symptoms. The changes sketched above run their course
on the skin, and may, therefore, easily be watched on the living-
animal. In contrast to other skin diseases, one notices many
variations in the morbid changes in their development, and es-
pecially a rapid development of papules and vesicles, as well as
moist spots only covered by the deepest layer of cells, and
formed by the papillae, which come plainly into view after the
crusts are removed. The recognition of the disease is also
made easy by the fact that in some cases the different stages of
development of the changes may be seen at the same time on
the affected animals, and in this way the progress of develop-
ment may be established by comparison, even without any
history. On the other hand the little pathological forma-
tions easily escape because of the hair coat, and moreover severe
inflammatory processes are caused by scratching, gnawing and
rubbing, which are associated with hemorrhage and suppura-
tion and affect not only the skin but also the subcutaneous con-
nective tissue. This fact interferes with the clearness of the
clinical picture.
Itching always accompanies this skin disease, and is the re-
sult of irritation of the nerve endings situated in the papillae,
wdiich are subject to serous and cellular infiltration. It is es-
pecially intense in the acute cases as well as in extensive inflam-
mation; it disturbs the animal considerably and is not depend-
ent on the external temperature or on the time of day.
In acute cases fever sometimes arises, and a feverish
exacerbation coincides with a fresh appearance of vesicles.
The great restlessness caused by the itching, the fever, as
well as the long continued loss of albumin from the moist sur-
faces, considerably affect the condition of the animal in chronic
cases, and in consequence this skin affection, which is benign
of itself, may lead to considerable emaciation and even to com-
plete exhaustion.
In the various species of animals the clinical picture of
eczema is essentially the same, but in particular points devia-
tions may be noticed which are important, both as regards the
course and diagnosis of the affection, and which on this account
will be mentioned separately, together with some etiological
considerations.
(a) Eczema of the Horse.
In horses eczema chronicum (chronic squamous eczema,
Kleien und Schuppenflechte, Hungerraude [German] ; eczema
sec [French]) occurs particularly from insufficient nourish-
ment and faulty skin hygiene, and develops in tender skinned.
850 Eczema.
active animals (Cadeac), among which it may even occur as an
enzootic (Alix, AVoehrling), Accompanied l)y more or less se-
vere itching-, little papules and vesicles form, especially on the
orbital rims, on the neck, shoulders, thighs, at the root of the
tail and even over a large part of the trunk; these are only tem-
porary and are succeeded by fine scales and crusts which fall
off with the matted hair, and in this way small hairless patches
arise. By the occurrence of fresh eruptions this process is re-
peated in the surrounding skin, and larger, irregular, hairless
patches develop by coalescence of the small bald surfaces.
As a result of long continued inflammation, the skin thick-
ens at these places, becomes rough, then dry, and scales continu-
ously (Eczema siccum) ; later on, however, it becomes moist and
covered with thick crusts under which a layer of purulent secre-
tion is often found, especially if the crusts are scratched off,
owing to severe itching. The trouble usually improves during
the winter but gets worse during the warm season, and can per-
sist on the same animal with such variations even for several
years, although occasionally it heals spontaneously. Darker
hairs often grow on the places that have previously been bald.
The exact cause of the complaint is unknown. In some of
the cases on record the actual condition might have been scabies.
In two eases mentioned liy Megnin, the affection occurred in strips which
crossed the long axis of the body vertically, like marks on a zebra, and these were
separated by healthy portions of skin.
lodism of horses may sometimes make its appearance in the form of squamous
and crusty eczema, *and scales and scabs form on the sises soon occur, so that the disease is hard
to cure definitely, and in the meantime may leae consider it an open ques-
consi.Sf tw r } ?* \ ^"^''"'i "P"" ^' ^ trichophytic « characteristics of
dcnie eczema or take a chrome course. In this form the cir
e Tcl'l^ • «<'?r^^'''''"^"">' ^«™1°P« 0" the back (E ors "
especia ly in old animals and in insuUBcient care of the skfn and
genera ly runs the course of chronic eczema. Prom the ro^t of
t e sk^ of the' r'l''''' ""^ "°t "'f'-'^'!"ently further forwa ds
the skin of the back appears bald or sparsely covered with hair;
858 Eczema.
it is usually unevenly thickened, forming thick and firm folds,
and between these, as also in other places, it secretes moisture ;
sometimes scales and scabs are also encountered. The disease
is accompanied from the commencement by intense itching, and
sometimes the eczema is obstinate and persistent. Eczema
occurring on the skin of the tip of the tail may lead to ulcer-
ation (tail ulcer) because the animal licks and gnaws the itching
place.
Circuniscri])ed eczema arises rather frequently on the
bridge of the nose (E. nasi), on the cheeks (E. buccarum), on
the arch of the orbit (E. superciliorum), and on the neck (E.
nuchaO where its occurrence may be due to wearing a muzzle
or to the collar. In this form the lesion is generally moist and
scaly, although small vesicles may be seen around the diseased
parts, and on the neck, especially in fat animals, bleeding cracks
between the folds of the skin. At the elbow joint or hock a
chronic eczema may arise, which is evidently due to the irrita-
tion of lying or sitting on hard ground; it is characterized by
the formation of thick, horny scales, accompanied by slight
itching. In dogs the skin of the scrotum (E. scroti) or the pre-
puce, in bitches the lips of the vulva (E. vulva^) may be the only
localization of the disease, which is moist or vesicular on the
scrotum of the dog, and may lead to severe swelling of the loose
cellular subcutaneous tissue as a result of frequent rubbing of
the fine skin. In the neighborhood of the other natural open-
ings of the body the disease probably develops from the acrid
action of the excreta; so especially on the eyelids (E. palpe-
brarum) in consequence of inflammation of the conjunctiva and
of the lachrjTiial canal, on the lips, especially in the neighbor-
hood of the angles of the mouth (E. labiorum) also about the
anus and in the region of the perineum (E. ani).
Of the circumscribed forms of eczema, the greatest impor-
tance attaches to eczema of the external ear and of the external
auditory meatus. This complaint is designated as inner ear-
worm or otitis externa, and has been studied especially by
Becker and Imhofer. Aside from the otitis externa, which de-
velops in distemper as a painless moist eczema and accompa-
lued by copious gray secretion (according to Lange in 50% of
distemper cases [see Vol. I]), eczema of the external ear de-
velops either at the same time with eczema of the other parts
of the skin, or mostly as an independent affection through the
influence of chemical irritants, although, at least in some of the
cases, microorganisms, especially pus cocci, may lie responsible.
According to Imhofer the infectious material penetrates from
the hair bulbs into the numerous glands of the auditory meatus
and starts an inflammatory process which finally produces a
connective tissue degeneration of the glands, in consequence
of which, this disease should be distinguished from eczematous
otitides and known as otitis externa genuina. Such a distinction
cannot, however, be made clinically. In consequence of the
Eczema of the Dog. 859
unfavorable anatomical conditions, ear wax and dirt easily
accumulate in the external meatus, wliicli then decompose and
form irritant substances. The process of decomposition is
favored by bandages on the head and the skin of the external
meatus is now and then macerated by penetrating water or by
medicines. The disease may also be produced by mechanical
injuries, such as scratching, rubbing, violent shaking and the
like, especially if animal parasites are present or if the meatus
is soiled Avitli substances which later decompose. Breed is of
importance inasmuch as dogs with long and thick hair round
the external meatus, such as dachshunds, setters and poodles,
are chiefly attacked, as in them the ear wax does not soon dry
up and soon decomposes because of the increased warmth in the
auditory canal.
The sjmiptoms consist in violent itching and severe pain,
shaking the head, scratching of the ears, crying out or whining
without apparent cause, and holding the head obliquely or
stiffly, accordingly as one or both ears are affected. At the
commencement or in a slight case the animals show pleasure
when the ear is scratched or pressed, but later they avoid being-
touched; they even show an inclination to bite and appear surly
and dejected. The external meatus usually contains a copious,
yellowish, chocolate-colored to dark brown smeary ill-smelling
secretion (otitis catarrhalis according to Becker) produced by
a mixture of the serous exudate with the copiously secreted
ceramen; sometimes it produces complete occlusion of the ear
passage, and in consequence loss of hearing and matting of
the hair around the ear. If pressure is exercised on the base
of the ear, the secretions produce a squashing or popping noise.
Sometimes one finds on the contrary merely a greenish yellow,
evil-smelling pus without visible admixture of ear wax (otitis
purulenta according to Becker). The skin itself appears dif-
fusely reddened, swollen, sometimes cracked and easily bleed-
ing, especially on the crests of its folds. Through long continu-
ance the process becomes chronic, and leads to the formation
of bleeding spots which may be as large as a cent piece. These
show no tendency to heal, especially at the folds (otitis ulcerosa
according to Becker), and if healing is effected, relapses occur
readily. The complaint may be accompanied by slight to mod-
erate fever.
In the meantime, a new formation of connective tissue
takes place in the neighborhood of the ulcers, through which
warty granulations form or more frequently a diffuse firm
thickening of the whole auditory meatus occurs (otitis chronica
hyperplastica according to Becker) and even lime salts may be
deposited, as a result of which the ears may stand out from the
head. At times the ear passage is completely closed through
thickening of its Avail, and then the few glands which have re-
mained unaffected change to cyst-like cavities. As sequelae of
otitis may be noticed: othematoma, ulceration of the tip of
860 Eczema.
tlio oar, eczema or even phlegmons of the ear flap; in excep-
tional cases perforation of the drmn of the ear and otitis media
are said to occnr.
A fnrther form of circumscribed eczematoiis disease is the
eczema of the skin between the toes (E. interdigitale, Inter-
trigo) which begins with a vesicular eruption, but later assumes
a moist character, and in this form may continue for a long
time; owing to the severe pain it greatly impedes locomotion.
This form of eczema develops chiefly in pointers, probably as a
result of irritation of the skin during the chase by thorns and
punctures between the toes.
(e) Eczema of Swine.
In swine eczema is observed comparatively rarely and is
designated as soot of young pigs (pitch scab, scab rash). It
attacks almost exclusively^ only young pigs which are badly
cared for and kept in dirty sties, or pigs which are weak and
anemic from chronic diseases (rickets, swine plague, hog
cholera, pyobacillosis). Sarcoptic scab often forms the foun-
dation for the disease or the very frequent mange of young
swine is mistaken for "soot of young pigs" or ''pitch scab."
On different parts of the l)ody, but chiefly on the thighs, on the
sides of the chest, on the bell}^, occasionally on the eyelids, an
intensely itching vesicular eruption occurs, which now and then
affects the whole surface of the body. The contents of the
vesicles soon become purulent, but after bursting thick crusts
form on the red moist surfaces which become dark broAvn or
l)lack in color because of the admixture of dirt. The affection,
which is often mistaken for pox, exhausts the feeble animals
greatly, but usually heals with suitable treatment.
Tn new-born litters of the higher breeds severe eezenia-like skin disease, sonie-
tiines o])izootic in extent, may develop on the second to fifth day of life. Accord-
ing to the description of Walthers a parchment-like covering develops at different
places on the skin, on which small vesicles arise. After they burst blackish brown
crusts, with central depressions, form on the sensitive and itching moist surfaces
so that the skin appears as if smeared with soot. The sick animals are feverish,
they suck little, become very weak, and finally die with symptoms of diarrhea.
In 6 or 7 days all animals of a litter are affected, and the disease also attacks the
litters of other sows as well as the teats of the mother swine. In strong aniuials
the affection only develops 4 or 5 days after birth, and runs a mild course.
Diagnosis. Eczema is easily recognized in all species, when
typicall.y manifested, by the rapid development of nodules,
vesicles and pustules as w^ell as by the reddened and moist con-
dition of the skin which in spots is deprived of the superficial
layer of the epidermis. The last mentioned symptom makes
it possible to distinguish between simph^ descpiamation or scal-
ing of the skin, because here the skin, still covered with horny
epidermis, appears dry underneath the easily remova])le dry
scales. The recognition of eczema is often rendered difficult
Eczema of the Swine. 861
by tlie associated traumatic inflammation of the skin, because
then the cutis is exposed through suppuration and tissue de-
struction, and even ulceration and purulent inflammation of
the subcutaneous connective tissue may be present. In such
cases it is possible to form an opinion on the nature of the
disease from its locality and history ; moreover, in eczema one
often finds small vesicles and moist surfaces at the edges of
the more severely inflamed parts of the skin. A special diag-
nostic significance attaches particularly to the presence of moist
spots (Kaposi recommends in doubtful cases to rub diluted
potassium hydrate on the affected skin, whereupon small
moist dots or vesicles appear in cases of eczema). The more or
less similar diseases with the formation of large crusts on the
skin may be differentiated on this basis, since in them a deep
necrotic ulcerous base becomes visible after removal of the
crusts.
The demonstration of eczema does not, however, exhaust
the requirements of diagnosis, for the discovery of the cause is
of great importance, both practically, and from a therapeutic
point of view. Skin diseases caused by animal parasites,
and especially the ditferent forms of scab frequently exhibit the
characteristics of eczematous inflammation, and therefore a
mistake in diagnosis is easily possible, especially _ in horses,
dogs and swine. A slow^ development at the beginning and
increased itching- at night, and in warm places as well as the
presence of vesicular eruptions speak in favor of a parasitic
cause of the disease, but these signs cannot always be found
at every examination even in the severe forms of eczema, and
moreover in neglected cases only a severe form of dermatitis
is generally present. Acariasis may be easily recognized by
the favorite localization of the disease and in the pustulous
form by the presence of large nodules and peculiar bluish trans-
parent pustules as well as by the fact that the thickening of
the skin is always considerable; the squamous form of acarus
scab can in many cases only be differentiated from circum-
scribed eczema by the aid of the microscope, unless it occurs un-
der the form of alopecia areata. Sarcoptic scab is often easily
recognized on the basis of its occurrence in certain favorite
spots and from the fact that in proportion to the severity of the
skin disease the itching is intense, but not infrequently this also
is only possible through microscopic examination and by dem-
onstrating the transmissibility of the disease. Microscopic ex-
amination cannot be avoided, especially in those cases in which
the customary treatment of eczema produces no improvement,
since it is usually successful in cases that are not advanced too
far. In suspected sarcoptic scab the examination often re-
quires long and repeated investigation, while the dermatocoptes
or dermatophagus mites are easier to find. Larger parasites
which subsist and wander on the surface of the skin (ticks,
fleas, lice) generally may be found without much difficulty.
862 Eczema.
Ill itching of the skin the integument at most shows only
the effects of scratching, while changes in the skin itself are
wanting. Acne in horses (socalled summer or heat rash, etc.)
is distinguished from eczema by the occurrence of large, but not
crowded, nodules between which the skin appears normal; at
the same time sensitiveness to pressure is more pronounced
than itching at the originally affected spots, and the disease
heals in a short time. Dermatitis pustulosa contagiosa in con-
trast to eczema is characterized by its highly contagious nature
and b}^ the formation of small vesicles on roundish elevated
spots of the sldn, after their bursting gummy scabs form;
itching is entirely absent. Erythema of the fetlock may be dis-
tinguished from eczema by its transient nature, but it may de-
velop into eczema if neglected. Necrotic inflammation of the
skin of the fetlock (socalled necrotic "greasy heels") may be
differentiated from eczematous greasy heel by the character of
its s}^nptonls. Herpes tonsurans and favus may be distin-
guished from seborrheic eczema by their contagious nature,
also by the joresence of fungous elements round about the hair
or in the superficial layers of the skin (sometimes difficult to
prove), also by the fact that in herpes tonsurans the hairs break
oif closely at the orifice of the hair follicles or above, and in
favus they appear dull and brittle, whilst in seborrheic eczema
they fall out entirely; in favus also the peculiar character of
the scabs is an important distinguishing factor.
Traumatic inflammations of the skin also enter into con-
sideration in the diagnosis of eczema, but here the skin always
undergoes a more or less deep destruction of tissue and a layer
of skin of variable thickness mortifies, the inflammatory changes
developing more by way of a reaction. Besides, suppuration
is more frequent in this affection, while nodules, vesicles and
23ustules do not form.
Variola can only be mistaken for eczema in the initial
stage or towards the end of the affection, otherwise the initial
fever, the outbreak of the complaint over a large area of the
body as well as the very characteristic appearance of the large
vesicles should prevent error. The exanthema of distemper
begins with the appearance of red spots followed by larger
greenish colored flat pustules, after their rupture wrinkled dry
deposits form; moisture is trivial and itching is, as a rule,
completely absent. Foot-and-mouth disease may simulate inter-
trigo, yet its typical course, a similar eruption in the mouth and
the contagious-infectious character of the complaint, especially
on comparison of several cases of the disease, should furnish
sufficient diagnostic points, besides the skin trouble is not so
diffuse and uniform as in intertrigo.
Finally in those cases where the eczema is associated with
anemia and cachexia, the cause of the bad nutrition must be
investigated, besides a possible disease of the digestive organs
Eczema of Swine. Prognosis. Treatment. §63
must always be borne in mind in view of tlie possibility of auto-
intoxication
Prognosis. Eczema is generally a benign disease especially
it its occurrence is attributable to external influences and if it
IS not very much neglected. In very chronic cases the deeper
seated changes in the skin can, however, no longer be remedied,
the more so as acute relapses frequently occur which again and
again interrupt the improvement that has commenced to become
manifest. In such badly neglected cases the sick animal falls
away markedly in nutrition in consequence of continued unrest
and loss of protein, and thus the prognosis is unfavorably in-
fluenced. Similarly the complaint may be regarded unfavorably
if it occurs as a result of some chronic internal disease, which
to a certain extent renders an energetic treatment of the skin
disease impossible.
Relapses are observed frequently, and even in very mild
cases and in those improving quickly under treatment a later
attack IS not precluded, although more frequently it occurs in
badly nourished animals than in healthy ones.
Treatment. Above all the animals should be protected
from certain external influences. Animal parasites should be
destroyed by suitable remedies, dust and dirt should be re-
moved with the brush. A great drawback to treatment, espe-
cially m advanced cases, is furnished by the hair coat, conse-
quently it is very advisable to have the hair clipped at and
about the diseased spots.
Itching must be controlled in every case in large animals
by tying up and by covering, in small animals by well-con-
structed muzzles, collars or bandaging of the affected spots.
Frequently the employment of even the most varied artifices
does not achieve this object, until the alleviance of the itching
or commencing healing in the inflammatory process secures re-
lief to the animal.
In acute eczema it is advisable to protect the skin from the
effects of water, soap or even air, and besides to remove the
existing scales, crusts or secretions, which is most suitably ac-
complished with cotton soaked in oil, hydrogen peroxide, 'lime
water, linseed oil, and if need be with compresses or poultices
of 5% Burow's solution. For the last named object salicylic
acid (as a 2 to 5% ointment or in the form of a 1 to 3% oil),
or carbolized oil may be employed. In eczema of the ear Avarm
creolin solution should ])e injected cautiously, and the hair of
the neighborhood clipped, after which the collected secretions
may be removed with forceps or a similar instrument, the end
of which is wrapped with cotton soaked in oil or in creolin
solution, and which is introduced as far as possible into the
deepest parts of the auditory passage.
As long as only erythema, nodules and vesicles exist on the
skin, drying or protecting substances, such as dusting powder or
864 Eczema.
ointment, may be applied. The l)est dusting powders are tlie
strongly hygroscopic vegetable powders (Unna) because after
absorbing the exuded secretion they turn it into a paste which
protects the skin well. To these i3elong flour, amylum tritici
and a. oryzge, lycopodium, tannic acid, etc. Very favorable
results, however, are produced also by mineral substances such
as zinc oxide, lead carbonate (white lead), talcum, creta alba,
the different bismuth preparations (bismuth subnitrate, airol,
dermatol, xeroform, thioform) iodoform, etc., which may be
mixed advantageously with the vegetable powders in the pro-
portion of 5-10 :1. In more severe cases it seems proper to re-
tain the thickly applied powder on the surface of the skin by
means of a bandage, or to introduce it into the external audi-
tory canal by shaking the flap of the ear or by insufflating the
powder. On later treatments these powders are removed in
the same manner as are the deposits on the skin. Besides the
protecting powder, 10% creolin or ichthyol collodion, or trau-
matizin (guttapercha dissolved in 6 parts of chloroform) may
be applied to those places on the skin that are suitable.
Ointments or pastes are properly employed later on or if
dusting powders cannot be employed on account of long hair or
will not stick to the skin. To these belong : zinc oxide ointment,
carbonate of lead ointment, lead and tannic acid ointment,
diachylon ointment with olive oil (Hebra) or with vaselin
(Kaposi) or paraffin (aa) ; the ung. simplex (Unna), in horses
hydrarg. bichlor. ammoniatum, which often has a very good
effect (1 part to 10 parts of lard) ; Unna's zinc paste (10 parts
of zinc oxide, 2 parts of terra silica, 28 parts of benzoated lard)
or Unna's sulphur-zinc paste (4 parts of precipitated sulphur to
the previously mentioned paste). Just as effective are sapolan,
5 to 107c protargol ointment, also nafalan (according to Uebele
best as house nafalan; 50% nafalan, 15% zinc oxide, 20% adeps
lana? anhydr, 15%) solid paraffin), naftalan as well as pastes
made with airol, xeroform, iodoform. Reinhardt found a mix-
ture of 15 parts of crude carbolic acid and 100 parts of green
soap very efficacious in eczema of the fold of the fetlock; this
was spread over the skin and a bandage applied.
Itching is usually relieved or allayed entirely by means of
the dusting powders or ointments ; but if in spite of these it is
very severe, good service may be afforded by Jessner's ichthyol
paste (ichthyol, zinc oxide and powdered starch aa 1 part, vase-
line 2 parts), possibly painting with 10% lunar caustic, or com-
presses of lead water, Goulard's extract, or Burow's solution
may be employed. In case of need the following may be suitably
employed: anesthesin in 3% alcoholic solution or as a 10%
ointment, or as dusting powder with 9 parts of pulvis salicylicus
cum talco, also cocaine ointment (1 part cocaine with 25 parts
of paraffin ointment or lime water-linseed oil). Schlesinger re-
ports quick and favorable results with d\Tiial (didymura salicy-
licum) used as a dusting powder or as a 10% ointment.
Eczema of Swine. Treatment.
865
In the presence of mncli exudation the drying powders
entioned above have a good effect (ointments do not adhere to
tlX^^\''''u'{''''^- r"^^^^'" "^"^^^"^^^ ^1^^ ^^i^«^«^^^ ^"rfaces the
i.I 1 /•''"r ^^fPPl;^.^^ thickly 2 or 3 times daily and before
nowd.?F ^'^^'"'^ *^f skm should be cleansed of the adherent
en mlXI'"'''"' ""^f- ^''''' '^'''^'''^ P^^^^^^i-^ ^i-e apt to form
h'vH^i^^^l t^ "l/^-" ^'-"^'V'^^ of copious secretion and thus
mtr nl.%i v' ^^T^ employment must at times be discon-
dX!/^i h' P'^'^"' ^? substituted. Thiol is suitable as a
clustmg powder or as a solution m water and glycerine (2 -5 -5)
while Bissauge employs powdered sugar Avith good result ' Iii
r^l ' •''^''''- f/T' P^^l^i^f the part with 2 to 6% silver nitrate
or picric acid (1 part to 86 parts of water [Lassartesse]) and
subsequent application of powders are usually efficient, but this
expedient cannot always be resorted to in light-haired horses,
because the remedies stain the hairs dark o? yellow. All the
remedies indicated above dry the surface of the skin, while silver
P^int fl""'' P'''^^/."^^^^«^g^^l^te the serous exudate, thus hard-
ening the superficial layers of the epidermis. As soon as the
applied " "'^'"^"^^ becomes less, ointments or pastes may be
The skin should be protected from external influences for
some time after it has become covered with fresh epithelimn
uJ^^^ purpose boracic acid (2-3%) mixed with vaseline
is always useful further Unna's zinc glue (white glue and
glycerine of each 20 parts, zinc oxide 60 parts, water 100 parts)
as well as nafalan, naftalan and safolan.
^ In the treatment of chronic and seborrheic eczema one must
begin by removing the large crusts in the manner already indi-
cated as well as by cutting away the warty growths or skin
excrescences which may have formed; in most cases washing
with soap may be emp oyed, and aside from seborrheic eczema
It seems suitable to make fatty applications. The further treat-
Thv JL r^r'f.i^ ^'^ ^Y ^«;^^^itijn of the surface of the skin
or by the state of the epidermis. If moist surfaces or folliculitis
are present, the same means may be employed as in the moist
lllf.fjTu' ^fr^^ ^^"' ^?' ^%'''^' ^^ ^^'^ exudation has
ceased or folliculitis is reheved, or if this has not been present
trom the commencement, preparations of tar may be used ad-
vantageously, by means of which the separation of the large and
cracked horny layer is facilitated. The different preparations
o± tar, such as pix liquida oleum rusci, ol. fagi, ol. cadinum are
a equa ly efficacious and are generally employed diluted with
0 , alcohol or fat The following mixtures are in use among
others: pix liquida, sapo kalinus, spir. dilutus 2:2:1- or pix
liquida spir. dilutus aa;^r ol. cadinum, oh sesami ^; or ol
rusci, ol. fagi, ol. sesami aa, etc. The liniment or oil is applied
rather copiously on the diseased skin, left on for 3 to 5 days and
af erwards the black scab and scaly layer is carefully removed
1 he procedure can be repeated several times, but bearing in
Vol. 2-55
866 Eczema.
mind the possibility of an intoxication, only small surfaces
should be treated at one time. In order to avoid phenol pois-
oning Glauber's salts may be given in small doses internally.
Creolin and lysol are effective and applied in the same form as
tar. Still creolin should be used with caution, as contrary to the
experience of Frohner, the authors have often seen poisoning
after its employment. In this stage good effects are also pro-
duced by naphthol and naphthaline (5 to 15% ointment [both
of little use for the horse on account of danger from poison-
ing]), glycerinated iodine (1 part tincture of iodine and 4 parts
glycerine), resorcin, salicylic acid (5 to 15% ointment), especial-
ly in marked thickenings of the horny layer or in seborrheic
eczema. All these remedies cause a separation of the horny
layer, lessen the itching and promote the absorption of the exu-
date from the tissue of the cutis. In obstinate chronic eczema
of the horse with cracking of the skin, Eoder saw good effects
from sulphur and mercury ointment with the addition of can-
tharides, while Sehindelka often obtained very good results in
chronic seborrheic eczema of dogs by using sulphur baths and
bran baths w^ith the addition of sulphurated potash. In chronic
greasy heel of the horse, Storcli found lead nitrate efficacious
when he used it after removing the granulomas from the
cleansed skin, pressing it down with the finger in a layer as
thick as the back of a knife blade and securing it with a bandage
that w^as changed 3 or 4 times daily. Sommer healed very severe
cases of eczema of the fetlock with Dealin (a combination of
oxygen and fatty substances) in x)owder form.
If the disease process is already considerably improved and
only few scales desquamate from the skin, which has regained
its softness and elasticity, then the process of desquamation is
hastened by rubbing in of bland remedies (olive oil, ungu.
simplex). Any itching that may still be present at this stage
may be controlled by nafalan, naftalan or sapolan.
In every kind of eczema internal treatment requires full
consideration, especially if at the same time symptoms are pres-
ent pointing to a disease of the digestive organs. In this con-
nection the disinfection of the digestive canal or the employ-
ment of mild purgatives is proper. Thus Sehindelka obtained
good results in many cases in dogs through internal medicines
(1.0 gm. of cinnamon powder, 1.5 gm. eucalyptol, 30 drops of
oil of peppermint: 1.5-5 gm. daily in five doses). Arsenical
preparations have always been ascribed a favorable influence
(of Fowler's solution a tablespoonful for horses, 5 to 10 drops
a day for dogs). This good influence is confirmed by recent
o])servations. Paron and Urechie among others saw recovery
occur in man after the internal use of calcium chlorate (3 gm.
daily) in solution; improvement commenced the next day, and
in five days the itching had disappeared. Care must be taken
to secure the suitable feeding of the animal with non4rritating
and easily digested food stuffs.
Malt and Potato Eruption. 867
Literature. Bar, Schw. A., 1902, XLIV, 1. — Becker, Unters. lib. die Otitis,
ext. d. Hinides. Diss. Giessen., 1907 (Lit.).— de Benedictis, Clin. Vet., 1904, 73. —
Frohner, Monh., 1908, XIX, 120, 124. — Imhofer, Beitr. z. Anat. etc. d. Ohres, d.
Nase imd d. Halses. Bd. II, 289 (Lit.).— Mathis, J. vet., 1901, 593.— Mouroux,
Bull., 1904, 521.— Moussn. Eec, 1898, 81.— Noack, S. B., 1893, 123.— Prietscli, ibid.,
1893, 124.— Qiialdncci, Clin, vet., 1903, 281.— Eichter, Z. f. Tm., 1905, IX, 23.—
Eoloflf, Pr. Mt., 1868-69, 116.— Eottliinder, Beitr. z. Atiol. d. Ekzema in d. Fessel-
beuge. Diss. Leipzig, 1908 (Lit.). — Siedanigrotzky, S. B., 1890, 21; 1892, 18. —
Unna, Pathol, u. Therapie d. Ekzems. Wien, 1903.— Veiel, Miinch. med. W., 1904,
1.— Walther, S. B., 1889, 79.
8. Food Rash.
(a) Malt and Potato Eruption.
{Schlempenmmihe unci KartoffelausscMag, Rindermau'ke, Fuss-
mmiJce, Fuss grind [German] ; Eczema des dreches
de pommes de terre [Frenchj.)
Malt eczema is a disease generally occurring only in cattle
and affecting the skin of the ends of the extremities with a form
of vesicular eczema. It is found mostly in steers and dry cows
if they receive many potatoes or their industrial residues, es-
pecially distiller's slop for any length of time.
History. The disease was first described by Spinola in the year
1836. After him several authors investigated the nature of the affec-
tion, among others Roloff, Ziirn, Rabe, Johne, Brautigam, without, how-
ever, having solved the problem conclusively.
Occurrence. Malt eczema occurs chiefly in the fattening
stables of potato distilleries, and especially in the spring. It
causes considerable loss in the affected stock by preventing
fattening and by occasional cases of death.
According to Ohlmann potato residues may also cause a similar
eruption in horses ; Gros-Claude and Frank saw the occurrence of an
eruption in sucking foals whose mothers were fed with germinating
potatoes or potato slop.
Etiology. The disease usually develops in those cattle
which receive very little green and corn food and many pota-
toes. The effect is the same whether raw or cooked tubers, or
leaves of the potato plant, or distiller's slop or other industrial
residues of potatoes are used as food. Steers ingest an aver-
age of 60, cows of 40.1 liters of the potato slop daily without ill
effects; 32 pounds of raw potatoes may cause a severe rash
(Marker). These figures are not of absolute value, for in this
respect not inconsiderable differences have been noticed in dif-
ferent years and at different times of the year in so far as, in
spite of like methods of feeding, the disease is frequent in cer-
tain years and is moreover much more frequent in spring than
during the rest of the year. That the disease occurs particu-
larly in the spring is, at least in part, due to the circumstance
868 Malt and Potato Eruption.
that the potato distilleries are generally in full operation only
during the winter and the animals are generally fed only with
distiller's slop at this time. Yet it appears not unlikely that
the frequent occurrence of the affection in spring is related to
the sprouting of the potatoes at that time or with their decompo-
sition, or with the strong fermentation of the slop. Musterle
has noticed that fermentation and acidification become very ac-
tive if slop mixed with raw fodder is allowed to stand several
hours before feeding. That this cannot be the only cause, how-
ever, is proved by the fact that even fresh tubers and the leaves
or stalks of the potato plant can occasion the disease and even
produce it in horses, if they are used as litter and come in con-
tact with the skin of the fetlock region (Roll). This circum-
stance and the fact that malt eczema occurs only in certain years
seem to prove that potatoes cause the disease only under cer-
tain conditions that are not yet clearly imderstood.
Concerning the immediate cause there seems to be a connection between the
occurrence of the disease, tlie amount of slop or potatoes ingested and the presence
of a chemical poison in the potatoes (Johne). The poison is absorbed from the
digestive canal and gains entrance to the blood vessels of the skin, producing a
similar effect on the papillary bodies and their epiout 9.-5 grammes of potassium). The symptoms of potassium poisoning (general
nuiscular exhaustion and heart weakness) are, however, completely absent, and the
idea of a dermatitis caused by potassium has hitherto not been sujiported by a
single observation.
Ziirn's hypothesis that the disease is caused by fission fungi in the feces
gaining access to the extremities cannot be accepted, for the disease is not con-
tagious, experiments with the intestinal contents not having proved effective in
transmitting the disease to healthy animals. Eabe's view that the disease is really
a dermatop)hagus scab cannot be acknowledged as correct, since the mites are fre-
quently found on the fetlocks of healthy animals and are demonstrable in only
about one-third of the cases in sick animals (Johne). Finally there is no confirma-
tion of Brautigam's opinion who found the same micrococcus in the slop, in the
intestinal contents and in the fluid of the vesicles, and considered that this caused
the inflammation of the skin, owing to its increase in the skin and in the sub-
cutaneous tissue when the former is soiled by the feces.
While experiences in general are in favor of the harnilessness of
corn and wheat slops, Schroder noticed a considerable outbreak of the
disease in a large herd of cattle and also in a horse from feeding on maize
Predisposition. Symptoms. 869
slop, and the s^^niptoms were qviite similar to those of malt eczema,
with this diiference, however, that thev assumed a much more severe
form and caused the death of 12 cows and of 13 calves.
Predisposition. Animals newly stabled for fattening are
affected first of all, that is animals which are changed from
another food to potato slop; the disease therefore is observed
most often in fattening establishments in which the animals are
changed frequently. With the same mode of feeding milch
cows do not contract the disease or only exceptionally ; the dis-
ease occurs less seldom in steers that are out in the open than in
animals that are constantly kept in the barn. In some animals
an actual idiosyncrasy against distiller's slop appears to be
present, for only in this manner can the fact be explained that
in the same year and in the same stable there are animals that
become ill from a few bucketfuls of the slop, while there are
others that remain healthy in spite of having ingested great
amounts of the slop (Johne). The conditions of the stables
have no influence in this direction.
Symptoms. The disease manifests itself only in a later
stage of feeding with potatoes and slop, developing mostly in 2
to 3 weeks, and stands in general in direct relation to the
amount of injurious food ingested, now assuming a mild and
again a severe form.
In the more frequent mild form a vesiculous inflammation
of the skin is limited to the lo\ver parts of the limbs (Schin-
delka) ; it is, how^ever, also accompanied by general symptoms
which usually precede the trouble. With a slight rise of tem-
perature the appetite declines, defecation is retarded, tears and
saliva are copiously secreted and the gait is peculiarly stiff.
On the second or third day a swelling of the feet develops,
from the coronet to above the fetlock joint, which may he
limited to the posterior extremities, but may also involve the
anterior ones or even affect them exclusively; the skin is red-
dened, painful, hot; the hair appears ruffled. Small vesicles
appear, and after they burst a moist red surface remains, on
which the secreted serous fluid dries up, forming large crusts
and scabs. The eruption may extend from the metatarsus or
metacarpus to the hock or carpal joint or even beyond; but
after a certain time no new crusts form, while under those pres-
ent the superficial layer of epidermis becomes horny ; the crusts
then become loose and healing results, with scaling, in 2 to 4
weeks. At the affected places the hair falls out, but with tlie
onset of healing it begins to grow again. In rare cases the
changes do not pass beyond the erythematous stage.
In the severe form the skin inflammation extends over large
portions of skin, especially if the mode of feeding is continued
unchanged in spite of the occurrence of the disease, and the
animals stand in dirty, badly ventilated barns. The trouble is
870 Malt and Potato Eruption.
accompanied by severe general symptoms. In addition to the
extremities of the limbs a similar eruption occurs on the thighs,
especially on their inner surfaces; further, on the skin of the
scrotum or udder, under the lower belly, on the sides of the
body, on the neck, tail and in the anal region. At all these places
the skin, the greater portion of which loses its hair, is thrown
into close folds, raw and in spots purulent, covered with thick
crusts, while at the joints deep cracks are formed from which
angry looking ulcers develop. In such severe cases the extremi-
ties finally become considerably thickened, abscesses develop
under the skin, at the coronet the integument may even become
necrotic and a purulent inflammation of the joint may arise.
Sometimes supiDurating ulcers with reddish edges as large as a
one-cent piece are seen at the same time in the oral cavity,
especially on the edges of the upper jaw (Cadeac).
Meanwhile profuse diarrhea sets in, together with total loss
of appetite and great weakness, which enfeeble the animals
more, so that some lie continuously on the ground and eventu-
ally die from exhaustion or in consequence of pyemia or sep-
ticemia. With the onset of diarrhea the exudation in the skin
becomes less, Avhereupon it becomes drier and stiffer and more
closely attached to the subcutaneous tissue.
In potato rash the following symptoms have been noticed aside
from the usual ones: Inflammation of the hair bulbs and general fall-
ing out of the hair in horses, inflammation of the prepuce in steers
and sheep, reddening of the vulva in cows, edema at different places in
the skin, and finally itching of the skin in sheep ; and all these have
occasionally been observed without a visible outbreak of rash (Schin-
delka).
Course and Prognosis. In the great majority of cases the
disease runs a favorable course, resulting in complete cure
within 2 to 4 Aveeks. In neglected cases, however, the animals
become emaciated in consequence of the increasing inflammation
of the skin and of the diarrhea which often is associated with it,
and the affection ma}^ then last for several months; but even
here recovery may occur if the attack is limited to the feet.
"Cases of death are observed only exceptionally and generally
only when the inflammatory process has involved the deeper
layers of the skin and if the ulceration of the integument, the
purulent ichorous inflammation of the subcutaneous connective
tissue or of the articulations of the feet lead to a general in-
fection.
The prognosis is generally favorable if the necessary change
of food is carried out in good time ; a severe course is only to
be feared under very unfavorable hygienic conditions.
Diagnosis. The history of the case, which is usually easily
obtained, that is, feeding on potato slop or potatoes in large
quantities, and likewise the acute vesicular and moist character
Diagnosis. Treatment. 871
of the inflammation limited to, or at least beginning on, the
extremities facilitate the diagnosis. In the fattening barns of
potato distilleries the soealled dirt eczema and dermatophagns
scab are also seen freqnently, bnt dirt scab does not extend
above the fetlock joint and is not accompanied by general symp-
toms, while dermatophagns scab develops mncli more slowly
and corresponds in character to chronic eczema withont vesicles
and moistnre. The demonstration of scab mites in the crnsts
does not necessarily exclnde malt eczema, for the parasites may
also be fonnd on the skin in this disease; it is accordingly of
importance in all cases to make a diagnosis from the clinical
sjanptoms of the disease. Ulceration of the claws, intertrigo
between the claws, fnrther foot-and-month disease are limited
to the interdigital spaces or the edges of the coronet ; the large
vesicles present in foot-and-mouth disease will not easily be
mistaken for those of malt eczema. Panaritium (foot rot) may
indeed form a complication of distiller's slop eczema, but since
more distant portions of the skin are involved in eczema, it can
readily be differentiated from panaritium due to other causes.
Treatment. The first step in treatment is the removal of
the cause by the suspension of malt feeding, by reducing the
daily rations of swill or potatoes down to the non-injurious
quantity, and by the addition of raw food or crushed grain,
bran or oil cake. The less potatoes or slop the animals receive
the more rapidly they recover, and only when all bad symptoms
have disappeared, the daily quantity of the previously injurious
food may again be gradually increased; yet it appears in-
advisable, at least at the fattening period, to feed the maximal
quantity. If dry food is not procurable in sufficient amount,
one can lessen the injurious effect of the malt by making a mash
of one-third of corn and two-thirds of potatoes (Marker), be-
sides the addition of chalk (50 to 100 giii. to 50 liters of swill)
or lime water (2 to 3 liters daily) is advantageous (Haubner &
Siedamgrotzky). The result of the treatment will be aided by
daily exercise of the animal in the open. Eggeling saw the
disease disappear from a herd after the distiller's waste was
kept heated by steam at 60°. Musterle saw the disease dis-
appear almost completely after the feed scalded with boiling
wash had been given to the animals at a temperature of not
less than 45° R.^
In the local treatment it is necessary to keep the animals
dry and to litter their stalls well with dry straw. Otherwise the
principles of treatment are the same as in eczema (see page
863).
Literature. Baranski, O. Eev., 1886, 65. — Brautigam, Tnaug.-Diss., 1886
(Lit.)— Eggeling, Pr. Mt., 1881-82, .58.— Johiie, S. B., 1877, 148 (Lit.).— Marker,
Handb. d. Spiritusfabrikation, 1877.— Musterle, Munch, t. W., 1910, 189.— Ohlmann,
872 Other Food Rashes.
Tm. Eimdseh., 1891, 70.— Eabe, Haiin. Jhl)., 1877-75, 80; D. Z. f. Tm., 1879, V,
284.— Sehindelka, Hautkrankheiten, 1908, 380.- Schroder, W. f. Tk., 1894, 397.—
Ziirn, Pflanzl. Parasiten, 1889, 280.
Other Food Rashes. Hess frequently saw an eruption simi-
lar to that of eczema in cattle fed on malt. The extremities
were usually affected and in severe cases the udder as well,
and in such cases a general disturhance of health was observed.
Recovery occurred in 8 to 30 days. For treatment 10 to 30%
of creolin ointment was recommended. Schmidt observed in
several cows a nodular eruption with subsequent formation of
hemorrhagic cracks and scabs. (Hess, Kongr. Bern., 1895, 286.
—Schmidt, W. f. Tk., 1903, 273.)
Large amounts of the skins of pressed grapes (Eoll) or the husks
of grapes and vine leaves (Faller) given as food cause an eruption
similar to malt eczema which is accompanied bv diarrhea. (Faller,
A. f. Tk., 1899, XXV, 225.)
Reinhardt saw an eczematous eruption on the extremities, round
about the eyes and mouth in 3 calves fed on rice bran (W. f. Tk.,
1891, 87).
Doderlein observed in cattle an exanthema like that of malt eczema
after feeding on white mustard (AV. f. Tk., 1896, 77).
Sipp described an attack of dermatitis similar to slop eczema;
it had occurred in cows and Indloeks after feeding the residues of
pressed beet-root and affected the skin of the extremities, head and
neck (Pr. Mt. 1852-53, 65).
An enzootic of hop exanthema was recently reported by Zaruba in
a large cattle herd. The disease occurred year after year on this estate
after the animals had daily received a certain quantity of tendrils of
the hop plant freed from the umbels, and after a bad harvest the
disease showed a wide extension. The skin of the udder and of the
posterior extremities was affected mostly ; in some animals, however,
the fore extremities and the lower chest, and in one case the whole sur-
face of the body were attacked. The clinical picture agreed in general
with that of malt eczema. The cessation of hop feeding, exercise in
the open and suitable local treatment produced a cure within 10 davs
(T. Z., 1907, 577).
Roder saw a severe moist eczema limited to the fetlocks in three
horses after feeding on peat molasses (S. B., 1900, 255).
Finally Mouilleron observed in horses an eruption similar to that
of malt eczema, which occurred after feeding on corn glucose cakes.
Fever and general symptoms, as well as motor disturliances were noted
in the acute cases. Tlie disease usually commences in the fold of the
fetlock, gradually passing on to the anterior surfaces of the extremities,
and spreads up to the hock or carpal joint. At times, the skin
at the inner surface of the thigh, the prepuce, the neighborhood
of the rectum, the eyes and the lips is also involved. At the last named
places one misses the otherwise prominent moist surfaces, the skin ap-
pears very dry, stiff, cracked and painful. If the disease develops
more slowly, moisture is slight at the extremities, and the exanthema
is very obstinate; but in other cases it can be made to disappear in
3 to 5 weeks by a change of food and by proper local treatment (Rec.
1907, 569).
Buckwheat Rash. Etiology. §73
(a) Buckwheat Rash. Fagopyrismus.
Buckwheat exanthema is a skin disease occurring from the
simultaneous effects of buckwheat and sunlight; according to
the intensity of these factors it may occur either as a simple
redness of the skin or, as a more or less intense inflammation,
which may even lead to necrosis of the skin.
Occurrence. The disease is found chiefly in sheep ; swine,
cattle and goats being attacked much less often, and horses
only exceptionally. Only white or white spotted animals are
affected. The disease appears only in certain years and in
certain localities (Dammann).
Etiolog-y. The cause of the disease is found in the inges-
tion of l)uckwheat {Haidekoni; Polygonum fagopyrum and P.
persicaria). The green flowering plant is most dangerous, but
the grain, the straw, the chaff and the bran may also produce
the disease. The eating of buckwheat fodder alone will not
cause the disease, the effect of sunlight on the white or white
spotted parts of the skin being also requisite.
The immediate cause of the skin affectiou is not yet known, and it is not
even possible to offer an entirely satisfactory explanation why the combined in-
fluence of the buckwheat fodder and of the sun rays is always necessary to produce
the disease and why the feeding- of the same material is harmless for black animals
and for the black portions of the skin. Experience has shown that both black
animals and animals that were dyed black remained free from the disease, as did
also the pigmented portion of the skin of spotted animals, and that white animals
whose hide was covered by dust and dirt were affected less severely, other things
being equal. On the other hand, it has also been observed that buckwheat fodder
usually is not effective even in white animals if it is given in cloudy weather, in
winter or in the barn. It is not necessary for the occurrence of the eruption that
the animals should be exposed to the action of sunlight at the same time that they in-
gest the buckwheat fodder ; cases have been observed in which the disease followed the
exposure to sun rays in 3 to 4 weeks after a copious ingestion of such food.
The combined action of buckwheat and sunlight was recently determined experi-
mentally on white mice and guinea pigs by Ohmke, who found that buckwheat loses
its injurious effect by extraction with alcohol and that the extract exerts a toxic
effect upon white animals on exposure to sunlight.
Dammann believes that the cause of the disease is found in certain fungi in
the buckwheat which come in contact with the skin and which injure the unpig-
mented parts of the skin, either themselves or through their poisonous products.
Pathogenesis. Buckwheat food evidently contains poison-
ous substances which may develop in the plant itself under cer-
tain conditions of soil or through the influence of microorgan-
isms. The experiments of Ohmke do not eliminate the correct-
ness of the view that poisonous substances form in the digestive
canal after the ingestion of infected food and then are absorbed,
just as are those that may be present in the fodder. According
to Schindelka, the affection of the skin is produced by toxins
gy4 Buckwheat Rash.
which are circulating in the blood and which cause an injury to
the vasomotors under the influence of the chemical rays of the
sun, in those portions of the skin in which the action of the
sun rays is not prevented by pigmentation. The functional dis-
turbance of the vasomotors is then said to lead to changes in the
vessel walls. The same substances are also supposed to pro-
duce certain disturbances in the digestive organs and in the
central nervous system.
Symptoms. The exanthema develops mostly on the face
and on neighboring places such as the ears, the throat and
possibly the neck.
In mild cases an erythematous inflannnation of the skin
occurs which manifests itself by intense redness, slight swelling
and sensitiveness of the skin at the affected spots as well as by
itching. The symptoms diminish in one or two days and the
animal recovers, yet desquamation as well as brownish dis-
coloration of the affected parts of the skin are observed for
some time.
In severe cases the clinical picture of a vesiculous or ery-
sipelatous inflammation of the skin is presented; the deeply
reddened and painful skin swells considerably at the places
previously mentioned, and in consequence the ears droop limply.
Often lentil to pea-sized vesicles with clear contents form on
the skin (socalled head- or pox-erysipelas of sheep) ; after they
burst moist spots form, which, however, become covered with
crusts on drying of the secretion. At this time violent itching
exists which causes the animal to shake its head and rub it
against fixed objects. Generally brain s}^nptoms are also
noticed, the animal running restlessly to and fro, leaping about
wildly, executing forced movements, or appearing as if badly
stunned. In many cases the animals also have convulsions.
The appetite is more or less diminished.
If the brain disturbances are considerable or if dyspnea
occurs as a result of narrowing of the nasal passages, a fatal
result may take place after 8 to 1:^ hours, otlierwise the disease
usually results in recovery in a few days, especially if the ani-
mals are led to a shady and cool place after the onset of the
first sjauptoms.
Treatment. Change of food and placing the animal in a
cool and shady place or into the barn soon bring about improve-
ment. The administration of mild purgatives (castor oil 50 to
250 gm., neutral salts 50 to 100 gm.) is indicated. If severe
inflammatory symptoms are present, local treatment must be
carried out consisting in cold compresses with clean water or
with lead lotion, possibly also in washing with lime water, while
later inunctions of carbolized oil (1:10), lime water and linseed
Clover Disease. 875
oil on the reddened skin, as well as a drying powder (such as
powdered zinc oxide and starch equal parts) do good service.
Literature. Dammann, Gesundheitspfi. d. Haustiere, 1902, 322.— Heniiinger,
B. Mt., 18S6, 15.— Klein, A. f. Tk., 1891, X, 220.— Noack, S. B., 1897, 141.—
Ohmke, Z. f. Physiol., 1909, XXII, 685. — Schindelka, Hautkrankheiten, 1908, 376.
(e) Clover Disease.
Clover disease consists in a variable inflammation of the
white portions of the skin of the head and of the limbs, also
frequently affecting the mouth; general symptoms of illness
may sometimes be noticed.
Etiology. Especially after generous or exclusive feeding
of Swedish or bastard clover (Trifolium hybridum), the disease
has repeatedly been observed in horses (Damman, Haubner,
Zipperlen, Michael, Heimann), Kovats saw it also after feed-
ing on red clover (Trifolium pratense). Enzootic outbreaks
have been noticed in cattle in consequence of pasturing in clover
meadows (Berndt, Nevermann) or after feeding with red clover
(Nissen). Sheep also have been thus affected (Berndt, Never-
mann).
The actual cause of the disease is not yet known. Accord-
ing to Haubner it is due to fungi, but this view cannot be
considered to be proved. One might assume that the poisonous
effect of the clover is somewhat similar to that of buckwheat
in fagopyrism (see page 873).
Symptoms. In mild cases there is merely a redness, per-
haps also a moderate swelling of the white parts of the skin
on head and limbs, which soon disappears and leaves behind a
somewhat prolonged desquamation. In cattle the skin of the
extremities, of the udder, and of the lower belly are favorite
localizations of the eruption, yet the front of the chest, the
lower part of the neck, and the parts around the mouth may
also be affected.
In a severe attack the parts of the skin mentioned above
become dark red to bluish red in color, considerable swelling
and tenderness may be noted sometimes followed in places by
vesicles, and then a large quantity of yellow colored gummy
fluid exudes upon the skin which soon dries into ratlier thick
scabs. Collections of pus then form, whereupon it exudes
from fissures in the scabs which have in the meantime become
cracked, or a purulent layer is disclosed after falling away of
the scab, which generally takes place within 14 days. Itching
and inflammation of the hair bulbs were observed by Haubner,
and Kovats saw inflammation of the hnnphatic vessels with the
876 Exanthema Caused by Other Leguminosae.
formation of a])scesses along their course. In case of an in-
tense intoxication the affected portions of the skin may become
subject to dry necrosis.
In severe cases in horses phlegmonous stomatitis (see page
196), jaundice, colic and nervous disturbances similar to those
seen in fagopyrismus were noted in addition to the symptoms
described (see page 874), also amaurosis and paralysis (Fried-
berger & Frohner). In cattle Nissen very often saw sjanptoms
of pseudo-aphthous inflammation of the mouth (see page 193)
with the formation of diffuse, yellow croupous deposits on the
mucous membrane of the lower lip, on the hard palate (es-
pecially between its bars), and at the posterior part of the
lingual ligament. Some animals even presented the symptoms
of a purulent conjunctival catarrh.
Cases accompanied by severe nervous and digestive dis-
turbances generally lead to death in a short time, but in the
other cases recovery ensues with suitable treatment.
Treatment. In slight cases it is sufficient to stop the clover
feeding in order to secure a quick recovery of an ailing animal,
while in bad cases the addition of local treatment with cold
applications appears necessary; for these, clean water or better
Goulard's extract or lead lotion, or Burow's solution may be
employed, and afterwards the treatment may be similar to that
applied in eczema (see page 863). The nervous disturbances
require symptomatic treatment, while the inflammation of the
mouth is to be treated on the principles already outlined else-
where (see page 198).
Literature. Berndt, Pr. Vb., 1905, II, 23. — Heimann, Z. f. Vk., 1909, 490.—
Jakobs, B. t. W., 1905, 790.— Kovats, Vet., 1895, 266.— Michael, S. B., 1898, 112.—
Nissen, Maanedsskr., 1909, XX, 602.— Zipperlen, Eep., 1885, 163.
Exanthema Caused by Other Leguminosae. Kiihn and Bigoteau
saw an extensive eruption of an eczematous nature in cattle after feed-
ing on lucerne if this fodder was given in large ciuantities, especially
if it was young and luxuriantly grown ; the same observation was made
by Marek. Burmeister noticed a similar skin disease in horses which
had received vetches in addition to lucerne.
The symptoms in cattle are similar to those of malt eczema (see
page 869), only that the eruption, which also commences on the fet-
locks of the hind legs, spreads rapidly over the whole of the lower
legs, and sometimes over the inner surface of the thighs, the udder or
the scrotum, and even over the lower abdomen as well as the anterior
extremities. The skin of the lower chest and of the breast may also be
involved (authors' observation). There is swelling and redness of the
skin as well as vesicle formation, whereupon copious serous fluid is
secreted which dries into thick scabs which subsequently crack. Under
the scabs much pus is collected. Considerable tenderness is always
manifest.
Erysipelatous Inllainiuatioii of the Skin. Etiology. S77
In horses the disease oeciirs either at the same time on the skin or
mucous membrane of the mouth, or only the skin of the limbs covered
Avith white hair is attacked, leading to edematous swelling, the secretion
ot sticky fluid on the surface of the skin, and scab formation.
Besides stopping or reducing of lucerne feeding, the treatment is
the same as that in malt or moist eczema (see pages 863 and 871).
Literature. Bigoteau, Bull., 1894, 456.— Burmeister, Mag., 1844 112 —
Kovanyi, A. L., 1907, 471.— Kiilin, B. t. W., 1894, 521. ' ^ '
9. Erysipelatous Inflammation of the Skin. Dermatitis
Erysipelatosa.
{Rotlaiif, Rose; Erysipelas.)
By erysipelatous dermatitis is understood a diffuse, sero-
cellular infiltration of all the layers of the skin, which is mani-
fested by an intense red color, pain and swelling, and which
after an acute course passes on to healing with desquamation
of the skin.
In the strict sense the name applies only to diseases caused by
Fehleisen 's streptococcus erysipelatis. It is, however, unknown whether
this etiologically uniform type of disease — idiopathic and Avound ery-
sipelas—also occurs in animals, but cases which have been met with
actually correspond wdth this disease very much clinically, and in con-
sequence some authors (Roll, Malzew, Semmer, Lucet) have considered
them to be identical ^\\\\\ true erysipelas.
_ From the definition given it is clear that the red spots developing in swine
erysipelas do not correspond to the meaning of the pathological term of erysipelas,
but have merely the significance of redness of the skin.
Etiology. The external influences mentioned in the etiology
of erythema (see page 839), especially the effect of too great
warmth, sun rays as well as chemical substances, produce on
intense exposure an infiltration of the skin with sero-cellular
exudate extending into the subcutaneous connective tissue.
Brandes also proved experimentally that kainit mixed with the
litter or strewn in the manure pile produced violent inflamma-
tion of the skin and even necrosis of the extremities and udder,
and if taken into the stomach may cause a fatal internal disease,
especially in hens. Traumatic effects especially play a part as
means of infection. From such causes the disease develops on
the head and limbs and seldom on other parts of the body, es-
pecially in horses. The same origin is probably to be attrib-
uted to the quite common erysipelatous dermatitis on the head
and neck in swine (Schindelka), as well as to the inflammation
which now and then occurs in dogs (Frohner, Miiller).
Lucet isolated a streptococcus quite similar to the streptococcus erysipelatis from
the affected skin of a horse that had died with symptoms of erysipelas of the head.
This streptococcus was demonstrated on microscopic sections in the distended lymph
spaces which were filled with exudate.
878 Erysipelatous Inflammation of the Skin,
Certain food rashes, especially buckwheat exaiitheina and
clover or lucerne disease, give rise in severe cases, to symptoms
similar to those of an erysipelatous inflammation of the skin
(see iDages 874 and 875).
Straub has noted an erysipelatous inflanimation of the fetlock region in military
horses after drill on stubble fields, while Spath saw a similar disease in cattle that
were littered on pine and fir needles. Cadeae and Nys attribute a vesicular inflam-
mation of the skin of horses to the action of an acrid substance of Blaps mortisaga.
The affection occurred in the months of June and July, and especially affected
the head and the region about the mouth. Kossorotow noticed in horses which
had been ridden over fields thickly grown with wolf's milk (Euphorbia) a disease
which was manifested by an inflammation of the skin, with moderate fever, red-
ness, excoriations and rhagadae.
Symptoms. Erysipelatous inflammation begins either with
small spots which spread and merge into one another, or it
may commence with large uniformly reddened patches, in horses
for instance at the ends of the extremities; there is uniform
redness of the skin, swelling, elevation of temperature and
increased sensitiveness on handling. These morbid changes
which may moreover be accompanied by intense itching, remain
unchanged for several days, later on, however, the skin becomes
softer, the brownish epidermal layer desquamates in fine or
coarse scales, and underneath the healthy skin reappears. In
an intense inflammation large and small vesicles develop (Ery-
sipelas vesiculosum et bullosum) which soon burst or suppurate,
whereupon the surface of the inflamed skin is for a time covered
with crusts (E. crustosum). The development of dermatitis is
often accompanied by a feverish rise of temperature, loss of
appetite and depression, but these symptoms disappear as soon
as desquamation commences. ^ ...
The pathological processes show certain peculiarities, ac-
cording to their cause and even more according to breed of the
animal, especially as regards the localization of the changes.
Thus painful hot swellings develop in horses on the head, around
the orbits, the nasal openings and the cleft of the mouth, in
consequence of which respiration as well as mastication may
be greatly hindered, while at other times the inflammation on
the unpigmented extremities occurs at the coronets, on the fet-
locks and shin bones, and then consideralile thickenings develop
in consequence of infiltration of the subcutaneous cellular tissue
which also recede after cessation of the inflammation.
A peculiar form of erysipelatous dermatitis was observed by Lebrun as an
enzootic in military horses. Vertical wounds running parallel with one another
developed in the region of the cleft of the mouth and became covered with
crusts. At the same time there was ptyalism and hyperemia of the mucous
membrane.
Diagnosis. Erysipelatous dermatitis manifests itself by
diffuse inflammatory changes in the skin and by its acute devel-
opment accompanied by fever. This distinguishes erysipelas
from the much milder erythema, further from eczema which
Treatment. Gangrene of the Skin. 879
develops more slowly, extends only graduall}^ and is usually
afebrile. But in eczema the small vesicles develop from the
beginning Avhile the skin is still comparatively healthy, while
in erysipelas large vesicles form only later when the skin is in-
tensely inflamed. In phlegmons purulent infiltration of the
subcutaneous connective tissue exists.
Treatment. Local treatment is only necessary in severe
cases of erysipelas, while slight cases heal without any treat-
ment. Cold applications of clear water, Goulard's extract, lead
water, also Burow's solution, or applications of lime water may
be used. Later on the reddened skin may be anointed with
carbolized oil (1:10), or covered with astringent powders (see
page 863). In cases where erysipelatous inflammation is caused
by an infection, a subcutaneous injection of 3% carbolic acid
or 1 :5000 corrosive sublimate solution at several points of the
periphery of the affected spot (in horses one can inject 10 to 30
cc. at one place) checks the advance of the inflammation (Gut-
zeit, Feldmann). The following may also be used: 10 to 20%
ichthyol, resorcin, creolin, iodoform ointment, then gray mer-
cury ointment, or disinfecting solutions. Where considerable
general disturbance of health exists corresponding symptomatic
treatment is indicated.
Literature. Cadeac, J. vet., 1902, 515.— Gutzeit, Z. f. Vk., 1892, 301.—
Kossorotow, Pet. A. f. Naturwiss; 1897, 42.— Lebrim, Bull., 1906, 286.— Nys, Eec,
1907, 44 (Eev.).— Spath, Mt. d. Ver. bad Tzte., 1903, 86.
10. Gangrene of the Skin. Gangraena Cutis.
{Gangrenous inflammat'wu of the skin; dermatitis gangrcenosa.)
By gangrene of the skin is understood a death of circum-
scribed portions of skin, which is produced either as a direct
result of tissue destruction, or from an arrested blood supply
to the part, or which arises in the course of deep seated inflam-
mations of the skin.
Etiology. In the unpigmented and perhaps sparsely haired
skin the chemically acting (ultra-violet) rays of the sun produce
hyperemia on prolonged and direct exposure, and soon after
erysipelatous redness and inflammation, and if their effect on
the skin is very intense, they may finally cause death of the
skin in these places. This form of gangrenous inflammation of
the skin (gangraena Solaris) occurs mostly on the white spotted
extremities and on the white marks on the head in horses; it
is noted exceptionally in cattle. Aside from the sun rays, hot
dry winds may cause the same effect, and similarly gangrene
of" the skin may also result in consequence of freezing (con-
gelatio) or burning (combustio).
880 Gangrene of the Skin.
Chemical substances circnlating- in the blood may cause
dry gangrene of the skin. This is observed most frequentl}- in
ergot poisoning in which parts of the skin and even whole parts
of the extremities, the ears, the tail, in fowls the comb, the
wattles and tip of the tongue, in ducks the beak, etc., mortify
and are cast off (Ergotisnius gangraenosus). The cutaneous
gangrene occurring sometimes in clover disease is likewise
caused by chemical poisons. Necrosis of the skin in horses is
also sometimes a s^nnptom occurring in lupinosis; Lathyrus
sativus, lucerne and buckwheat may produce a like action on
the uncolored parts of the skin. A similar gangrenous inflam-
mation develops on the extremities of horses on the coronets
and fetlocks, sometimes mtliout any assignable cause (socalled
necrotic eczema) in which, however, the injurious effect is prob-
ably due to bacteria.
The frequent skin gangrene occurring in swine is mostly
caused by the bacilli of swine erysipelas (Jensen), Avliich mul-
tiply in the vessels of the skin, producing in mild cases a serous
infiltration (urticaria) and in severe cases a tissue necrosis.
The same thing may also be noticed quite frequently in swine
plague or hog cholera. In the course of purpura hemorrhagica,
gangrene of the skin may occasionally be observed. Other
pathogenic bacteria (Bac. necrophorus and perhaps others)
doubtlessly play a part in cases where a quick destruction of
neighboring tissues results from insignificant injuries.
In the Hungarian stnd at Mezohegves in a stable where a slight inflammation
of the heels of the animals had been noticed every year in tlie mouths
of July and August, in the year 18S0 gangrenous inflammation of the fold of the
fetlock occurred among 1 and 2 year old stallion foals which were kept here, and
assumed an enzootic character. Thirty foals became affected and the disease assumed
such a severe character that in some cases gangrene of the tendons, ligaments
and bones developed. The cause was probably an infection with the bacillus of
necrosis.
Continuous pressure on the skin at times causes mortifica-
tion in consequence of disturbing its nutrition, and this may
frequently be seen in animals lying on the ground for a long
time, on parts of the skin which immediately cover bones. The
same is brought about by severe contusions.
Finally, corrosive substances such as concentrated acids,
alkalies, etc., cause a mortification of the parts that are touched
immediately as well as neighboring portions of skin, in conse-
quence of coagulation and destruction of the cell albumen.
Symptoms. Gangrene of the skin is preceded either by
acute eczema, in which case reddening, increased sensitiveness
and swelling of the skin are noticed, or it presents itself im-
mediately without such prodromal symptoms. After the onset
of necrosis the skin becomes brown, and at the same time its
Symptoms. Treatment. Necrobacillosis of Sheep. 881
sensitiveness diminishes to complete anesthesia. If the process
remains more superficial, only the epidermis of the stiff and
dry skin dies and is thrown off in thick lamellae from the cutis,
which is then covered by a fresh outer skin.
If, however, the necrotic process extends more deeply, the
skin in its whole thickness turns into a black, dry, parclnnent-
like layer, round about which acute inflammation may often be
noticed. The pus exuding from this inflamed wall separates
the dead portion of skin, which is Anally cast off, and the ul-
cerated surface remaining in its place heals by granulation and
cicatrization, unless a general infection is associated with the
inflammation. In more severe cases the necrotic inflammation
extends still deeper, to the tendons and ligaments, whereupon
a purulent ichorous process arises in the neighboiing joints,
which leads to destruction of the joint surfaces and finally to
general infection by metastasis. This course is especially to
be feared on the extremities of horses, cattle and sheep, and
even if no fatal pyemia or septicemia intervenes, the animal
becomes quite useless because the joints become stiff or the
cicatrices contract very much, thus interfering with motion.
In many cases of wound infection the inflamed skin changes
to a greasy, pulpy, dirty colored mass (Gangrgena humida).
The process can be arrested after a time even in these cases,
and after throwing off of the necrotic tissue, a healthy granula-
tion tissue develops, followed by cicatrization, while in other
cases a general infection is associated at times with the local
complaint.
In dry necrosis (mummificatio) the skin alone or together
with its subjacent layers becomes insensitive without exhibiting
any inflammatory symptoms; the skin shows a black, dry ap-
pearance, while under it the tissue is hemorrhagically infil-
trated. Finally the dead portion is cast off from the living
tissue by sloughing.
Treatment. In commencing gangrene the friction of the
affected parts of the skin with desiccating (lead, zinc oxide) or
disinfecting (iodoform, carbolic, boracic) ointments, seems in-
dicated. The dead parts should be removed with the knife and
the remaining ulcerous surfaces treated according to the rules
of surgery. Sloughing is hastened through the production of
hyperemia by means of warm fomentations and poultices.
Literature. Cuille, Eev. gen., 1905, VI, 457.— Frohner, Monh., 1901, XTI,
205.— Jensen, D. Z. f. Tm., 1892, XVIII, 40, 272.— Paszotta, Monh., 1901, XII,
■ 256.— Seqiiens, Vet., 1896, 471.— Tatray, ibid., 1895, 161.
Necrobacillosis of Sheep. Skin necroses caused by the bacillus
necrophoriis occur especially in sheep, and not infrequently in enzootic
extension. The respective cases of disease have been designated vari-
ously, according to the localization of the lesions. (Concerning the
Vol. 2—56
882 Necrobacillosis of Sheep.
relations of necrobacillosis to aphthous inflammation of the month in
sucklings, see page 188.)
To this disease belongs especially the socalled sore mouth of sheep
(Impetigo labialis), which generally attacks only lambs and commences
at the edges of the lips with small vesicles, which are filled with clear
fluid. At the same time the lips appear more or less swollen, and in severe
cases the appetite is diminished. By rubbing of the mouth, and some-
times in taking food the vesicles burst and leave intensely reddened,
bleeding surfaces which afterwards become covered with brown crusts.
By the formation of fresh vesicles in the neighl)orhood the process
spreads to the angles of the mouth and to the region of the nose, and
the skin of the lips is transformed into a raw, granulating surface
coated with dirty masses which appear either purple red or yellowish
white and are always covered with broad cracked scalis. If the process
is fairly extensive, a purulent mass makes it appearance on pressure
upon the crust. On the inner surface of the lips one finds only excep-
tionally raw granulating surfaces which are more fre(iuent on the gums
and hard palate, and a peculiar smell, reminding one of Limburger cheese,
is emitted from the mouth. The nutrition of the animal becomes poor
in consequence of the painful complaint and many animals even die.
In certain outbreaks the disease attacks the neighborhood of the
nasal openings, the cheeks and the eyelids, or in some animals it may
occur on the extremities where similar changes develop as on the lips.
This form of the disease is designated hy Mohler Us "lip and leg ulcer-
ation of sheep."
'From its localizations on the coronary band the disease is also
known as "foot scab of sheep" ("foot rot of sheep" in America, "con-
tagious foot rot" in England, "pietin contagieux" in France). The
inflammation begins at the coronary band and small ulcers develop at
the heels, which discharge a purulent secretion, emitting a peculiar odor.
In severe cases the process extends more deeply and fistuloe may form,
sometimes also necrosis of ligaments, tendons and bones (jMohler & Wash-
burn).
Owing to its localization on the genital organs the disease manifests
itself in female animals hy a painful swelling of the vulva, by ulcer-
ation on the vulva and on the adjoining skin, and by a slimy or purulent
discharge from the vagina. In rams and not infreciuently in wethers,
the disease begins with the formation of pale yellow small spots in the
skin of the prepuce, the preputial opening and on the penis. These spots
soon change into ulcers, Avhieh gradually liecome larger, often coalescing
with one another, so that the whole surface of the sheath becomes ulcer-
ous. The sheath is generally more or less swollen and reddened.
The various forms of necrobacillosis just described now and again
occur combined with one another. Tlius contagious foot rot or the
disease of the genital oi-gans may be observed together with impetigo
labialis; indeed all three forms of the disease can l)e present at tlie
same time.
Necrobacillosis of sheep has been found principally in North Amer-
ica, England and France as an enzootic (MacFadyean, Berry, Williams,
KnoAvles, Flook, Moussu, Besnoit), but outbreaks have also been re-
corded in Germany (Peter, Hasenkamp, Pr. Vb.), in Hungary (Vigadi)
and in New Zealand (Gilruth).
While the bacillus of necrosis is the actual cause of the changes,
predisposing factors play an important part in the spread of the dis-
ease, rendering possible the entrance of the bacilli into the tissues of
Necrobacillosis of Sheep and Other Animals. 883
the body and a rapid extension of the disease in a flock. Of special
importance in this connection are abrasions or wounds of the mncons
membrane or of the skin. Such lesions easily occur on the lips and the
edges of the nose from the ingestion of very rough or hard food, or
when feeding on pastures in which thorny, prickly shrubs are accessible.
Consequently numerous cases are noticed, especially in dry years.
Abrasions and wounds easily arise on the extremities by travelling over
recently graveled roads, on frozen snow, and also by pasturing on
meadows containing thorny, prickly plants. The skin of the vagina
and that of the prepuce is easily subject to abrasions in the covering
act. As further predisposing causes may be noted: a diminution of
the power of resistance of the skin through cold, standing in dirty,
soiled straw and travelling on muddy roads. Weakness and insufficient
nutrition also cause a predisposition to the disease.
At times, however, necrobacillosis seemingly appears without the
intervention of any predisposing factors, attacking especially the mucous
membranes, principally in very young animals, owing to the softness
of their tissues or probably to an increased virulence of the bacillus.
Artificial transmission of the disease was successful by rubbing the
crusts into the scarified skin (Mead), on the mucous membrane ( Vigadi),
by putting a pledget of cotton impregnated with the discharge from
the genital organs into the preputial opening (MacFadyean) and by
inoculation of cultures of the necrosis bacillus. In an enzootic in the
Prussian district of Wittenberg, the shepherd was also infected by the
affected sheep, and large lentil-sized nodules formed on his hands, which
in 3 to 4 days changed into small ulcers and healed up in about 10 days.
The course of the disease is generally benign, yet now and then
losses of 10% of the affected animals have been noted.
The treatment consists in removing the crusts and granulations
and then in washing or swal)bing the places with disinfecting fluids.
When the disease is localized on the lips and edges of the nose, inunc-
tions with a 5% cresol or tar ointment, to which 10% flowers of sulphur
may be added are more appropriate. The sheath or vagina may be
syringed out daily with a 2% solution of potassium permanganate or
w^ith 75% hydrogen peroxide. Animals with extensive ulcerating sur-
faces or strongly granulating ulcers are best killed.
Preventive measures are cleanliness and the disinfection of the
quarters of the animals, isolation of new bought animals for a period of
two weeks, isolation of diseased subjects and the avoidance of infected
pastures for the space of a year.
Literature. Kondor, Ung. Vb., 1901. — MacFadyean, J. of comp. Path., 1903,
375. — Mead, Am. v. Eev., 1905, 441. — Mohler, Lip-and-leg ulceration of sheep.
Anim. Ind. Circ. 160, 1910.— Otto, S. B., 1905, 237.— Peter, B. t. W., 1899, 168.—
Pr. Vb., 1901, II, 25.— Williams, J. of comp. Path., 1904, 64.
Necrobacillosis of Other Animals. Besides occurring in sheep,
necrobacillosis not infrequently affects other species of animals, partly
as a sporadic and partly as an enzootic disease. Of these is to be men-
tioned first of all diphtheria of calves (see Vol. I). In Para-
guay, Elmassian & Ulizar saw an enzootic of necrobacillosis in adult
cattle, where the necrosis attacked the skin almost regularly in the
perineal region, and only exceptionally on the tail, udder and ears.
884 Necrobacillosis of Other Animals. Herpes Labialis.
The interdigital panaritiiiin and the necrotic (malignant) inflammation
of the claws in cattle also belong to this category (see Vol. I).
Finally many cases of pseiido-aphthous inflammation of the mouth (see
page 193) arise from an infection with the necrosis bacillns. This
was the case in an enzootic in cattle described by Vigadi. The disease
commenced here with apathy, diminished appetite and slight fever.
After 1 to 2 days salivation occurred, and on the reddened mucous
membrane of the mouth, especially on the inner surface of the lower
lip, of the dental pad of the upper jaw and the tip of the tongue,
necrotic patches appeared which varied in size from that of a lentil to
that of a quarter; they were roundish, grayish white; after their re-
moval the tissue of the mucous membrane was intensely reddened and
bleeding. In several cases the necrotic process also attacked the deeper
layers, whereupon deep ulcers with dirty grayish white smeary deposits
were formed. Simultaneously with these changes the lips, the alfe of
the nostrils and the region of the cheeks showed painful swellings, in
some eases diffuse, yellowish lirown scabs under which the skin was
intensely reddened, denuded of epithelium, and moist. Not infrequently
the skin of the feet was also affected, while the swollen and painful skin
of the interdigital clefts, more frequently, however, that at the edges
of the coronet, became necrotic at places varying from a one-cent to a
twenty-five-cent piece in size, and gave place to bleeding ulcers with
ragged edges. Now and then also grayish bro^ATi, firmly adherent scabs
were formed at the same time on the swollen skin of the fetlock region
which covered a moist surface denuded of epithelium. Recovery fol-
lowed in slight cases within 10 days, and it occurred even in the
severe cases by keeping the affected parts clean but without other special
treatment.
Finally the enzootic necrosis of the vagina of cattle is caused by
the necrosis bacillus, and occurs together with necrotic inflammation of
the claws (Ellinger).
In goats, enzootics of inflanuuation of the mouth have been observed
in France and Germany, the clinical appearance of which coincides with
that seen by Yigadi in cattle ; only that the process remained limited
to the mucous membrane of the mouth, and the neighliorhood of the
mouth. According to Cadeac and Mohler these cases also belong to
necrobacillosis.
As a further form of the disease may be noted the necrotic inflam-
mation of the fold of the fetlock in horses, which may occur as an en-
zootic, and also the necrobacillosis of rabbits.
Literature. Elmassian & Ulizar, A. P., 1906, 969.— Pr. Vb., 1903, II, 18.—
Vigadi, A. L., 1906, 423.
11. Herpes Labialis.
By herpes one designates a disease of the skin with acute onset
which heals in a short time, and which is characterized by vesicles filled
with serous fluid arising on a circumscribed surface. Such an eruption
usually develops on the lips and alae of the nostrils of horses in the
course of gastro-intestinal catarrh, or in acute infectious diseases. The
cause is unknown ; but a local irritation of certain nerves is suspected,
such as single branches of the trigeminus. At the aforementioned places
thickly clustered lentil-sized vesicles develop filled wdth a clear yellow
serum, there is also slight itching, moderate redness and swelling. After
Herpes Labialis. Pemphigus. 8^5
1 to 3 days the vesicles dry up to brown crusts, and after these fall off
the redness of the skin soon disappears.
Treatment is only necessary in the presence of excoriations and
then an ordinary dvisting powder or painting with lead acetate solution
may be resorted to.
Herpes Zoster. (Shingles; Zona, Fr.) In human medicine this term is ap-
plied to a peculiar vesicular eruption in which small vesicles occur profusely in the
territory supplied by a definite nerve, and which may be traced to a disease of the in-
tervertebral ganglia or the nerves themselves, or to an affection of the trophic nerve
fibers. A similar affection is said to have been observed by Megnin in a horse on
whose body thickly clustered vesicles formed, which crossed the direction of the
hairs, forming stripes 1 to 2 cm. broad which were separated from one another
by healthy stripes of skin of like width, so that the appearance was like that of a
zebra skin. Further, Hebrant claims to have seen shingles in a two-year-old dog.
On one flank of this dog, a patch about 3 cm. broad was covered by sero-fibrinous
masses, round about which and as far as the median line, little nodes and dried
lip exudate could be seen; severe itching occurred in paroxysms. After 10 days
a similar eruption appeared on the opposite side of the body. At first moderate
atypical fever was present. The animal recovered in 2i^ weeks. A certain simi-
larity of the complaint to moist eczema of the dog undoubtedly existed. (Hebrant,
Ann., 1905, 12).
12. Pemphigus.
{Blaseuaaschlag ; Dermatitis bullosa.)
Pempliigus is an independent disease of the skin charac-
terized by large vesicles; in its acute form it passes on to re-
covery in a few weeks, in its chronic form on the contrary —
and ill the narrower sense of the word only this is designated
as true pemphigus — vesicular outbreaks recur several times,
which finally, however, end in recovery (Pemphigus vulgaris,
P. chronicus benignus), or the healthy epidermis fails to form
again on the constantly increasing diseased areas (P. chronicus
malignus, P. foliaceus).
Occurrence. In animals, especially in horses (Demoussy
Dieckerhoff, Graffunder) and in cattle (Loiset, Lucet), excep-
tionally also in swine (Winkler) vesicular skin eruptions were
observed repeatedly, which always terminated in complete re-
covery in a comparatively brief space of time, and which for
this reason may be taken to correspond with pemphigiis acutus
of man, although it does not appear impossible that many cases
included herein have really been attacks of urticaria bullosa
or eczema bullosum. True pemphigus is undoubtedly an ex-
ceedingly rare disease in animals.
Etiology. Of the causes of the disease nothing certain is
known. Its frequent occurrence occasionally appears to point
to an infection (Loiset saw it in cattle in the form of an en-
zootic). Bacteriological investigations hitherto conducted have
led to no positive result (Ballart saw^ one case of transmission
of the disease from a cow^, Dasch from a dog to man).
g86 Pemphigus. Impetigo.
Symptoms. At times feverish symptoms, perhaps also
digestive disturbances, herald an approaching attack, while in
other cases the eruption appears without any such signs. On
the skin, especially on the trunk, on the lower belly, on the
inner surfaces of the thighs and elsewhere, vesicles arise upon
the skin which is swollen, accompanied by intense itching or
without itching. These vesicles form within 1 to 2 daj^s and
may become larger than a goose egg; they are semi-spherical
or flattened and may exhibit a plate-like depression in their
center. The content is clear watery or yellowish, later on it
may become milky, and flows out after the thin wall bursts,
while this latter remains adherent to the skin for a long time,
or it is removed by rubbing, and then an intensely red surface
becomes visible, which for a time continues to exude a serous
secretion, but in a few days is covered with new epidermis.
In this way the process heals completely in the course of 2 to 4
weeks ; in rare cases, however, healing occurs only with the
formation of scabs, and then fine glistening cicatrices remain
at the places of the vesicles.
Treatment. After rupture of the vesicles occurs, it is suffi-
cient to appl}" a non irritating dusting powder to the skin or an
astringent ointment (see page 863); in case of very extensive
eruption washing with soap and thorough cleanliness are to be
recommended.
Literature. Basch, T. Z., 190S, 266.— Graffunder, B. t. W., 1890, 15.-5.—
Jakobscn, Maanedsskr., 189:5, IV, .Sll.— Liicet, Eec, 1894, 244.— Paulicki, Mag.,
1872, 29.— Saner, W. F. Tk., 1902, 231.— Winkler, ibid., 1891, 47,
Pemphigus Chronicus. Frohner saw tlie whole of the liody of a
dog, with the exception of the head and limbs, covered with large vesi-
cles, which after bursting, left clear liright red surfaces, with a cherry
red center. These showed no disposition to heal and were continually
covered with fresh crusts, until finally the animal died, completely ex-
hausted, with symptoms of hemorrhagic inflammation of the rectum.
Lafosse saw a skin disease similar to pemphigus foliaceus, in a mule,
After all the hair had fallen out, broad epidermal scales formed
on the bald skin, after detachment of which the fresh layer of epidermis
Ava.s soon lifted up by the exuded serous fluid underneath, and in this
Avay new scales always were formed. The animal meanwhile became
emaciated, and later on was attacked by diarrhea. (Frohner, Monh.,
1892, III, 497.)
13. Impetigo.
{Ecthyma.)
By impetigo or ecthyma is understood in human medicine an ex-
anthema chiefly affecting children, in the course of which pustules form
on different parts of the body, but especially on the face; they develop
on a red base without itching, and are followed later on by thick,
soft, honey-like crusts. This skin affection is sometimes decidedly in-
Impetigo. Dermatitis Lichenoides. Acne.
887
fectious (Impetigo contagiosa) and is accompanied by acute swelline
of the neighboring lymph glands ; it always runs a favorable course
According to Burke the disease develops in horses with fine skin
under the influence of irritating agencies and unfavorable hygienic con-
ditions. The resultant pustules are superficial, at first white like mother-
of-pearl, later purulent, then rupture quickly, and their contents
dry up into yellow crusts ; when these fall off a hairless spot remains
which heals without scaling. In contrast to eczema the exanthema runs
a rapid course and heals quickly ; there is no itching and transmission
to other animals is easy (Vet. Journ. 1890, 77).
According to Benion a similar disease develops in young swine in
the neighl)orhood of the eyes, more rarely on other parts of the body
with the formation of small pustules, in the place of which soft crusts
arise later on. The process is accompanied by a catarrh of the con-
junctivae, nose and mouth, and heals within 2 to 3 weeks (Diet., 1888,
A.vl, 268).
Schindelka several times saw an eruption in old nursing or pregnant
bitches which occurred independently of distemper.
As a secondary affection impetigo develops in the course of dis-
temper, strangles, swine plague and hog cholera as well as in rinder-
pest.
The treatment consists in softening of the scabs or washing with
creolm or soap solution and subsequent dressing with a disinfecting or
astringent ointment.
Dermatitis Lichenoides. By this name Dages described a disease of the
horse m the course of which large, dry, bald, non-itchiug surfaces formed on the
root of the tail, ou the back, neck and thighs. After the lapse of six months the
skm on these spots became painful, inflamed and infiltrated, and ha2elnut-sized
nodules developed on it; at the same time there was violent itching. Later on
the nodules liegan to bleed, and thick, yellowish crusts formed, underneath which
the skm was covered with pus. Finally the nodules became smaller, and in their
places pea-sized elevations remained, on the surfaces of which the epidermis was
thick and rough. The acute attack lasted a month, it recurred annually in winter,
and the affection finally became so extensive that the horse had to be killed at
the end of three years. Neither in the epidermis, nor the crusts or in the pus
could vegetable or animal parasites be demonstrated, and transmission experi-
ments on guinea pigs were unsuccessful. (Dagos, Bull., 1894, 442.)
14. Acne.
{Heat rash, summer rash, summer scab, sweating eczema of the
saddle region, saddle scab, heat nodides, heat pox, nodular
or tubercle rash in horses; Acne simplex s. vidgaris;
Boutons [French]; Akne [German].)
By acne one understands an inflammation of the sebaceous
glands and hair follicles, not infrequently passing on to pus for-
mation, and characterized by pin-point to bean-sized nodules
appearing in the otherwise healthy skin.
According to Schindelka the skin diseases mentioned in the title
are considered as acne since they do not exhibit the characteristics of
eczema with which most authors have classified them (socalled papulo-
vesicular eczema).
Etiology. In certain cases acne probably results from an
infection with pus bacteria (Frick) wliicli evidently enter
888 Acne.
through the orifices of the hair follicles or sebaceous glands, or
are rubbed into them. According to Frick mechanical influ-
ences only play the jDart of accidental causes in these cases.
The disease occurs in those parts of the body which are
frequently exposed to mechanical influences, especially to rub-
bing, or which perspire readily. Such places are, in horses, on
the back and on the sides of the chest (friction l3y the saddle,
girth, traces) on the front of the chest and in the shoulder
region (rubbing by the collar and breast strap), in the croup and
tail region (friction by the breeching and crupper), as well as
on the head (mechanical friction from the halter). In dogs
the forehead, the cheeks, the bridge of the nose and the external
surfaces of the limbs are favorite spots for acne, because these
parts are preferably rubbed by the muzzle or come in contact
with the hard ground.
The disease, which was studied closely by Bartke, Qualitz, Steffens,
Grammlich, v. Hennings, Kalkoff, and Kupfer under the name of sweat
eczema (heat pox) of riding horses, is an acne-like affection of the skin,
especially prevalent in the military horses of the Prussian Army since
the introduction of the new army saddle (according to Kupfer 50 horses
on an average in each regiment were affected in one summer), but it is
also observed when other saddles are used. The connection between the
frequency of this trouble and the introduction of the new army saddle,
is found in the fact that the trees of the new saddle are longer, and the
wallet is put further back, extending to the sensitive lumbar region,
Avhich on motion, and especially in walking, makes decided transverse
motions and furnishes much opportunity for friction between the skin
and the wallet. Saddles which do not fit well to the trees and which
are weighted too heavily, too much stirrup riding, lack of cleanliness in
the saddle region are also of importance. The chief effect is due to
friction, for the trouble does not occur under the saddle itself, but at
the back of the pannel and flap. The causal action of sweat and dust
is sho^\ai by the fact that the disease is observed almost exclusively in
summer. Horses with bad conformation and weak tottering gait are
apparently especially inclined to the disease.
At times an extensive outbreak of acne occurs in horses
over the whole body in the warm summer weather (socalled sum-
mer rash) when the animals perspire profusely at work.
The checking of glandular secretion by obstruction, by dirt,
of the orifices of the sebaceous glands or of the opening of the
hair follicles, possibly also by medicines rubbed on the skin
may, according to Veiel, occasion acne in such a manner that
the glandular tissue becomes mechanically irritated as a result
of tiie dried secretion. It cannot be denied, however, that the
bacteria which are usually present on the skin, or that products
of disintegration formed under the influence of the bacteria,
play an active part in the causation of acne.
Whether aene which occurs occasionally after the application of certain medic-
aments such as tar, petroleum, paraffine, vaseline, also after continued employment
of creolin or lysol solution in wound treatment, is to be taken as due to the
Predisposition. Symptoms. 889
closing of the glandular brifice or whether the chemical irritation produced by
these substances plays a part, cannot be decided from the results of observations
that have been made hitherto.
Acne arises secondarily in acariasis and rarely in the course
of strangles in horses, in distemx)er (personal observation) and
according to Frohner in bromism.
Predisposition. Horses and dogs are most inclined to the
affection, hogs and sheep only exceptionally. Yonng animals
and short-haired dogs appear most frequently to l)e attacked
by acne (Sehindelka).
Symptoms. In horses millet to pea-sized nodules develop
on the aforementioned parts of the body (Fig. 126), which are
distributed either diffusely (Acne disseminata) or thickly
Fig. 126. Acne in the horse.
clustered together and concentrated in groups of nodules (A.
confluens). Little vesicles form in the center, the contents of
which are first clear and soon after become turbid. Soon after
bursting of the vesicles the content dries to a small scab, and
mats the enclosed hair. Later on the scabs fall off with the
matted hair, whereupon little hairless spots remain for a long
time. In some nodules suppuration occurs, and on pressure
bloody pus or a thick tallow-like mass may be pressed out from
them. After this the swelling disappears in a short time, and
the remaining saucer-shaped loss of substance soon heals, leav-
ing a light but rather thin-skinned bald place behind (socalled
shell nodule) . Many nodules retrogress without previous vesicle
formation or suppuration and disappear, leaving no trace be-
hind them.
^90
Acne.
The apparently sound skin in the immediate neighborhood
is slightly swollen, only if the disease is rather severe, it becomes
warmer, sensitive to pressure and harder, and the nodules them-
selves become much harder (Acne indurata). Slight itching is
generally noticed in the stage of development and healing; but
there is more tenderness than itching.
On the hairless or sparsely haired parts of the skiu of the horse (sheath,
inner surfaces of the thighs and fore extremities, lower belly, chest) Schindelka
saw a peculiar folliculitis which commenced in small areas with the appearance of
millet sized or somewhat larger nodules. The nodules are at tirst palpable, deep in
the !-kin, later on they become prominent on the surface of the skin, some of them
Acne nodes on the bridge of the nose of a doij
Schindelka.)
(After
change to pustules in 3 to 4 weeks, and after they burst, roundish ulcers develop
with elevated edges. These heal gradually, leaving behind cicatrices, round about
which fresh nodules are formed. (Some nodules, however, dif^appear after several
weeks without previous suppuration. In exceptional cases acute swelling of the
lymph vesi-els and lymph glands occurs. The diseaKe may last for months. The
development of folliculitis was always preceded by influenza. A similar disease was
seen by Marek on the anterior surface of the forearm of a horse which had not
previously been attacked with influenza.
In dogs acne is principally characterized by the prominence
of inflammatory symptoms, especially if the eruption is on the
bridge of the nose (Fig. 127) or on the face, in consequence of
Symiitonis. Course. Treatment. 89]
which the swelling of the skin and its tenderness are far greater.
This circumstance is perhaps explained by the fact that in the
skin of the dog- the hair follicles are arranged gronp-wise ronnd
a common dnct, and that on this account several hair follicles
and sebaceous glands are always affected at the same time.
Suppuration of the hair follicles or sebaceous glands is noticed
much oftener in dogs.
In sheep and swine the clinical form of the affection appears
to be similar to acne of the horse.
Course. In many cases, for example in the horse, the acne
nodules, usually after previous vesicle formation, disappear in
1 to 3 weeks without leaving any trace, or suppuration takes
place and little bald spots are presented to one's ol)servation.
Since in both cases fresh nodules are often formed, in the mean-
time, in the surrounding area, the course of the affection be-
comes prolonged and even chronic. If suppuration takes place
the perifollicular connective tissue becomes involved in the i)ro-
cess, and then little abscesses arise which extend into the sub-
cutaneous connective tissue, coming in contact and frequently
communicating with each other. Finally, however, cure results
here also by scar formation. Sometimes these abscesses do not
])reak, and pea to pigeon egg-sized hard nodules may then per-
sist in the skin for a long time. Finally the process may lead
to the formation of socalled tallow cysts (molluscum atheroma-
tosum, Schindelka) which arise from the cyst-like dilatation of
the sebaceous glands, the walls of which are much thickened and
are filled with a fatty rancid mass. They form likewise hard
swellings in the skin and may attain the size of a pigeon 's es^^.
Treatment. The causes of the disease so far as they may
be discovered should be removed, and if possible the horses
should be kept from work ; under such conditions cure frequent-
ly results in horses without any further treatment. At first
gentle washing with disinfecting solutions seems to be useful,
while the employment of tar preparations is contraindicated ;
the internal use of ichthyol with water or Fowler's solution
(ichthyol, dist. water or Fowler's solution in equal parts; 5 to
20 gm. for the horse, 10 to 20 drops for the dog) may do good
service (Schindelka). Salicylic ointment is used to advantage
in the incipient stage (5:100) (Midler). Later on the dilated
nodules are pressed out, perhaps after previous splitting with a
pointed knife or opening with Paquelin's thermo-cautery
(Frick), and the resulting wound and its neighborhood is care-
fully washed and dressed with any disinfecting fluid (tincture
of iodine 5%, pyoctanine solution 1:1,000, corrosive sublimate,
etc.).
The before mentioned follioulitis of the non-hairy parts of the bouy in
horses was intliienced by treatment only insofar as the tenderness was lef-seneil
after washing with Burow's solution, and no fresh crops of vesicles occurred after
892 Comedo. Funinculosis.
the internal employment of Fowler's solution. On the other hand the adminis-
tration of sulphur, ichthyol, resorcin, and salicylic acid preparations always resulted
in the abundant occurrence of fresh nodules.
Ill the soealled sweating eczema of the saddle region, the following
remedies have been applied: Priesnitz's compresses vrith. creolin or
Burow's solution and subsecinent inunctions of vaseline, lead or boracic
ointment (Grammlich), sponging ^\^th corrosive sublimate or creosote
solution (hydrarg. biehlor. corros. 2 parts; creosote 5 parts; glycerine
and alcohol of each 100 parts [Mauke] ), finally the application of a lini-
ment consisting of 100 parts of alcohol and two parts each of bacillol,
soft soap and Peruvian balsam (Wilde). In recent times the disease
has been treated successfully by cleansing the parts with softening dis-
infecting solutions and using drying and protecting sul)stances on the
diseased places. Kurze produced the best results by fomentations with
warm infusion of hay seeds.
As a prophylactic measure it is well to pad the harness or
muzzle and always to keep them clean. Against the occurrence
of soealled saddle scab, Kupfer uses oilcloth or Victoria-Battist
behind the edge of the panel and flap.
Literature. Bartke, D. t. W., 1897, 214.— Frick, ibi.l., 1898, 365.— Friihner,
Monh., 1890, XI, 410; 1903, XIV, 461.— Grabenteich, Z. f. Yk., 1907, 323.— Gramm-
lich, ibid., 1899, 262.— V. Hennings, ibid., 1900, 75.— Kalkoff, ibid., 1901, 140.—
Kupfer, ibid., 1905, 27.— Mauke, S. B., 1906, 186.— Mrowka, Z. f. Yk., 1905, 49.3.—
Miiller, Yortr. f. Tierarzte, 1890, 2, H. 16.— Schindelka, Hautkrkh., 1909, 359.—
Steflfens, Z. f. Yk., 1896, 163.
Comedo. (Grubs in the skin, acne punctata.) Comedos are cylin-
drical plugs secreted in the sebaceous glands, which often appear colored
black at their outer end and may be pressed out as whitish or yellowish
worm-shaped bodies. According to Schindelka, they occur quite fre-
quently in domesticated animals, but are most frequent in r'ogs and
swine on the hairless or sparsely haired parts of the body. '^I'he plugs
are expelled in time or inflammation or suppuration of the sebaceous
gland (acne) may occur.
Funinculosis. Furuncle arises through the extension of acne in-
flammation from the walls of the sebaceous glands to the neighboring
tissue with subsequent death of the hair bulb and the immediately
adjoining tissue. The tendency to frequent affection with multiple
furuncles, which is occasionally met with, especially in dogs, is desig-
nated as furunculosis.
The symptoms of furuncle are similar to those of acne, except that
the inflammatory focus is much larger, the pain more intense; in the
surrounding tissue an inflammatory edema is present, the neighboring
lymph glands are often enlarged, and within the focus one finds the
dead piece of tissue in the center of the pus. In these cases general
septic or pyemic infection may follow (Frick). The persistence of the
disease in dogs through the formation of abscesses and ulcers requires
operative measures, which consist in timely splitting of the abscesses
and removal of the pus together with the necrotic tissue (Frohner, Monh.,
1890,1,410).
A furunculosis-like disease of sheep was noted in the year 1905 by Teetz in
Germany in two flocks of ewes and lambs. With general symptoms of weakness
there was intense swelling of the lips and the skin of the angle of the jaw down
Sycosis, Contagious Pustular Inflammation of the Skin. 893
to the chest, the wool fell out in this regiou, aud closely placed openings formed
upon the gray-blue skin which were almost circular, pea-sized, with yellowish,
brittle, plug-like contents aud a bad odor. Washing with creolin water, inunctions
with creolin tar ointment and deep splitting as well as curetting of the dead parts
caused recovery with only one death (Teetz, B. t. W., 1905, 791).
Zschokke saw a number of nut-sized, ])luish red furuncles on the back of a
pig affected with cuticular anthrax.
By this is understood an inflammation of the follicles
of the long hair, wherehy nodules or pustules form which, are of variable
size ; from their center a hair shaft protrudes. The causes are mostly
the same as in acne. The disease has hitherto been noted on the parts
of the skin covered with long hair, in horses as well as in dogs, and re-
quires treatment similar to that of an acne rash.
15. Contagious Pustular Inflammation of the Skin.
Dermatitis Pustulosa Contag-iosa.
(Socalled English or Canadian [American] horsepox; Der-
matitis pustulosa canadensis [Axe], Acne
contagiosa [Dieckerhoff].)
Contagious pustular dermatitis is a skin disease peculiar
to the horse, in the course of which pustules arise on the swollen
skin which appear chiefly at those places which come in contact
with the harness and which may be as large as lentils. The
pustules are caused by the acne bacillus of Dieckerhoff &
Grawitz, which in its turn belongs to the group of the 1)ac.
pseudotuberculosis of Preisz.
History. The disease was first described l)y Goux (1841) and at
the same time was recognized as a contagious disease. Bassi saw it in
the year 1876 in Italy, in English and American horses. Axe in the year
1879 in England; by this author it was called dermatitis pustulosa
canadensis, since in his opinion the affection was brought to England by
Canadian horses. Since then the disease has been observed frequently
in Europe and its etiology has recently been investigated. Thus Schin-
delka considers that it is identical with the impetigo contagiosa of man
and he found micrococci in the pus as causes of the inflammation;
Siedamgrotzky succeeded in transmitting it to rabbits and guinea pigs
by inoculation. By bacteriological and inoculation experiments Grawitz
& Dieckerhoff proved a bacillus to be the cause of the disease, the classi-
fication of which was more exactly established by Nocard.
Occurrence. The disease occurs as an enzootic, especially
in horses of the English breed.
Etiology. The fission fungus described by Grawitz &
Dieckerhoff as the acne bacillus is about tw^o microns long; it
multiplies by division, forming coccus-like chains which remain
connected with each other for a time in 2 to 4-linked series.
The bacilli may bo stained Avith the usual aniline dyes and also
by Gram's method.
894 Contagious Pustular luflammatiou of the Skin.
Cultivation. The bacilli grow best at body temperature on solidi-
fied cattle or horse blood serum ; they assume the form of small round
colonies which are at first pure white and later on yellowish gray.
Pathogenicity. The introduction of a few drops of the
culture diluted with water, by friction, into the healthy or super-
ficially scarified skin of a horse produces typical pustules. In
calves, dogs and sheep the effect is similar but milder. In the
rabbit, on the contrary, a severe inflanmiation of the subcu-
taneous connective tissue develops which may lead to death,
while guinea pigs die of septicemia two days after rubbing in
of even a moderate amount of the culture.
Natural infection takes place through parts of the harness
as well as through cleaning utensils. The favorite localization
of the disease is on the saddle region and on the chest wall, in
all probability owing to the fact that these parts are pressed on
by the saddle or girths ; the hyperemia produced by the pressure,
and possibly also superficial losses in the continuity of the epi-
dermis aause the infection to ])e established more easily in these
places, but the eruption occurs also, less often, in other places,
particularly on the extremities.
Symptoms. Two to three days after artificial, somewhat
later (according to Sehindelka 6 to 8, and even 14 days, at times
as early as 24 hours [Liihrs]) after natural infection the
skin swells at one or several round or oval places from a one
cent to a twenty-five-cent piece in size, becomes warmer and
more sensitive, its surface moist, while the hair appears ruffled.
Soon hemp-seed to lentil-sized vesicles with thin walls develop
in variable number on the swollen parts of the skin ; their con-
tents, which are at first generally turbid, in a short time become
purulent. The thin wall of the vesicle or pustule generally
bursts after one to two days, whereupon its contents dry up and
form thick, honey-yellow, gluey, tenacious, flat or centrally de-
pressed crusts, under which grayish white or grayish green pus
collects. Meanwhile a fresh layer of epidermis forms under the
crusts, the crusts loosen and fall off, together with the hair,
after about a week, and in their places round, hairless, colorless,
non-scaling patches remain, which later are covered by new
hair. During the whole time the skin between the inflamed sur-
faces remains healthy.
The development of the exanthema occurs without itching,
without fever or any signs of ill health, only the parotid glands
and the thyroids swell acutely in isolated cases, but this s>anp-
tom disappears when the vesicles dry up. In mild cases the
affection passes off in 3 to 4 weeks, while eruptions may arise in
the neighborhood from the broken up morbid products of the
affection.
After a very severe infection or by keeping animals at
Contagious Pustular Dermatitis of Cattle. §95
work in spite of their illness, the process assumes a very severe
character, the inflammation penetrating into the deeper layers ;
the corinm dies in places and, after the falling away or removal
of the dollar-sized scabs, crater-shaped ulcers make their ap-
pearance, which gradually are filled with granulations and
finally heal, leaving scars. Moreover, the lymph vessels lead-
ing from the inflamed regions swell into hard, sensitive cords,
m the immediate neighborhood an edematous infiltration
develops, and the regional lymph glands swell or, exceptionally,
suppurate. Friedberger saw the disease occur on the legs in
connection with an inflammatory swelling of the joints. Finally
healing takes place, but in such cases the disease lasts several
weeks, and may continue as long as two months.
Diagnosis. The peculiar localization of the morbid pro-
cesses, the pustules forming in groups on the swollen parts of
the skin, the absence of itching and the contagious character of
the affection, which can in all cases be proved by experimental
inoculation, are distinctive features of the disease, and distin-
guish it from the intense itching eczema, further from acne,
and also from the galls caused by saddle and harness,
which occur without vesicle formation. At times the disease
may arouse suspicions of farcy if the affection exceptionally
develops on the extremities, if edematous swelling occurs in the
region of the exanthema, and if further also inflammation of
the lymph vessels and ulceration takes place; the presence
of pustules and the tendency to healing, and on the other hand
microscopical examination or experimental inoculation (Vol. I)
will in such cases prevent errors in diagnosis.
Treatment. The exclusion of sick animals from work,
washing the diseased places with a disinfecting fluid (1:1,000
corrosive sublimate, 2% carbolic acid, creolin, lysol solution,
Burow's solution) or inunctions of a 10% naphthalin, naphthol,
or salicylic ointment will generally lead to healing in a short
time.
Sick animals are to be isolated from healthy ones, and the
infected harness and cleaning utensils should not be used on
healthy horses without previous thorough disinfection.
Literature. Burke, The Vet., 1886, 69.— Dieckerhoff & Grawitz, V. A., 1885
CII, 148.— Friedberger, W. f. Tk., 1880, 413.— Goux, Eec, 1843, 807.— Liihrs Z f'
Vk., 1906, 267.— Schinclelka, O. Vj., 1883, LX, 61.— Siedamgrotzky, S. B., 1883,
18.— Trasbot, Bull., 1899, 163.
Contagious Pustular Dermatitis of Cattle. Lienaux saw a skin inflamma-
tion in a tw» year old emaciated heifer caused by Preisz's pseudotuberculosis
bacillus. It began with the development of nodules, which in time enlarged from
pea to hen-egg size and broke open. The loss of substance which occurred in this
manner healed here and there, but in other circular places the skin died, and after
its sloughing an ulcer with an intensely red base and covered with thick pus
resulted; in its neighborhood the skin was raised a certain distance from the
underlying tissue. In the surrounding tissue similar nodes or necrotic spots formed
896
Other Pustalai- Inflannnations of the Skin.
and the skin became covered with thick crusts of dried pus. Postmortem examina-
tion showed no changes in the internal organs. Pustulous inflammation of the
skin in cattle can also give rise to inflammation of the lymph vessels; the abscesses
thus forming do not, however, break open. The clinical picture then coincides with
that of the skinworm (streptothrix fareinica) of cattle (A-'ol. I) (Lienaux, Ann.,
1902, 237).
Other Pustular Inflammations of the Skin. Kiiniper and Schumann ob-
served a contagious exanthema in military horses affecting the region of the
rectum and perineum and on the under surface of the tail, in mares also on the
vulva (Fig. 12S). It was not accompanied by itching or by general disturbances
of health. Vesicles occurred at these places as large as mustard seeds, peas or
128. Pustuh
kin exantlicma in the rectal and vaginal region of a mare.
one-cent pieces, and after bursting they left unpigmented spots secreting a yellow-
ish fluid. In a very short time these changed to elevations, turned brownish red
in color covered with crusts and depressed in the center, which continued to exude
a yellowish fluid after the crusts had fallen ofl'. The disease could not be transmitted
to healthy horses by inoculation, Init Kiimiier nevertheless was of the opinion that
it was transmissible by means of the cleaning utensils. In an enzootic among
remounts the disease could be traced with great probability to a cleaning cloth soiled
by petroleum or rancid hoof grease. (Kamper, Z. f. Vk., 1903, 440. — Pr. Mil. Vb.,
1908.— Schumann, S. B., 1906, 186.)
Scheferling saw an epizootic skin disease, at maneuvers and also in military
horses, which could not be transmitted artificially and which was characterized by
Hardening- of the Skin. Iclithyosis. 897
vesicles filled with reddish fluid appearing round about the angles of the mouth,
and by the loss of hair in the att'ected places. The formation of vesicles as well as
the falling out of hair progressed in the direction of the lymph vessels up to the
ear region; aside from intense itching there was acute swelling of the lymph vessels,
of the lymph glands and of the parotid region, and disinclination for food. Re-
covery always occurred in a few weeks.— (Scheferling, Z. f. Vk., 1903, 322.)
In two cases in old Scotch terriers the authors have had the opportunity of
observing a peculiar skin disease leading to the formation of multiple abscesses.
With the exception of the ends of the extremities the whole of the body was
studded with pea to walnut sized hard, painful nodules, which l)ecame softer as they
gradually increased in size and finally fluctuating. They ruptured early and dis-
charged a thin fluid pus mixed with blood and harboring fine diplococci. The loss
of substance healed slowly, and not at all in one case; the open patches gradually
increased in size and at their borders the skin was undermined in spots. Owing to
the constant new-formation of nodes and abscesses one dog died of exhaustion, the
other recovered. Fever was absent in both cases. The disease could not be pro-
duced artificially by intravenous and subcutaneous inoculation of the abscess con-
tents.
A similar disease has recently been described by Cuille (Rev vet., 1905, 750),
who proved that the disease was caused by the bacillus necrophorus alone or by this
and pyogenic st'-eptococci and staphylococci.
16. Hardening- of the Skin. Scleroderma.
Gabarret and Lecuyer described a skin disease of swine which
occurs especially in old boars and gradually leads to hardening and
thickening of the skin. Starting from a spot in the middle line of the
back, the process gradually progresses forwards and backwards, as well
as on the sides of the body. At first the skin is firm, cool and moist
later on, however, it becomes dry, very firm and can no longer be picked
up in folds. Together with the gradually increasing thickening of the
skin (up to 5 cm. thick) the subcutaneous connective tissue atrophies,
the fat layer disappears almost completel.y, and the shrunken skin is in
almost immediate contact with the bones. The animals become greatly
emaciated and finally die. The thick skin is extremely hard to cut, the
cut surface shows a lardaceous luster and is pure white in color. On
cooking it does not become softer, but harder. According to Basset
this is a physiological process met Anth in all boars. (Basset, Bull,
1910, 44.— Lecuyer, J. vet., 1882, 300.)
Pflug saw a similar disease in a calf.
Ichthyosis. (Fish scale disease.) This disease was observed in newborn
calves whose skin was covered to a variable extent with horny scales 1 mm. thick,
and as a result appeared very rough and stiff. The gray or bluish scales of epidermis
formed narrow bands separated from one another by narrow grooves or clefts
which were arranged vertically to the axis of the body. The cause of the affection
lies in an unusual hyperplasia of the papillse of the skin, which leads to the formation
of a very thick and horny epidermis. In the cases which hitherto have been ob-
served the calves lived only 1 to 4 days. In a case noted by Sand the sharp edged
scales of the calf injured the mucous membrane of the genital passage during par-
turition. (Sand, D. Z. f. Tm., 1893, XIX 111.)
Acanthosis Nigricans. (Keratosis nigricans; papillary and pigmentary
dystrophia.) This abnormality consists in a s^^nmetrical bilateral hypertrophy of
the papillary bodies, increase of pigment in the stratum corneum and germinativum
of the epidermis, further, contrary to the like-named disease in man, also in an in-
crease of pigment in the papillary bodies, round about the glands and blood vessels,
and finally in a moderate thickening of the horny layer chiefly in the furrows of the
skin. This disease was first described in veterinary literature by Schindelka and
was recently studied by Habacher. At the Vienna clinic seven eases occurred in
the course of ten years; and the authors have observed three cases. It develops
Vol. 2—57.
898
Acanthosis Nigricans. Thickening of the Celhilai- Tissue.
chiefly in .young animals from causes not exactly known. The places of predilection
of this skin affection are the axilla, the fohl of the stifle, the extensor side of the
toes, then the skin of the scrotum, the region around the anus, the under surface
of the tail, the lower belly, the under side of the neck, the region of the corners of
the mouth, the eyelids and the lips. On these places swelling of the skin and falling
out of the hair occurs, the skin being at first softer to the touch than usual, and,
in consequence of the more plainly prominent normal skin grooves, it appears like sha-
green or seal-skin leather (Fig. 129). With the simultaneous occurrence of a deep
grayish blue to black-brown pigmenta-
tion isolated papillary or condyloma-
like elevations become plainly notice-
alile, parallel or crosswise ridges form
which se^jarate the furrows. In con-
sequence the skin becomes harder
and firmer or rough like a grater.
Slight exfoliation is noticed only ex-
ceptionally, but itching is generally
present. At times the process in-
volves the claws or the neighboring
mucous membranes, and in such
ca^e red, soft, not bleeding, granu-
lations are formed on the mucous
membrane.
For the differential diagnosis
acariasis must particularly be con-
sidered, because in this disease the
deposit of pigment in the skin may
also occur, but it does not show a
symmetrical localization and the
abnormal pigment can be removed
together with the superficial layer of
the epidermis; moreover in acariasis,
mites are present in the skin.
The treatment consists in the
emploAnnent of bran baths with sub-
sec(uent inunctions of fat, in the
internal use of arsenical preparations,
as well as in the employment of
salicylated alcohol (3%) or of ol.
Jecoris Aselli with 2-3% salicylic
acid. In the cases of the authors
10% naphthol ointment was used
with advantage, while Uebele
achieved success with 5% salicylic
ointment or with Esterdermasan,
provided any granulations that were
lasting cure is however not often ob-
Monh., 1909, XXI, 97 [Lit.].)
Fig. 129. Acanthosis nigricans on the un-
der surface of the neck of a dog.
present were removed with the scissors. A
tained, relapses being common. — (Habacher,
Proscholdt found, on the inner surface of the ear of a horse, flat, warty,
generally unpigmented, more rarely pigmented papillary acanthomas, which arose
from a primary epithelial and secondary connective tissue proliferation. The
etiology is unknown. — (Proscholdt, Papillary Acanthoma, etc., Diss. Bern., 1908.)
17. Thickening of Cellular Tissue.
{Elephantiasis.)
Pachydermia.
On the posterior extremities of horses, very rarely on the head,
the skin, together with the subcutaneous connective tissue, may thicken
considerably as the result of long continued or frequently repeated in-
flammatory processes (eczema, erysipelatous inflammation, lymphan-
gitis, glanders), or from continuous venous stasis and edema. The affected
parts of the body become deformed and the legs resemble the thick
cylindrical limbs of an elephant, but if the head is affected it becomes
like that of a hippopotamus. On the feet the hypertrophy of the skin
and of the subcutaneous connective tissue commences at the coronet
Herpes Tonsurans, History. oqq
and fetlocks and extends to the legs and even to the thighs The bend
mg of the jonits is more and more, limited, and finally becomes impos-
sible ; then the horse can only move by flexing the hip joint and drag-
ging Its colnmn-hke limbs along the ground; if it lies down it is unable
to rise without help. In spite of this the animal may be used for work '
for 1 to 2 years provided it is not made to go faster than at a walk
Ihe skm IS at hrst rather soft and pits on pressure (Elephantiasis
mollis) ; later on, however, it becomes very firm, almost hard as wood
S' I- -^^ surface appears smooth (E. l^vis s. glabra) or lumpy
(E. papil aris et verrucosa). Kitt observed an actinomycotic elephan-
tiasis ot the ear muscles in a pig.
The skin disease itself is incurable and the treatment is limited
to keeping clean the thickened parts of the body (washing with Burow's
solution or acetate of lead lotion). (Barth, Z.. f . Vk., 1908, 60.— Eber-
iiarcl, r>. t. VV., 1906, 3.)
18. Circinate Ringworm. Herpes Tonsurans.
{Ringflechte, KaJihnachende Flechte, Borkenflechte, Scherende
tlechte, Teigmal, Teigmaul, Maulgrind, Kdlher-, Ldm-
mer-, Gaisgnnd [German] ; Dermatomycosis s. Tri-
cophytia tonsurans, Tinea s. Porrigo decalvans;
Teigne tondante ou tonsurante, Trico-
phytie, Microsporose, Teigne de
Gruby, Herpes episootique
des poulains [French] . ) > -,-, ,
Herpes tonsurans is a contagions disease of the skin, which
IS caused by a thread fungus, the tricophyton tonsurans, and is
characterized by the occurrence of more or less roundish, sharp-
ly defined spots in the sphere of which the skin is at times cov-
ered with vesicles, but generally with scabs or scales, and
appears either naked or covered by short hair stumps.
History. The tricophyton fungus was discovered in man almost
at the same time by Gruby (1843) and by Malmsten (1849) and was
named tricophyton tonsurans by the latter author. In a horse the
fungus was first seen by Bazin (1853), but the parasitic nature of
herpes in the domestic animals was first established in cattle and dogs
by the classic investigations conducted by Gerlach (1857, 1859). Hahn
(1861) further proved that the ringworm of calves was also of a trico-
phytic nature; in the cat, Fenger (1861), and in sheep, Perroncito
(1872) were the first to find the tricophyton fungus. Further interest-
ing observations and investigations on herpes of domestic animals were
conducted by Haubner, Bodin, Brauer, Siedamgrotzkv, Leisering, Ziirn,
Bodm, Almy & Bodin, Mathis, Pusch, Schindelka, U'. Frohner, Krama-
reff, Sabouraud, Suis & Suffran, Pecus & Sahouraud, Matruchot & Das-
sonville, and others.
Shortly after the discovery of the parasitic thread fungus on the
skm, some investigators inclined to the view that it was merely a common
form of development of the aspergillus glaucus, while Grawitz, who
first cultivated the fungus on artificial media, declared the dermatomy-
cetes to be identical with the oidium lactis. Afterwards, however, the
900
Herpes Tunsuraiis.
diffei-t'iice belwccn the Iricopliytou fuiigns and tliat of faviis was estab-
lished, and l)y FreiK'h authors (Saliouraud, Jiodiii, IMegiiiii, ]\Iatriichot
& Dassonville, Neumann and others), several varieties of tricophyton
were distinguished. The theory concerning the multiplicity of trico-
phytes has l)een supported by some German authors (Pick, Kaposi,
Neisser), but Krai, Willsch, Maiocchi and Marianelli have raised
weighty objections which are leased on the results of their investigations.
Occurrence. Herpes occurs in all domestic animals but
most frequenth^ in cattle, next in horses, more rarely in dogs,
cats and asses, and least frequently in swine, sheep and fowds ;
it w^as seen by Leyendecker in a freshly shot hare. The disease
appears to be more or less limited to certain localities, and
chiefly attacks young animals. In Germany it is especially fre-
quent in cattle introduced
from Oldenburg and Hol-
land, particularly i'n
young stock from Olden-
burg (Gerlach, Pusch). In
Normandy it is also com-
mon. Marshy regions gen-
erally appear to be favor-
able for the occurrence of
herpes. According to local
conditions the disease is
most prominent in stabled
animals or in animals out
on pasture, 3^et according
to the observations of
most authors the com-
plaint is a pasture dis-
ease. In this manner the
disease, which generally
occurs only in isolated
cases in cattle and horses,
may assume an epizootic
extension. Its economic
significance is due to the
fact that the nutrition of the affected animals is disturlied and
that the treatment entails much trouble and expense ; moreover,
the possibility exists that the disease is communicated to the
attendant or to the household of the owner.
b c
Fig. 130. Tricophyton tonsurans of a calf.
a hair; b remnants of a hair sheath; c fun-
gous mantle around the hair; d fungous fihi-
nients ; e horned epithelial cells. (Magnif. 200.)
Etiology. Tricophyton tonsurans occurs on the skin of ani-
mals in the form of filaments (liyplkT?) which are about 4 microns
thick, either segmented or undivided; they are fairly uniform
and sometimes forked and break up into round or oblong spores
(conidia) wdiich strongly refract the light; they may be of yel-
lowish browai tinge and occasionally form chains. The mycelia
are found more particularly in the crusts and scabs, the conidia
around the hairs (Fig. 130).
Etiology. 901
Cultivation. Cultures of the tricophyton fungus are hard to ob-
tain because it is difficult to isolate it from the germs of other fungi
occurring on the skin. For this reason Sabouraud used wort as a
medium for the culture of the tricophyton fungus, or a medium com-
posed of four parts of maltose, 2 parts of peptone, 1.5 parts of agar
and 100 parts of the distilled water on which only the tricophyton grows
luxurianth', while Krai effected the isolation by grinding the hair
with pulverized silicic acid and subsequent plate culture. Sabouraud
only places the broken up roots of the pulled-out hairs upon the culture
medium in order to prevent as much as possible infection with the
other microorganisms infesting the hair shafts. Pure cultures may
also be olitained by treating the pathological products with potassium
hydrate and other chemicals, whereby the tricophyton remains uninjured
while other fungi are destroyed (Kitt).
The tricophyton fungus develops on culture media rich in carbo-
hydrates and poor in protein, in the presence of oxygen. For its
growth a temperature of 33° C. is most suitable, while above the body
temperature the growth is very scanty or ceases altogether; at a tem-
perature of 20 to 24° C. it does fairly well, but in a lower temperature
it makes very slow progress (Bodin). Gelatine is liquefied and
a substance with ammoniacal smell is formed, and there develops
gradually a leatherish, mealy looking, firmly coherent deposit, the
under side of which is usually sulphur yellow, while the surface appears
white ; after long standing yellowish or reddish tints may be seen. The
growth of the fungus becomes especially firm and dry on agar (Kitt).
On potatoes a wrinkled, fuzzy skin-like covering develops, which is white
or yellow, reddish or even brownish in color.
Cultures of the tricophyton fungus like that of the filament fungi
of the skin in general are characterized by a rather marked pleomorphism
and by great variability, according to their age and origin, as well as
according to the composition or age of the culture medium (Krai).
Considerable differences present themselves not only as regards pigment
formation but also the size of the conidia spores. On the surface of the
animal body the tricophyton fungus increases exclusively by the forma-
tion of socalled mycelium spores, which arise by division of the proto-
plasm of the hyphfe into four-cornered cells by transverse septa, these
cells become rounded off, are detached and after germination again de-
velop into hyphffi. On artificial media spores (socalled chlamydospores)
may also be' formed by separation of parts of the protoplasm within the
hyphse. But spores also arise by lateral sprouting, and in the filament
fungus more or less closely placed pear-shaped inverted projections
arise, which soon assume a round form and then are detached (conidia) ;
the conidia-bearing hyphffi appear either in clusters (according to French
authors the tricophyton in its limited sense), or they may show a crest-
shaped form on account of the closely placed projections (according to
French authors the microsporum). Now and then much larger elongated
oval, often multicellular spindle spores arise by the development of pro-
jections (also called lateral chlamydospores). One also meets Avith
spirally rolled hypha? in the cultures. The mode of fructification is
much influenced "by the composition of the culture medium.
On account of cultural peculiarities and clinical differences many
authors (Sabouraud, Bodin, Megnin, Almy & Bodin and others) dis-
tinguish several kinds of tricophyton fungi which are said to cause
different forms of illness. Thus Sabouraud divided the filament fungi
concerned in the production of herpes into two great groups. The
902 Herpes Tonsurans.
Tricophj^ta megalospora are said to be distinguished in that they form
unequal spores, 4 to 6 microns large, arranged in chain-like formation
around the hairs, and besides to cause falling out of the hair as a whole,
while in cultures the conidia-bearing hyphsB are arranged in clusters.
On the other hand the spores of Tricophyta microspora (also called
simply microsporum) do not encircle the hair in chain-like masses, but
lie (juite irregularly and very close to one another (mosaic-like) ; be-
sides they are said to be rather small (2 to 3 microns), of equal size,
and the mouldy deposit which they form accompanies the hair for some
distance, outside of its sheath; then the hairs break a few millimeters
from the surface of the skin, whereupon the affected parts appear as if
clipped short ; besides at the points where the hairs break oif club-shaped
and brush-shaped hyphae with spores come to view which look like
sterigmae. Finally the cultures are supposed to be characterized by
crested conidia-bearing hypha?.
The Tricophyta megalospora were further divided by French authors into sev-
eral sul)divisions to which special forms of disease are said to correspond. Thus
Tricophyton ectothrix is said to be found exclusively on the surface of the hair
roots, Tr. endothrix in their interior, while Tr. endoectothrix is found in
both places. The tricophytes occurring in the domestic animals are classed with
the Tr. ectothrix or endoectothrix, yet Galli-Valerio found a Tr. endothrix in a calf,
which he identified with Tr. Sabouraudi, which is frequently met with in man. The
Tr. mentagrophytes penetrates the hair bulljs, causes inflammation and suppuration
and, in consecpience, falling out of the hair. The fungus is said to occur frequently
in the domestic animals and the Tr. epilans, found by Megnin in cattle and horses,
as well as also the Tr. caninum or Tr. felineum are probably identical with it.
Besides Matruchot & Da-ssonville distinguish the Tr. equinum, Peeus & Sabouraud
the Tr. gypseum granulosum as special varieties of the Tr. mentagrophytes occurring
in horses. Tr. flavum causes in horses the formation of bald and dry herpes.
Tr. Megnini produces herpes of fowls, while Tr. faviforme s. verrucosum Bodin
approaches favus fungus culturally, but produces in horses and asses the clinical
forms of herpes.
Of the Microsporum Audouini which causes in children the Tricophytia
capillitii, two varieties are differentiated as occurring in animals, namely Micros-
porum Audouini var. equinum and the M. Audouni var. caninum.
Besides these varieties a fungus described by Matrouchot & Dassonville is
classed with the tricophytes viz. the Eidamella spinosa which is characterized
chiefly by the formation of perithezia in the cultures and is reported as having
produced a herpes-like disease in a dog.
The views concerning the multiplicity of herpes fungi, which are
outlined in the preceding paragraphs, ^vere strenuously contested and
the investigations of Kriil, Wiilsch, Maiocchi and IMarianelli proved that
the cultural peculiarities of herpes fungi vary too much, according to
their origin and age, as Avell as the age and condition of the nutritive
medium ; further that the skin lesions vary too much according to the
anatomical structure of the parts of the skin attacked, the variable
susceptibility of the animals and the variable degree of virulence of the
fungus, therefore the establishment of new species of pathogenic skin
fungi is not justified. The differentiation of several species of tricophy-
ton has therefore been given up recently and the view is generally
being adopted that the microsporum and the tricophyton, as also their
several forms, represent varieties of the same species of fungi which
have accpiired certain constant and characteristic peculiarities. These
characteristics have developed under the influence of the vital condi-
tions which vary greatly, according to the species of affected animal and
according to the condition of the skin ; they may be transmitted to
later generations, and on the other hand the fungi may regain their
original form by changes in their conditions of growth.
Etiology. 903
Nevertheless, especially some French authors maintain the view
that the Tricophyton megalosporum or the Tr. microsporum, as also
the diseases caused by them (tricophytia or microsporosis) differ from
each other. But the researches of Krai and others are not in accord-
ance with this view, and besides the clinical differences given above are
not sufficiently marked to justify, at least for the present, the recog-
nition of two forms of the disease.
Tenacity. Fungi that are preserved in the crusts resist desiccation for a long
time. Gerlach succeeded, for instance, in producing herpes tonsurans by rubbing
crusts into the scarified skin, which had been preserved in paper capsules at room
temperature for half a year. fSiedamgrotzky and Megnin could produce the disease
with herpes crusts that were 18 months old. Fungous material which was more
than two years old, however, remained non-effective (Siedamgrotzky, Duelaux), and
in cultures also the fungus had lost its power of germinating after 2 years (Thin).
In water the fungous spores can no longer germinate after 8 days, while in olive oil,
lard or vaseline they retain their vitality for only two days. They are killed
by a 1 per cent solution of acetic acid in an hour, but a one per cent of soda solu-
tion or sulphur ointment destroys them only after an exposure of several hours.
Pathogenicity. Ground, up scabs or liairs containing tri-
cophyton fungi cause the disease after being simply rubbed into
the uninjured skin, but the fungi infect much more certainly
if the skin is moistened before the application and if the upper
layer of epidermis is scraped off or the skin gently scarified.
In young animals the first s;^inptoms appear in 8 to 14 days,
but if the skin had been moistened or scarified they appear
earlier, whereas older cattle are affected somewhat later and are
often not infected at all by simple rubbing in of the scab ma-
terial. If the fungus is placed lineally on the skin, one sees in
its wider spread the inclination to rounding off (Gerlach).
Artificial transmission is easiest from horses and cattle to cattle,
horses and dogs; it is most difficult from sheep and swine to
the other species of animals and even from sheep to sheep, and
swine to swine. Such transmissions can actually be made in
some cases from horse to sheep and swine (Siedamgrotzky,
Eailliet), from cattle to sheep (Eailliet, Schindelka), from goats
to cattle (Neumann), from cats to horses and cattle (Williams) ;
also from man to the cat (Fenger) and to other young animals
(Horand & Vincens), as also from animals to man (Gerlach,
Haubner, Bodin and others). Herpes may also be transmitted
from the domestic animals to guinea pigs and rabbits (Bodin,
Sabouraud, Friedberger & Frohner). The presence of pus cocci
in the skin checks the growth of the tricophyton fungus (Sabou-
raud, Marianelli).
Natural infection results frequently by immediate con-
tagion, affected animals coming in contact with healthy ones in
the stable or still more in the stock yard or in the pasture. Suck-
lings are often infected while sucking affected mother animals.
The transmission may also occur in the covering act; in this
manner breeding animals may transmit herpes to entire herds
(Pusch). Finally animals may be infected by persons affected
with the disease.
904 Herpes Tonsurans.
Indirect contagion also plays an important part and may
be occasioned especiallj^ by cleaning ntensils, blankets, harness
or objects on which the animals rub themselves. Moreover
persons may carry the fungus in their clothes or the disease
may develop from placing healthy animals in a stable which
has previously been occupied by animals that have been suffer-
ing from the disease (Schindelka).
Sabouraud and Bodin are inclined to believe that the tricophyton funjfiis
thrives free in Nature on different plants and that animals are liable to contagion
on coming in contact with them.
As predisposing causes the following may be noted : housing
in warm, damp, dirty stables and particularly basement stables
where the animals lie on a thick layer of manure ; in such stables
the disease frequently remains stationary. Maceration of the
skin by getting wet or from frequent washing assists the locali-
zation of the fungus, also excoriation of the skin, while exposure
to sun and wind, cold sta])les and living in the open are said to
inhibit the growth of the fungiis. Consequently herpes spreads
much in pasturing districts in fall, in damp summers and es-
pecially in winter (Pusch).
The important role played by predisposing factors is shoven by the fact that one
cannot always succeed in transmitting the disease artificially in its progressive
form to other animals of the same species, because one is not always in a position
to produce the favorable conditions. Thus for instance in one experiment of the
authors infection failed to occur in a calf although it was kept for three weeks in
constant and immediate contact with a badly affected calf and although macerated
scab material had been rubbed on the scarified or shave^
of the mites. This is evident with respect to scab of man in Hebra's
textbook (1844), -sdth respect to that of the domestic animals in those
of Gurlt, Hertwig (1844) and Gerlach (1857). More recent researches
(Fiirstenberg, Megnin, Railliet, Johne and others) have ascertained the
part played by the parasites in the production of scab in the individual
species of animals.
Occurrence. Scab is a frequent disease of domestic ani-
mals, and occurs sometimes sporadically, at other times as an
enzootic, in practically all countries. The greatest extension
occurs in animals living in flocks which are insufficiently cared
for.
Scab of the Horse. In Germany in the rears 1S02 to 1908 a total of 10,289
horses fell ill; the number affected varied between 425 (1897) and 959 (1908);
out of every 10,000 horses 1.2, 1.6, 1.5, 1.5, 1.6 and 2.2 were affected in the years
1903-190S. The greatest spread of scab in recent years occurred especially on the
east Eussian boundary in the government districts of Gumbinne, Konigsberg,
Danzig, Marienwerder, Posen, but in the years 1901-190.3 also in Bavaria
(Upper, Lower Bavaria, Lower Franconia) ; in the year 1908 the government
districts of Marienwerder, Danzig, KonigsV)erg, Gumbinnen, Potsdam, Allenstein
and Breslau were particularly infested.
In Austria in the years 1891-1900, 3,438 horses were affected with scab, the
number varying between 190 and 617 (1899). The highest number of cases
occurred in Galicia, in which province 2,454 cases were reported. Dalmatia follows
next.
In Eussia between 1895-1896 there were 4,717 horses ill with scabies.
In Sweden in the years 1892, 1894-1895 there were 193 cases.
In Hungary 35,881 horses suffered from scab in the years 1894-1905; the
number of cases varied between 949 (1898) and 5,895 (1901). The highest
figures of morbidity were observed in the southeastern counties.
Scab of the Sheep. In Germany sheep scab used to be very widespread;
in the years 1883-1884, about 260,000 sheep were affected, and of these 78,557 were in
Alsace-Lorraine (61% of the total). Since energetic measures of eradication
were enforced there has been a decided decrease in the number of cases. In the
years 1892-1908 a total of 1,448,122 cases of sheep scab was reported, and the
frequency varied in individual years between 53,955 (1906) and 143,468 (1901);
in the year 1903 out of every 10,000 sheep 72.56 were affected, but in the years
1905-1908 the frequency per" 10,000 was 71.32, 68.24, 102.76 and 132.68. ' The
greatest extension of sheep scab occurred in the government districts of Kassel,
Hildesheim, Erfurt in the districts of Jagst and of the Danube.
In France sheep scab apparently does not occur frequently; the greatest
extension occurs year by year in the northern, northeastern and the western de-
partments.
In Great Britain the disease is noticed annually in all parts of the country,
but it occurs most frequently in the Welsh counties. From 2,000 to 4,000 flocks
are annually affected.
Occurrence. Etiology. 931
In Italy sheep scab is rather common. Most eases occur in the south pro-
vinces on the Adriatic Sea, although the affection is also endemic in the other parts
of the country. In the years 19UU-iy08, 44:4:, 2'6 4: cases were diagnosed.
In the Netherlands 42,751 cases of scab in sheep were reported between
1894-1903, of which 15,482 occurred in the year 1896 and 23,626 in the year 1897,
while in the remaining years the morbidity varied between 380 (1894) and 5,189
(1898). It was always most frequent in the provinces of Oberyssel, Drenthe,
Friesland and Grouingeu, in which three-fourths of the cases occurred.
In Austria a total of 11,414 cases of sheep scab was observed in the years
1891-1900. The most severe outbreaks occurred in Bohemia, Tyrol and Vorarlberg,
Dalmatia and Carinthia.
In Hungary 77,188 sheep fell ill of scab in the years 1894-1905; the
morbidity varied in separate years between 1,856 (1899) and 12,582 (1891).
In Switzerland in the years 1894-1906 a total of 6,781 eases was recorded, the
greater portion of them in the cantons of Waadt and Freiburg.
In the Balkan countries (Roumauia, Bulgaria, Servia, Bosnia and Herzegovina)
scab is frequent, while on the contrary in Denmark, Norway, Sweden no cases have
been recorded in the last few years.
In Africa sheep scab seems to be prevalent, for in Cape Colony no fewer than
230,587 sheep fell ill in the year 1894. In Algeria the number of affected flocka
varied in individual years between 5 and 42.
Scab of Goats. In countries in which intensive goat breeding is followed
scab is not rare. Thus in Austria 5,407 goats were attacked in the j^ears 1891-1900,
most cat^es occurring in Salzburg and Dalmatia. In Bosnia and Herzegovina
11,560 cases of scab were reported in the years 1901-1906. In Italy in the years
1901-1906, the disease affected 4,556 goats; it was especially frequent in Sicily and
Sardinia. In the Cape Colony in the year 1894, 203,409 goats suffered from the
complaint; in Asia also it is a frequent disease (Cadeac).
Scab of the Dog. Sarcoptic scab of dogs is frequent, especially in large
towns. Thus 6,225 out of 70,000 dogs attended in the Berlin clinic in the years
1886-1894 suffered from scab, while in Munich in the year 1889 of the dogs
receiving internal treatment 16% were affected with sarcoptic mange. — Out of
9,732 dogs brought to the Budapest clinic in the course of the last 15 years, 367
(3.8%) were found to be suffering from sarcoptic scab. Of 894 cats, 56 (6.3%)
were suffering from scab.
Etiology. The mange parasites (Sarcoptida) are very
small mites belonging to the order of the Acarina, of the class
Arachnoidea. Owing to the fusion of head, thorax and abdo-
men, the body is rounded or oval. It is more or less grooved
and covered with spines and bristles. On the head may be
found the biting, sucking or puncturing rostrum, which is placed
differently in the individual varieties. The young mites have
three and later on four pairs of articulated extremities, which
ill some cases end in suckers and in others in bristles.
The males are much smaller than the females, which lay
oval eggs. In the eggs embryos with 3 pairs of legs develop,
which, according to external conditions, but especially according
to the temperature, hatch in the course of 3 to 10 days. The
larvae change after 2 or 3 moultings to four-footed but still sex-
less nymphae which finally develop into sexually mature mites.
The complete development requires 2 to 3 weeks, and then the
pregnant female lays an average of 15 eggs, from which an
average of 5 male and 10 female mites develop. In unhindered
development and increase, Gerlach calculates that one pair of
parasites can produce half a million male and a million female
mites within 3 months in the sixth generation. The males live
5 to 6 weeks, but the females die, after laying their eggs, in 3
to 6 weeks.
932
Scabies.
The parasitic mange mites on the bodies of domestic animals are
divided into the three following varieties :
1. Sarcoptes (burrowing mite). The anterior portion of the tortoise
shaped or roundish boily which is barely visible with the naked eye, measuring
0.2 to O.o mm., is forn)ed by the head, of blunt conical shape. This is provided
with two strong Iowim- jaws and covered from above with a chest-head shield which
gives it more or less a horseshoe form. The feet are short and thick, the pos-
terior ones do not extend over the edge of the abdomen; in the male cup-shaped
suckers on unjointed, fairly long pedicles are situated on the first two and the fourth
pairs of feet ; in the foinale on the first two pairs ; in the male the third, and in the
female both hind pairs of feet end in long bristles.
The following three varieties must be considered:
(a) Sarcoptes seabiei communis s. Sarcoptes major; in the horse, sheep,
goat and man; skin transversely grooved, on the back 6 long-drawn glandiform
thoracic, and 14 spear shaped dorsal spines arranged in 4 rows, on the posterior
edge of the body four strong bristles (Fig. 138).
(b) Sarcoptes squamiferus;
in the dog, sheep, goat and pig;
the anatomical arrangement sim-
ilar to the preceding, consequently
Johne, Kitt and others considered
the mite as a variety of tlie Sar-
coptes seabiei communis.
(c) Sarcoptes minor s.
notoedres; attaches itself to the
skin of cats and rabbits; body
Fig. 138. Sarcoptes seabiei v. equi. Above,
Isft, male. Below, female, from back; right,
above, female; below, nuile, from abdominal
side. Magnif. 75. (After :Megnin.)
Fig. 139. Sarcoptes minor.
Above, female ; below, male ;
both from abdominal side;
Magnif. 75. (After M^gnin.)
roundish, without thoracic spines, only 12 dorsal S])ines; back without scales, skin
concentrically grooved (Fig. 139).
The sarcoptes mite penetrates under the skin by the aid of its powerful
jaws and head, and inunediately digs a tortuous passage above the papillae of the
cutis, in which the female always penetrates further to lay her eggs, wliile
the male takes up Ins aliode superficially in the neighliorliood of the opening of
the burrow or wanders at)out on the surface of the skin.
2. Dermatocoptes (rsoroi)tes, Dermatodoctes, sucking mites). These have
ovoid bodies 0.5 to (t.S iiun. long, nuich larger than those of the burrowing mite and
readily perceptible to the naked eye. The head is longer than broad, pointed, the
lower jaw is straight, suitable for ])uncturing, the back without spines and scales,
with two strong shoulder bristles, slightly grooved, the feet long; all four pairs in
the male and the 1st, 2d and 4th pairs in the female end in tulip shaped suckers,
Etiology.
9B3
which are placed on long pedicles with three joints, while the third pair of feet in
the female terminates in two long bristles; in the male on the posterior edge of the
body there are two prolongations, and on the abdominal side two tumbler shaped
suckers which in copulation take up the two generative appendages of the female
(Fig. 140).
To this class belong:
(a) Dermatocoptes communis; in the horse, cow, buffalo and sheep.
(b) Dermatocoptes cunieuli; parasitic in the external auditory canal of the
rabbit.
The dermatocoptes mites bore through the epidermis layer with their jawa
and rostrum as far as the cutis, in order to suck up fluid (hence often colored red) ;
they do not penetrate into the epidermis layer but remain on the surface of the
skin, between and under the encrustations.
3. Dermatophagus (Chorioptes, Symbiotes, scale-eating mite) ; is 0.3 to 0.4
mm. long, its size is midway between that of the two previously described mites;
the body is elongated, oval, the head blunt, shorter than broad, bluntly conical; the
blunt wedge-shaped lower jaws are only suitable for crushing substances which are
taken up; the suckers are goblet shaped, on short non-jointed pedicles; in the
female they are found on the first two and on the posterior pair of legs, while the
140. Dermatocoptes communis v. equi. On the right, female, viewed from above
On the left, male, abdominal view. Magnif. 75. (After Megnin.)
third i)air end in long spines; in the male there are suckers on all four pairs of legs,
the last pair is, however, generally rudimentary; the genital plugs or processes are
similar to those of dermatocoptes, only with the difference that the plug shaped clasp-
ing organ of the male D. communis besides the roundish bristles, bears also a rather
long bristle, like a blade of grass and slightly twisted.
To this variety belong:
(a) Dermatophagus communis; in horses, oxen and sheep.
(b) Dermatophagus auricularis (Symbiotes eeaudatus) ; resii!os in the ex-
ternal auditory meatus of dogs, cats and rabbits (Fig. 141).
The masticatory apparatus of the dermatophagus mite pernits them to feed
only on the crusts and epidermis scales of the inflamed skin, but no: to bore thi'ough
or dig into the skin.
Besides the enumerated varieties, sub-varieties may occur according to the
species of animal on which the mites become parasitic (Sarcoptcs scabiei var. equi,
ovis, capra% suis, etc.) ; this far-reaching division originated on the one hand through
the frequent non-success of transmission, and on the other is founded on differences
in size, which, however, probably also depend on the special peculiarities of the body
of the host (thickness of skin, hairiness, etc.).
934 Scabies.
In the individual species of the domestic animals tlie following varieties of
mites occur.
Ju the horse: Sarcoptes !-cabiei, Derniatocoptes coiiuiiunis, Dermatophagus
equi. The principal form of disease is tlie sarcoptic scab.
In cattle: Sarcoptes (a])parently often only after transmission from other
animals), Derniatocoptes coninumis, Dermatophagus communis (bovis) ; — principal
form, dermatocoptic scab.
In sheep: Sarcoptes squamiferus, Dermatocoi)tes communis, Dermatophagus
communis (ovis) ; — chief form, dermatocoptic scab.
In the goat: Sarcoptes squamiferus, Derniatocoptes communis, Dermatophagus
communis (capra^) ; chief form, sarcoptic scab.
In the dog: Sarcoptes squamiferus, Dermatophagus aurieularis (canis) ; chief
form, sarcoptic scab.
In the cat: Sarcoptes minor, Dermatophagus aurieularis (felis) ; chief form,
sarcoptic scab.
In the pig: Sarcoptes squamiferus.
In the rabbit: Sarcoptes minor, Derniatocoptes and Dermatophagus cuniculi; —
chief form, sarcoptic scab.
The tenacity of scab mites varies according to the different varieties. Ac-
cording to Gerlach the least resistant are the sarcoptes, which die in dry air in a few
days (the sarcoptic mites of the pig after a week | Brandl & Gmeiner]), and in damp
media only live a fortnight at the longest. The dermatocoiites mites remain alive
outside the animal body 4 to fi weeks, but longer in damp and dirty stables, and can
remain alive even in dry air for 10 to 14 days; Giinther succeeded in obtaining a
positive result from inoculations of
mange scabs kept preserved for 8
weeks at room temperature. The
dermatophagus mites remain alive
for 10 days, and in damp warm
stables for .50 days. From the eggs
of mites the larvae "an develop even
after several weeks have elapsed.
To the influence of certain
chemical substances the varieties of
iiMtes show a similar attitude as a
whole. They are destroyed immedi-
ately by pure or 10% creosote, liquid
carbolic acid, wood tar, Peruvian
balsam, 30% oil of chloroform,
bisulphide of carbon ; an almost
similar effect is produced after a few
^. ^ .^ ^ , . , . ^ (2, 5 or 10) minutes by creolin,
Fig. 141. Dermatophagus auncularis. On ^^ . ^^.^^^y^ saponatus or aqua
the left, egg-beanng feinale from the ab- <,,esolica, tincture of iodine, oil of
donimalside; on the right the same viewed turpentine and petroleum, 3 to 5%
from above. Magnif. 75. (After Megiiin.) eatery solution of carbolic acid, con-
centrated vinegar, ol. animate foetid,
2 to 3% cargolized oil, .5% salicylic oil and 20 7f' decoction of tobacco, while green
soap, sjjirit of sal ammoniac, gray mercury, 5 to 10%. decoction of tobacco, 0.5%
corrosive sublimate kill the mite after 1 to 2 or many hours.
With reference to the derniatocoptes mites of sheep scab the investigations of
Brandl & Gmeiner show that the mites were killed immediately by chloroform and
carbon bisulphide, by 5% carbolic acid in 1 minute, by 2% water solution of liq.
cresoli sapon. in 2 minutes, by 2i/{>%. creolin water in % to 4 minutes, by 1% car-
bolic water in 4 minutes, by 3% carbolized oil and Peruvian balsam in 8 minutes,
by Lngol 's solution in 10 minutes, by tincture of iodine in 20 minutes, by petroleum
in 22 minutes, by 1% corrosive sublimate only in .50 minutes. In one hour they
are not killed by glycerine, rectified spirits, 20% tobacco decoction, 1% watery
arsenic solution, gray mercury, 10% corrosive sublimate ointment. Isolated
derniatocoptes mites ceased their movements definitely after direct eontact with
Frijhner's scab dip in 2^^ to 4 minutes, with Kaiser's dip in 3 minutes, with
Ziindel's in 5; but they remained active after an hour in Gerlach 's scab dip, in
arsenical baths, as well as in Walz 's dip.
The infection occurs indirectly or hy the direct contact of
afrected animals Avith healthy ones, Avhereby either fnlly de-
veloped mites or tlieir larvae or eggs get on the healthy skin and
Etiology. Pathogenesis. 935
here develop protected by the hairy covering or hidden between
the folds of hair. The most varied objects, when coming in con-
tact with the affected skin or when touching the encrusted parts,
but especially cloths and harness, are frequently the media of
infection. Infection by immediate contact happens mostly when
many animals live close to or in contact with one another, as
for instance sheep, pigs, hounds, further in narrow stables or
in horses worked in pairs where the mites can wander from the
body of one animal to that of another.
The infection is the easier, the more undisturbed the mites
can live on the skin. Among sheep the disease may on this ac-
count very easily assume an enzootic character, since the mites
can remain undisturbed in the depths of the close fleece. In other
animals the development and spread of the skin affection occurs
the more quickly the poorer the skin hygiene, and with this the
experience coincides, which finds scab the more severe the poorer
the owner, while on the bodies of well cared horses it occurs
less often, and does not attain such great extension. Here clean-
ing and curry-combing hinder the settlement of the parasites,
and sometimes after a successful infection a portion of the mites
are later removed from the skin. Other skin diseases and de-
Inlitating influences greatly predispose the body to the com-
plaint.
Susceptibility. Scab generally spreads easily and quickly
only in animals of the same species, while infection from one
species to another occurs much more rarely.
With reference to the direct infection of individual species of animals, and of
animals and man, the following was noticed (principally from the statistics of
Friedberger & Frohner) :
All varieties of sarcoptes of domestic animals are communicable to man.
Sareoptic scab of man, sheep, dogs, cats, pigs, camels and rabbits is communicable
to the horse.
Sarcoptic scab of horses, sheep, goats, cats and pigs (personal observation)
is communicable to cattle.
Sheep can be affected with sarcoptic scab by dogs and goats.
Dogs can be affected with the sarcoptic scab of man, pigs, cats, goats, sheep
and foxes.
Pigs may be infected l)y sarcoptic scab of goats.
The sarcoptic scab of man may be transmitted to rabbits.
While therefore the possil)ility of transmission of sarcop-
tic scab to other species of animals exists, the affection arising
thus is sometimes of a mild and transient character, but in
other cases severe disease has been noted. It appears that the
dermatocoptes and dermatophagus scab cannot be transmitted
from one species of animal to another ; at most the mites cause
transitory itching.
Pathogenesis. The sarcoptes mites usually localize on that
part of the skin on which they happen to get foothold, while the
dermatocoptes mites living on the surface of the skin, and con-
sequently little protected, seek out the more protected parts, or
the dermatophages seek out the skin of the extremities or the
936 Scabies.
anal region. There is probably no doubt that the sarcoptes
mites, while boring passages under the epidermis layer, as well
as dermatocoptes mites that bite and hold on to the skin, cause
an inflammation by their mechanical irritation, which manifests
itself by hyperemia of the cutis, exudation, and further sequelae.
Scab mites also produce an especially injurious effect by an
acrid juice which they secrete and inoculate into the epidermis
and deeper parts, through which sarcoptes and dermatocoptes
mites cause an existing inflammation to become more intense.
Rubbing in of powdered dead mites as well as extracts obtained
from their bodies actually causes itching and soon also the de-
velopment of papules and vesicles (Bourguignon, Gerlach).
Rul)bing, scratching and the like caused by the itching visibly
increase the aggravation of the inflammatory process.
Symptoms. The duration of incubation, the degree and
extent of the mange, depend, apart from the variety of mites,
very largely on the number of mites present on the skin. Symp-
toms of disease Avill be noticed only in the presence of numerous
mites; if only isolated mites get on the healthy skin, 4 to 6
weeks may elapse before they have increased sufficiently to
cause perceptible changes in the skin, while after an intense
infection the first symptoms may become evident after two
weeks.
Scab is essentially an eczematous dermatitis. From the
])ite or puncture of mites transient red spots arise, or at other
places nodules, vesicles and pustules and at these points the
clinical picture of eczema squamosum develops or more fre-
quently of eczema crustosum with subsequent thickening of the
skin. In more severe cases the skin is changed into thick folds,
the hair falls out and the surface of the skin is covered with
crusts of varying thickness under which the cutis, robbed for
the most part of its epidermis, appears bright red, sensitive,
moist and bleeding. The pathological changes are the more
severe the longer the disease continues; besides the variety of
mite has an influence in so far as the sarcoptic mites generally
cause a more severe disease of the skin than the dermatocoptes
and dermatophagus, which are parasitic only on its surface.
Itching is a constant symptom and it is characteristic to a
certain degree that it increases with w^armth; in summer it is
more intense than in winter; at night or under cover affected
animals are more restless than in the daj^ime and out of doors,
and the itching will be more intense when the animals become
warmed up by work. This severe itching partly changes the
external appearance of the affection, while rubbing, biting and
scratching aggravate the inflammatory process, and the con-
tinuous unrest leads to loss of condition. Mange declines in
cool weather, and in the course of the winter it may appear to
be healed, but on the return of warm summer weather it makes
its appearance again and assumes larger extension. With
Diagnosis. Veterinary Police. 937
such variations the disease may last for years in horses, dogs
and swine.
Diagnosis. While scab simulates eczema in regard to the
tissue changes which occur, its recognition is possible by its
localization on certain parts of the body, by the obstinate itch-
ing wdiicli increases wdth warmth, and especially if its occur-
rence and spread point to an infectious origin. Nevertheless
the diagnosis is completely assured only by demonstration of
scab mites in the diseased parts of the skin. Examination for
mites should not be neglected in doubtful cases, for instance if
the complaint is only beginning to develop or has spread over
a great portion of the body, so that its starting point can hardlj-
be determined; the exact determination of the variety of mite
is generally possible only by this procedure.
The simplest way of demonstrating the mites consists in detaching crusts
from the diseased skin, especially their deeper parts or still better scrape away the
debris of the part of the skin which is covered with crusts and spread it out on a
glass plate, watchglass or piece of paper, and afterwards warm it; this may most
suitably be done by exposing it to the sun's rays. The warmth causes the mites to
move about, and they may be seen on a dark background as small moving points.
With the point of a needle they may be put on a glass slide and examined under
the microscope. This procedure is suitable for the investigation of dermatocoptes
and dermatophagus mites. It is more advantageous to take off the crusts from the
skin and put the scrapings in 10% potassium hydrate for 1 to 2 hours, afterwards ex-
amining them between glass slide and cover glass, when in the softened and partly
dissolved material the uninjured remaining mites or parts of their bodies will be
easily recognized under the microscope (characteristics of scab mites see pages 932
to 934). Sarcoptic scab may be diagnosed also by placing the scabs on a man's
arm (in 6 to 12 hours itching occurs and pustules form containing minute mites).
Veterinary Police. The frequent enzootic occurrence of
scab and the considerable losses entailed thereby justify its in-
clusion in the notifiable diseases. The rules and regulations
generally affect solipeds only (horse, ass, mule) and sheep.
In solipeds, veterinary police regulations are necessary only
with regard to sarcoptic and dermatodectic scab, while they do
not appear to be needed against the rather harmless dermato-
pliagic scab. A similar view ought to be taken with regard to
dermatocoptic and sarcoptic scab of sheep, although sarcoptic
scab is not included under the animal orders of the German
Empire. The scab of goats ought also to be included in the
veterinary police regulations. On the contrary on account of
the very slight transmissibility of sarcoptic scab and the non-
transmissibility of other forms of scab to other species of ani-
mals the extension of the orders for restriction of trade in re-
gard to other species of animals does not seem warranted. The
regulations concern themselves on the one hand with the com-
pulsory veterinary treatment of scabs and on the other with
the isolation of affected animals. In the treatment of the horse
where the disease is widespread it must not be forgotten that
the cost of treatment may exceed the value of the horse, in which
case slaughter of the animal will be justified. The skins of
938 Scabies.
mangy animals should be used in tanneries only after thorough
disinfection and complete drying, the wool of mangy sheep
should be sold only in enclosed sacks.
Literature. Brandl & Gmeiiier, W. f. Tk., 1900, 1.S7, 177, ,349, 489; 1901,
229. — <'habert, Traite ]e, 5. Vj., 1S77, XLVII, 53.— Meiise, Handb. d. Tropen-
krankh., 190—, TTT, 791.— Roloff, A. f. Tk., 1877, III, 311.— Sander, ibid., 1896,
XXII, 63.— Wallraff, Eep., 18-54, 297.
(e) Scabies of the Dog.
True mange of the dog is caused by the Sarcoptes scabiei
s. squamiferus ; in addition to this parasite the Dermatophagus
communis (var. canis) is found exclusively in the external ear
passages.
956 Scabies.
1. Sarcoptic Scab. This disease, Mliicli is very general in
dogs, occurs most frequently on the head, the bridge of the nose,
the orbital rims or on the base of the ears; not infrequently,
however, the morbid changes occur on the front of the chest, on
the lower abdomen, in the axilla, on the inner surfaces of the
thighs, on the root of the tail, and subsequently they pass on
to the other parts of the body, and finally extend over the whole
body. Little papules appear on round inflamed places, some of
them changing to vesicles or even to pustules, especially on thin-
skinned places. On the diseased skin profuse bran-like scales are
formed at first, and later yellowish gray crusts ; the skin thickens
in consequence of frequent scratching or rubbing and exhibits
thick folds on face, neck and chest. The hair falls out prema-
turely and in this way irregularly shaped bald spots form, which
coalesce into large hairless patches. As in horses this form of
mange frequently runs its course accompanied hy profuse des-
quamation (Fig. 145).
Fig. 145. iiarcoptic manye in the dog.
The development of the disease is mostly accompanied l)y
violent itching, whereupon the animal becomes very restless if
kept warm, and injures the affected places by frequent scratch-
ing, gnawing and rubbing. If the disease is prolonged and
spreads to the greater part of the body, the animals become
emaciated and at times emit a peculiar mouse-like smell
(Hebrant & Antoine). Finally, if no treatment is undertaken,
tliey die with symptoms of cachexia.
2. Dermatophagic Scab. (Ear mange. Scabies auricu-
laris.) In the external auditory meatus of the dog dermato-
Scabies of the Dog. 957
phages frequently occur. Thus Becker found dermatophages
in the external auditory meatus in 17.3% of all dogs suffering
from external otitis, while in dogs without ear disease none
were found. Otherwise the mites seem to occasion only itching
and do not of themselves cause any inflammation, the skin of the
ear being found uninjured now and then in spite of an abundant
invasion. The otitis, which is frequent when mites are present,
is a secondary affection, being due to the fact that injuries and
soiling of the outer ear and auditory passage easily arise from
scratching and from shaking the head (see page 854). The
sjanptoms which may be referred to the presence of dermato-
phagus mites consist in frequent scratching of the ears, shaking
the head, whining, howling and rubbing the ears on any conve-
nient objects (Becker). These signs of itching are especially
noticed in warm places and during the night. Subsequently
baldness of the lobes of the ears, scratches, abrasions, bloody
ears, and finally the symptoms of otitis externa become mani-
fest (see page 854). In addition epileptiform spasms and deaf-
ness have also been reported (Megnin, Nocard, Becker). In
the absence of inflammatory products in the ear passages the
mites may be seen with the unaided eye as fine, grayish white
and partly movable points, or they cover the surface of the
skin with an adherent powdery layer (Becker). They are most
numerous near the drum of the ear.
Diagnosis. Sarcoptic mange may be mistaken for acariasis,
and all the more so as this very frequently commences on the
above mentioned parts of the head. But here itching is quite
slight or completely absent, and one often sees bluish red pus-
tules on the skin which always contain many acarus mites. Sar-
coptes mites are on the contrary difficult to demonstrate. Both
these forms of scab may be present at the same time in one ani-
mal. The difficulty in obtaining mites makes it hard to dis-
tinguish scab from dry eczema, in case this is not limited ex-
clusively to the back but occurs also on other parts of the body.
Intense itching which is out of proportion to the changes in the
skin is indicative of scab. Other parasites (lice, fleas, ticks)
may be seen with the naked eye.
Treatment and Prophylaxis. To secure lasting results it
is ver}'- advisable to extend the treatment over the whole body.
It should be commenced by clipping the hair at least over the
diseased places and round about them, after which the parts of
the body that are covered with crusts may be rubbed with green
soap, the softened crusts being removed with brushes and hike-
warm water after 1 to 2 hours. The treatment proper then
follows on the next day and is most appropriately carried out
in sections; thus each day only a third or a fourth of the
surface of the skin is treated energetically, the dressing being
left on the skin for 4 or 5 days and then washed off with luke-
958 Scabies.
warm soap and water or with y^ to 1% liver of sulphur solu-
tion. This operation must be repeated, with intermissions of
3 to 4 days until the skin forms no further crusts and the itch-
ing has disappeared completely. One must restrain the animal
as much as possible from licking- the application (muzzle, bind-
ing the mouth, broad collar of stiff paper, etc.).
Of the remedies which are capable of killing the mites, the
following are the most useful: tar in the form of liniment (pix
liquida, sapo viridis aa 1 part, alcohol 1 to 5 parts) ; creolin,
lysol, and ichthyol in similar form and composition; creosote
(in 10% oily mixture or with 5 parts of green soap and alcohol) ;
further for sensitive dogs and for the region of the eye and
nose, Peruvian balsam and styrax may be used (pure or mixed
with some alcohol, glycerine or oil). According to Fettick,
eudermol (salicylate of nicotine) in the form of a 1% ointment
has answered well (expensive!). Cresol liniment (aqua creso-
lica 2 parts, soft soap and alcohol aa 1 part) is of excellent
service in mild cases. Winter found a watery solution of
therosot (1:4) rapid and safe in its effect. When employing
tar or carbolic preparations it is advisable to give Glauber salts
internally to the affected animals (2.5 giu. per day) in order to
avoid phenol poisoning, or at least to watch the general condi-
tion and the urine for any signs of commencing intoxication
with phenol.
For the treatment of ear scab the external auditory meatus
is first to be cleansed, after which carbolic acid or creosote in
oil or glycerine (10%), also naphthol oil (naphthol 10.0 g.,
ether 30.0 g., olive oil, 100.0 g.), may be instilled for a few days.
During the treatment the animals should be fed well and
protected from cold. As prophylactic treatment careful dis-
infection of the stable and of blankets, etc., is recommended,
and the diseased animals should be separated from other ani-
mals until their recovery is complete.
Literature. Albreeht, W. f. Tk., 1901, 104.— Becker, Monh., 1907, XVIII,
547 (Lit.).— Brand! & Gmeiner, W. f. Tk., 1900, 177.— Deieh, S. B., 1903, 84.—
Fettick, Z. f. Tm., 1901, V, 291.— Frohner, A. f. Tk., 1887, XIII, 341.— Megnin,
Rec, 1881, 129.— Eievel, D. t. W., 1901, 105.— Sehlampp, Therap. Technik, 1906,
I. 234.
(f) Scabies of the Cat.
Sarcoptic Scab. Mange caused by the Sarcoptes minor be-
gins on the ears and in their immediate neighborhood, then it
generally passes on to the head, but exceptionally also attacks
the feet and the sacral region.
In conjunction with intense itching the animals wipe the
head with their paws, shake the head and rub on neighboring
objects. Small papules and vesicles form on the skin, and soon
this is covered with a thick, bran-like layer Avhicli later on grad-
ually changes to rather thick, grayish yellow, dry, fissured scabs
Scabies of the Cat.
959
(Fig. 146). Hand in hand with this process the hair falls out
on the diseased parts, while the skin itself becomes thickened
and w^rinkled. In severe cases the eyelids swell and purulent
conjunctival catarrh sets in. Owing to swelling of the aire of
the nostrils breathing becomes difficult, the animals become
emaciated and die of the disease in 3 to 6 months.
Dermatophagic Scab. (Ear mange.) This manifests itself
by similar symptoms to those in the dog (see page 956) but
occurs very seldom.
Diagnosis. The localization of the skin disease leading to
the formation of crusts in the neighborhood of the ears and
on the head is characteristic of the affection; the microscopical
examination of
the crusts, in
which the mites
are present in
great quantity,
makes the dis-
ease easily rec-
02'nizable.
Treatment.
Since cats will
not stand wash-
ing and bathing,
the treatment is
limited to the
use of ointments
which can be re-
moved by rub-
l)ing with dry
bran. The best
ointment is that
of Helmerich
(sulphur sublim.
suilli 60.0 gm.).
Sarcoptic mange in the cat.
150 gm., potassium carb., 8.0 gm., adeps
The treatment of small surfaces with
Peruvian balsam has afforded good results, but this remedy
may cause severe symptoms of brain irritation, and even death,
especially in an extensive spread of the disease (Schindelka,
Frohner). Styrax (with 4-5 parts of alcohol) can also be used and
is less dangerous. Schindelka always found sulphur in oil effec-
tive. Carbolic acid and tar preparations are to be avoided on
account of their poisonous effects on cats. Mange of the cat
is transmissible to man, horses, cattle and dogs ; one must there-
fore take care to isolate the affected animals.
The ear mange necessitates cleansing of the ear passage
with Peruvian balsam and glycerine, aa, or naphthol oil.
Literature. Dinter, S. B., 1862, 99.— Kobne, Mag., 1868, 288.— Megnin,
Eec, 1863, 68.— Schwartz, Eep., 1875, 165.
960 Scabies.
Scabies in Wild Felines. In zoological gardens lions and leop-
ards may become affected with scab due to Sarcoptes communis (Johne,
Koolisch, Delafond & Bonrgouignon), manifesting itself by intense itch-
ing and the occurrence of spots covered with crusts on the trunk, whence
the disease extends quickly over the whole body. The nutrition of the
animals is much interfered with and some of them die.
The treatment consisted, in Johne 's cases, in syringing vrith a spray
of Peruvian balsam (1:3 parts of alcohol) and afterwards rubbing with
long handled brushes. Five repetitions at intervals of 8 to 10 days
effected a cure. (Johne, A. f. Tk., 1880, VI, 146.)
Among other predatory animals, foxes are not infrequently affected with
sarcoptic scab and sometimes also infect hounds. (Deich, 8. B., 1903, 84.)
(g) Scabies of the Pig.
Sarcoptic Mange. This form of mange is caused by the
Sarcoptes scabiei v. squamiferus and occurs very frequently,
and as an enzootic, especially in large piggeries. Marked and
dangerous symptoms are seen especially in swine with a thick
curly hair growth, while now and again it has been noticed
that pigs of the English breeds living with these have not been
affected. It may here be stated that scab is very frequent in
pigs of the Hungarian breeds. Young swine or sucklings are
affected most often. Insufficient nourishment, debilitating dis-
eases (hog cholera, pyobacillosis, rickets, etc.) and other com-
plaints, and even inoculations for erysipelas may be follo\ved
by mange, previously apparently healthy swine being affected
in great numbers.
The disease develops with violent itching, especially on the
head and in the neighborhood of the eyes and ears, on the back,
on the sides of the body and inner surfaces of the thighs (Fig.
147). Dry, bran-like scales collect upon the small itching
nodules, the bristles fall out and large crusts form which are
said to be grayish white, so that the animal appears as if
sprinkled with dry guano. The authors' own numerous obser-
vations have led them to conclude that the scabs are mostly
brownish black on account of the admixture of particles of dirt.
The skin thickens in course of time, and is found in thick, strong
folds (Fig. 147), betw^een wdiicli superficial ulceration and even
abscess formation may occur.
The disease develops slowly, and in its severe form it hin-
ders the development of the animals or their fattening. Now
and then it leads also to cachexia and causes numerous deaths.
Johne saw sarcoptic scab in swine occurring as an enzootic; on account of the
wrinkling of the skin it proved to be incurable.
The mange mites of swine live also on the skin of other
animals as well as of man and here cause a local eczematous
disease which generally heals spontaneously in a few days.
Scabies of the Pig.
961
Diagnosis. From eczema or the socalled "smut" of young
pigs or from pitch scab, this true scabies is differentiated by the
very intense itching; but with certainty only by the discovery
of the mites, which is usually easy. The mange of pigs is also
mistaken very often for socalled ''smut" of young pigs which
doubtless occurs rarely as a non-parasitic eczema (Sohnle, Al-
brecht, Maj^er, authors' observation).
Treatment. This consists in removing the scales and
crusts by brushing with soap and water or by scraping with a
wooden spatula, and afterwards using parasiticides. In iso-
lated cases of the disease the following may be used: Hel-
merich's ointment; an intimate mixture of oil of turpentine
and flowers of sulphur (1:8)_; Fritscher's ointment (flowers of
sulphur and ung. liydr. cin. aa 14 parts, ol. anim. fetid 7 parts,
147
klarcoptic scab in the pig.
ol. cannabis 84 parts), or Imminger's ointment (hydrarg.
metall. and sulphur, flores aa 5 parts, canth. exacte pulv. 2
parts and vaseline 40 parts) ; cresol liniment, according to
Brandl & Gmeiner (Liqu. cresoli sap. 5 parts, soft soap 10
parts, water 85 parts). These applications may be rul)bed
alternately into one-half of the body. In large outbreaks mange
baths are more suitable and may be carried out (see page 952)
even during the cold season, in warm stables. Since adult swine
may carry the mites in infected piggeries although not affected
at all or at most only slightly, the treatment should be extended
to them likewise.
For the rest the same prophylactic treatment should be
adopted as in sheep scab (see page 954).
.n<^ Literature. Alhrecht, W. f. Tk., 1901, 58.— Brandl & Gmeiner, ibid., 19C0,
489 (Lit.).— Marek, Z. f. Tm., 1904, VIII, 288.— Mayer, W. f Tk 1905 709 —
Sohnle, Eep., 1891, 74. •'>,,■
Vol. 2-61
962
Scabies.
(h) Scabies of the Rabbit.
1. Sarcoptic Scab. (Head mange.) This form of mange
occurs frequently and often as an enzootic like the dermatocop-
tic scab. It is caused by Sarcoptes minor (Notoedres cnnieuli).
The symptoms are similar to those of sarcoptic scab of the cat
(see page 958), and the skin of the head, lips, bridge of the
nose, forehead, the base of the ears and the vicinity of the eyes
is attacked particularly, the eyes appearing surrounded by
large, fatty, spectacle-shaped scabs (Gmeiner). Very frequent-
ly the process extends to the skin of the fore and perhaps also
of the hind paws. Itching is comparatively slight, but in young-
Fig. 148. Ear manyG in the rabbit.
animals emaciation is early noticeable. Left to themselves the
animals die without exception. The disease is not transmissible
to other animals (Gmeiner).
According to Gmeiner, Sarcoptes squaniiferns also occurs in the rabbit (Sare.
pra^eox s. scabiei v. cimiculi), and, in contrast to Sarcoi)tes minor, over the Avhole
})ody. (ialli-Valerio noticed this form of seal), which apjjcars to bo prevalent in
Italy and France and to be niiudi more contagious and dangerous than the former.
2. Dermatocoptic Scab. (Ear mange.) One observes the
clinical picture of an otitis externa, in the course of which in-
tense itching occurs ; thick, yellowish, l)ro\vn deposits, and dis-
charge from the ear make their appearance on the inner sur-
Scabies of Fowls. 963
face of the shell of the ear (Fig. 148). At times the orifice of
the ear, as well as the middle ear or the petrous bone is affected
with a violent inflammation (Ziirn, authors' observation) and
the head is then held obliquely. Exceptionally the inflamma-
tion extends to the coverings of the brain. After the develop-
ment of these complications the animals die. (Ziirn and Schin-
delka also saw sarcoptic scab on the skin of the bridge of the
nose.)
Dermatophagus mites occur only exeeptioiially in the external ear passage of
the rabbit, and then together with dermatocoptes mites.
Treatment. For this the following may be employed : Hel-
merich's ointment, formalin paste; according to Gmeiner es-
pecially oleum carvi (5% ointment). Reichert made the observa-
tion that a third of the body may he treated at one time with
12 gm. of cresol liniment (amount for 1 kilogram of body
weight) without injurious effects. On the other hand, wash-
ings or baths are very badly borne by rabbits. Ear mange may
be treated with 5 to 10% creolin or carbolic oil or by painting
with glycerinated creolin or carbolic acid ; according to Gmeiner
here also oleum carvi (mixed with 10 parts of almond oil) an-
swers best.
Literature. Gmeiner, D. t. W., 1903, 69 (Lit.) ; A. f. Tk., 1906, XXXII, 170
(Lit.).— Neumann, Eev. vet., 1892, 141.— Zurn, W. f. Tk., 1874, 277.
(i) Scabies of Fowls.
1. Foot Mange. (Foot itch; Gale des pattes [French].)
This form of scab is caused by the Knemidocoptes mutans, which
mite was formerly generally known as Sarcoptes or Derma-
toryctes mutans.
The Knemidocoptes mutans (Fig. 149) is a little animal that is very similar
to the sarcoptes mite, having, when fully developed, four stubby pairs of feet (the
clinging disks are rudimentary in the female) and a short conical head; immedi-
ately behind the head, on the back, there is a U-shaped chitinous structure, and the
dorsal part of the abdomen shows scaly formation. The male is oval, 0.2 to 0.25 cm.
long and 0.15 to 0.17 mm. wide, with two long bristles at the hind end; the female
more rounded, 0.4 to 0.45 mm. long, 0.35 to 0.38 mm. wide. The mite bores
passages into the epidermis.
Brandl & Gmeiner and Eeichert found that of all remedies investigated against
the Knemidocoptes mutans, liquor cresoli saponatus in watery solution had the
strongest effect; also chloroform (pure or with 10% of oil), further creolin,
bacillol, lysol killed the mites very quickly, as did also etheric oil and Peruvian
balsam with oil or alcohol.
The skin disease caused by this mite occurs mostly in
blooded fowls (Cochin China, Brahma, Bantam, Dorking), less
often in the native l)reeds, exceptionally in turkeys, pheasants,
pigeons and singing birds. Ostertag observed the transmission
of the mites to a horse. The development and spread of scab
is promoted by crowding of the fowls, although even under these.
964
Scabies.
conditions the extension is only slow and some birds of a flock
always remain healthy. The affection attacks exclusively the
legs downwards from the tarsal joint. Little grayish white
scales appear mostly on the anterior surface of the tarsus and
toes, which afterwards spread by continuity and gradually
change into gray scabs 1 cm. thick, rough and yellowish (Fig.
150). These show a leaf-
like construction. Some
lamellae have a peculiar
lardaceous or mother-of-
pearl luster, and adhere
to the surface of the skin.
The foot, which is covered
with crusts down to the
toes, has the appearance
of having been plastered
thickly with lime or mor-
tar (socalled lime leg,
scaly leg, elephant limb,
fish scale disease). Be-
tween the lower lamellae
of the scabs numerous
mites are to be found in different stages of development, while
the skin appears inflamed and raw. Itching is manifested liy
the restlessness of the animals and by pecking into the scabs
with the beaks.
Bending of the joint and motion are interfered with by the
armor-like scabs which surround the foot. The liirds become
lame; in consequence they are soon unable to stand and squat
down continuously. In many cases arthritis sets in as a com-
plication, and single toes or even all the toes may be lost. In
such severe cases the birds fall off in condition and finally die
of cachexia. Several months or even a year may elapse, how-
ever, before the disease reaches this degree.
Fig. 149. Knemidocoptes mutans. Female, on
the left viewed from the back, on the right from
the abdominal side, in the middle an egg.
Magnif, 75. (After Megnin.)
The involvement of the head and neek mentioned by many authors in con-
nection with foot mange was nndonbtedly caused l)y the Knemidocoptes la'vis.
The treatment consists in softening the scabs with glycer-
ine or soft soap, rubbing with a little brush and subsequent
applications to the dried diseased surfaces with any anti-para-
sitic remedies, of which Helmerich's ointment is perhaps the
best. Of other remedies Peruvian balsam and styrax may be
employed, while tar or carbolic preparations appear little suited
for young animals. Brandl & Gmeiner found cresol liniment
(cresol water 5 parts, soft soap and alcohol aa 2.5 parts) or
cresol ointment (1 part of cresol, 10 parts of paraffin ointment)
very effective. Reichert recommends the use of oleum carvi
in ointment form (1:5). Apart from very neglected cases, a
cure generally results.
Scabies of Fowls.
965
To insure success disinfection of tlio fowl houses and
jjerches is necessary.
2. Mange of Feathered Parts of the Body. ( Scabies dephi-
mans.) This form of scab is caused by the Knemidocoptes
(Sarcoptes) laevis.
The Knemidocoptes Isevis which has been called Sarcoptes leevis by Eailliet is
very similar to the Knemidocoptes mutans, from which it differs in that the female
possesses no shield-like chitinous formations on the back, the U-shaped chitinous
structure is less developed, the body more circular and the hind pair of legs pro-
ject over the edge of the body. The differences in sizes between these two kinds
of mites are inconstant, as the authors had an opportunity of ascertaining.
The Knemidocoptes Iscvis columbas, the Kn. leevis gallinse, Kn. laevis phasiaui
are only subdivisions of the Knemidocoptes laevis.
Fig. 150. Foot mange in the fowl.
Tliis form of mange occurs in chickens, sometimes as an
enzootic, also in j)igeons and exceptionally in pheasants. It
occurs particularly in spring and summer, and disappears al-
most completely with the approach of autumn, but reappears
the following spring. It usually begins in the sacral region
and then passes on to the back, the abdomen, the thighs, the
neck and the head. Frequently, however, the head or the upper
part of the neck may be first attacked (Fig. 151). Contagion
seems to spread chiefly by treading, consequently the loin re-
966 Scabies.
^ion is the first to be attacked. On the affected parts of the
body, falling ont of the feathers is noticeable, often also they
break off at the level of or close to the snrface of the skin;
the large feathers of the tail and wings are not involved. The
stumps" of feathers remaining in the feathered bulbs become
cleft and fine scales form on the skin. At the periphery of the l)ald
patch the quills of drawn out feathers are covered with epider-
mis scales in which the mites are demonstrable. The skin itself
is elastic, pale red and not noticeably thickened ; at times, how-
ever, one finds it inflamed and dotted with nodular formations.
In such cases the hens lay fewer eggs, emaciation sets in, and
Fig. 151. Scab caused bij Knemidocoptes Iccvis on the neck and head of a cock, with
favns on the comb.
now and then the birds become cachectic and die. Cocks are
attacked more severely as a rule.
The falling out of the feathers due to Knemidocoptes kevis has, according to
Neumann, frequently been mistaken for abnormal moulting. According to the same
author most cases of feather picking are caused by the Knemidocoptes tevis.
Mange of the feathered parts of the body occurs now and
then in conjunction with foot mange, and leads in such cases to
the supposition that scab of the feathered area may be due to
Knemidocoptes mutans. A mistake is quite easily possible
Dermatophagic Scab. Aearus Mange. 967
since botli varieties of mites present only few differences (see
page 965).
In geese, Eailliet observed scab of the feathered parts of the body caused by
the Kneniidocoptes prolificus. Ou the head, especially around the beak and the eyes,
further under the mandible, punctiform, hard nodules formed which contained
sexually mature females, also many eggs and larvae of the mites.
Railliet was successful in treating scab of the feathered
parts with daily sulphur baths ; fresh feathers grew on the bald
surfaces. In general the same remedies may be employed as in
foot mange.
3. Dermatophagic Scab. It is caused by the Dermato-
phagus gallinarum (Epidermoptes bilobatus Rivolta and E.
bifurcatus) and begins on different parts of the body, princi-
pally on the neck and breast ; in severe cases it may even attack
the whole body, the comb and the wattles not excepted (Pried-
berger). Fine, transparent, yellowish scales first appear on
the skin, mostly without itching (Rehm also noticed itching)
which thicken later on to form strong, dirty brown, doughy
crusts. Then the skin appears thickened and tumefied (Rehm).
Within a short time the birds become emaciated and ex-
hausted, and not infrequently a fatal termination is observed.
This form of mange now and again develops along with foot
mange and perhaps also with scab of the feathered parts of the
body.
Since dermatophagus mites not infrequently produce no
disturbances in the health of fowls, one should always make
sure when they are present whether in such cases the skin
changes may not be brought about by vegetable parasites
(Tricophyton, Achorion) (Neumann).
The treatment is the same as in foot mange. Kitt recom-
mends a 5% solution of epicarin.
Literature. Brandl & Gmeiner, W. f. Tk., 1900, 349 (Lit.).— Friedbergor,
D. Z. f. Tm., 1881, VII, 281. — Megnin, Les parasites et les maladies parasitaires,
1880. — Neumann, Maladies paras, des oiseaux dom., Paris, 1909.- — Rehm, B. B., 1901,
264.— Eeichert, Die Fussriiude d. Gefliigels, Diss. Giessen, 1909 (Lit.).
22. Aearus Mange. Acariasis.
{Akarusaussclilag, Haarsackmilbenausschlag [German] ; Gale
domestique [French].)
The aearus mange of the domestic animals is a contagious
skin disease caused by the aearus mite, which is characterized
by the absence of, or by slight itching, by falling out of the
hair mostly with simultaneous desquamation, or by pustule
formation with subsequent decided thickening of the skin.
History. The aearus mite was discovered by Berger (1841) in the
external ear passag'es of man, Init he did not announce his discovery
968 Acarus Mange.
until 1845, attention having been called a month after his finding to
the occurrence of mites in the comedones of man by Heale (1841), and
soon after by Simon (1842). In the dog the hair follicle mite was first
found by Tulk (1844) ; in the horse by Wilson (1844), and Gros (1845) ;
in the cat by Leydig (1859) ; in the pig hy Obermeier and also by Korzil
(1878) ; in cattle by Faxon (1878) ; in goats by Niederhaensern'(1881) ;
and in ra])l)its bv Pfeiffer (1903). Besides these authors, Miescher
(1843), Gruby (1845), Megnin (1877-1892), Csokor (1879) and recently
Gmeiner (1908) have investigated the hair follicle mite; the last men-
tioned author also elucidated the pathogenesis of the complaint.
Occurrence. Acariasis is a frequent and obstinate disease
of dogs ; it appears to be prevalent all over the world and, ac-
cording to Lemke, has hitherto been found to be absent only in
Eskimo dogs. Exceptionally it also occurs in cats ; pigs are at-
tacked somewhat more frequently, but on the whole rarely and
only in certain neighborhoods, but then they fall sick in great
numbers. Isolated cases have also been noticed in cattle, goats,
horses and rabbits, while in sheep these mites cause no skin
changes (Oschaty found acarus mites in the Meibomian glands
of sheep). Acariasis has further been noticed in a Sambu stag,
in a roebuck, also in field mice, in house mice, bats and rats. In
socalled grubs (comedo) of man the mites are also encountered
frequently, but generally occasion no special injury.
Frohner found 2 per cent of acariasis among 70,000 dogs treated in the Berlin
clinic. At the Budapest clinic 2% of the dogs attended proved to be affected.
In the Vienna clinic 10% of all dogs with skin disease are affected with acariasis.
According to Stiles acariasis is not rare in cattle in North America, especially
in the southern districts where very considerable damage is caused, since only
parts of the skin of the attacked animals is suitable for tanning.
In pigs Csokor and Legram & Eegulato saw an epizootic occurrence of the
disease.
Etiology. The hair follicle mite (bulb mite, Acarus s.
Demodex folliculorum) belongs to the order of Acarina, of the
class of Arachnoideae as representative of
the family Dermatophila (Demodicida). Its
body is elongated, lancet-shaped, or like a
laurel leaf; at the thorax the three-jointed
legs are given off immediately behind one
another, on both sides (in the larva three
and in the fully developed animal four
pairs), while these are absent on the long,
conical, cross-striped al)domen, which is ser-
rated at the edges. The lyre or horseshoe-
shaped head is provided with a movable
niorum.' liagni''f.'^''i5o". i-Qstrum, with Upper and lower jaw and also
(After Megnin.) with fcclcrs (Fig. 152). The male is smaller
than the female; the eggs are oval spindle-
shaped, the larvae hatched from the eggs are similar to fully
developed mites, but have only three rudimentary pairs of legs
and attain their full development after three moultings.
Etiology. 969
In the domestic animals the following hair follicle mites occur :
1. Demodex follieulorum (var. canis) ; the head and chest part somewhat
shorter than the abdomen; the male 0.22 to 0.25 mm., the female 0.25 to 0.30 mm.
long; both 0.045 mm. wide; the eggs spindle-shaped 70 to 90 microns long, 25
microns wide. Originator of acariasis in the dog.
2. Demodex phylloides; comparatively broad, laurel-leaf like, the length
of the head and chest part and of the post-abdomen about equal; the male 0.22 mm.
long, 0.057 mm. broad, the female 0.25 to 0.26 mm. long, 0.06 mm. wide; the eggs
oval, constricted at each end (Csokor). Cause of acariasis in the pig.
Besides these one encounters special varieties of mites in the seba-
ceous glands of the other animals.
Of the tenacity of hair sac mites the following may be stated from the
investigations of Brandl & Gmeiner and those of Gmeiner: — In dry air the mites
are capable of living ly^ days at most, while in very moist atmosphere they remain
alive as long as three days, but they are killed in a few seconds by a temperature
of over 41°. They resist the cold of winter for three days at most if the
humidity is high.
Of chemical substances the hair follicle mites are killed immediately by acid,
carbol. liquefactum, bacillol, creolin, cresolum crudum, creosote, liquor cresoli
saponatus, lysol, tar, chloroform, bisulphide of carbon; in about a minute by the
ethereal oils, especially ol. anethi and ol. carvi, further aqua cresolica, creolin,
cresol or tar liniment, 2 to 10% carbolic acid solution; in 2 minutes by tincture
of iodine, formaldehyde-solution; in 3 minutes by salicylic acid in 10% alcohol,
and 1% alcohol eudermol solution; in 6 minutes by Gmeiner 's solution of ol.
carvi with alcohol and castor oil. The mites were killed by Peruvian balsam (pure) ,
in 12, by liquid styrax in 55 and by 1% corrosive sublimate solution in 19 minutes.
The infection occurs undoubtedly in the great majority of
cases by immediate contact of healthy with diseased animals.
Short-haired and young dogs are especially susceptible (among
177 dogs observed by Schindelka to be suffering from acariasis,
141 were short-haired, and only 36 long-haired), which is ac-
counted for by the fact that in short-haired dogs the mites gain
access to the skin more easily, and in young animals they pene-
trate more easily into the orifices of the hair follicles. Certain
skin diseases (eczema, sarcoptic scab) as well as distemper also
increase the susceptibility to a certain degree. In contrast to
the frequency of the eruption, the artificial transmission of the
disease to healthy animals has succeeded only rarely, and at
most a transitory skin affection occurred after rubbing in pus
containing the mites (Haubner, Cornevin) ; only Guinard suc-
ceeded in producing the disease in its typical form in a young
dog. It is not a rare occurrence that some dogs of the same
breed and kept under like conditions are not infected 1)}^ their
companions. For the infection to occur, certain predisposing
circumstances not yet known are evidently of influence.
(Prietscli observed contagion of a billy goat and a deer from a
dog.)
Pathogenesis. The hair follicle mites penetrate through the
orifice of the hair follicle, and subsequently also into the regional
sebaceous glands ; they increase there so that their number in a
hair follicle or sebaceous gland may amount to from 30 to 60
(Friedberger) and even 100 to 200 (Gruby). They occur mostly
in all parts of the hair follicle and sebaceous gland and lie almost
070
Acarus Mange.
'^y^
without exception with their heads directed towards the base
of the cavity (Fig. 153). The constant increase of the mites and
their eggs and larvae cause a sac-like dilatation and lengthening
of the hair follicle and sweat gland, whereby the epithelial layer
of the hair follicle and later on also the hair papilhie are caused
to atrophy. In consequence the hairs will break off in the hair
follicles or become loosened from the papillae. The irritation pro-
duced by the numerous mites further causes a dilatation of the
neighboring blood vessels as well as an increased formation of
epidermal cells, whereupon an accumulation of horny masses
and even of horny balls and horny plugs may occur, and many
of the orifices of the hair follicles are blocked up by them. There
occurs an increased new-formation and desquamation of epi-
dermal cells on the surface of the skin between the openings of
the hair follicles. Later on an invasion of
staphylococci takes place (Staphylococcus
pyogenes albus), probal)ly in consequence
of dilatation and bulging of the hair bulbs,
especially of the hair follicle. These in-
crease on the walls of the hair bulbs and
sebaceous glands, gradually penetrate
downwards and cause an inflammatory pro-
cess in the hair follicles and sweat glands
and in their neighborhood, finally leading to
the formation of small and in some cases
large abscesses ; suppuration of the wall of
the hair follicle or sebaceous gland does
not, however, occur. The formation of
pustules occurs from a secondary infec-
tion with staphylococci, which in its turn
may lead to a general septic infection or
intoxication (Gmeiner).
The further extension of the eruption
on the same animal results from licking
and rubbing, as well as from the fact that
the mites come out of the originally
diseased hair follicles and penetrate into the neighboring
healthy ones, or that the healthy parts of the body of the ani-
mal come in contact with objects previously contaminated by
their pustular contents. The spread of the eruption and still
more the formation of pustules are aided by oft-repeated rub-
bing of the skin with irritant substances, and even by very
often repeated washings. It is peculiar that the disease may
remain limited for a long time to small areas in individual ani-
mals, or that it may assume a pustular character only late or
sometimes not at all.
Fig. 153. Acarus mite in
a hair follicle. Magnif.
150. (After Megnin.)
Symptoms. The symptoms of acariasis differ in part ac-
cording to the breed of the animals, but great variations may
be noticed even in animals of the same breed.
Symptoms.
971
In dogs in which, acariasis is of the greatest practical im-
portance on acconnt of its frequency and severe course, the ill-
ness appears in two principal forms.
The squamous form declares itself as a squamous eczema
which remains limited for a time to small surfaces. On the
orbits and in their neighborhood, further on the elbows or on
single toes, more
rarely on the
body, the hair
falls out in small
patches, and in
this way round-
ed, often sharp-
ly defined pro-
nounced bald
spots (Fig. 154)
arise, reminding
one of alopecia
areata. At these
places the unpig-
mented skin is
somewhat red-
dened and most-
ly covered with
bran-like scales.
Sometimes it is
only bald and
may contain
small nodules.
After a certain
time the skin as-
sumes a bluish
gray color on the
affected spots.
In many cases
the affection be-
gins with round,
red or copper-
colored spots
and scarcely
perceptible scal-
ing. But after a
time these spots
assume a lead gray color (Schindelka
most slight.
In this form the affection may last for months, and it may
even remain unchanged to the end ; it causes scarcely any itch-
ing and exerts no influence on the general condition of the af-
fected animal. But often the pathological changes in the skin
attain a high degree, or the affection occurs from the beginning
in the followingdescribed form.
Fi"-. 154.
Acarus mange in the dog. Falling out of the
hair in sharply circmuseribed patches.
i). Itching is absent or at
972
Acarus Mange.
Ill the pustular form (Fig. 155) liempseed-sized firm
nodules, which subsequently change to pustules, develop in the
swollen and inflamed skin of the regions already mentioned.
Then the neck, the chest and the inner surface of the thighs and
other places are attacked. These often appear peculiarly bluish
red, and reddish pus or a tallow-like thick mass, containing
numerous mites in different stages of development, is evacuated
from them by pressure. The skin is arranged in thick folds
l)etween which it is intensely inflamed and appears covered with
many brown or more gray scabs, as well as with bran-like scales.
The hair falls out over the whole area that is covered with
scales or over the greater part of it (Fig. 155).
Fig. 155. Acariasis in the dog with pustule formation and thickening of the skin.
In this form also the itching is slight, or completely absent.
The surface of the unpigmented skin appears peculiarly copper
red (socalled red mange), the skin of the head a turkey or
warthog color. Through the presence of numerous thick crusts
and folds of skin it presents the appearance of a fissured tree
bark (Fig. 156). If in such cases intense itching is noticed, the
suspicion is aroused that sarcoptic scab is also present (Schin-
delka). In this case the frequent scratching and rubbing visibly
increase the inflammatory process and ulcers may arise in place
of the broken pustules, through which cavities in the subcu-
taneous connective tissue may be reached. At the same time
Plate V. Pustular acariasis in a pug. Pustules and ulcers in the bluish red col-
ored, thickened and prominently folded skin.
Symptoms.
973
the affected parts of the body swell visibly. Then the animal
falls away greatly in condition, gives oft" a very objectionable
smell, and finally dies, completely exhausted, as a result of in-
toxication or general septic infection.
In mauy cases the disease extends over the whole body, the neck appears
covered with bran-like scales, and scattered single pustules may be present, yet
the hair falls out only in isolated circumscribed places and the skin here shows
the appearance of moist eczema.
Horneck found the mites in the secretions from the eyes, ear and prepuce
of dogs affected with acariasis.
In cats the hair follicle mites very rarely cause disturbances.
The head, round about the eyes, nose and ears are spots of
predilection of the disease, which causes similar changes as in
the dog, although at times
they are transitory and
not very pronounced.
Sometimes the hair folli-
cle mites are encountered
in the external ear pas-
sage w i t h o u t h a V i n g
caused any s\anptoms of
disease (Hyrtl, Megnin).
In pigs the disease as-
sumes a similar form to
that in the dog, only that
here the mites live in the
sebaceous glands, and be-
sides purulent vesicles are
formed through coales-
cence of pustules, which
are as large as a hazel-
nut and may contain 1,000
mites; after breaking up
they may lead to ulcer-
ation without any ten-
dency to healing. Now and
then, however, only millet-
sized to lentil-sized com-
edo-like nodules appear in the skin, from which a soft pulpy
mass can be expressed (Knoll). These changes are generally
found on thin-skinned spots (around the snout, cheeks,^ fore-
head, lateral surfaces of the neck and body, lower belly, in the
folds of the stifle, inner surfaces of the thighs), while the back
of the neck, the back and the external surface of the thighs al-
most always remain healthy, even in severe cases. According
to Eieck, isolated pustules not infrequently occur in the folds
of the stifle. In a case described by Miiller the skin of the legs
of a pig had the appearance of pearl beading.
In European cattle acariasis is very rare, but may, in large
herds, attain the form of an enzootic, as the observation of
Fig. 156. Acariasis in the clog. Folds and
thickening of the skin on the head and fore
legs.
[)74: Acarus Mange.
Biigge proves, wlio encountered the disease most frequently in
4 to 8-year-old animals, but sometimes also in younger animals
and only very rarely in older ones. With the exception of a
case in which Gros saw the disease on the muzzle of a cow, the
skin affection usually prefers the body, neck and shoulders
(Old, Grhnm, Biigge) ; it may, however, affect the whole surface
of the body (Biichli). In Biigge 's cases, in which many animals
were affected simultaneously, the hock joint was the central
point of the disease. On the skin one finds nodules of hazelnut
size, conical and closely crowded, hairless, and at times reddish
colored, from which purulent, cheesy masses with very many
mites may be expressed. Biigge also noticed moderate itching,
and in consequence the animals licked the diseased places. While
Old sometimes saw spontaneous healing, in other cases cure did
not always result even after suitable treatment.
In the goat the hair sac mites occasion only quite excep-
tionally pea to hazelnut-sized reddish nodules, occurring prin-
cipally either on the body (Niederhausern, Nocard, Railliet),
or on the head and legs (Bach). Slight itching may also be
present. Healing does not result even after appropriate treat-
ment.
In the horse Gros saw in one case reddening of the skin
around the nose, while Walther noticed in a horse intense itch-
ing on the left side of the root of the tail, and hairless, round
spots as large as a twenty-five-cent piece on wdiicli the swollen
skin was covered with sticky fluid oozing out like drops of sweat.
In Schenzles' cases the disease simulated, on the other hand,
alopecia areata, and started on the head at the bridge of the
nose, around the eyes, on the forehead, nape of the neck and
in the region of the parotid gland, with the occurrence of hair-
less spots as large as a fifty-cent piece, irregular in form and
with poorly defined boundaries. Subsequently the circum-
scril)ed loss of hair extended backwards to the shoulder region,
and finally spread over the whole body, after repeated rubbings
with carbolized glycerine. At this time fine scales appeared on
the otherwise healthy skin. Itching was absent up to the end
of the attack.
Ill rabbits, Pfeififer observed acariasis in China. The affection
began with falling out of hair and scaling around the eyes, whence it
extended to the root of the ear and the external and internal surfaces of
the shells of the ear as well as on to the skull. In the meantime it caused
folds and thickening of the skin, scabs, copious secretion of purulent
material, as well as destruction of eyelids and ears, or it produced a
violent inflammation of the middle and internal ear, and now and then
occasioned even a fatal inflammation of the membranes of the brain;
the eyeballs remained uninjured except for a superficial keratitis. The
acarus mites found in the contents of the hair follicles were much smaller
than those of the dog.
Diagnosis. The pustular form of acariasis produces a
rather characteristic form of the disease in dogs. The often
Diagnosis. Prognosis. 975
peculiar copper-red color appears especially important diag-
nostically, further the thickening of the skin, together with a
marked diminution in elasticity, also the pustules situated in
the depths of the skin, mostly bluish red in color, and itching
which is at most only slight. All these signs enable one to
differentiate the disease easily from primary acne, sarcoptic
scab, distemper, exanthema and from simple eczema. In the
other species of animals relatively large, hairless and reddish
nodules with thick contents awaken a suspicion of acariasis,
yet the disease may be recognized positively only by the micro-
scopic demonstration of the mites.
The squamous form is far more difficult to differentiate
from other affections. Apart from the localization of the dis-
ease or its appearance at the same time on several parts of the
body,^ the best conclusion can be formed by the microscopic
examination of the fluid substance extruded by lateral pressure
on the raised folds of skin, or of the skin scrapings. (Since in such
cases the mites are present in the hair follicles only sparingly,
a single test is not always sufficient.) In this form of acariasis
one must exclude especially circinate ringworm, favus, eczema,
such as that caused on the eyelids through conjunctival catarrh
(distemper), also sarcoptic scab and alopecia. But every fall-
ing out of the hair in the dog without traceable cause must ap-
pear suspicious in this connection. As regards the differential
diagnosis between sarcoptic scab and acariasis one should fur-
ther bear in mind that both skin affections can be present simul-
taneously in the same dog.
Prognosis. In the large animals a spontaneous cure of the
disease appears to be possible, also at times in dogs when the
attack is slight ; Uebele has repeatedly seen spontaneous healing
in spite of extensive acariasis, and this is said to be the rule in
the diffuse affection in young terriers, which is called distemper
rash ])y breeders. On the other hand permanent healing can,
in case of extensive eruption, be secured only rarely, even by
proper treatment, and sometimes even when the disease is not
very extensive, because the mites live deep under the surface
of the skin and therefore it is difficult to destroy them with
parasiticides, and besides secondary infection with staphylococci
has often already occurred. As a matter of fact, not infre-
quently dogs that are apparently cured suffer renewed attacks
after weeks or months. At times, however, complete cure or a
marked improvement is noticed without any treatment.
In pustular acariasis of carnivora the prognosis is un-
favorable; it therefore appears most expedient to kill such ani-
mals. A much more favorable opinion may be given in the
squamous form where the complaint is limited to a small area,
yet even here one should always reckon with the possibility of
a further extension, and therefore be cautious in giving a prog-
nosis, all the more so as even quite trivial and apparently slight
976 Acarus Mange.
cases, and still more those that are further advanced, require
treatment continued for weeks or months. Other things being
equal, the prognosis is always more unfavorable in young de-
bilitated dogs than in older ones. According to Sdiindelka,
many more dogs may be cured by exercising sufficient patience
and perseverance than is usually assumed (of 177 cases 50 were
cured).
Treatment. First of all the hair should be clipped and,
according to the extension of the disease, this should be done
either over the diseased areas and their neighborhood, or pref-
erably over the whole body; then, and also later, it appears
absolutely necessary to split all nodules or pustules with a
pointed knife and to remove their contents. In this way one
gets rid of many mites, especially if a bath in a 5% solution of
liver of sulphur is administered each time. The pressing out of
fresh pustules and subsequent bathing is advisable also in the
treatment of the later stages, and so is the emplojmient of
periodical fomentations and rubbings with soap liniment, salicy-
lated alcohol or salicylic oil, 10% lysol vasoliniment, in order
to cause loosening of the skin and detachment of the horny
plugs in the hair follicles.
Of the parasiticides the most suitable of all are non-
irritant substances, since by their use there is the least danger
of causing an extension of the disease or of the squamous erup-
tion becoming pustular; particularly the employment of tar
cresol preparations and corrosive sublimate easily occasion
a spread of the process. The remedies should be applied with-
out force, but nevertheless thoroughly, with a soft brush, with
the hand or a pad of cotton wool. Very frequent washings may
also be harmful. The selection of remedies is influenced by the
species of animal and by the form and extension of the disease,
and also by the condition of the patient. During long continued
treatment a change of the anti-parasitic remedies not infre-
quently becomes necessary.
Peruvian balsam is well adapted for mild cases and pro-
duces favorable effects, especially if mixed with alcohol.
Siedamgrotzky produced a cure with this preparation in a
severe case, but others saw no particularly good results in such
cases in spite of long continued treatment. The high price of
the drug limits its employment to mild cases of disease ; on the
other hand it can scarcely be dispensed with in acariasis local-
ized on the head. In circumscribed disease eudermol is of good
service (Fettick) in the form of 1% ointment, but it is also ex-
pensive; in many cases a brief depression becomes manifest
after the application. Salicylated oil (1 part salicylic acid dis-
solved in 30 to 40 parts of warm oil), creolin or ichthyol (with
alcohol aa), corrosive sublimate ointment (1:100) or carbolic
ointment (1:10) at times give good results. The application
of these remedies must be repeated several times at intervals
Treatment, 977
of a few clays (see page 957). Of good service in the squamous
form is caraway oil, which is recommended by Gmeiner (ol.
carvi and alcohol aa 10 gm. ol. ricini 150 gm.) with which the
diseased parts should be rubbed energetically once or twice
daily with the fingers ; a sulphur bath is given once every week.
According to Brandl & Gmeiner, liquor cresoli saponatus is
the most effective remedy, but the authors cannot confirm this.
Schindelka obtained healing repeatedly with bisulphide of
carbon (sulfuretum carbonicum s. carboneum sulfuretum).
After the skin is prepared properly, pads of bisulphide are
pressed upon the affected spots for several minutes, and then
a paste of formalin (formaldehyde 1 to 3, vaseline 50, zinc
oxide and powdered starch aa 25) is applied to the carefully
dried skin. This treatment repeated three to five times at in-
tervals of 3 to 4 days is said to accomplish its object as a rule.
In cases where the skin is much thickened Schindelka uses a
shaking mixture of carbon bisulphide, flowers of sulphur and
powdered neutral soap (7:1:2). The carbon bisulphide makes
the skin tender, and its use necessitates great caution on ac-
count of the danger from fire. Uebele found the effect of this
treatment uncertain. Instead of carl)on bisulphide less poison-
ous and non-inflammable vitran (with Peruvian balsam aa)
may be used, especially if the disease is limited.
Of other methods of treatment the following deserve to be
mentioned: The method of Brusasco in which the animal is
bathed in liver of sulphur solution (200 gm. of potassium sul-
phuratum in 70 liters of water) ; on the following day a third
of the body is dressed energetically with a diluted ointment of
cantharides (1:6 parts of lard) and on the sixth day the animal
is bathed again in liver of sulphur solution. After an interval
of 3 to 4 days the treatment is repeated until cure results. Meg-
nin also recommends sulphureted potash baths daily during
the first month ; during the second month every 2 or 3 days for
the space of a quarter of an hour; the same author proposed
also a mixture of 100 gm. of flowers of sulphur, 200 gm. of un-
slaked lime and one liter of water, to be rubbed into the affected
skin with a sponge. Lesbre bathes the diseased animals in liver
of sulphur solution, then washes it several times a day with
lukeAvarm cresol emulsion, finally dressing the diseased places
with the following ointment: 20 gm. of naphthol, 0.25 gm. of
corrosive sublimate and 100 gm. of lanoline. Cadeac paints the
previously scarified skin mth tincture of iodine, while Dupas
treats acariasis with 96% alcohol in a similar way as Schin-
delka with carbon bisulphide. On the contrary Altmann often
saw definite cure result from repeated applications of petro-
leum (in extensive disease only half the body may be
treated at one time). Nicolas treats the affected animals with
injections of a 2 to 2i/o% carbolic acid solution into the depths
of the skin (not under the skin), both in the region of the affec-
tion and also in the neighborhood; the good effect of this treat-
Vol. 2—62
978 Other Mites in the Domestic Animals.
iiient in local acariasis was iiotod several times by the authors,
Moiissu t'ound Tessier's mange bath (see page 953) effective
in cases of acariasis which were not very extensive; the ani-
mals are rubbed for 2 or 3 minutes with brushes while in the
bath and kept from licking- their bodies; cure resulted after a
month. Roth recommends operative treatment in cases of cir-
cumscribed disease, which consists in cutting the epidermal
layer horizontally with a sharp knife until drops of blood ap-
pear, the animal being narcotized; the places are then disin-
fected, and powdered with xerof orm ; a bandage is applied and
renewed after two days ; healing occurs after 5 or 6 days. Eber
has also seen favorable results from this procedure. In septi-
cemic symptoms Uel)ele saw surprising results from collargol
clysters (0.5:50 parts of lukewarm physiological salt solution).
In all cases the treatment is to be continued long enougli
until no fresh nodules or pustules arise and the skin regains its
healthy appearance. During the whole duration of the treat-
ment the animal nnist be nourished intensively, the stal)le must
be kept clean, and care must be taken that the treated parts of
the body are not licked. The affected animals must be sepa-
rated from the healthy ones, and after their recovery kept under
observation for a month ; on the appearance of suspicious signs
immediate treatment must l)e undertaken. Acariasis of the
other animal species may be treated in the manner recom-
mended for sarcoptic scab. Schenzle was successful in a horse
affected with general squamous acariasis with caraway oil solu-
tion (according to Gmeiner) while in Walther's cases a pro-
tracted treatment with a mixture of tar. glycerine and alcohol
was necessary.
Considering^ the all too frequent failure of the treatment, Frohner and Schin-
delka consider that acariasis of the dog should lie included in those diseases which
are under legal supervision.
Literature. Altmann, B. t. W., 1907, 41.— Brandl & Gmeiner, W. f. Tk.,
1900, 37.— Biigge, B. t. W., 1900, 522.— Cadeac, J. vet., 1906, 80.— Csokor, O. V.,
1879, LI, 132.— Dupas, Bull., 1906, 457.— Fettick, Z. f. Tm., 1901, V, 291.— Galtier,
Eev. gen., 1907, TX, 22.— Gmeiner, Z. f. Tm., 1909, XTTT (complete Lit.).— ' M ,<>
Fig. 157. Dermanyssus avium. Female, on the left from the back, on the right from
the abdominal side; in the middle an egg. Magnif. 75. (After Megnin.)
2. Laminosioptes cysticola. (Sarcoptes cysticola.) It is
a minute parasite with longish body, eight legs, and two long
bristles on the hind end of the Ijod}^ The parasites live on the
skin of fowls, turkeys, pheasants, etc., and chiefly in the sub-
cutaneous cellular tissue of old animals, where they develop
millet-sized nodules which later on become chalky. If they are
limited to the surface of the skin only, desquamation is pro-
duced. They cause the animal to fall away in condition if they
are present in very large numbers.
3. Dermanyssus avium. (Fowl mite.) It is yellowish white,
blood red if gorged with blood, readily visible to the naked eye,
with four pairs of legs at the thorax (Fig. 157). It lodges by
day in the crevices of fowl houses or stables, in cages and the
980 Other Mites in the Domestic Animals.
nests of the hens or other hirds, Avliilo at night it wanders onto
the body of the bird (fowls, tnrkeys, pigeons, geese, cage birds,
pheasants) where it sueks the blood, and disturbs the peace of
the animals. Sometimes, however, the mites also gain access
to the bodies of the birds in daj^time, especially into the ear
passage, and exceptionally one iinds them in great number all
over the body. They are very tenacious of life and may remain
alive for several months without nourishment; according to
Megnin, their eggs will resist a temperature of 120° C.
Fowl mites cause anemia, cachexia, loss of feathers by the
unrest and abstraction of l)lood which they .produce, and pre-
judice the production of eggs in the hens. Not infrequently
birds die completely exhausted. Now and then the mites settle
also in the nostrils and in the external ear passages, when the
birds run about as if wild and swing their heads about (Klee).
Fig. 158. Leptus autumnalifi. On the left, from the ahdominal side; on the rijjht,
(gorged) from the hack. (After Megnin.)
In such cases the animals die after a short illness. Otto saw
mites occur in immense numbers in 3^oung hens where not only
the whole bod}^ but also the larynx and trachea were affected.
From fowls they may also pass to mammalia (cattle, horses,
dogs, cats) especially in stables where chickens are kept. They
cause very severe itching as well as skin rashes. Even
man may now and then be attacked by the mites. They may
also penetrate the external ear passage of cattle, and if tliey
are there in great numl)er they cause restlessness and attacks
of dizziness. According to Trouessart and Freund the last men-
tioned cases are Railletia auris, which was designated as Garaa-
sus auris by Leydy and others.
Literature. Freund, Zool. Jahrb., 1910, XXTX, 31.3 (Lit.).— Goodall, Vet.
Eec., 1006, 251.— Klee, D. t. W., 1901, ,-?.— Miilnns, S. B., 18S0, 7.S.— Otto, S. B.,
1908, 4.5.— Tronessart, C. E., 1902, 806.
4. Leptus autumnalis. (Autumn grass mite.) It is the
larvae of Trombidium holosericeum (Fig. 158) and lives free in
Leptus Autunmalis. Argas Reflexus. 981
the fields and shrubs; its oval mite-like body is furnished with
three pairs of legs. It occurs in fowls in the summer and
autumn, in the region of the roots of the feathers. Although
the parasite only remains on the body of the animal for a few
days, it causes the formation of little red pustules, and also
itching, which is so intense that fowls, especially young birds,
may have epileptiform spasms and die in a few days. More
rarely the parasites cause little red nodules and pustules upon
which reddish colored mites are found; the eruption may occur
especially on the head, the inner surfaces of the thighs, the
lower chest and abdomen, also in the region of the genital organs,
and at times over the whole body (Roth, Liel)ert) ; later on bald
spots develop, accompanied usually by moderate itching. (The
assertion of Roth that dogs are frequently infested with Leptus
autumnalis, is only true of certain localities.)
In horses the parasite at times causes an inflammatory
eczematous condition.
Literature. Liebert, D. t. W., 1909, 501.— Eoth, W. f. Tk., 1906, 341 (Lit.)-
5. Argas reflexus. (A. marginatus, mussel-shaped seam
tick.) An ovoid parasite 6 mm. long, blackish colored in the
middle, at the edges yellowish (Fig. 159), which is prevalent all
over Europe and extremely tenacious of life, being able to live
and even to multiply from 14 to 24
months without sucking blood in the in-
terval (Railliet, Grhiliani). It lives in
the day in the crevices of pigeon cotes,
but at night wanders onto the body of
the pigeon and sucks blood. It attacks
young birds especially, which may die
after 8 to 15 days in consequence of un-
rest and loss of blood. Its larvfB also
remain on the body of the birds for a
long time, or do not leave them at all.
At times chickens, ducks and geese are ^^'^s- ^^^- -J-'i/"^^ reflexus.
attacked. It may even infest the body ""''^'"''^ 'UTryT' '^^^""
of persons attending pigeons and causes
painful bite wounds as well as edematous swelling on the skin.
The parasite transmits the spirochaetosis of fowls in Bulgaria
and on the Island of Cyprus.
The Argas persicus occurs in Persia and also in Tunis, and is the
intermediary of the spirochetosis of chickens. The birds are affected by
this mite in the same manner as by the A. reflexus. According to Carr6,
ite larva live very frequently on chickens in Persia. After a slight in-
vasion the parasite is found almost exclusively on the inside of the thighs
and wings, whence it passes on to the sides of the body. After an inten-
sive invasion one finds it all over, except in the region of the eye, and
then they form mulberry-shaped groups, giving the appearance as if
982 Other Mites in the Domestic Animals.
shot were imbedded under the skin. If no treatment is undertaken the
birds die in large numbers.
Literature. Carre, Bull., 1909, 172.— GalliA'alerio, Cbl. f. Bak., 1909, L,
(Orig.). 189.
6. Varieties of Trombidium. Of these the following occur in birds:
Harpirhynchus nidulans, which lives in the feather bulbs or in nodules and in
little cysts of the skin, and may generally be found there in large numbers.
Syringophilus bipeetinatus, which is parasitic on chickens and pigeons, and
Syringophilus uncinatus which lives on peacocks; it lodges within the quills of the
feathers; the feathers become lusterless and stunted, the quills lose their transparency
and contain in the center a yellowish gray dust-like mass, in which very many mites
are visible under the microscope; the affected feathers finally fall out.
Analges varieties or feather mites are similar to mange mites, and live in the
plumage of the feathers as well as the quills, exceptionally also in the subcutaneous
connective tissue; they are either quite harmless or cause hardening of the feathers,
and at times emaciation of the birds. They cause changes in the feathers similar
to those brought about by the syringophilus varieties.
Treatment. For the purpose of removing parasites from
the bodies of the birds sufficient sand or a mixture of sand and
ash must be provided in order that the birds can bathe in it at
will (to the sand ash mixture 2 to 57o of flowers of sulphur
may be added or finely powdered aniseed or parsley seed).
Besides, the bodies of the birds may be sprinkled freely with
remedies which have an intense odor and an anti-parasitic
action. Peruvian balsam and styrax (in 20 to 30 parts of
alcohol), also fennel, aniseed or rosemary oil (diluted with
20 to 50 parts of water or oil, especially for small birds) are
appropriate for this purpose. Finally insufflation of flowers
of sulphur or pyrethrum powder between the feathers may be
recommended, the bases of the feathers being previously
smeared with a little soap in order that the powder may adhere
better and the insect powder act more energetically. The
autumn grass mite has been removed by Liebert by means of
bathing the animals once with 1% lysol solution. According
to Carre the larvjie of Argas persicus are easily removed by
painting with oil of turpentine or kerosene.
Since the enumerated ectoparasites mostly exist outside
of the animal body in chicken houses, cages, pigeon cotes, etc.,
and many only attack the birds at night, a thorough cleaning and
disinfection of the abodes and removal of coops and birds' nests
from the cow l)arns and horse stables are necessary for the de-
struction of the mites. The walls are scraped, the wooden parts
planed and washed with hot water or hot sodium lye, or are
scorched. After all crevices in the walls haye been stopped up
or done away with, the walls are lime-washed with milk of lime,
calcium chloride, or a mixture of lime and creolin, and lime
is sprinkled on the floor of the barn. The development of chlo-
rine or formalin vapors may also be considered. Bird cages are
best scalded, but in case of necessity they must be burnt. It is
also well to wrap the ends of the perches with tarred tow; paint
hollow roosts with anti-parasitic fluid; supply the roosts in
"' Parasitic Insects. Hemijitera s. Rhynchota. 983
cages with reeds into which the mites creep in the daytime, when
they can be destroyed.
24. Insects Parasitic on the Domestic Animals.
Of the class of insects belonging to the Hexapoda, several
species of the orders of Rhynchota, Hemiptera, Diptera, and
Aplianiptera as well as Hymenoptera are known to cause
more or less severe disease. Their injurious influence is exerted
in various ways. By creeping around on the surface of the skin
they irritate and hinder the animals from eating, especially on
pasture, and in weakly individuals this may now and then liave
serious consequences. Some insects nourish themselves on the
sweat or blood of their hosts, others inoculate acrid substances
into the skin or into the mucous membranes of the natural open-
ings of the body, causing acute edematous swellings, which
sometimes materially interfere with eating and breathing, but
at times produce severe general s5T:nptoms of poisoning. At the
bitten or stung spot deep seated changes may occur in the skin
or subcutaneous connective tissue, such as pustules, hemor-
rhages, abscesses, etc., which, on account of the itching usually
present, lead to traumatic artificial eczemas with the well known
results. The larvae of some varieties establish themselves on
raw surfaces, in the skin, and in the subcutaneous connective
tissue, or in the body cavities, occasion persistent and even se-
vere tissue changes, and in this way may cause the death of the
animals. Finally, certain varieties may bring al)out the spread
of infectious diseases by inoculating bacteria or protozoa adher-
ing to their bodies into the skin wounds.
In the following pages these parasites will be discussed
briefly, while detailed descriptions will be left to zoological
works.
A. Hemiptera s. Rhynchota.
(a) Lice. (Pediculida.) Parasites generally occurring in
badly nourished or cachectic animals, the females of which glue
their pear-shaped eggs (nits) to the hairs. They suck blood,
cause itching and, when present in great number, lead to a
further decline in condition. They may multiply immensely,
especially in young cattle during the long stabling in winter,
from neglect of skin hygiene, and now and then cause extensive
eczema. In Germany lice occur more frequently in military
horses, especially in the eastern provinces where much oppor-
tunity for contagion from civilian horses is present (Wohler).
In the domestic animals several varieties of blood sucking lice (Haematopinus)
occvir; thus in the horse Haematophinus s. Pediculus equi s. macroeephalus (Fig.
160), in cattle the H. eurysternus and the H. tenuirostris, in calves the H. vituli,
in goats the H. stenopsis, in dogs the H. piliferus, in pigs the H. suis s. urius. The
Hseniatopinus suis is the largest existing louse, its length reaching 4.5 mm.; very
984
Parasitic Insects.
young pigs in which lice are numerous on the skin may die as a result of unrest and
disturbance of sucking (Sequens saw 40 head die out of 140; sarcoptic scab might,
however, have also been present at the same time).
( b ) Hair Insects and Feather Insects. ( Mallophaga. ) These
are parasites similar to the preceding ones; they do not suck
blood, but eat epidermal scales with
their pincer-shaped jaws and gnaw
through the fine hair. The females
also glue their eggs to the hairs.
They are mostly parasites on the
head, neck and legs of animals, and
cause itching and perhaps also
eczematous inflammation of the
skin.
The varieties occurring in the domestic
animals are: Trichodectes pilosus in horses,
Tr. scalaris in cattle (Fig. 161), Tr. climax in
goats, Tr. sphaerocephalus in sheep (some-
times when present in great numbers they
produce itching, causing the animals to rub
their bodies vigorously and gnaw them; the
wool falls out and the affection may then be
mistaken for scab) ; Tr. latus in dogs, lastly
Tr. subrostratus in cats.
The number of feather insects occur-
ring in domestic birds is very large. They
disturb the rest of the animal and cause
loss of condition when present in large
They comprise (according to Ziirn) :
Fig. 160. Haematopinus equi.
Magnif. about 25. (After Kitt.)
numbers.
In chickens: Goniocotes hologaster, G. dissimilis, Lipeurus variabilis, L.
heterographus, Menopon pallidum.
In ducks: Doeophorus icterodes.
In geese: Doeophorus adustus, Lipeurus jejunus, Trinotus conspurcatum, Tr.
squalidum.
In pigeons: Goniocotes compar, Lipeurus bacillus, Colpocephalum turbinatum.
In turkeys: Goniodes stylifer, Lipeurus polytrapezius, Menopon stramineum.
In peacocks: Goniocotes rectangulatus, Goniodes falciformus, Menopon
phaenostomum.
(c) Bedbug. (Acantha lectularia.) These pass at times
on to birds, fowls and pigeons which are kept in rooms or near
to dwelling houses (Lucet).
Treatment. Lice and hair parasites are killed by various
anti-parasitic remedies and removed from the body of the ani-
mal. According to the experimental investigations of Biihler
creolin liniment (creolin and soft soap, of each 1 part, alcohol
7 parts) ranks first of all on account of its astounding effect as
well as its cheapness and slight toxicity; the liniment is rubbed
into one-third of the body at a time, and after the third day a
bath in i/o to 1% liver of sulphur solution is given. In severe
invasion the process must be repeated 2 or 3 times. Cresol or
tar liniment is also very effective, but less innocuous, as is also
carbolic acid solution (5%) ; the somewhat more effective Peru-
vian balsam is comparatively expensive. Washing with 2 to
Hemiptera s. Rhynchota.
985
3% creolin, lysol, cresol or bacillol solutions has a good effect
in every variety of animal but must be repeated several times.
Gross recommends for horses a 6%, others a 10 to 15% creolin
emulsion, while Schindelka always had good results with a 0.2%
creolin solution, which made the employ-
ment of other measures superflous. Two
per cent solutions probably answer best,
but must be employed repeatedly. Gray
mercury ointment, which is not particular-
ly reliable, may also be employed in mild
cases ; a piece about the size of a hazelnut
may, in the case of horses, be placed on
the inner surface of the harness, in cattle
between the horns, in dogs half the quan-
tity on the inner surface of the collar, but
in all animals it is most properly rulDbed
on the diseased parts of the skin. On ac-
count of the danger of mercury poisoning
the employment of mercurial ointment
must be avoided if several animals in a
stable, particularly young ones, must be
treated. Widespread louse infection is not
removed by partial applications of mer-
cury ointment. Frohner obtained very
rapid results by cautious washing with a
1% corrosive sublimate solution. With
tobacco decoction (1:20-25) which is also
effective, the body should be washed only in
sections where there is general disease in horses and cattle, in
order not to run any danger from nicotine poisoning. In dairy
barns where preparations containing tar or cresol cannot be
used, because their smell is taken up by the milk, Schindelka rec-
ommends washing with decoction of wormwood or of chrysan-
themum inodorum; decoction of stavesacre (sem. staphisagriae
5:100) may also be employed, but according to Biihler the effect
of this drug is not very reliable. The same is true for the Per-
sian insect powder (flores pyrethri) and other insect powders
which exert a parasiticidal effect only after previous moisten-
ing of the animals or if applied in form of a paste; they are
applicable chiefly in small sucking animals and birds. Petro-
leum with linseed or rape oil also kills the parasites, but in fine-
skinned animals it sometimes causes dermatitis. Good effects
are also produced by ethereal oils (1:10 alcohol or water),
and by benzene w^ater. Fatty oils or fats have been used suc-
cessfully.
The socalled vinegar of arsenic (arsenic and potash of each 15 parts, vinegar
and water of each 1500 parts) suggested by Viborg and Schleg exerts a prompt
effect but is dangerous, especially in extensive disease, and therefore is to be
avoided.
Fig. 161. Trichodectes
scalaris (on a hair).
Magnif. about 25. (After
Kitt.)
98C Parasitic Insects.
Two or three repetitions of the treatment after 3 to -4 days
appear to be indicated in order to destroy the parasites as they
hatch from the eggs. By washing with vinegar the eggshells
will be dissolved and the embryos killed. Clipping the hair ma-
terially facilitates the destrnction of the parasites; in horses,
however, it should (according to Wohler) be undertaken only if
numerous parasites are present, since the soaked hair prolongs
the effect of the anti-parasitic remedy. In winter the treatment
of a large herd of horses may have to be omitted, the measures
being directed only to the prevention of a further spread of the
parasites by treating and isolating the manifestly affected
horses.
Against feather mites the parasiticides may be employed,
which have previously been recommended as suitable for birds
(see page 982). Careful cleanliness and skin hygiene aiford the
most effective protectives against lice and similar parasites in
general, and play an important part in the treatment. If the
atfection obtains a considerable extension, disinfection of tlie
barns and of any objects with which the affected animals come
in contact is indicated.
Literature. Biihler, Expenii. inul klin. T'nters. iiber Wert mid Wirkinig <1.
Kreolinliniiiientes, Diss. Giessen, 1909 (Lit.)-— Wohler, Z. f. Vk., 1906, 219.
B. Diptera. (Flies.)
(a) Long antennaed (Nematocera). These are small in-
sects whose larvae develop in water, damp earth or shady places ;
in the mature condition they feed on plant juices, but the females
of some varieties also attack domestic animals and suck blood.
Of the gnats the following are noteworthy:
The stinging gnat (Culex pipiens) prefers the skin of man,
])ut now and then also stings animals and produces painful
swellings on them.
The sand flies (Simulia') are much more important in this
respect. The Simulia reptans and the Simulia cinerea cause
inflammation on the thin hairless parts of the skin of the horse,
for instance on the inner surface of the thigh, on the internal
upper surface of the ear, which only heals gradually and with
desquamation. The Simulia reptans appears at times in great
swarms and causes fatal results. Thus in May of 1881, in 10
townships of an Upper Hungarian county, 37 head of cattle and
4 horses died as a result of their ])ites. In Sweden (Schonen
province) gnats occur especially in hot summers and attack cat-
tle, horses, and also sheep. The Simulia ornata may also occur
in similar swarms (in one instance out of 170 cattle that were
stung, 27 died), and, according to Dammann & Oppermann, may
transmit the infection of hemorrhagic septicemia in deer and
cattle. According to Wigand one observes severe circulatory
disturbances and falling of temjjerature in animals poisoned by
Dipt era. 987
gnat stings ; also edematous swellings always on the alKloHiinal
portions of the body where the skin shows round spots similar
to flea stings.
The treatment and prophylaxis are similar to those used
against the Columbac's fl}^
Columbacs fly (Simu'lia maculata s. Columbaesensis), 3 to
4 mm. long, posterior ash-gray, on the sides and underneath
colored yellow, 3 black stripes on the back, with black spots on
the abdomen.
The female lays her eggs at the end of May and beginning of June in tlie
wooded regions of the lower Danube in the water of the mountain brooks; they
take the form of slimy masses, from which the larvae are hatched in 2 to 3 weeks.
AVith a clinging apparatus situated at the hind end of the body these adhere to
stones and plants in the water, until after several moultings pupte emerge which
remain torpid during the winter, but the following year, towards the end of the
month of April they emerge as fully developed gnats (Tomosvary).
The Columbacs fly owes its name to the fact that in certain years it increases
enormously in the neighborhood of the Servian fortress of Columbac on the lower
Danube, and from here spreads in great swarms, and for long distances. As a rule
several swarms follow each other, the first about the middle of April, the second the
beginning of May, the third al)out the middle of May; the last swarm which con-
sists of the last hatching, occasions only little injury. They occur in great numbers
mostly in the warm spring after a mild winter, while torrential rain, great droughts
and severe spring frosts considerably interfere with their development. The swarms
collect before sunrise and follow the direction of the wind, leaving tlie Danube pass
above Bazias and are then driven by the wind in different directions (Tomos-
vary). They appear at times in immense numbers in southern Hungary, especially
in the counties of Torontal, Temes and Krasso-Szorcny, also Arad, Csanad and
Hunyad, in Servia, the swarms form dark clouds and may cause a very large num-
ber of fatalities especially among cattle, but also among horses and other domestic
animals. In such years the swarms sometimes go further north to Austria and
Germany, but seldom cause death in these countries.
In the County of Temes, .52 horses, 131 cattle, 316 sheep and about 100 swine
died in the year 1783, while in the year 1830 several hundred horses and cattle
perished. In the year 1813, 200 head of cattle in Arad, and in Versecz 500 head
were killed by the" gnats. In the year 1880, 400 pigs, 80 horses and 40 cattle died
in Kubin within 4 hours, and in the county of Hunyad about 100 cattle, 5 horses
and 80 pigs. Great swarms were last noticed in the years 1888, 1889, 1895. In
the year 1895 in the county of Hunyad alone from May 21 to May 31, 6 horses, 274
head of cattle, 53 sheep, 66 goats and 92 pigs died and the loss amongst wild stock
was also considerable. In the southern parts of the county the gnats cause more
or less considerable losses every year.
On the approach of the swarms the animals become rest-
less and seek refuge in the stables or in the water. The attack
on animals that are kept in the open occurs by immense numbers
of gnats, the females preferably injuring the regions of the
mouth, nose, eyes, genital organs and rectum with unnumbered
stings; through the natural openings they also penetrate into
the interior of the body and attack especially the mucous mem-
brane of the throat and larynx. At the seat of each sting a
small painful swelling develops, from the coalescence of which
extensive tumefaction occurs; those around the nasal openings
and pharynx interfere with the breathing, and as a result death
may occur in 5 to 24 hours. In the production of the fatal re-
sult there is no doubt that the poison inoculated by the flies
plays a part. In a few cases the swellings disappear after 2 to
3 weeks ; for some days the animals eat badly or not at all, and
'988 Parasitic Insects.
therefore they become weak and their temperature rises.
Kemeny noticed blindness and a bounding heart beat in 2 horses ;
the blindness persisted later on. (The gnats also attack the
skin of man, especially that of women and children, and infants
may die as a result of the stings.)
The postmortem examination of dead animals shows an
edematous infiltration of the subcutaneous or submucous con-
nective tissue at the spots corresponding to the swellings, and
the sting punctures on the skin or mucous membrane may be
recognized as bright red points. Now and then one finds dead
gnats in nose, larynx and trachea. The autopsy findings indi-
cate death by suffocation ; the spleen is often acutely swollen.
Apart from housing the animals in dark places, the treat-
ment consists in cold compresses or general spongings, also in
rub-downs with ammonia, acetate of lead or alcohol; besides
carbolized or salicylated oil (10%) or a mixture of lime water
and oil may render good service. In case of heart weakness
cardiac remedies may be used. Wigand administers i/o to li^
liters of brandy at one^dose, or 14 to y^ a liter at intervals of
1 to 2 hours until improvement has occurred.
Since a radical extermination of the gnats or even a limi-
tation of their numbers appears impossible, the safest prophy-
lactic measure consists in housing the animals in dark stables
at the time of the appearance of the swarms (from April 20 to
10-15 of June) and only letting them out to pasture at night.
If it is necessary to give the animals their freedom during the
day then it is advisable to produce thick clouds of smoke by
burning manure or damp weeds, and thus to ward off the gnats
from the herd (the production of smoke is also advisable in
front of the stable door). Besides, working animals may be
smeared on the thin-skinned parts of the body, e. g., around the
natural openings, with any stinking mixture, such as inspissated
tobacco decoction to which fat and petroleum may be added
(Schonbauer), also with assafetida, tar, naphthalin or iodoform,
etc.
(b) Short Antennaed Flies (Brachycera). Mostly large
insects, with three short antennas consisting of three joints.
The following families are parasitic on the domestic animals
and suck the blood:
a. Gadflies (Tabanida) ; large flies living in woods and
on pastures, which attack large animals on hot summer days,
penetrate their skin, suck their blood and thus harass them;
after they have left the animal a drop of blood oozes to the
surface of the skin from the punctured spot.
Among the numerous varieties the cattle gadfly (Tabaniis bovinus) a fly 27
mm. long is most frequent, and principally annoys cattle; similar flies are the
T. autumnalis, T. morio, T. tropicus, the T. lineola and others.
Haematopotae; narrow, longish flies with white-dotted wings; their chief
representative is the rain gadfly (Haematopota pluvialis) which harasses the animals
on the approach of stormy weather.
Diptera. 989
The blinding gadfly (Chrysops coecutiens) is a fly 9 mm. long with broad
spreading wings and sharply defined abdomen; it flies especially about the head of
the animals, and occasionally causes inflammation of the eyes and ears.
h. Flies (Muscida) in the restricted sense. Most insects
belonging to tliis class merely annoy the animals and hinder
them from eating at pastnre or they cause waste of food. Some
of their representatives also cause considerable disturbance of
health.
In inhabited places the house fly (Musca domsstica) is frequent everywhere;
it occurs in large numbers in stables and in the brushwood about meadows; other
flies are the M. corvina which sucks the sweat, the M. vomitoria (vomiting fly),
the M. cada,verina which is parasitic on dead animal bodies, the Sarcophaga carnaria
(meat fly) and the Sarcophaga magnifica, the female of which deposits its larvae,
that are born alive, on wounds and swellings as well as in the ears, and in the
vagina of female animals. In a case observed in a goat by Wirth the larvae of the
Sarcophaga magnifica were found in a necrotic patch of the vagina; fever was also
present.
The larvfc of Lucilia caesar and L. sericata, which belong to
this class, produce the fly larvae disease of lambs; this is
prevalent especially in Holland and New Zealand. The larvae
of these species of flies are hatched from the eggs that have
been deposited in the perineal region of lambs suffering from
diarrhea. They cause violent itching, wander from here to the
root of the tail and to the sacral region, where they riddle the
skin and produce an inflammation which still more exhausts the
weakened animals. According to Gilruth the larvae at times
pass through the abdominal wall into the abdominal cavity.
The fly larva disease was observed by Graber in Grermany (Pr.
Mt., 1877, 78, 82) and by Jordal in Norway (Norsk Vet.—
Tidskr., 1905, 121).
In America the larvae of Lucilia macellaria establish them-
selves on wounds, whose healing process they disturb, and even
wander into the nasal cavities. According to Jerwolajew (B.
t. W., 1905, 676, Rev.) the '' Welfare fly" in Russia deposits its
eggs on wounds on sheep and cattle, where the liberated larvae
destroy the tissues, and at times this destruction extends so
deeply in the umbilical region as to produce hernia.
The treatment consists in removing the larvae of the flies
with forceps, applications of 5% carbolic acid or creolin solu-
tion, in painting with 5% carbolated oil, or in the introduction
of creolin suppositories (creolin 1 part and cacao butter 20
parts). The removal of flies from the stables is attempted by
establishing conditions unfavorable to their life (sharp draughts,
partial exclusion of daylight, fly nets, etc.), by mechanical de-
struction of flies and their broods and by keeping off the flies
from animals in the open (by blankets, etc., by substances hav-
ing an objectionable smell).
The stinging fly (Stomoxys calcitrans), belonging to the same family,
takes up its al)ode in stables and may be recognized because it rests on
the walls with the head directed downwards ; it attacks the feet of horses,
990 Parasitic Insects.
causing the aiiiiiials to kick and staiiii). Tlic naciaatol)ia species are
much smaller and found especially out in the pastures ( Ilaematobia
stimulans, H. ferox, etc.) ; they disturb animals when grazing.
The tempest fly (Hydrophobia s. Anthomyia) is a small fly which,
on the approach of rain, flies in great numbers around the eyes and noses
of cattle. The tsetse fly (Glossina morsitans) resides in the swampj^
regions of Africa and transmit the trvpanosomes of Nagana bv its bite
(Vol.1).
c. Bot Flies (Q^strida). These large flies pass tbrougn
one period of their development in the bodies of animals as larvae,
consisting of 12 segments, and here canse more or less severe
disease, according as they localize in the cavities of the facial
bones, in the stomach, intestines or in the snbcntaneons connec-
tive tissue. The completely developed larvse leave the body of
the host and change in the earth to barrel-shaped pnpte. The
female of the gadfly developing from these pnpa) harasses the
larger animals on warm snmmer days.
The CEstrus (Hypoderma bovis) is a black fly, 13 to 14 mm.
long, wdth gray head and brownish narrow wings wdiicli stand
out from the body. It swarms at the beginning of simnner and
into the autumn, more especially from June to September, but
produces no harassing buzzing and does not disturb the ani-
mal, nor does it cause them to be stampeded, as many assume.
This stampede is much rather caused by other insects, prin-
cipally by Tabanidae (Ostertag, Strose, Hoffmann).
The development of the oestrus is not yet knoAvn in all its details,
although many investigators have occupied themselves with its study
(Brauer, Hinrichsen, Ruser, Koorevaar, Hoffmann, Ostertag, Jost,
Strose). The pairing of the flies takes place on high mountain tops,
sunny rocks, towers and other high lying places. Nothing definite is
knoMTi of the manner in which the eggs are deposited. Since hitherto
no eggs of the oestrus have been found on the animal host, the first
assumption would be that the female deposits her eggs on grass, and
that later the eggs themselves or their larva? are swallowed by the cattle
when grazing (Hinrichsen). But on the other hand it may easily be
possi])le that the a^strus deposits its eggs on the l)odies of cattle, where
the eggs cannot be found, being hidden in the depths of hair or because
the larvte, which are transparent and therefore not readily recognized,
are hatched in a very short time.
The penetration of the embryos into the bodies of cattle probably
takes place in great part or exclusively by the digestive canal in such
a manner that either the eggs or the larva^ of the fly are swallowed by
the animal, or according to Ostertag, the larva^ reach the cavity of the
mouth by active wandering. Strose on the contrary considers it possible
that some of the larvte penetrate through the skin into the subcutis, their
powerful chitinous mouth apparatus rendering them quite capable of
doing this.
For the correctness of the last named assumption it may he stated that wander-
ing larvae only rarely are found on the way between the esophagus and the sub-
cutis, further that the youngest larvae in the subcutis correspond morphologically to
the esophageal larvae and that larvae are often found simultaneously under the skin
Diptera.
991
aiKl in tlie esophaf^us in the like stage of ilevelopmeut. in favor of tliis view obs^er-
vation sliows fiirtlier tliat tliin-isliinned young cattle more frequently carry llv bites
than other cattle, that in man the uncovered parts of the skin mostly form the
dwelling places of the larvae, and finally that Brauer has observed the penetration
of the larva? of CEstromyia satyrus into the skin of guinea pigs and rabbits. The
circumstance that in autumn and at the beginning of winter larvie have not yet
been found under the skin might be because the discovery of the small and trans-
parent larva} in the subcutaneous cellular tissue presents insuperable diflSculties.
The wandering of the larvae takes place
variously according to their mode of penetration
into the body. The swallowed larv^ bore
through the mucous membrane of the esophagus
and pharynx, and are found in great number in
the submucous connective tissue of the gullet
from the months of July to November. Thence
they wander along the blood vessels and nerves
in the direction of the spinal column, and even
pass through tlie openings lietween the vertebrje
into the spinal canal, and mostly remain there
in the dural fatty tissue, from the month of
December to March ; from January to July they
get nito the subcutaneous connective "tissue
which they may do without first entering the spinal canal. The
larva?, which accidentally bore through the skin a short time after the
eggs are deposited, penetrate into the subcutis at the point of their
deposition without any wandering about. After two moultings and
therefore three stages of development have been gone through, they
emerge from the swellings which they have produced, become pupa3 in
the ground in the course of 12 to 36 hours, and the fully developed
insect appears after about 30 days.
Fig. 162. Larva of Hij-
poderma hoc is, on the
left from the back (con-
cave), on the right from
underneath (convex).
Natural size.
Fig. 163. Bites of oestrus in the loin region of an o\„
Experiments of transmission with oestrus larvie have been carried out chiefly
Ijy Koorevaar, who placed larvse obtained from the spinal canal of slaughtered
cattle under the skin of a dog and a goat. In 14 days the dog was killed, and all
the larvae introduced were found to be alive, some in the subcutaneous connective
tissue, some between the muscles, in the abdominal cavity, in the wall of the pharynx,
outside of the trachea, and in the fatty tissue of the vertebral canal. In a goat
swellings were visible in the subcutis after 12 days. Similar experiments by Euser
and Jost with esoi)hageal larva3 were negative, but in two experiments by Strose
on a calf the results were positive; the introduced esophageal larvte became quite
mature in 3 to 10 weeks and were found in the subcutaneous tissue.
992 Parasitic Insects.
Tlie occurrence of the (jestriis fly is limited to certain locali-
ties. Usually one finds the i\y from Scandinavia to Southern
Europe ; further it is prevalent over Asia, Africa, North Amer-
ica and Australia (Strose). But the local prevalence of the
oostrus depends essentially on external circumstances. Thus
the fly plague is observed exclusively in those regions where
the cattle are out day and night from the beginning of spring
on, or are driven there in the morning hours. On the contrary
those regions remain free from the pest where no pasturing is
done or where the grazing only begins in autumn, or where
the cattle are driven out to pasture only in the midday hours
(as in many localities of South Germany). Factors that are as
yet unknown, perhaps climatic or certain conditions of soil
also appear to be of influence, for only in this manner can the
observation be explained that certain neighborhoods are avoided
by the flies, although imported cattle infested with oestrus swell-
ings remain on the pastures during the whole summer. On the
other hand the spread of the fly by cattle with oestrus swellings
cannot be denied in all cases (Strose),
In Germany warbles are most frequently met with in Eastern Prussia, in some
districts of Western Prussia and in the province of Posen, in a considerable part of
Pomerania, Brandenburg and Altmark, in the greater part of Sclileswig-Holstein,
in the whole of East Friesland, Oldenburg, in several districts of Westphalia and
of the Ehine country.
The oestrus larvae living in the subcutaneous connective
tissue produce nodules which may become as large as walnuts
and in which they lie imbedded in pus. In the skin the swelling
gradually increases in size and shows an opening which is at
first about the size of a pin's head, but later on 4 to 7 mm. broad
and circular. This is produced l)y the boring movements of the
larva, which in its second stage of evolution is already provided
with a breathing apparatus, and on that account requires air.
From the opening at first a sero-purulent secretion issues, which
mats the hair in the neighborhood. At a later stage the black-
looking hind end of the larva is close beneath the opening and
the larva itself may be expressed from the swelling. It is 22
to 27 mm. long, up to 15 mm. thick and according to its develop-
ment white, gray, or grayish black. The formation of the swell-
ings begins at times as early as in the month of January, gen-
erally, however, in the months of February and March, and
exceptionally later. They disappear a few weeks after the
emerging of" the larvae, from the end of April to the beginning
of June, and leave no trace behind them. Isolated warbles can,
however, be noticed in the month of July in any neighborhood
where pasturing begins late. Now and then the larva? die under
the skin, or after tlie exit of the larva the cavity of the nodule
is filled with granulation tissue in which lime salts may be de-
posited, and in this way hard nodes persist in the skin (Cas-
parini).
I
Diptera. 993
The exit of the larvae mostly occurs in the early morning
hours but also at night, and more rarely at midday and in the
afternoon. The assertion of some authors that the exit of the
larvae occurs exclusively in the early hours of the morning is,
according to Strose, not true in all cases. This peculiar be-
havior of the larvae is apparently due to the fact that strong-
pressure is exerted on the warbles on lying down and getting
up, and subsequent stretching of the muscular tissue on the
back of the cattle (Strose).
The larvae of other oestrus flies cause lumps similar to those of tHe
Hypoderma bovis. Thus in cattle, especially in South Russia, on the
Balkan peninsula, in Italy and in Norway, are found the larvae of
Hypoderma lineata. The warble fly of Australia also presumably belongs
here. The larvae of H. actaeon live under the skin in red deer, those of
Hypoderma diana in the roebuck. On the other hand one finds the
larvae of Hypoderma bovis also in warbles of horses and asses. Rips saw
warbles, usually along the back, in about 20% of the animals of a large
transport of horses ; they were found only on damp parts at certain
places of the skin. The animals often stretched themselves, they had
a cramped gait and edematous swelling of the anterior limbs on account
of simultaneous serous inflammation of the connective tissue under the
shoulder blade. [Only the Hypoderma lineata occurs in the United
States. — Trans.]
In man warbles occur under the skin, especially in Central America, Mexico,
and in a large portion of South Africa, only exceptionally in Europe, more par-
ticularly in Scandinavia. They belong to the hypoderma species which are parasitic
in animals, and are chiefly found on uncovered parts of the body.
The importance of warbles depends wholly upon their num-
ber. They generally exercise no prejudicial effect on the state
of health of the animal, but if present in great numbers (50
to 120) they cause emaciation and a diminution in the ability
to work and in the milk supply. Some young cattle even die or
become affected with extensive skin edema. A much greater
importance attaches to the larvae in every case through the
depreciation of the. skin and the flesh, since the skin of the in-
fested animals is either perforated or, after the exit of the
larvae, it contains little cicatrices, and thus its value will be
diminished in proportion to the holes or scars, the more so as
these changes are mostly met with in the most valuable part of
the skin, namely that of the back, loins and croup.
The injury aaused through the depreciation of the skin and flesh is calculated
in Germany to be at least $1,500,000 to $2,000,000 annually, in England up to
$40,000,000 (Ostertag, Strose), and in Ireland up to $2,500,000 (Miiller). The
lessened value of the skin of each head of cattle affected with warbles is put
by Strose as at least $1 to $1.50. The diminished value of the flesh of a beef is
calculated by Kiilman at $7.50 to $10.00. In Australia also the larvae seem to
occasion considerable injury, and there the disease is notifiable.
With reference to the considerable economic injury the
extermination of warble flies deserves full consideration. In
neighborhoods where driving the cattle to pasture cannot be
99-i Parasitic Insects.
avoided, especially in the moniiiiii: hours, tlie warble plague
may be combatted l)y a systeinatic destruction of the maggots.
This prophylactic measure, must, however, evidently be carried
out bj'- concerted efforts in affected regions.
The right time for conuneneing the det^tnietion of the larvae is from the end
of April to the beginning of May, shortly before pasturing begins. At this time
the larvae are not so far develojted that they can crawl out from the swellings,
but most warble lumps already have an opening through which the larvse may
be removed. The procedure in getting rid of the larvaj is as follows: If the
pressing out of the larvte with the fingers cannot be accomplished, then they must
be pulled out with small, narrow forceps, or one punctures the end of the larva
lying near the hole with a crochet needle, whereupon the contents of the body of
the larva flows out, and the swelling may be evacuated by strong pressure with the
fingers. Larvge which cannot be removed even then may he left in the lumps where
they die and gradually suppurate out without usually disturbing the general health
of the animal. Exceptionally, however, a phlegmonous inflammation may develop
here, or more frequently a nettlerash arises some hours after the evacuation of
the warble lump. For the purpose of puncturing and pulling out the larva one
may employ a needle supplied with a small barb (after the nature of the crochet
needle). The dilatation of the opening of the warble lump with a knife should
only be undertaken by a veterinary surgeon. The last named procedure has now
and then been followed by very distressing phlegmons (Schmidt). During pasturing,
up to about July 1 the animals should be examined about every 14 days for newly
arising warble lumps, and any larvae present must be removed at the same time.
The removal of the larva^ is done in the stable or yard if possible.
Closing of the openings of the swellings with heavy oil or tar and the use
of ointments only kill a part of the larvae; the procedure is therefore not suitable
for combatting the pests. But the effect of removing the larvae is supported by
suitable care of birds which destroy the larvae and the warble flies; such birds are
the starling, jackdaw, hoopoo, thrush, red-start, wagtail and titmouse (Strose).
In Denmark some communities engage persons specially for the purpose of
removing the larvae. These examine the herds in their care from 4 to 6 times in
spring and early summer, and if warbles are present destroy the larvje with small
steel pincers. In Germany the procedure is also customary in various parts of the
country and in the Grand Duchy of Oldenburg the intention is to enforce its practice
by law.
The larvae of other hot flies reside within the body, for instance the
larvaB of CEstrus ovis in sheep in the cavities of the facial bones (see
page 21), the larvge of Gastrophilus equi, especially in the stomach
of the horse (see page 452), the larvae of Gastrophilus peconnn, G.
hfemorrhoidalis and of G. nasalis, also in the stomach or duodenum of
the horse (the larva? of G. pecorum also in cattle), (see page 453). The
flies annoy the large domestic animals only when laying their eggs.
According to Railliet the larva? of Ochromyia anthropophaga live
under the skin of the dog, and cause lentil-seized and painful nodules on
the tail, on the ears and the feet.
Literature. Jost, Ilypoderma bovis, Diss. Leipzig, 1907 (Lit.). — Ostertag,
Z. f. Flhg., 1906, XVI, 407.— Eips, Z. f. Vk., 1909, 138.— Strose, Arb. d. G.-A.,
1910, XXXIV, 41 (Lit.).— Villemoes, Z. f. Flhyg., 1906, XIV, 226.
(c) Pupipara. The Hippobosca equina occurs frequently,
and is a brown fly 8 mm. long, with yellow head, three yellow
points on the breast, and longish rounded wings. It annoys
horses in summer, and exceptionally also cattle and dogs, by
settling in the region of the rectum and vagina, as well as on
the thin skin on the inner surface of the thighs.
To this class also belongs the Melophagus ovinus (sheep
Fleas. Hymen optera. 995
tick, sheep louse iiy), a wingless insect similar to a louse, that
lives between the wool, nourishing' itself on the sweat, on the
wool fibers, and the blood of its host, and molesting the animal
by causing itching. , The sheep tick harbors in its body the
Critidia melophagea, a protozoon similar to the trvpanosome,
which has been discovered in the Pathological Anatomical In-
stitute in Budapest, but its transition into "the blood of the ani-
mal host has not been observed. To get rid of melophagi the
same procedure should be adopted as with lice, namely dipping
in tobacco decoction, decoction of walnut leaves in vinegar, solu-
tions of assafetida (2:100) or the use of weak creolin solutions.
Friedberger & Frohner recommended applications of gray mer-
cury ointment (3 to 4 gm.) along the back and below the neck.
Shearing also helps materially in getting rid of the parasite.
The purification of the stables and subsequent whitewashing
with chloride of lime is essential ; crevices in the walls especially
should be thoroughly cleansed and filled up.
C. Fleas. Aphaniptera.
Fleas occur in dogs, cats and rabbits, also in chickens and
pigeons, and the flea which is parasitic on man, Puplex irritans,
may infest the bodies of the domestic animals. The fleas also
which reside outside the animal body, especially in the dust
and clefts of the ground, settle on young and feeble animals,
not rarely in very large numbers and cause intense itching
which may lead to the development of severe dermatitis.
Their removal is best effected by diligent care of the skin
and by occasional baths. In severe cases the same treatment is
indicated as with lice (see page 983).
In America and Africa there lives a far more dangerous
flea, viz., Pulex s. Sarcopsylla penetrans, which by its bite may
cause violent inflammation with subsequent ulceration and
necrosis of the skin in men and animals.
D. Hymenoptera. (Hautfliigler.)
(a) Bee (Apis mellifica). In the neighborhood of bee-
hives animals are at times attacked by ])ees when these are
swarming, and they may cause death by their stings. At the
points of the stings the skin or mucous membrane swells, and
dyspnea may occur owing to the swelling of the nasal mucosa
and also symptoms of collapse, diarrhea, further hemoglobi-
nemia and jaundice (Albrecht).
Literature. Albrecht, W. f. Tk., 1892, 241.— Funfstiick, S. B 1S8.5 75 —
Ganter, B. Mt., 1905, 10.— Hable, O. Vj., 1892, N. F. IV, 96.— Jaenow, Z f Vk
1898, 22. ' fi J
(b) Bumble-bee (Bombus terrestris). This at times at-
tacks horses and cattle if the nests of the insects are rooted up
996 Parasitic Thread Worms in tlie Skin.
by the plough (Bissaiige). The symptoms are similar to those
of bee stings (B. Kovacs saw sjTiiptoms similar to those of
hydrophobia in a dog [Vet., 1895, 361]).
25. Parasitic Thread Worms in the Skin.
The thread worms which are parasitic in the skin and sub-
cutaneous connective tissue of mammalia belong to the family
of Filaria. Of this class the following varieties are known :
1. Filaria hemorrhagica. A fine, thread-like worm which
shows transverse striae on its white body, while its head end is
covered with a round papilla-like prominence ; the male 28 mm.,
the female 40 to 70 mm. long. The course of evolution is un-
known.
In its mature state the parasite lodges in the subcutaneous
and intermuscular connective tissue of horses of oriental de-
scent (Hungarian, Russian, Tartaric) and causes frequent
cutaneous hemorrhages in spring and summer, the socalled
summer hemorrhage (Drouilly, Trasbot, Megnin, v. Ratz and
others).
The exuding blood lifts the skin or the epidermis in the
form of a lentil or hazelnut-sized nodule, which bursts in 1 to 2
hours, whereupon blood exudes for a time from the fine open-
ing thus formed ; after a while, however, the bleeding ceases and
the slight wound heals. The nodules form as a rule in great
number and close together, but only in the warm time of the
year. The disease may recur annually in the same horse for
3 or 4 years, but afterwards disappears completely.
Unless severe anemia is caused through the hemorrhage
(Bruncwic, Liautard), the health of the animals is not affected.
The complaint is chiefly annoying, because the exuding blood
soils the skin and harness. The treatment consequently con-
sists only in frequent washing and cleaning of the skin, and
besides it appears advisable to protect the bleeding region from
chafing by the harness wherever possible.
Literature. Condamine & Drouilly, Eec, 1878, 1144. — Eailliet, Zool. med.,
1895, 507.— Eailliet & Moussn, C. E., 1892, 545.— v. Eatz, Vet., 1898, .393.
2. Filaria irritans. The silver white cylindrical larva, 2
to 3 mm. long, of an hitherto unknown thread worm (Rivolta,
Laulanie). According to Roger it may be the larva of OxAT^iris
equi (see page 487). It resides in the subcutaneous connective
tissue of horses and causes a skin disease described by the name
of dermatitis granulosa s. pruriginosa s. verminosa C Summer
sores" [French]). These are noticed exclusively in horses
in the summer, and manifest themselves by the formation of
little nodules in the skin, where it comes in contact with the
harness, and on the legs, also not infrequently on other
parts of the body, and even in the conjunctiva of the eyes
Filaria Irritans. 997
(Queraud) ; from these nodules ulcers arise, the walls and
edges of which are covered with brownish red granulations.
Between these, millet-sized to hempseed-sized, yellow, cheesy
or calcified foci may be found, each one of which harbors the
filarial larva, the white color of which forms a distinct contrast.
The granulating ulcers show a great tendency to further
spread and obstinately resist every treatment; this is due in
part to the continued rubbing from intense itching. The ulcers
generally heal towards the end of the summer, but recur in the
following years when the warm weather comes.
A similar complaint (socalled caloris), was observed by
Schindelka in military horses in Hungary, particularly^ in the
neighborhood of Kecskemet and Debreczen. Gero & Moharos
have recently described it under the name of ^'calore sores."
The last named disease, which appears chiefly to attack stud
horses, begins with the appearance of circular swellings, chiefly
on the body, but now and then also on the limbs, from the sur-
face of which a sticky fluid exudes. This dries, becomes parch-
ment-like and is cast off after 6 to 8 days, whereupon malignant
and gradually increasing ulcers form. The process only rarely
extends deeply and then may lead to septic infection and death.
With the onset of cold weather ulcers which have previously
resisted all treatment heal spontaneously. (Two cases of this
disease have been observed by Marek, but no parasites could
he detected in the ulcers, which already commenced to heal.)
For treatment Eey recommends applications of sulphide
of arsenic in a thin layer, whereupon a dry scab, about 1 cm.
thick, forms on the surface, which falls off after 8 to 10 days
and healing then generally occurs in a short time. Blaise
treats the granulating surface with ether, chloroform or iodo-
form at intervals of 1 to 2 days, and by this procedure produced
a cure within a fortnight. Vanuta recommends the use of the
red-hot iron, while Darrou saw favorable results from the in-
jection of a 2% sterile solution of potassium permanganate at
several places in the region of the wounds (1.0 cc. in 4 or 5
places). Lienaux employed an arsenic paste (acid, arsenic,
pulv. sabinse aa, gummi arab. aqua dest. q. s.). Queraud found
painting with picric acid solution, and also (in the treatment of
conjunctival ulcers) copper sulphate very effective. In the so-
called calore sores, in the cases of the authors, a mixture of
1% picric acid solution and glycerine has answered well.
Literature. De Does, Holl Z. f. Niederl. Tndieii, 1006, 303.— Gero & Moharos,
A. L., 1906, 493.— Hnguier, Bull., 1904, 469.— Lienaux, Ann., 1907. 137.— Queraud,
J. v6t. 1907, 621.— Roger, Eev. vet. 1907, 6 (Lit.).— Schindler, O. M., 1903, 49.
As Dermatosis aestivalis buccarum Ablaire describes a peculiar skin
disease of the horse which occurs very frequently in the valley of the
Meuse, hut is also known in Saiimur and Algeria, and also in Africa
under the name of "eczema zebre." After a transitory edematous
998 Parasitic Thread Worms in the Skin.
swelling has developed, the hair of the submaxillary region becomes
bristly and matted by dried droplets of serum. Soon the hair falls out,
and narrow whitish stripes arise on the skin running in bow shape,
and covered with scales ; they itch intensely, and change into ' ' summer
sores" as a result of rubbing. Disinfectant fomentations and applica-
tions of zinc oxide and camphor ointment proved effective.
While Ablaire assumes nocturnal parasites as a cause of the disease,
Langiny believes it to be due to fly stings ; Diudonne, Cadiot & Railliet
refer it to the presence of oestrus larvae. (The creeping about of the
larvae of Gastrophilus nasalis was noticed in the skin of man in Russia.)
Nicolas & Cazenave, however, consider the complaint to be a superficial
inflammation of the lymphatic vessels in the skin which progresses
centrally, vet Petit saw no signs of a Ivmphangitis in such cases under
the microscope. Ablaire, Bull, 1905, 538.— Langiny, Bull., 1908, 279.—
Nicolas & Cazenave, ibid., 1908, 287.
3. Filaria immitis. The embryos of this worm live in the
blood of dogs (see A^ol. I), while the sexually mature worm
occurs in the right half of the heart and in the blood vessels, also
in the subcutaneous and intermuscular connective tissue, and
either free or enclosed in cysts which one can feel under the skin
(v. Ratz found them in great number in the subcutaneous and
intermuscular connective tissue of three young Italian grey-
hounds).
4. Filaria bancrofti. This thin worm which may attain a
length of 50 cm. lives in tropical regions under the skin of man
in the IjTiiph vessels, and causes a very great thickening of the
legs (elephantiasis Arabuni), while its embryos circulate in the
blood in large number. Its larvae live in crustacese of fresh
water (Cyclops), they are taken up with these in the drinking
water, and are set free in the stomach after digestion of the
crustaceae. In the same regions the worm is also encountered
under the skin of cattle, horses and clogs, and several worms
may frequently be met with at the same time (Plot, Railliet).
Rivolta, later Siedamgrotzky, Schneider and Kiinnemann each found
in a case of circumscribed inflammation of the skin of a dog a lively
moving thread-like worm in the contents of pustules examined under the
microscope, which probably belong to the Anguillulides and had gained
access to the skin of the animal while lying on infested places.
In deer Kless found the Filaria flexuosa (Fil. terebra) which gives
rise to the formation of nodules in the subcutaneous connective tissue;
isolated nodules of this kind were visible on the skin as bluish and
Avhite elevations.
Literature. Cinotti, N. Ere, 1906, 466.— Kless, Z. f. Flhyg., 1908, XVII,
116.— Kiinnemann, D. t. W., 1905, 269.— Schneider, O. M., 1894, 337.— Siedam-
grotzkv, S. B., 1883, 19.
Index, Vol. II.
Abdominal pulsation
Abortion, infectious, Vol. 1 . . . .
Abscess in the brain
Abscess in the esophagus
Abscess in the liver
Abscess in the spinal canal . . .
Acanthia
Acanthoeephala
Acanthosis nigricans
Acariasis
Acarus, eruption caused by . . .
Acarus, f aringe
Acarus, f olliculoruni
A.carus, scabies
Achorion gallinarum
Achorion keratophagus
Achorion Schonleinii
A^chorion, varieties of
Acne
Acne bacillus
Acne contluens
Acne contagiosa
Acne disseminata
Acne indurata
Acne punctata
Acne simplex
Acne vulgaris
Actinobacillosis, Vol. I
Actinomycosis, Vol. I. . .
Actinomycosis of the brain . . .
Actinomycosis of the esophagus
Actmomycosis of the intestines.
Actinomycosis of the larynx . . .
Actmomycosis of the liver
Actinomycosis of the nasal mem-
branes
Actinomycosis of the peritoneum
Actinomycosis of the stomach . . .
Actinomycosis of the throat. . . .
Actinomycosis of the vertebrte. .
Adenocarcinoma of the intes-
tines
Adenocarcinoma of the liver . . .
Adenocarcinoma of the lungs. . .
Adenocarcinoma of the stomach
Adenoma of the intestines
Adenoma of the liver
Adenoma of the lungs
PAGE
794
740
633
231
526
706
984
475
897
967
967
PAGE
Adenoma of the stomach 316
Aegagropili 275
Aggiutmation, Vol. 1..5S7, 721, 747
Aggressins, Vol. I
30, 84, 96, 136, 382
Albinism 726
Albuminuria, Vol. 1 977
Alimentary canal, paresis of... 265
Allantiasis 357
Allergy, Vol. 1 574, 708, 747
Allorriiythmia 112
183 j Allotriophagia, Vol. I ' 963
968 Alopecia adnata 833
967 Alopecia areata 835
925 ^Vlopecia furfuracea 837
924 Alopecia pityroides 837
917 Alopecia seborrhoica 837
918 Alopecia symptomatica 834
887 Ameba meleagridis 505
893 Amebic dysenteiy 349 •
889 Amphistoma of the brain ...... 673
893 Amphistoma Collinsi 474
889 Amphistoma tuberculatum .... 474
890 Amputation neuroma 714
892 Amyloid degeneration 515
887 Amyloid induration 515
887 Amyloid kidney, Vol. 1 987
666 Amyloid liver 515
642 Amyloid reaction 516
657 Amyloidosis hepatis 515
240 Analgia 982
388 Anaphylaxis 843
52 Anaplasmosis, Vol. 1 783
542 Ancbylostomiasis 482
Anehylostomvun bovis 485
20 I Anchylostonnun duodenale 483
581 I Anchvlostomum radiatum 485
316 Anemia, Vol. 1 845
217 Anemia cerebri 622
705 Anemic necrosis of the intestines 399
Aneurism, Vol. 1 1109
388 Angina 39, 206
543 Angma diphtheritica. Vol. I . . . 419
159 Angina membranacea 46
316 Angioma of the brain 657
388 Angioma of the liver 541
543 Angioma of the nasal cavities.. 20
160 I Angioma of the peritoneum . . . 581
999
1000
Index.
PAGE
Angiiillula stercoralis 495
Anoplocephala mainillana 465
Anoploeephala perloliata 405
Anoplocephala plicata 4G5
Anthomyia 990
Anthi-ax, Vol. 1 1
Anxiety psychoses 802
Aphaniptera 995
Aphonia 52
Aphtha, epizootic, Vol. 1 32S
Aphtha, sporadic 187
Apis mellifica 995
Apoplexy, cerebral 628
Apoplexy, nervous 623
Apoplexy, spinal 689
Area Celsi. 833
Argas marginatus 981
Argas persicus 981
Argas reflexus 981
Argas, see also Vol. 1 840
Arsenical dips 952
Arteritis, Vol. 1 1104, 1111
ArteiT, celiac, occlusion of 411
Arthritis urica, Vol. 1 968
Articular rheumatism 804
Artificial feeding 123
Ascariasis 475
Ascariadae in the intestines .... 475
Ascaxiadae in the liver 559
Ascaris columbas 481
Ascaris erassa 481
Ascaris lumbricoides 475
Ascaris marginata 476
Ascaris megalocephala 475
Ascaris mystax 476
Ascaris ovis 475
Ascaris suilla 475
Ascaris vituli 475
Ascites adiposus 565
Ascites chylifonnis 565
Ascites ehylosus 565
Aspergillus 1 42, 356
Aspergillus in birds 356
Aspergillus fumigatus 3, 142
Aspergillus glaucus 142
Aspergillus niger . 142
Aspergillus nigreseens 142
Asthma, bronchial 65
Asthma, dyspeptic ()5
Asthma, nasal 4
Asthma, nervous 65
Asthma, si^asmodic 65
Ataxia 591
Ataxia, cerebellar 592
Ataxia, cortical 591
Ataxia, locomotor, progressive.. 702
Ataxia, periiDheral 591
Ataxia, spinal 591
Atelectasis 57
^PAGE
Atony of rumen, reticulum and
omasum 265
Atony of rumen in young calves 270
Atrichia " 833
Atrophy, yellow of liver.. 522
Atrophy, pancreatic 562
Atrophy, senile 94
Atropin 97
Aura epileptica 769
Auto mutilation 694
Bacillus acnes 893
Bacillus Aerti-yck 357
Bacillus bipolaris septicus 133
Bacillus botulinus 357
Bacillus bovis morbificans 357
Bacillus bronchiolitidis vituli... 135
Bacillus coli communis, Vol. I
146, VoL II 135, 199
Bacillus dysenteriae 349
Bacillus enteritidis 350
Bacillus necroiDhorus 47, 199
Bacillus nodulif aciens bovis,
Vol. I 640, Vol. II 532
Bacillus perfringens 805
Bacillus pneumoniae felis 105
Bacillus pneumoniae tigris 105
Bacillus proteus 357
Bacillus pyocyaneus, Vol. I 151,
Vol. II' 135
Bacillus pyogenes. Vol. I 146,
Vol. II.. 126 135
Bacillus salivarius sej^ticus 199
Bacillus septicaemiae anserum,
Vol. I 100, Vol. II 127
Backsteinblatteni, Vol. I 67,
Vol. II 841
Bacterium astheniae 342
Bacterium lymphaticum aeroge-
nes ."^. . 582
Bacterium subtile agiiorum .... 198
Balbiaua 244, 827
Banti's disease 533
Barlow's disease, Vol. 1 949
Basedow's disease 798
Bees 995
Beri- Beri-like disease in fowls. . 755
Bezoar 275
Bile coloring matter in the ui-ine 507
Biting flies 994
Black-head 504
Black- water fever. Vol. 1 764
Blenorrhea, nasal 5
Bloating, acute, of ruminants.. 262
Bloating, chronic, of ruminants. 262
Blood, diseases of, Vol. 1 845
Blood parasites, Vol. 1 760, 902
Blood stroke 628
Blood sweating 832
Bombus terrestris 995
Index.
1001
PAGE
BoSbyx processionalis 183, 197
Boophilus bovis, Vol. I 768,
Vol. II 979
Bonia disease (306, 638
Borna streptococcus 609
Bot flies 990
Botliriocephalus conlatus 469
Bothriocephalus felis 472
Botliriocephalus f uscus 469
Bothriocephalus latus 469
Bothriocephalus IdUiiicoUis 473
Botryomycosis, Vol. 1 672
Bots, of stomach 452
Bottom disease 530
Botulism 357
Botulism toxin 357
Brachycera 988
Brain, anemia of 622
Brain, contusion of 623
Brain, diseases of 584
Brain, hemorrhage of 628
Brain, hyperemia of 618
Brain, hyiieremia of active 619
Brain, hyperemia of passive.... 619
Bram, inflammation of acute... 632
Bram, inflammation of chronic. 644
Bram, inflammation of purulent 633
Brain injuries 623
Brain parasites 660
Bronchial asthma 65
Bronchial catarrh 54
Bronchial catarrh of birds 63
Bronchial croup 62
Bronchial diseases 54
Bronchiectasis 57
Bronchiolitis 56
Bronchitis, capillary 56
Bronchitis, catarrhal 54
Bronchitis, croupous 62
Bronchitis, diy 57
Bronchitis, putrid 57
Bronchitis, sclerotic 59, 155
Bronchitis, verminous 66
Broncho-pneumonia 125
Broncho-pneumonia, enzootic of
young: animals • 133
Broncho-pneumonia, fibroplastic 155
Broncho-pneumonia, infectious,
of lambs 133
Broncho-pneumonia, pseudotu-
bercular ^3
Broncho-pneumonia, purulent, of
geese 1-^ ^
Broncho-pneumonia, verminous. . 66
Broncho-pneumonia, verminous
diffuse • • • • ^^
Broncho-pneumonia, verminous
lobar ■ • • ■ ~^
Broncho-pneumonia, verminous
lobular ^3
PAGE
Broncho-stenosis 64
Brush on the toimiu- 184
Buckle .' 709
Buckwheat eruption 873
Bulbar paralysis 673
Bulbar paralysis, acute 673
Bulbar paralysis, infectious .... 674
Bulbar paralysis, progressive . . 674
Bumblebees 995
Cachexia, aqueous 545
Cachexia, strumiprivi 799
Cadaverin 349
Calving fever 778
Calvities 832
Cancer of the liver 539
Carcinoma of the brain 657
Carcinoma hepatis 539
Carcinoma of the intestines.... 388
Carcinoma of the larynx 52
Carcinoma of the liver 539
Carcinoma of the lungs 159
Carcmoma of the nasal cavities 20
Caremoma of the peritoneum . . 581
Carcinoma of the stomach 316
Carcmoma of the throat 217
Catalepsy 791
Catarrhal fever malig.. Vol. I.. 408
Catarrhus antri Highmori 30
Catarrhus bronchialis 54
Catarrhus intestinalis acutus. . . . 325
Catarrhus intestinalis chronicus. 340
Catarrhus laryngis 39
Catarrhus narium 3
Catarrhus sacci aerophori 36
Catarrhus sinus frontalis 34
Catarrhus venti-iculi acutus 285
Catarrhus ventriculi chronicus. . 292
Cauda equina, compression of.. 754
Cauda equina, inflannnation of. . 750
Cella infraorbitalis, inflannna-
tion of 34
Cement cough 133
Cephalomyia ovis 22
Cephalomyia rufibarbis 22
Cephalomyia stimulator 22
Cephalomyia trompe 22
Cephalomyia Ulrichii 22
Cercaria 547
Cercomonas hepaticum 560
Cerebro-spinal meningitis 606
Cestodes, see Tfenia 464
Cetonia aurata 495
Cheiracanthus hispidus 461
Chemotherapy, Vol. 1 802
Cheyne-Stoke's disease 585
Chlamydozoa, Vol. I
290, 296, 425, 466, 751
Cholangioitis chron. fibrosa petri-
ficans 550
1002
Index.
Cholangioitis cliron. liyperplas-
tiea 550
Cholelithiasis 510
Cholera of fowls, Vol. 1 87
Cholera of swine, Vol. 1 257
Cholesteatoma of the brain 657
Cholesteatoma of the spinal cord 705
Cholin 349
Chorea 792
Chorea of young- animals 793
Chorioptes 933
Chi-ysops coecutiens 989
Circulate ring■^vorm 899
Cirrhosis hepatis 530
Cirrhosis hepatis annularis .... 534
Cirrhosis hepatis atrophica .... 530
Cirrhosis hepatis hyperplastica. 530
Cirrhosis pulmonum 153
Clover disease 875
Coccidiosis hepatis 559
Coecidiosis intestinalis 497
Coccidiosis intestinalis avium . . 502
Coccidiosis intestinalis bovum . . 497
Coccidiosis intestinalis canum . . 502
Coecidiosis mtestinalis caprarum 501
Coccidiosis intesthialis ovum . . . 501
Coccidium Arloingi 501
Coccidium avium 503
Coccidium bigeininum 502
Coccidium Faurei 501
Coccidium f uscum 927
Coccidium nudum 929
Coccidium ovif orme 559
Coccidium perforans 502
Coccidium Pf eifferi 503
Coccidium tenellum 503
Coccidium tnineatum 503
Coccidium Zurni 497
Coenurosis 660
Coenurus cerebralis 660
Coenurus cerebralis in spinal
canal 705
Colic, catarrhal 337
Colic, distension 364
Colic, false 447
Colic, flatulent 358
Colic, habitual 310. 370, 407
Colic, impaction 364
Colic, periodic .310, 370, 407
Colic, rheumatic 337
Colic, symjDtomatic 447
Colic, thrombo-embolic 393
Colic, wind 358
Colpocephalum 984
Coma 584
Coma puerperal 778
Comb, white 924
Combustio 879
Comedo 892
Commotio cerebri 623
PAGE
Commotio medullas spuialis 685
Complement tlxation. Vol. I . . . .
147, 717, 747
Complement flxation in echino-
coccosis 158
Compressio medulloe spinalis. . . . 702
Compressio oesophagi 231
Concrementa sacci aerophori . . . . 36
Confusion, mental 800
Congestion, intestinal 337, 393
Constitution, psycopathic 803
Contusion, cerebral 623
Contusion, niedulo spinal 685
Convulsion, i^uerperal 775
Coordination system 588
Coprolith 312
Coprostasis 364
Corpora alieni reticuli, rumhiis
et omasi 274
Corpora alieni ventriculi 274
Coryza 3
Coiyza of birds 8
Coryza contagious, Vol. 1 366,
Vol. 11........ 19
Coryza gangrenous, Vol. 1 408
Coryza ozena 3
Coryza, pustular, of the horse . . 19
Cough, enzootic 43
Cranial cavity, dropsy of,
chronic 644
Cranial cavity, dropsy of, con-
genital 656
Cranial cavity, dropsy of, idio-
pathic 646
Cranial cavity, dropsy of, pri-
maiy 646
Cresol dips 952
Cretinism 800
Crop, animal parasites of 244
Crop, hard 243
Crop, incision of 244
Crop, soft 242
Croup 46
Croup of Cattle, Vol. 1 417
Cryptocystis trichodectis 468
Culex pipiens 986
Cyathostomum 489
Cvathostomum tetracanthum . . . 489
Cysticercosis 464, 822
Cystieercdsis hepatis 555
Cysticercus 465
Cysticercus bovis 823
Cysticercus bovis in the brain . . 672
Cysticercus cellulosa3 823
Cysticercus cellulosa? in the brain 672
Cysticercus eellulosse "in the
spinal canal 705
Cysticercus f asciolaris 472
Cysticercus fistularis 582
Cysticercus inermis 823
Index.
1003
PAGE
Cysticercus pisif ormis 408, 555
Cysticercus pisiformis in the
brain 073
Cysticercus tenuicoUis 408, 555
Cysticercus tenuicollis in the ab-
dominal cavity 582
Cysticercus tenuicollis in the
liver 555
Cysticercus tenuicollis in the
liuig's 159
Cytodites nudus 82
Cytoleichus sarcoptoides 82
Dandruff 837
Daphnia pulex 403
Davaiuea eesticillus 473
Davainea crassula 473
Davainea proglottina 473
Defect psychoses, congenital.... 803
Degeneratio adiposa hepatis .... 513
Deg-eneratio amyloidea hepatis.. 515
Delirium, circular 802
Delirium, idiopathic 802
Delirium, maniacal 802
Dementia accidental 801
Dementia paralytic 802
Demodex folliculorum 908
Demodex phylloides 909
Dengue fever, Yol. 1 190
Dermanyssus avium 979
Dermatitis, bullous 885
Dermatitis, erysipelatous 877
Dermatitis, gangrenous 879
Dermatitis, granular 927, 996
Dermatitis, lichenoid 887
Dermatitis, prurighious 996
Dermatitis, pustular 893
Dermatitis, jDustular, contagious 893
Dermatitis, pustular, contagious
in cattle 895
Dermatitis, verminous 990
Dermatocoptes 933
Dermatoeojites communis 933
Dermatocoptes cunieuli 902
Dennatocoptic scabies in cattle. 944
Dermatocoptic scabies in goats. 955
Dennatocoptic scabies in horses 939
Dermatocojitic scabies in rabbits 902
Dermatocoptic scabies in sheep. 948
Dermatodectes 932
Dennatomyces galluiarum 924
Dermatomycosis achorma 917
Dermatomycosis aspergillina . . . 927
Dermatomycosis tonsurans 899
Dennatophagiis auricularis .... 933
Dermatophagus connnunis 933
Dermatophagus gallinarum .... 924
Dermatophagic scabies in cats. . 959
Dermatophagic scabies in cattle. 945
PAGE
Dennatophagic scabies in dogs.. 950
Dermatophagic scabies in fowls. 907
Dermatophagic scabies in goats. 955
Dermatophagic scabies in horses 940
Dermatophagic scabies in rabbits 963
Dermatophagic scabies hi sheep. 949
Dermatoryetes mutans 963
Dermatoiyctic scabies 963
Dermatosis aestivalis 997
Dermoid cysts in the brain 657
Dennoid cysts in the lungs 159
Dermosporidium canis 929
Diabetes insipidus. Vol. 1 918
Diabetes mellitus. Vol. 1 922
Diaf arin 295
Diamond skin disease, Vol. I 07,
Vol. II 841
Diaphragm, hernia of 391, 419
Diaijhragm, rupture of 257, 302
Diaphragm, spasm of 794
Diarrhea chronic 340
Diastasolin 295
Dicraniotsenia echinobothrida . . 473
Dicraniotaania sphenoides 473
Dicraniotienia tetragona 473
Dicrocoelium lanceolatuni 546
Dilatatio oesophagi 235
Dilatatio ruminis ab alimentis. . 249
Dilatatio ventriculi acuta 295
Dilatatio ventriculi chronica . . . 309
Diphtheria. Vol. I.. 419, 423, 424, 437
Diplococcus intracellularis equi. 609
Diploeoecus intracel. meningiti-
dis 009
Diplococcus pneumoniae, Vol. I
172, Vol. II 609
Diplospora 502
Dips 952
Diptera 980
Dipylidium caninum 468
Dipylidium Chyzeri 472
Disphargus laticeps 244
DisiDhargus nasutus 244, 402
Disphargus reticulatus 244
Disphargus spiralis 244
Disphargus micinatus 244, 462
Distoma armatum 474
Distoma eonnnutatuni 474
Distoma dilatatum 474
Distoma eggs in feces 547
Distoma lineare 474
Distoma ovatum 474
Distoma oxycephalum 474
Distomatosis 545
Distomatosis of the lungs 159
Distomum albidum 555
Distomum campanulatum 555
Distomum coniunctum 555
Distomum f eliuum 555
Distomum hepaticum 545
1004
Index.
PAGE
Distomum hepaticum in the ab-
dominal eavity 582
Distomum lanceolatum 545
Distomum magnum 555
Distomum truncatum 555
Dithyridium 583
Diverticulum 235
Diverticulum of the intestine . . 388
Diverticulum of the oest)i»hagus 23G
Diverticulum of the oesophagus,
false 236
Diverticulum of the oesophagi;s,
true 23G
Dochmiasis 482
Dochmiasis in cavnivora 482
Dochmiasis in cattle 485
Dochmiasis, lai-val 493
Dochmius Balsami 482
Dochmius cernuus 48G
Dochmius duodenalis 483
Dochmius longenuicronatus .... 486
Dochmius radiatus 485
Dochmius stenocephalus 483
Dochmius trigonocephalus 482
Docophoi-us 984
Dourine, Yol. 1 815
Drepanidiotsenia anatina 473
Drepanidiotfenia cantaniana . . . 473
Drepanidiotsenia conica 473
Drepanidiotsenia coronula 473
Drepanidiotaenia fasciata 473
Drepanidiotsenia gracilis 473
Drepanidiotaenia infundibulifor-
mis 473
Drepanidiotaenia lanceolata ..... 473
Drepanidiotaenia megalops 473
Drepanidiotaenia setigera 473
Drej^anidiotaenia sinuosa 473
Dysentery 340, 347
Dysentery of adult cattle 347
Dysentery, coccidial of cattle... 497
Dysenteiy, red, of cattle 497
Dysenteiy, white, of fowls 502
Dysidrosis 830
Dyspepsia 249
Dyspepsia, acute 249, 285
Dyspepsia, chronic 262
Dysperistaltica 427
Dysthyrea 799
Ear drum perforation -36
Ear worms 858
Ecchondroma in the nasal cavi-
ties 20
Echinococci in the brain 673
Echinococci in the liver 542
Echinococci in the lungs 156
Echinococci in the peritoneal
cavity 582
Echinococci in the spinal canal . . 705
PAGE
Echinoeoeeosis hepatis 542
Echinococcosis pulmonum 156
Echinococcus altriciparieiis .... 543
Echinocoecus alveularis 542
Echinococcus cysticus 543
Echinococcus endogenus 543
Echinocoecus exogenus 543
Echinococcus granulosus 543
Eehmococcus hydatitosus 543
Echinococcus multiloeularis 469, 542
Echinococcus polymorph us .... 469
Echinococcus scolieipariens .... 543
Echinococcus simplex 543
Echinococcus veterinoruni 543
Echinorrhynchus tilicollis 496
Echinorrhynchus gigas 495
Echinorrhynchus polymorphus. . 496
Echinorrhynchus sphaerocei^halus 496
Echinostomum perfoliatum .... 474
Eclampsia 774
Eclampsia puerperal 775
Ectasia oesophagi 235
Ecthyma 886
Eczema 845
Eczema, anal 858
Eczema, buccal 858
Eczema, calorie 846
Eczema, diffuse 856
Eczema, dorsal 857
Eczema, dry 849
Eczema, interdigital 853
Eczema, labial 858
Eczema, mercurial 847
Eczema, nasal 858
Eczema, nuchal 858
Eczema, palpebral 858
Eczema, partial 857
Eczema, red 848
Eczema, scrotal 858
Eczema, seborrheic 852
Eczema, solar 847
Eczema, sycosif orm 852
Eczema, symptomatic 847
Eczema, vulvar 858
Eczema Zebre 997
Eidamella spinosa 90'2
Eimeria cuniculi 28,502, 559
Eimeria Ziirni 497
Elephant bone of fowls 964
Elephantiasis 898
Elephantiasis Arabum 998
Emesis 245
Emphysema alveolar 92
Emphysema x^nlmonary, alveolar 92
Emphysema pulmonai-y, alveolar
acute 90
Emphysema pulmonary, alveolar
genuine 92
Emphysema pulmonary intersti-
tial' 99
Index.
1005
PAGE
Empliysema pulmonary vicarians
57, 90
Empyema 1^3
Empyema antri Highmori 30
Empyema sacci aeropbori 3G
Empyema sinus frontalis 34
Empyema sinus maxillaris 30
Encephalitis 632
Encephalitis, acute 636
Encephalitis, chronic 644
Encephalitis, diffuse 642
Encephalitis, hemorrhagic acute 639
Encephalitis, purulent 633
Encephalitis, simple 63G
Encephalomalacia 631
Enchondrosis of the cricoid carti-
lage • • • • ^*^
Enchondrosis intervertebralis. . . 702
Endocarditis, Vol. I lOSG
Enteralgia 445
Enteralgia catarrhal 337
Enteritis in birds. Vol. 1 9S,
Vol.11 356
Enteritis, caseous. Vol. 1 639
Enteritis, catarrhal 325
Enteritis, croupous 344
Enteritis, croupous, of cats 346
Enteritis, croupous, of horses. . . 344
Enteritis, membranous 344
Enteritis, mycotic 347
Enteritis, septic 347
Enteritis, typhoid 347
Enterodynia 445
Entero-hepatitis, infectious 504
Enteroliths 364
Enterorrhagia 323
Epidermophyton gallinarum . . . 924
Epidermoptes bifurcatus 967
Epidermoptes bilobatus 967
Epidrosis 830
Epilepsy 766
Epilepsy, idiopathic 766
Epilepsy, Jackson's 7()S, 774
Epilepsy, nocturnal 771
Epilepsy, reflex 768
Epilepsy, secondary 766
Epilepsy, symptomatic 766
Epilepsy, true '^^^
Epistaxis 1
Epithelioma of the brain 657
Epizootic tracheal catanli 43
Ergotism 880
Erosions, hemoniiagic 351
Eructation 248
Eruption, granular 927
Eruption, malt and potato 867
Eruption on skin from eating corn 872
Eruption, vesicular 885
Eiysipelas 877
Erysipelas, bullous 878
PAGE
Erysipelas, crusted 878
Erysipelas of swine, Vol. I.... 60
Erysipelas, vesicular 878
Ei-ythema 838
Esophagitis 220
Eustrongylus gigas. Vol. 1 1028
Eustrongylus gigas in the liver 559
Exanthema, due to iodine 850
Exophthalmia 799
Exostoses in the cranial cavity . . 657
Extra-pyramidal tract 587
Fagopyrism 873
Fainting 623
Faulting goats 775
Falling disease 766
Fasciola hepatica 546
Fasciola lanceolata 546
Fatty degeneration 513
Fatty infiltration 513
Fatty liver 513
Favus ^^17
Favus of fowls 924
Favus herpetic 921
Feather pulling. Vol. 1 967
Feather mites i>84
Feather shedding 832
Feeding, artificial 123
Festuca Hieronymi 798
Fibroma of the brain 657
Fibroma of the intestines 388
Fibroma of the lungs 160
Fibroma of the nasal cavity ... 20
Fibroma of the peritoneum .... 581
Fibi-oma of the stomach 316
Fibroma of the throat 217
Filaria Bancrofti 998
Filaria flexuosa 998
Filaria haemorrhagica 996
Filaria immitis 998
Filaria irritans 996
Filaria labio-papillosa 582
Filaria nasuta 244, 462
Filaria papillosa 495, 582
Filaria tenuinalis 67
Filaria tracheobronchialis 69
Filaria uncinata 462
Fish scale disease 897
Fish scale disease of birds 964
Fleas ^95
Flexibilitas cerea 792
Flexion of the cecum 428
Flexion of the colon 427
Flies 989
Fluke, liver 545
Follicular inflammation, nasal. . 19
Folliculitis 890
Food balls in the rumen 275
Foo
Foot scabies of horses f'^lO
Foot scabies of sheep 94!)
Forag'e poisoning 0(1(5
Foreign bodies in the bronchi .. (j4
Foreign bodies in the esophagus 2l20
Foreign bodies in the gall ducts 512
Foreigii bodies in the intestines 381
Foreign bodies in the liver .... 512
Foreign bodies in the pericar-
dium, Vol. 1 1042
Foreign bodies in the rumen . . 274
Foreign bodies in the stomach.. 312
Foreign bodies in the stomachs
of carnivora 312
Foreign bodies in the -stomachs
of ruminants 274
Fungus poisoning 355
Fungus poisoning, differential
diagnosis 355
Furuncle 8-'2
Furunculosis S92
Gadflies 21, OSS
Gallstone colic 510
Gamasus auris 9S0
Gangrene, humid SSI
Gangrene, pulmonary 147
Gangrene of the skhi S<9
Gangrene, solar 879
Gapes 80
Gas formation in the thorax. . . . 17S
Gastritis, catarrhal 292
Gastritis, phlegmonous 351
Gastritis, polypous 293
Gastritis, proliferative 293
Gastritis, purulent 351
Gastritis, traumatic 274
Gastritis, verrucous 293
Gastrodiscus Aegyptiacus 474
Gastro-enteritis 347
Gastro-enteritis dysenteric 347
Gastro-enteritis hsemorrh. bovum 350
Gastro-enteritis hsemorrh. canum,
Vol. I 211, Vol II. 350
Gastro-enteritis mycotic 3(50
Gastromvcosis ovis, Vol. 1 57
Gastrophilus 452
Gastrophilus equi 453
Gastrophilus flavipes 454
Gastro])hilus hemorrhoidalis . . . 453
Gasti'0])liilus nasalis 453
Gastrophilus peeorum 453
Gid r)f50
Gingivitis 183
Glioma of the brain 05(5
Glioma of the spinal cord .... 705
Gliosareoma of the brahi 656
PA(iE
Gliosareoma of the si>inal cord. 705
(ilo.ssina niorsitans, Vol. I, 807,
Vol. 11 990
Glottis edema 50
Gnathostoma hisi»idiuii 461
Going light 342
Goiter, exophthalmic 798
Gongyhincma i)ulchi-uin 241
Gongylonema scniatiuii 241
Gonit)Cotes 984
Goniodes 984
Granuloma cholesterinicum .... 656
Graves' disease 798
Greasy heels 862
Gregariuce rhinitis 28
Grippe, Vol. I 170, Vol. II. . . . 43
Guttural pouches, catarrh of . . . 36
Gutturoliths 36
Hair balls in the intestines . . . 381
Hair balls in the rumen 275
Hairlings 984
Hairsack mite 967
Hairsack mite eruption 967
Hair worm disease 68
Haemangioma caveniosum 541
Haematopinus 945
Hfematopota? 988
Hjemopis sanguisuga 28, 216
Haemoptoe 88
Harpirhynchus 982
Hay fever 3
Head scabies in rabbits 962
Heat pox 887
Heat stroke 620
Heaves 92
Helix carthusiana 548
Helmintiiiasis 463
Helminthiasis, larval 493
Helminthiasis, nodular 493
Hematemesis 321
Hematidrosis 832
Hematobia 990
Hematoma 381
Hematomyelia 689
Hematothorax 181
Hematozoa, Vol. 1 760
Hematuria. V^ol. 1 979
Hemianopsia 595
Hemoglobinemia, Vol. 1 884
Hemoglobinuria, Vol. 1 760
Hemiplegia alternans 591
Hemiplegia laryngis 729
Hemiptera . . .\ 983
Hemistoma alatum 474
Hemophilia, Vol. 1 900
Hemorrliagia cerebri B28
Hemorrhagia hepatis 517
Hemon-hagia meduUae spinalis., 689
Index.
1007
PAdE
Hemorrhagia nariuin 1
Hemoriiiagia ventriculi ....... 321
Hemorrhoids 323
Hepar adiposuin 513
Hepar amyloidiuiu 515
Hepatic coecidiosis 559
Hepatitis acuta traumatica dis-
tomatosa 550
Hepatitis cysticercosa 555
Hepatitis enzootica poreellorum 521
Hepatitis fibrosa 530, 551
Hepatitis hemorrhagica niortifi-
cans 521
Hepatitis indurativa 530
Hepatitis indurativa distomatosa 551
Hepatitis interstitialis diffusa
chronica 530
Hepatitis parenchymatosa acuta 519
Hepatitis parenchymatosa acuta
diffusa ovum 520
Hepatitis suppurativa 526
Hernia, external 412, 425
Hernia, internal 412, 425
Herpes labialis 884
Herpes tonsui'ans 809
Herpes zoster 885
Heterakiasis 481
Heterakis brasiliensis 481
Heterakis compressa 481
Heterakis differens 481
Heterakis dispar 481
Heterakis inflexa 481
Heterakis maculosa 481
Heterakis papillosa 481
Heterakis perspicillum 481
Heterakis vesicularis 481
Hippobosca equina 994
Holostoma erraticum 474
Honeycomb ring-w^orm 917
Honiwonu disease 21
Hunger scabies 849
Hydatids in the liver 542
Hydremia of cattle. Vol. 1 846
Hydrocephalus externus 599
Hydrocephalus ex vacuo 647
Hydrocephalus hydatideus 660
Hydrocephalus intern us acutus.. 560
Hydrocephalus in tern us chroni-
cus 644
Hydi'oeephalus inter, chron. ac-
quisitus 646
Hydrocephalus inter, congenitus 656
Hydronephrosis, Vol. 1 1025
Hydrophobia fly 990
Hydropneumothorax 179
Hydrops antri Highmori 30
Hydrops ascites 564
Hydrops ascites adiposus 565
Hydrops ascites chyliformis . . . 565
Hydrops ascites chylosus 565
PAGE
Hydrops ascites parasitarius . . . 583
Hydrops sacci aerophori 36
Hydrops sinus maxillaris 30
Hydrorhachis 676
Hydrothorax 176
Hymenoptera 995
Hyperalgesia 677
Hyperemia, cerebral 618
Hyperemia, pulmonary 84
Hyperidrosis 830
Hyperphisia mucosfB narium... 5
Hyperphisia polyposa mucosae
laryngis 52
Hyperthyrea 799
Hyphomycosis destruens, Vol. I
739, Vol. II 196
Hypoderma actseon 993
Hypoderma bovis 990
Hypoderma in the lirain 673
Hypodeinia diana 993
Hyiiodernia in the esophagus . . 241
Hypoderma lineata 993
Hypoderma in the spinal canal 706
Hypotrichia 833
Hypotrichosis Incalis cysta 927
Hysteri^i 803
Ichthyosis 897
Ichthyosism 357
Icterus 506
Icterus neonatorum 509
Ictrogen 523
Idiosyncrasy 840, 843
Ileitis catarrhalis acuta 320
Ileus 247
Immune serum, polyvalent 141
Immunization, Vol. 1, 24, 51, 86,
96, 156, 194, 280, 351, 402,
727, 740
Impetigo 886
Impetigo, contagious 886, 893
Impetigo, labial 882
Incarceration of the intestine... 412
Indican in the urine in obstipa-
tion 368
Indican in the urine in dilata-
tion of the stomach 300
Indigestion, acute 249
Indigestion, chronic 265
Indigestion, chronic, of rumi-
nants 265
Indigestion, gaseous 255
Indigestion, ingluvial 243
Indigestion, intestinal 364, 376
Indigestion, mephitic 255
Indigestion, simple 268
Indigestion in the stomach 290
Indigestion, traumatic 282
Induratio brunea i^ulmonum. ... 86
1008
Index.
PAGK
Infarct, hemorrhagic in the in-
testines 300
Intiammation, higluvial 24"J
Inliuenza, Vol. 1 1 '"O
Influenza baeiUus 15
Influenza of cattle 45
Influenza-like disease of cattle.. 45
Influenza-like disease of rabbits. 15
Infra-orbital cavity, inflamma-
tion of 34
Infusions in the rectmn ...333, 371
Infusions in the udder 788
Infusions in the veins 124
Ingluvitis 242
Inhalation 7, 42, 63, 213
Injections, intranasal 213
Injections, intrapharyngeal .... 213
Injections, intratracheal
43, (31, 78, 82
Insects of the skin 983
Insolatio 620
Intertrigo ^^^
Intestinal calculus 388
Intestinal catarrh, acute 333
Intestinal catarrh, chronic ..... 340
Intestinal catarrh, infectious, hi
birds 326
Intestinal catarrh, infectious, m
swine 326
Intestinal coccidiosis in birds... 502
Intestinal coccidiosis in car-
nivora 502
Intestinal coccidiosis in cattle. . . 497
Intestinal coccidiosis in rabbits. 502
Intestinal coccidiosis in sheep
and goats 501
Intestinal compression 388
Intestinal constriction 387
Intestinal croup 344
Intestinal diseases 245
Intestinal hemorrhage 323
Intestinal incarceration 412
Intestinal injuries 388
Intestinal intussusception 438
Intestinal invagination 438
Intestinal meconium 381
Intestinal meteorism 358
Intestinal mycosis 347
Intestinal occlusion, internal.... 364
Intestinal pain, catarrhal 337
Intestinal resection 410
Intestinal spasm, catarrhal .... 337
Intestinal stenosis 387
Intestinal strangulation 412
Intestinal stricture 387
Intestinal torsion 425
Intestinal typhoid 347
Intestinal volvulus 425
Intestinal worms 463
Intussuseeptio intestini 438
PAGE
Invaginatio intestini 438
Invaginatio intestini agonalis. .. 439
Involuntaiy motions 600
Involuntary motions in gid .... 666
Irrigation of rectum 333, 371
Irrigation of rumen 274
Itching of the skin 829
Ixodes bovis 979
Ixodes reduvius 979
Ixodes ricinus 978
Jackson's epilepsy 592
Japp disease of lambs 46
Japs 80
Jaundice 506
Jejunitis catanlialis acuta 329
Keratosis nigricans 897
Kidney diseases. Vol. 1 977
Knemidocoptes laevis 965
Knemidocoptes mutans 963
Knemidocoptes prolificus 967
Kolumbacser flies 216
Kriebel flies 986
Kum Gata disease 292
Lachnosterna 495
Ladrerie 822
Lammosioptes cysticola 979
Laparo-enterotomy 387, 392
Laparo-gastrotomy 313, 321
Laparotomy. .392, 425, 437, 445, 452
Laparotomy test 422
Laryngeal catarrh, epizootic ... 43
Lai-yngeal catarrh, infectious .. 43
Laryngeal compression 50
Laryngeal diseases 39
Laryngeal edema 50
Lai-yngeal paralysis 729
Laryngeal spasm 737
Laryngeal tumors 52
Laryngeal whistling 729
Laiyngitis, catarrhal 39
Laryngitis, croupous 46
Laryngitis, fibrinous 46
Laryngitis, granular 40
Legumenous eniption 876
Leiomyoma of the intestines. . . . 388
Leptomeningitis 596
Leptothrix buccalis 161
Leptus autumnal is 980
Leukemia, Vol. T 869
Leukemia of fowls, Vol. I. . .99, ^77
Lice 983
Limnaeus minutus 547
LimnaBus pereger 547
Limnaeus truncatulus 547
Index.
1009
Lingulatula denticulata 559
Lingulatula in the liver 559
Ling'ulatula tsenioides 2(3
Lip and leg ulceration 882
Lipeurus 984
Lipoma in the brain 657
Lipoma in the intestines 388
Lipoma in the laiynx 52
Lipoma in the liver 541
Lipoma in the Imigs 159
Lipoma in the nasal cavities ... 20
Lipoma on the peritoneum 581
Lipoma in the pharyngeal cav-
ity 217
Lipoma in the spinal cord .... 705
Lipoma in the stomach 316
Liver, abscess of 526
Liver, actinomycosis of 542
Liver, amyloid 515
Liver, atrophy, acute yellow .... 522
Liver, cancer of 539
Liver, cirrhosis of 530
Liver, eoccidiosis of 559
Liver, cysticercosis of 555
Liver, diseases of 506
Liver, echmococcosis of 542
Liver, excision of 540
Liver, fatty degeneration of . . . 513
Liver, fluke disease 545
Liver, foreign bodies in 512
Liver, incision 528
Liver, induration 530
Liver, necrosis of 528
Liver, parasites of 542
Liver, laipture of 517
Liver, sclerostomiasis of 532
Liver, tuberculosis 541
Liver, tumors of 539
Lombriz, Vol. I 118, Vol. II. . . . 457
Long-horn insects 986
Lophophyton gallinarum 924
Louping ill 676
Lucerne, eruption from eating. . 876
Lucilia 989
Lumbago, Vol. 1 886
Lumbago rheumatica 812
Lung, abscess of 145
Lung, atelectasis of 131
Lung atrophy, senile 94
Lung, cysticercosis of 159
Lung distomatosis 159
Lung echinococcosis 156
Lung emphysema, acute 90
Lung emphysema, alveolar .... 90
Lung emphysema, chronic 92
Lung emphysema, interstitial . . 99
Lung emphysema, simple 91
Lung, gangrene of 147
Lung, hair worms in 68
Lung, hemorrhage from 88
PAGE
Lung inflammation, see pneu-
monia 84
Lung, parasites of 156
Lung, pentastomes in 159
Lung, phthisis verminous 66
Lung, tumors of 159
Lung wonn diseases 66
Lupine disease 523
Lupinosis 523
Lupinus alba 523
Lupinus coeruleus 523
Lupinus flavus 523
Lymphadenitis of abomasum . . 316
Lymphadenitis of rumen 267
Lymphangioitis epizootica. Vol. I 734
Lymphangioitis farciminosa bo-
vis. Vol. 1 667
Lymphangioitis pseudofarcinosa,
"Vol. I. 734
Lymphosarcoma in the larynx.. 52
Lysis " Ill
Lyssa, Vol. 1 463
Macro-bronchitis 56
Mai de Caderas, Vol. 1 835
Malignant edema, Vol. 1 815
Mallophaga 984
Malt, eniption caused bv 867
Malta fever, Vol. I * 196
Mar.ia, transitory 802
Massage of intestine through
rectum 372
Massage of nmien for removal
of foreign bodies 259
Mauke 850
Maxillaiy sinus, catarrh of 30
Measles 822
Meat poisoning 357
Meconotorium 386
Megastomum entericum 474
Megrims 727, 762
IMeiancholia 802
Melanoma of the esophagus . . . 240
Melanoma of the intestines .... 388
Melanoma of the larynx 52
Melanoma of the liver 543
Melanoma of the spinal cord... 705
Melano-sareoma of the brain . . 657
Melano-sareoma of the intes-
tines 388
Melano-sareoma of the liver . . . 543
Melano-sareoma of the Imigs . . 159
Melano-sareoma of the spinal
canal 705
Melo])hagus ovinus 994
Meniere's disease 765
Meningitis acuta 596
Meningitis boum enzootica 215
Meningitis cerebro-spinalis en-
zoot 606
1010
Index.
PACE
Meningitis intenia fiOO
Meningitis pueri)eralis 597
Meningitis purulenta 5^0
Meningitis serosa -^Oi)
^Meningitis spinalis acuta ()~0
j\Ieningo-eneephalitis o90
Menopon ^■'^4
^lesenterie arteiy, occlusion of. . 393
Mesenteric vein, occlusion of... 411
Mesocestoides imbutiforniis .... 473
Mesocestoides lineatus 583
Meteorism, acute 255
Meteorism, clu-onic, in calves... 270
Meteorism, chronic, in ruminants 202
Meteorism, circumscribed 405
Meteoi'ism, intestinal 358
Meteorism, local 402. 405, 418
Metliylguanidin 349
Micro-bronchitis 50
Micrococcus ambratus 133
Micrococcus meningitidis cere-
brospinalis 610
Microsporosis 913
Microsporum 914
Miescher's tubules 827
Mieschei-'s tubules in esophagus. 241
Milk fever 778
Milk scab Oil
Molluseum atheromatosum 891
Molluscum contagiosum, Ynl. T. . 424
Moniezia alba 466
Moniezia Benedeni 467
Moniezia denticulata 466
Moniezia expansa 466
Moniezia trigonophora 467
Monilia Candida 195
Monophlegia 590
Monostoma attenuatum 474
Monostoma caryophyllinum .... 474
Monostoma flavum 34, 80
Monostoma hepaticum 555
Monostoma verrucosum 474
Morbus Basedowii 798
Morbus caducus 766
Morbus sacer 766
Mosaic liver 557
Motor tracts 588
Mouth, catan-h of 182
Mouth, diseases of 182
Mouth, inflammation of 185
Mucor conoideus 142
Mucor mucedo 142
Mucor racemosus 142
Mucor spinosus 30
Muguet 105
Mumifieatio 881
Mumps 203
Musca domestica 988
Muscarin 349
Muscle, degeneration, fatty .... 815
PAGE
Muscle, degeneration parenchy-
matous 815
Muscle, degeneration in suck-
lings 815
IMuscle, rheumatism of 811
Muscle, spasm of 796
Mustard, eruption caused by... 872
Mycosis intestinalis 347
Mycosis, primaiy 142
]\Iycosis, secondary 142
Mycosis, true 142
Myelitis, ascending 693
Myelitis, chronic 695
IMvelitis, descending 693
Myelitis, diffuse . ." 693
Myelitis, disseminated 694
Myelitis, focal 691
Myelitis from compression 702
IVIyelitis, spinal 680
Myelitis, transverse 691
Myelo-encephalitis 690
Myelomeningocystocele 705
Myoma of the intestines 388
Myoma of. the stomach 316
Myositis rheumatica 811
Myxoma in the brain 657
Myxoma in the intestines 388
Myxoma in the nasal cavities. . . 21
Myxoma on the peritoneum 581
Nasal cataiTh 3
Nasal catarrh, benign, of cattle 8
Nasal catarrh, chronic, of cats. 6
Nasal catarrh, infectious, of
fowls 8
Nasal catarrh, infectious, of
geese 10
Nasal catarrh, malignant, of
sAvine 11
Nasal cavity, parasites of... 21, 28
Nasal coccidiosis 28
Nasal croup 17
Nasal diseases 1
Nasal flies 452
Nasal hemorrhage 1
Nasal inflammation 11, 15
Nasal irrigation 7
Nasal membrane, necrosis of . . . 19
Nasal tumors 20
Nasal vein, thrombosis of 3
Neerobacillosis 881
Necrosis nodosa hepatis 528
Nemathelminths 475
Nematocera 986
Nematodes 475
Nematodes in stomach of horse 456
Nematodes in lungs of sheep. . . 67
Neoplasms, see tumors.
Nephritis, Vol. 1 986, 988
Index.
1011
PAGK
Nerve compression 714
Nerve diseases 584
Nerve diseases, functional 702
Nerve diseases, peripheral 714
Nettlerash 840
Neuralgia colica 445
Neuralgia trigemina 721
Neurin 34!)
Neuritis 714
Neuritis eaudae equina; 750
Neuritis interstitialis 71(J
Neuritis parencliymatosa 71()
Neuromata 714
Neuromata from amputation... 714
Neuroses 702
Noma 200
Notoedres cuniculi 002
Nourishment, artificial 123
Obesity, Vol. 1 915
Obstipation 3()4
Obstruction, esophageal 224
Obstruction, ingluveal 243
Obturatio intestini 379
Ocelusio oesophagi 224
Ochromyia 994
Odontomata in the brain 057
Qlsophagostomum 493
Oesophagaxs, see Esophagus.
(Estras bovis 990
(Estrus maculatus 22
CEstrus ovis 21, 994
CEstrus purpureus 22
Oidium albicans 195
Ollulanus tricusjiis. .09, 73, 402, 558
Omasitis 284
Omentopexia 571
Onychomycosis 923
Oospora eanina 919
Oospora rubra 922
Ophthalmia neuroparalitica 719
Opisthotonus 014
Opsonine, Vol. 1 587, 724, 833
Optic nerve, paralysis of 717
Optic nerve, reflex 580
Osteoarthritis infectiosa 810
Osteoniata 20
Otitis catarrhalis 859
Otitis chronica hyperplastica . . 859
Otitis externa . ." 858
Otitis purulenta 859
Otitis ulcerosa 859
Oulitis 183
Oxyuriasis 487
Oxyuris ambigua 487
Oxyuris curvula 487
Oxyuris equi 487
Oxyuris mastigodes 487
Oxyuris vermicularis . 487
Ozena 3, 5
PAUE
Pachydermia 898
Pachymeningitis spinalis ossifi-
cans 080
Palisade worms 07
Palisade worms in horses 488
Palisade worms in the intestines 488
Pancreas, diseases of 501
Papilloma of the brain 057
Papilloma of the esophagus . . . 240
Papilloma of the pharynx .... 217
Papilloma of the spinal cord. . . 705
Paracholia 507
Paralysis 590
Paralysis of the auditory nerves 720
Paralysis, bulbar 073
Paralysis of the cochlear nerves 726
Paralysis of the esophageal
nerves .^. . . 223
Paralysis of the facial nerves.. 721
Paralysis of the femoral nerves 745
Paralysis of the glosso-labial
nerves 073
Paralysis of the o 1) t u r a t o r
nerves 747
Paralysis of the optic nerves. . . 717
Paralysis of the penis 749
Paralysis of the pharyngeal
nerves 214
Paralysis of the pudic nerves . . 749
Paralysis of the radial nerves.. 739
Paralysis of the r e e vi v. rent
nerves 729
Paralysis of the sacral plexus . . 748
Paralysis of the sciatic nerves. . 743
Paralysis of the spinal nerves.. 097
Paralysis of the sphinetero-cau-
dal nerves 750
Paralysis of the tibial nerves. . . 744
Paralysis of the t r i g- e ni i n a 1
nerves 718
Paralysis, unilateral 591
Paralysis of the vagus nerves. . 728
Parapedesis 507
Paraphlegia, enzootic, of the
horse 097
Paraphlegia, infectious 097
Parasites, animal, of the abdomi-
nal cavity 582
Parasites, animal, of the air
passages in birds 80
Parasites, animal, of birds 402
Parasites, animal, of the blood.
Vol. 1 902
Parasites, animal, of the brain . . 000
Parasites, animal, of the bron-
chi 00, 71
Parasites, animal, of carnivora. 462
Parasites, animal, of cattle .... 459
Parasites, animal, of the croji.. 244
1012
Index.
I'AC.K
Parasites, animal, of the es()])lia-
gus 240
Parasites, animal, of goats .... 06
Parasites, animal, of horses . . . 488
Parasites, animal, of the intes-
tines 463
Parasites, animal, of the liver.. 542
Parasites, animal, of the lun.iis
m, ]5(i
Parasites, animal, of the nasal
cavities 21
Parasites, animal, of the
phaiynx 216
Parasites, animal, of sheep 66
Parasites, animal, of the stom-
ach 452
Parasites, animal, of swine 461
Paresis puerperalis 778
Parotitis 203
Parturient fever 778
Parturient paresis 778
Partui'ient paresis-like disease.. 789
Parturition fever 778
Parturition spasms 775
Parturition spasms in cows . . . 778
Parturition spasms in doiis . . . 776
Parturition spasms in mares . . 777
Parturition spasms in sows . . . 778
Pediculida 083
Pellicula linguse 184
Pemphigus acutus 885
Pemphigus chronicus 886
Pemphigus f oliaceus 885
Pemphigus vulgaris 885
Penicilia 142
Penis, paralysis of 749
Pentastomum denticulatum 26
Pentastomum of the peritt)neal
cavity 583
Pentastomum of the liver 559
Pentastomum of the lungs .... 159
Pentastomum taenioides 25, 26
Percussion of the skull in gid . . 668
Peribronchitis nodosa 57
Pericarditis, Vol. 1 1039
Pericarditis externa 166
Perineuritis 71 6
Peritonitis 572
Peritonitis acuta 576
Peritonitis chemica 574
Peritonitis chronica 576, 578
Peritonitis chronica circum-
scripta 578
Peritonitis diffusa acuta 576
Peritonitis fibrin osa 575
Peritonitis bemorrhagica 575
Peritonitis operativa 572
Peritonitis perf orativa 573
Peritonitis purulenta 575
Peritonitis rheumatica 574
PAGE
Peritonitis traumatica 572
Perityphlo-he p a t i t i s meleagri-
dum . 504
Peroneal paralysis 744
Perversity, sexual 803
Pestis avium, Vol. 1 290
Pestis bovum orientalis, Vol. I.. 234
Pestis equorum, Vol. 1 285
Pestis suum, Vol. 1 275
Petit mal 771
Pharyngitis 206
Pharyngitis, catarrhal 207
Phaiy ngitis, croupous 208
Phai-yngitis, diphtheritic 208
Pharyngitis, purulent 208
Phai-yngomyia 216
Pharyngomyia picta 22
Phytoconcrementa 380
Pictou cattle disease 530
Pietin contagieux 882
Pituitas 184
Pityriasis rosea 912
Pityriasis seborrhoica 837
Pleiochromia 506
Pleuritis 161
Pleuritis acuta 163, 165
Pleuritis adhesiva 164
Pleuritis chronica 164, 170
Pleuritis fibrinosa 163
Pleuritis granulosa 164
Pleuritis hemorrhagica 164
Pleuritis purulenta 164
Pleuritis serosa-fibrinosa 163
Pleuritis, sicca 163
Pleurocercoid 465
Pleurocercoides Railliet 162
Pleurodynia . .84, 811
Pleuro-pericardial friction
sounds 106
Pleuro-peritonitis of birds 169
Pleuro-pneumonia, contag., Vol.
I 389
Pleuro-pneumonia, contag. sep-
tica vitulorum. Vol. I 111,
Vol. II 133
Plica polonica 851
Pneumatosis bovum 100
Pneumobacillus septicus 134
Pneumoconiosis 155
Pneumoenteritis septica 133
Pneumonia, abortive 113
Pneumonia, catarrhal 125
Pneumonia, croupous 101
Pneumonia, embolic 145
Pneumonia, fibrinous 101
Pneumonia, gangrenous 147
Pneumonia, hypostatic 81
Pneumonia, indurative 153
Pneumonia, insular 125
Pneumonia, interstitial, chronic. 153
Index.
1013
PAGE
Pneumonia, lobar 101
Pneumonia, lobular 125
Pneumonia, mycotic 142
Pneumonia, progredient 114
Pneumonia, suppurative 150
Pneumonia of young animals,
septic "^ 133
Pneumonomycosis 142
Pneumonomycosis aspergillina . . 142
Pneumothorax 178
Pneumotliorax, closed 179
Pneumothorax, open 178
Pneumothorax, valvular 179
Poisoning 347
Poisoning, sausage 357
Polyadenoma, bronchial 92, 159
Polyarthritis 809
Polyarthritis, puerperal 809
Polyarthritief, rheumatic 804
Polydesmus exitiosus ] S3, 186
Polygonum f agopyrum 873
Polygonum persicaria 873
Polyneuritis 754
Polyneuritis in fowls 755
Polyneuritis, infectious, Vol. I 818
Polyomyelitis, anterior acuta... 690
Polyomyelitis cervicalis 695
Polypi in the intestines 388
Polypi in the nasal cavities ... 20
Polypi in the stomach 316
Polyvalent immune sera 141
Pomphosis 842
Porencephalia 644
Portal vein, thrombosis of 411
Porthesia chrysorrha 196
Potatoes, eruption from eating.. 867
Proglottids . 464
Protozoan diseases. Vol. 1 760
Protozoan hepatitis in pigeons. . 560
Protrusio 649
Pruritus, cutaneous 829
Pruritus, local 829
Psammom in the brain 656
Pseudalis capillaris 68
Pseudalis ovis pulmonalis 68
Pseudo foot and mouth disease.. 193
Pseudo hypertrophy of muscle. 816
Pseudo leukemia, Vol. T 881
Pseudo tuberculosis. Vol. 1 633
Pseudo tvphus 347
Psittacosis. Vol. 1 100
Psoi'iasis 853
Psoroptes 932
Psorospermian rhinitis 28
Psorosperm tubes 827
Psoi'osperm tubes in the esopha-
gus 241
Psychic degenerations 803
Psychopathic constitution 801
Psychoses 800
PAGE
Ptomaines 349
Ptosis 717
Ptyalism 202
Pueeinia arundinacea 183
Puceinia graminis 183
Puerperal convulsions 775
Pulex 996
Pulsation, abdominal 794
Puncture of joint cavities 809
Puncture of the Liver 528
Pmicture of the peritoneal cavity
408, 571
Puncture of the pleural cavity 175
Pupil reflex ". 586
Pupipara 994
Putresin 349
Pyelitis, Vol. 1 1019
Pylorus, stenosis of 309
Pyobaeillosis, Vol. 1 141
Pyocephalus 634
Pyopneumothorax 179
Pyosepticemia of sucklings, Vol.
I ": 158
Pyothorax 163
Pyramidal tract 588
Rabbit infection 15
Race-course disease of horses... 814
Raillietia auris 980
Railroad disease 790
Ranula intlammatoria 205
Rasi:)e 851
Rat-tail 852
Rectal bleeding 325
Rectal catarrh 329
Rectal exploration 451
Rectal inflammation, hemor-
rhagic 325
Rectal infusion 333
Rectal parasites 453
Recurrent paralysis 729
Reflex action 586
Reflex epilepsy 868
Regurgitation 209
Reticulitis 284
Reticulitis traumatica 274, 276
Rhabdonema longum 495
Rhabdonema suis 495
Rhachitis, Vol. 1 930
Rheumatism, articular 804
Rheumatism, muscular 811
Rhinitis, catarrhal 3
Rhinitis, coccidial, of rabbits . . 28
Rhinitis, contagious, of rabbits. 15
Rhinitis, croupous 17
Rhinitis, follicular 19
Rhinitis, gangrenous, Vol. I... 40S
Rhinitis, infectious, of swine... 11
Rhinitis, phlyctenular 4
1014
Index.
PAGE
Rhinitis, proliferative o
Rhinitis, purulent lo
Rhmitis, pustular 19
Rhinorrhagia 1
Rhinorrhea 5
Rliinoscleroma (3
Rhipieephalus anuulatus ATS
Rhynchota 983
Rib furrows 94
Ringworm 899
Rogna 929
Rolling motion 593
Rose 877
Rosenbach's test 507
Roundworms 475
Rumen, distention of 249
Rumen, foreign bodies in 312
Rumen, gas in 255
Rumen, irrigation of 274
Rumen, massage of 255
Rumen, obstruction of 24i)
Rumen, paralysis of 2G5, 274
Rumen, puncture of 255
Rumen, section of 255
Rupture of liver 517
Rupture of rumen 257
Rupture of stomach 312
Saburra 277
Saccharomyces albicans 195
Saccharomycosis, Vol. 1 734
Saddle-place eczema 887
Sadism 803
Salivation 202
Salt sickness 485
Sand disease 292
Sand flies 98(5
Sand in the gall-duets 512
Sand in the intestines 351, 305
Sand in the stomach 277, 292
Sarcocystin 827
Sarcocysts 827
Sarcoma of the brain 657
Sarcoma of the esophagus .... 240
Sarcoma of the intestines 388
Sarcoma of the liver 53i)
Sarcoma of the lungs 159
Sarcoma of the nasal cavities.. 20
Sarcoma of the peritoneum . . . 581
Sarcoma of the phalangeal cav-
ity 217
Sarcoma of the spinal coid . . . 705
Sarcoma of the stomach 316
Sarcopsylla penetrans 995
Sarcoptes 932
Sarcoptes cysticola 979
Sarcoptes Isevis 965
Sarcoptes major 958
Sarcoptes mmor 958
PAGE
Sarcoptes mutans 9G3
Sarcoptes notoedres 032
Sarcoptes scabei connnunis .... 932
Sarco])tes squamiferus 932
Sareoptic scabies of the cat .... 958
Sarcoptic scabies of cattle 944
Sareoptic scabies of dogs 931
Sarcoptic scabies of the drome-
dary 947
Sarcoptic scabies of goats .... 955
Sarcoptic scabies of liorses .... 930
Sarcoptic scabies of rabbits . . . 962
Sarcoptic scabies of sliee]) - . . . . 947
Sarcoptic scabies of swine .... 960
Sarcosporidiosis 827
SarcosDoridium 827
Sausage poisoning 357
Scab r 929
Scabies 929
Scabies of birds 963
Scabies of camels 947
Scabies of cats 958
Scabies of cattle 944
Scabies of dogs 955
Scabies of the ear 959
Scabies of goats 954
Scabies of horses 938
Scabies of llama 947
Scabies mites 931
Scabies parasites 931
Scabies of rabbits 962
Scabies, red, of dogs 972
Scabies of sheej) 947
Scabies of sheep, false 838
Scabies of sheep, fatty 855
Scabies of sheep, moist 855
Scabies of swine 960
Scalma 43
Schisogony 498
Schweinsberg disease 530
Sciatica 743
Scleroderma 897
Sclerosis pulmonum 153
Sclerostomiasis, enzootic 490
Sclerostomiasis of horses 488
Sclerostomum bidentatum 490
Sclerostomum edentatum 489
Sclerostonunn eciuinum 489
Sclerostomum hypostonunn .... 495
Sclerostomum quadridentaluni. . 489
Sclerostomum tetraeanthum . . . 489
Sclerostomum vulgare 489
Scolex 4()4
Scurfy neck 851
Scutuium 920
Seasickness 764
Seborrhea 837
Seborrhea pityroides 837
Sebon-hea of sheep 838
Seborrhea sicca 837
Index.
1015
PAGE
Seborrhea universalis 837
Sedimentum lateritum 289
Senecio plants 531
Sensibility, disturbance of, in
brain diseases 590
Sepsis intestinalis 347
Septicemia of birds, Vol. 1 101
Septicemia hemorrhagica, "N'ol. I 77
Septicemia of sucklings, Vol. I 158
Septicidin 141
Serum anaphylaxis 843
Serum disease 843
Sexual perversity 803
Sheep, grubs of the head 660
Sheep lice-iiies 994
Sheep pox. Vol. 1 302
Sheep ticks 994
Shock 620, 623
Short-horn insects 988
Sialorrhea 202
Sight, disturbance of, in diseases
of the brain 596
Simondsia paradoxa 461
Simuliae 986
Skin bum 879
Skin, diseases of 829
Skm, induration of 897
Skin, inflammation of 885
Skin, irritation of 829
Skin mycosis 927
Skin, redness of 838
Skin reflex 588
Skull, fracture of 623
Smell, disturbance of, by brain
diseases 596
Snuffles, infectious, of birds.... 8
Snuffles, malignant, of rabbits. . 15
Solanin 867
Somnolence 684
Soor 195
Soor of cattle 196
Soor of sucklings 195
Sore mouth 882
Spasmus glottidis 737
Sphincter and tail, paralysis of 750
Spinal cord, compression of, by
abscess 706
Spinal cord, compression of, by
actinomycosis 705
Spinal cord, compression of, by
hardened intra-vertebral discs 702
Spinal cord, compression of, by
neoplasms 705
Spinal cord, compression of, by
parasites 705
Spinal cord, compression of, by
tuberculosis 705
Spinal cord, contusion of 685
Spinal cord, crushing of 685
Spinal cord, diseases of 676
Spinal cord, hemorrhage from.. 689
PAGE
Spinal cord, inflammation of . . 689
Spinal cord, injury of 685
Spinal cord, paralysis of 697
Spiradenitis coccidiosa 927
Spiroptera megastoma 456
Spiroptera microstoma 456
Spiroptera pectinifera 462
Spiroptera sanguinolenta
76, 240, 462
Spiroptera scutata 241
Spiroptera strongylina 461
Spiroptera uncinata 462
Splenisatio 164
Spondylitis tuberculosa 704
Sporogonia 498
Sporotrichum Beurmanni 574
Sporozoan dermatoses in dogs. . 929
Stable pneumonia 126
Staggers 660, 762
Stampede 802
Staphylococcus pyog. aureus. . , 134
Stasis hyperemia of the lungs. . 84
Stasis in veins of optic papillae 586
Stenosis of the intestines 387
Stenosis of the esophagus 231
Stephanunis dentatus 582
Stilesia centripunctata 467
Stilesia globipunctata 467
Stomacee 198
Stomach calculi 313
Stomach catarrh, acute 285
Stomach catarrh, acute, of young
animals 333
Stomach catarrh, chronic 292
Stomach catarrh, chronic, of cat-
tle 294
Stomach catarrh, chronic, of
parturient cows 270
Stomach catheter 304
Stomach catheter, introduction.. 305
Stomach dilatation, acute, in
horses 296
Stomach dilatation, acute, in
other animals 307
Stomach dilatation, chronic . . . 309
Stomach diseases 245
Stomach distention 249
Stomach, foreign bodies in 312
Stomach, hemon-hage from .... 321
Stomach impaction 307
Stomach, inflammation of 347
Stomach, occlusion of 307
Stomach, parasites of 452
Stomach, rupture of 301
Stomach, sand in 292
Stomach, torsion of 317
Stomach, tumors of 316
Stomach, ulceration of 314
Stomach worms in cattle 459
Stomach wonns in deer 461
1016
Index.
Stomach worms in goats 457
Stomach worms in sheep 457
Stomach worms in swine 461
Stomatitis, aphthous 187
Stomatitis, aphthous, contagious,
Vol. 1 328
Stomatitis, aphthous, sporadic... 185
Stomatitis, catarrhal 182
Stomatitis, erosive 196
Stomatitis, erysipelatous 196
Stomatitis, erythematous 182
Stomatitis, follicular 190
Stomatitis, gangrenous, of lambs 198
Stomatitis, mercurial 199
Stomatitis, mycotic 187
Stomatitis, oidian 195
Stomatitis, papulous, of cattle,
infectious 190
Stomatitis, phlegmonous ....... 196
Stomatitis, pustular, contagious.
Vol I. 360
Stomatitis, simple 182
Stomatitis, ulcerous 19S
Stomatitis, ulcerous, in callle... 193
Stomatitis, vesicular 135
Stomoxys calcitrans, Vol. I 812,
Vol II 9S9
Strabismus 717
Strangulation of the intestines 412
Strangula'ion of the spermatic
duct 413, 424
Straw eating 365
Streptococcus of Borna disease 609
Streptococcus erysipelatis 877
Streptococcus melanogenes .... 698
Streptococcus peritonitidis equi 572
Streptococcus pyogenes ^. 134
Streptococcus sei'um, Vol. I 385,
Vol. II •■•■ 141
Streptothricosis, Vol. 1 102, 667
Streptothrix 134
Stricture of the esophagus 231
Stricture of the intestines 387
Strobila 464
Strongylosis, intestinal 488
Strongylosis of lungs 66
Strongylosis of stomach in cat-
tle . 459
Strongylosis of stomach in goats 457
Strongylosis of stomach in sheep 457
Strongyhis Arnfleldi 68
Strongylus Axei 455
Strongylus canis bronohialis. . . .
69, 74, 76
Strongylus capillaris 68
Strongylus circumcinctus 457
Strongylus commutatus 67
Strongylus contortus . .457, 461, 462
Strongylus convolutus 459
Strongylus Curticei 459
PAGE
Strongylus filaria 67
Strongylus lilicollis . . .458, 461, 495
Strongylus follicularis 493
Strongylus longevaginatus .... 68
Strongylus micrurus 68
Strongylus minutissiuius 68
Strongylus neglectus 489
Strongylus nodularis 495
Strongylus oncophorus 459
Strongylus Ostertagi 457, 461
Strongylus paradoxus 68
Strongylus primitivus 80
Strongylus pulmonalis 68
Strongylus pusillus 68, 76
Sti'ongylus retortaef ormis ... 67, 457
Strongylus i-ubidus 461
Strongylus rufesoens 67
Strongylus sagittus 68
Strongylus tenuis 495
Strongylus tenuismus 455
Strongylus tetracanthus 489
Strongylus trachealis 80
Strongylus vasorum 69
Strongylus ventricosus . . . .459, 495
Strongylus vicarius 457
Stupor 584
Sturdy 660
Stuttgart disease of dogs, Vol.
I 211, Voh II 350
St. Vitus's dance 792
Submaxillaiy glands, inflamma-
tion of 205
Summer bleeding 996
Summer dysentery 326
Summer eruptions 887
Summer founder 84, 620
Summer scabies 887
Sunstroke 620
Surra, VoL 1 811
Sweat eczema 888
Sweat, excess of 830
Swine erysipelas, Vol. 1 60
Swine fever. Vol. 1 257
Swine plague. Vol 1 125, 258
Swine pox. Vol. 1 325
Sycosis 911
Symbiotes 933
Symbiotes eeaudatus 933
Symplektoptes cysticola 83
Syncope 623
Syngamus broncealis 80
Syngamus laiyngeus 82
Syngamus trachealis 80
Syphilis, VoL 1 844
Syringomyelia 712
Syringophilus 982
Tabanidae 988
Tabanus, Vol. 1 333, 812
Index.
1017
PAGE
Tabes dorsalis 701
Tabes mtestinalis 340
Taenia alba 406, 467
Tasnia cestieillus 473
Taenia coenurus 46S
Taenia crassicollis 472
Taenia crassula 473
Taenia cucumerina 468
Taenia denticulata 466
Taenia echinobothrida 473
Taenia echinococcus 469
Taenia elliptica 473
Taenia expansa 466, 467
Taenia inf undibuliformis 473
Taenia Krabbei 469
Taenia lineata 469
Taenia mammillana 465
Taenia marginata 46S, 556
Teenia mediocanellata 823
Taenia ovvuq 4g(j
Taenia peetinaia ... ' ' ' ^yg
Taenia perfoliata '•'•'- ^g^
Taenia plicata • '• ^ -'r;
Taenia proglottina 4ro
Taenia saginata o-3
Taenia serialis • • 4b J
Taenia serrata "i^JS, oob
Taenia solium
Taenia tetragona
823
473
Takosis7'Vol 1 125
Talma's operation 5/^1
Tapeworms, see Tc-enia 4bb
Tapeworms in the lungs 156
Taste disturbance in brain dis-
596
Teleangiectasia capillaris macu-
losa 541
Tembladera 'J^
Tetania 'J^
Tetanus, Vol. 1 4dy
Tetanus intermittens ' ^^
Texas fever, Vol. I 'J^
Thigh, paralysis of ^44
Thigh, spasm of '44
Thoracocentesis 1 ' 5
Thrombo-embolic colic ^J^
Thrombosis of the celiac artei-y 411
Thrombosis of the mesenteric ar-
teries ^^^
Thrombosis of the mesenteric
veins 411
Thrombosis of the nasal vems. . ii
Thrombosis of the portal veins. 393
Thrombosis of the veins leading
to the brain 631
Tibial paralysis ^44
Tic
Ticks
PAGE
Tinea decalvans 899
Tinea favosa 917
Tinea galli 953
Tobacco dips 953
Torsion of the abomasum 319
Torsion of the cecum 428
Torsion of the colon 426
Torsion of the eyeball 717
Torsion of the intestmes 425
Torsion of the rectum 434
Torsion of the stomach 317
Traumatic dementia 801
Traumatic psychoses 801
Trematodes 474
Trembling disease 757
Trephining of the cranial cavity 671
Trephining of the frontal sin-
uses 35
Trephining of the nasal sin-
uses 24
Trichina 816
Trichina of the intestines 817
Trichina of the muscles 817
TriciJB^ spiralis 487, 817
Trichinosis T^jvalis 817
Trichinosis in man 816
Trichocephalus 821
Trichocephalus affinis 4b-/
Trichocephalus crenatus 487
Trichocephalus depressiusculus . . 487
Trichodectes scalaris 5!^5
Trichomonas columbae
Trichophyta megalospora
Trichophyta microspora
Trichophyton tonsurans • .
Trichophyton tonsurans, vane-
ties of 902
Trichoi-rhexis nodosa • o^^
Trichosoma aerophilum..28, 69, ^b
Trichosoma annulatum 48 /
Trichosoma brevicolle 4b /
Trichosoma collare 487
Trichosoma contortuni -^44
Trichosoma leporis pulmonale.. 07
Trichosoma longicolle 487
Trichosoma retusum
560
902
902
487
796
978
Tilleta caries
183
Tinea cristae galli 924
Trichosoma tenuissimum 48/
Trichotrachelida3 487
Trifolium _ 8/5
Trigeminal neuralgia ^^1
Trigeminal paralysis 718
Trigemmal spasm ' t;^
Trinotum
984
Triodontus ^90
Triodontus minor 4JU
490
720
Triodontus serratus
Trismus ,
Trombidium holosericum Jb^
Tropidoeerca fissispma 463
1018
Index.
PAGE
Tn'panosomiasis, Vol. 1 797
Tsetse fly, Vol. I 807, Vol. II. . 990
Tubercular eruption 887
Tuberculosis, Vol. 1 498
Tuberculosis of the brain 657
Tuberculosis of the liver 542
Tuberculosis of the nasal mem-
branes ^20
Tuberculosis of the meninges . . 704
Tuberculosis of the pharynx 217
Tuberculosis of the spinal cord. 704
Tuberculosis of the stomach 310
Tuberculosis of the vertebra?... 705
Tumors, cerebral 650
Tumors, esophageal 240
Tumors, lar;vai2eal 52
Tumors, nasal 20
Tumors, pharyngeal 217
Tumors, pulmonaiy IGO
Tumors of the stomach 310
Turnips, disease from eating... 574
Turnsick 060
Tympanitis, acute, of ruminapt-
Tympanitis, eh r o n. \ ' 202
"nants -^c fog. Vol. 1 211
Ulcer of the stomach 314
Uncinaria 482
Uncinaria os papillatam 486
Uncinaria radiatum 485
Uremia, Vol. 1 982
Urticaria, Vol. I 221, Vol. II. . . 840
Urticaria annularis 841
Urticaria bullosa 842
Urticaria chronica 842
Urticaria ephemera 841
Urticaria ex ingestis 840
Urticaria febriHs 841
Ui-ticaria figurata 841
Urticaria gyrata 841
Urticaria idiopathica 840
Urticaria porcellanea 841
Urticaria sym]itomatica 840
Urticaria vesiculosa 842
Vaginal catarrh, Vol. 1 750
Vaginal necrosis, enzootic 884
PAGE
Vaginal section 392
Vagus, paralysis of _. 728
Vagus pneumonia 14* , 728
Variola, VoL I .^ 295.
Veins, occlusion of. Vol. 1 1116
Ventricle, edema of, chronic . . . 644
Vertebra, fracture of 685
Vertebra, tuberculosis of 705
Vertigo 762
Vertigo, abdominal 764
Vertigo, cardiac 763
Vertigo, essential 763
Vertigo, idiopathic 763
Vertigo, paralytic 765
Vertigo, symptomatic 763
Vertigo, verminous 763
Vetch, eruption caused by 876
Volvulus et torsion of the intes
tine - ■ • • • • f-:^
Volvulus of tl^- '-^sentcry .... 428
Volvul-- - '^'^ stomach 317
tV ""igr 245
Vomitmg of blood 321
Vomitus cruentis 321
Voi'ticella 828
Waltzing motion 593
Waltzing motion in intestinal
torsion 430
Watei-y brain 660
Watery head (55(3
White comb 904
Wild und Rinderseuche, Yol. 1 103
Wind colic 353
Wing paralysis in pigeons 810
Winslow's foramen, intestines in 41 f)
Winton's disease 530
Wolf's milk 87S
Wool eating, Vol. 1 966
Wool shedding 832
Worms in the nitestinal canal.. 463
Worms in the lungs 66. 159
Worms in the stomach 452
Yeast cells 3r)5
Yeast fungi 355
Zona 885
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