Olljp i. 11 lill ffiibrarg Nnrtlj (EarnUna ^tatF This book was presented by MILTON M. LEONARD, D.V.M. TO THE VETERINARY MEDICAL LIBRARY THIS BOOK IS DUE ON THED ATE INDICATED BELOW AND IS SUB- JECT TO AN OVERDUE FINE AS POSTED AT THE CIRCULATION 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 larns 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. Crepitant and other rales appear and disappear in the 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 T. Pj^ X , = = = = 5 _ l_ = J = = l_ ■ 0_ _ 1 i_ ■: 3_ _] ^ m ,120 55 _5( E = E i E E E q E E E E ^ = ^ E •x — A z: = ~ = X — — zz = z ~ b IOC 39( no 100 1 80 is 35 - ^ - ^ q /S b ^ s — E — = = := = E = 1 E E E ^ i 1 ^ i 1 E E zz E L = E E J&O ij2 _80 JO _6C 3Q i - = ^ ^ = - :z 2 7^ s 5. 1 E 5 S ^ i i 3 § Z ^ ^ i p S £ g ^ ^ i E m J6-5 _5C J5 10 zz 5 '^ E ^ 5 ^ E a! I i £ E ^ 5 ^ i = E 1 \ m =M =5 — — — — — — — — — — — — — ' — - J — 1 — — 1 — 1 — 1 — L_J 1 — 1 — 1 — 1 t=J 1 — 1 — != [= L= Fig. 13. Fever curve in croupous pneumonia of a horse. Crisis. Considerable increase in tiie ]nilse and acceleration in respiration occurred with the approach of the stage of resolution. the beginning of hepatization and persists either only one or two days or until resolution occurs. A saffron-colored nasal discharge coming on later usually points to the development of new infiltrations. It is, however, a very valuable symptom, since it is frequently the only symptom in central pneumonia wiiich may afford information concerning the cause of the fever 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, however, only at long intervals or after external stimuli, for instance, after percussion. In the stage of hepatization it ap- pears painful, hence less violent, even very feeble, but it be- comes markedly easy and moist with the advent of resolution. The course of the fever is usually very characteristic for 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 (febris continua — see Figs. 13 and 14). Toward the end of Z- K r7 1 i i ^ _c ^ 7 _ 9 10 11 la =i ^ 14 _i 5_ tl5 lko_ eo _ ~ H E ~ zz n ZH ~ = J _ E ho £5 tO'O 130. Ill m 55 _5C 4= ^ - ?v F E V i : E -4 P =t: zi: --^ ^ E _ E m m 11 To 15 21 1° 11 -- -- f- t u 7 r ^ .} '^ 1 -SiZ ^ 1 \ K i: =^ # - ^ - = 'ill )M1 11 20 -1-6 ^f r-3 -^ £ 77 - - E ~ - - rE ^r t - E: — v^ ^ 5B-I To JO rn - ~ E E E EE z: -^ ^ g ^^ = E E — i 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. T. P. R. 1 t ) i S S t H 41 s UO CO 41 l.W .... „ -^ ._.-!- r^- ^= .._. 405 1-20 io 110 ^-r.:r---F = = ^■^-! -''^-p- "==" = = snr, 100 39 on ,,^^m--^^^ ^~-.- 3Sr, so .oif.--|l-?ta^t^-:E 3s .1 .I'Mm^^ 37.1 60 -.-^fe^s:^^ — z- 37 r,n 7,7^t^^^tv£^t^k^S^ u;.- fn ■^^r^xf-izin^^iri-^^W -w^^-M---'^^Jz^.^ W JO mmiMn 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. 1 2 3 1 <• "^ 6 1 ,3-5 180 U-0 ITO 75 - .25 160 10- is-ti 150 63 = .1-5 ly 60 = ll-D UO 55 - 1(15 120 - ttro UO 19-5 100 ,' 1J - i9-0 90 J Lj -j /s _ ^- i lA- V-, — — — V ^^ 38-3 86 sn 7n PS- , , ST^ an — ' — — — — ?.!- . i?'0 50 — — ^ — — _L5 _ ies io - — — — — — Ji£ = :H id ~ rl -4- 4-4- -1— 1- z—A 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 T. p. R. — — ~ — -^ t 8 £ iO-5 12.0 50 _ _ _ — — — — — — — — _ _ _ — — . _ — ,Ul) IIU ^ a — - — z Zl ~ Z z; 39^ 100 40 5i — — — — — — — — -] _ — - - — . — — — 1 — ^9-n fin 35 - - H — - — — — - — ?8-5 so 30 1W1 rn — J- 1 , , l_ , _ ?^ — — n — — — z: t n '~ z sw 60 20 — ^ I \ — — f^ — A s/ ?5 s: — — — ji. 'r -h-f- Y" — — — — to 10 — — — — - V' ^ - - — — — - je5 m iQ Is 1 1 1 1 1 1 i L^ LJ 1 — 1 u Fig 27. Fever curve in primary pleurisy in a horse. Recovery. Ijronclius, into the trachea, II p. R. P= 7 8_ B JO _n_ m pn Xk 15 16 " IS p 120 50 — — — - — ' — - — — — — — ^ — — J — ^ _ _ _ _ -J _ _ _ _ _ lo;o no ii — T — 1 — — s - — — ■ — — — — — — — 1 — , , — _ r E E E E = E E E E — 1 — ? 2 E C ^ ?5 s z: i 195 390 11°. _80 "fi E = ?; — ^ ir ~ -y. ^H — = E ^ T E — ^ T-- k -f- y 1 !!: = (5 ^ ^ r- f ^ 1 ^ ^ ?r z: — i E ^ ^ 5 E zz ~ ^ n lS-0 70 »5 1 \ — ^ -4- E — P ^ il J. E Jt E ^ % Y d. i = E E ^ E E: E ■ 1 \ i?-5 eo to o ■ ^7n S(l IS •^ 3 - o - — 1 _ 1 1 I 1 , 1 __ ._ . 1 1 . . >, 1 aw _vo 20 — 1 — — — — — — — — — ' — — — — ' Li_ 1 1 1 1 1 1 1 1 1 1 1 1 UJ Fig. 28. Fever curve in secondary pleurisy in a horse, (following upon croupous 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 K m IfVO iQ'. — — DU toe 110 — ; — j,3 39; » — J — — j J90 90 r i|t ~ — ' - 580 ?Q -.n-^.. OTrr J = = =: - 25 = = «i 11 ¥ ii — II — ' — : ^M^ = ^ t n 00 "if 20 ; -f"^ ;5 ~ i ^ z 15 — = 3 — *- H - - 3B-; to !»5 5 ^ — 560 ^ 1 _ 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 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