A TEXT-BOOK OF THE DISEASES OF THE SMALL DOMESTIC ANIMALS BY OSCAR VICTOR BRUMLEY, V.S. PROFESSOR OF VETERINARY SURGERY AND DIRECTOR OF CLINICS, COLLEGE OF VETERINARY MEDICINE, OHIO STATE UNIVERSITY, COLUMBUS, OHIO LEA & FEBIGER PHILADELPHIA AND NEW YORK 14S417 COPYRIGHT LEA & FEBIGER 1921 PRINTED IN U. S. A. PREFACE. THIS book is intended to be a practical text on the Diseases of the Small Domestic Animals. The author feels that it is inadvisable to write an exhaustive treatise on this subject, as it is primarily intended to be a book for student use and for the busy practitioner. An attempt has been made to include most of the important diseases (medical and surgical) of small animals with which the veterinarian comes in contact. It is hoped that it will serve the purpose for which it is written. The author does not claim originality for all the material in the book. The literature and standard books have been consulted freely. For scientific reasons the metric system has been used throughout the text. A table of equivalents in weights and measures has been inserted so that the dosage can be readily determined in the other system, if desired. This was thought to be more desirable than including both under the treatment of each disease. The author wishes to express his appreciation for the valued assistance rendered by his colleagues in the College of Veterinary Medicine, Ohio State University, in the preparation of the manuscript. He is especially indebted to Colonel David S. White, Dean, for his kindness in arrang- ing and correcting the manuscript, and for his advice relative to the subject matter, and in many other ways contributing to the value of the book. Also to Dr. James Howard Snook iv PREFACE for suggestions in the chaptep on skin diseases and various other problems as they presented themselves. The author's thanks are extended to Dr. John Newton Shoemaker and others who have been liberal with their assistance during the preparation of the manuscript. O. V. B. Columbus, Ohio, 1921. CONTENTS. PART I. DISEASES OF THE RESPIRATORY SYSTEM. CHAPTER I. DISEASES OF THE NASAL PASSAGES. Examination 17 Acute Nasal Catarrh (Coryza. Rhinitis) 19 Empyema of the Infraorbital Fossae of Birds 20 Infectious Nasal Catarrh of Rabbits (Rabbit Plague. Rabbit Influenza. Rabbit Distemper) 20 Parasitic Nasal Catarrh of Rabbits (Rhinitis Coccidiosa) ... 22 Chronic Nasal Catarrh (Chronic Coryza. Rhinitis) .... 23 Epistaxis . .... 24 Parasites of the Nasal Passages 25 Neoplasms of the Nasal Passages 28 Papillomata 28 Polypoid Fibromata 28 Malignant Tumors 29 CHAPTER II. DISEASES OF THE LARYNX. Acute Laryngitis 30 Chronic Laryngitis 31 CHAPTER III. DISEASES OF THE TRACHEA AND BRONCHIAL TUBES. Examination 34 Acute Tracheitis and Bronchitis 34 Bronchial Catarrh of Birds (Bronchitis) 38 Mycotic Pneumonia (Aspergillosis) 40 Animal Parasites in the Trachea and Bronchial Tubes (Syngamosis. Gapes in Chickens) 42 Chronic Tracheitis and Bronchitis 44 vi CONTENTS CHAPTER IV. DISEASES OF THE LUNGS. Examination 47 Congestion of the Lungs (Hyperemia of the Lungs) .... 49 Active Congestion 49 Passive Congestion 50 Pulmonary Edema (Edema of the Lungs) 52 Bronchopneumonia (Catarrhal Pneumonia) 53 Cirrhosis of the Lungs (Chronic Interstitial Pneumonia) ... 57 Foreign Body Pneumonia (Gangrene of the Lungs) .... 58 CHAPTER V. DISEASES OF THE PLEURA. Pleuritis (Pleurisy) '.... 60 Hydrothorax . 65 Pneumothorax 66 Hemothorax . 67 PART II. DISEASES OF THE CIRCULATORY SYSTEM. CHAPTER I. DISEASES OF THE PERICARDIUM. Examination 69 Pericarditis . 73 Hydropericardium (Dropsy of the Pericardium) 76 Hemopericardium 77 CHAPTER II. DISEASES OF THE HEART. Valvular Insufficiency and Stenosis 78 Myocarditis 82 Acute Myocarditis 82 Chronic Myocarditis 84 Acute Endocarditis 85 Hypertrophy and Dilatation of the Heart 89 Rupture of the Heart . 92 CONTENTS vii i PART III. DISEASES OF THE DIGESTIVE TRACT. CHAPTER I. DISEASES OF THE MOUTH. Examination 93 Stomatitis 94 Catarrhal Stomatitis 94 Ulcerative Stomatitis 96 Gangrenous Stomatitis (Canker of the Mouth) .... 97 Phlegmonous Stomatitis 99 Parasitic Sto natitis (Thrush. Soor. Aphtha) .... 100 Benign Neoplasms of the Mouth 102 Papillomata 102 Fibromata 102 Osteoma 103 Retention Cysts (Ranula) 103 Malignant Neoplasms of the Mouth 104 Epitheliomata 104 Sarcomata 105 Foreign Bodies in the Mouth . 106 CHAPTER II. DISEASES OF THE TEETH. Examination 107 Malformations of the Teeth 107 Fractures of the Teeth ' 108 Incrustations of Tartar 108 Alveolar Periostitis (Pericementitis. Periodontrtis) .... 108 Caries of the Teeth 109 CHAPTER III. DISEASES OF THE TONGUE. Examination Ill Glossitis Ill Gangrene of the Tongue (Gangrenous Glossitis) . ... 1 12 viii CONTENTS CHAPTER IV. DISEASES OF THE SALIVARY GLANDS. Examination 115 Parotitis (Mumps) 115 Submaxillary and Sublingual Glands 118 Salivary Fistula 118 CHAPTER V. DISEASES OF THE TONSILS. Examination . . . 120 Tonsillitis and Lymphadenitis 120 CHAPTER VI. DISEASES OF THE PHARYNX. Examination 123 Pharyngitis .... 123 Acute Pharyngitis 123 Chronic Pharyngitis 125 Foreign Bodies in the Pharynx .' . 126 Paralysis of the Pharynx . 127 Croupous Pharyngitis of Birds 127 Neoplasms of the Pharynx 128 Polypoid Growths 128 Epithelioma . 129 CHAPTER VII. DISEASES OF THE ESOPHAGUS. Examination 130 Esophagitis 130 Foreign Bodies (Obstruction in Esophagus) 131 Esophagismus 135 Stricture of the Esophagus : 135 Dilatations and Diverticula of the Esophagus 136 Catarrh of the Crop in Birds (Soft Crop) 137 Obstruction of the Crop in Birds (Hard Crop) 139 Neoplasms of the Esophagus 141 CONTENTS ix CHAPTER VIII. DISEASES OF THE STOMACH. Examination 142 Gastritis 142 Acute Gastritis (Simple Catarrh of the Stomach. Acute Dyspepsia) 142 Chronic Gastritis (Chronic Catarrh of the Stomach. Chronic Dyspepsia) 146 Foreign Bodies in the Stomach 148 Acute Dilatation of the Stomach 152 Chronic Dilatation of the Stomach 154 Ulceration of the Stomach (Ulcus Ventriculi) 157 Hematemesis 160 Parasites in the Stomach 163 Neoplasms in the Stomach. . .' 165 CHAPTER IX. DISEASES OF THE INTESTINES. Examination 167 Enteritis 167 Acute Enteritis 167 Chronic Enteritis 173 Intestinal Hemorrhage (Enterorrhagia) 175 Diarrhea 178 Constipation (Obstipation. Intestinal Obstruction) .... 182 Volvulus " 185 Intussusception 186 Wounds of the Intestines 188 Croupous Enteritis of Cats (Membranous Enteritis) .... 190 Infectious Asthenia of Birds 191 CHAPTER X. PARASITES IN THE INTESTINES. Helminthiasis 193 Tseniasis (Cestoda) 193 Tsenise in Dogs 195 Tseniae in the Intestine of the Cat 197 Ta3nia3 in the Intestine of Rabbits 197 Taeniae in the Intestines of Birds . 198 x CONTENTS Nematoda 201 Round worms (Ascaridse) . . . ." . 201 Round Worms in the Intestine of the Dog 202 Round Worms in the Intestine of the Cat .... 202 Round Worms in the Intestine of the Rabbit . . . 202 Round Worms in the Intestine of Birds 202 StrongylidsE (Hookworm) . . . 206 Strongylidtc in the Intestine of the Dog 207 Strongylidir in the Intestine of the Cat 207 Strongylidie in the Intestine of the Rabbit .... 207 Trichinellidse (Whipworm) 209 Trichinellidjc in the Intestine of the Dog 210 Trichinellida v in the Intestine of the Rabbit .... 210 Trichinellidse in the Intestine of Birds 210 CHAPTER XI. DISEASES OF THE RECTUM AND ANUS. Examination 212 Occlusion of the Rectum and Anus . 212 Proctitis 214 Hemorrhoids (Piles) 216 Prolapse of the Rectum 217 Parasites in the Rectum 221 Neoplasms in the Rectum . 222 Suppuration of the. Anal Glands 223 CHAPTER XII. DISEASES OF THE LIVER. Examination 225 Icterus (Jaundice) 225 Congestion of the Liver 231 Active Congestion 231 Passive Congestion 233 Hepatitis 235 Suppurative Hepatitis (Abscess of the Liver) ..... 236 Atrophy of the Liver 240 Fatty Liver 241 Amyloid Liver 242 Cirrhosis of the Liver (Chronic Interstitial Hepatitis) .... 243 Neoplasms of the Liver 244 Cholelithiasis. Gall-stones 245 Rupture of the Liver (Ruptura Hepatis. Apoplexia Hepatis) . 246 CONTENTS xi CHAPTER XIII. DISEASES OF THE PERITONEUM General Remarks 248 Peritonitis 250 Acute Peritonitis 250 Chronic Peritonitis 255 Ascites (Hydrops Abdominis. Hydrops Ascites. Hydrops Peritonei) . . 257 PART IV. DISEASES OF THE REPRODUCTIVE ORGANS. CHAPTER I. DISEASES OF THE PENIS AND PREPUCE. Examination 263 Wounds of the Penis and Prepuce 263 Congenital Malformations 265 Preputial Catarrh (Balanitis) . . . . 265 Phimosis 266 Paraphimosis 267 Tumors of the Penis and Prepuce . " 268 Papillomata 269 Sarcomata, Epitheliomata and Carcinomata . . . . . 269 Venereal Granulomata 269 CHAPTER -II. DISEASES OF THE TESTES AND SCROTUM. Wounds and Injuries of the Testes and Scrotum 271 Orchitis .... .............. 271 Tumors of the Scrotum and Testes 272 Parasites in the Scrotum and Testes (Cuterebra Emasculator) 273 Castration (Orchectomy) 273 Castration of the Dog . . . . 274 Castration of the Monorchid and Cryptorchid Dog . . 275 Castration of the Cat 275 Castration of Birds (Caponizing) 276 xii CONTENTS CHAPTER III.. DISEASES OF THE PROSTATE GLAND. Examination 279 Prostatitis 279 Tumors of the Prostate Gland (Hypertrophy of the Prostate Gland) 280 CHAPTER IV. DISEASES OF THE OVARIES. Examination 283 Inflammation of the Ovaries (Oophoritis) 283 Tumors of the Ovaries 284 Cysts 284 Oophorectomy (Ovariectomy) 285 Oophorectomy in the Dog 286 Oophorectomy in the Cat 289 Poulardizing the Female Chicken 289 CHAPTER V. DISEASES OF THE UTERINE TUBES. Examination 291 Salpingitis 291 Pyosalpinx 291 Tumors (Cysts) 291 CHAPTER VI. DISEASES OF THE UTERUS. Examination 292 Metritis 293 Acute Metritis 293 Chronic Metritis (Pyometra) 296 Puerperal Septicemia 298 Eversion of the Uterus (Prolapse. Inversion of the Uterus) . . 300 Torsion of the Cornua Uteri 302 Rupture of the Uterus 303 Tumors of the Uterus 303 Fibromata 303 Myomata 304 Hydrometra 304 Dystocia 305 CONTENTS xiii CHAPTER VII. DISEASES OF THE VAGINA AND VULVA. Examination 309 Congenital Malformations 309 Vaginitis and Vulvitis 309 Prolapse of the Vagina , 311 Rupture of the Vagina 313 Tumors of the Vulva and Vagina 313 Fibromata 313 Papillomata 314 Sarcomata 314 Venereal Granulomata 314 CHAPTER VIII. DISEASES OF THE MAMMARY GLANDS. Examination 315 Wounds and Injuries of the Mammary Glands 315 Congestion of the Mammary Glands .316 Mammitis (Mastitis) 316 Tumors of the Mammary Glands 317 Benign Tumors 317 Fibromata 317 Lipoma 318 Malignant Tumors 318 Carcinomata 318 Sarcomata 318 PART V. DISEASES OF THE BLOOD AND BLOOD . PRODUCING ORGANS. CHAPTER I. Anemia 319 Leukemia 322 Infectious Leukemia of Chickens 325 Pseudoleukemia (Hodgkin's Disease) 327 Hemophilia 328 Scurvy (Scorbutus) 328 xiv CONTENTS Animal Parasites in the Blood. (Filariaj. Metastrongulinse) . 330 Dirofilaria Immitis (Filaria Ininiitis) 330 Hematozoon Lewlsi 332 Hsemostrongylus Vasorum 332 Spiroptera Sanguinolenta 333 CHAPTER II. DISEASES OF THE THYROID GLANDS. Examination and General Consideration 334 Congestion of the Thyroid Glands 334 Acute Thyroiditis 335 Goiter (Struma. Bronchocele) 336 Parenchymatous Goiter . 336 Cystic Goiter 339 Fibrous Goiter 340 Vascular Goiter 341 Malignant Goiter 342 Exophthalmic Goiter (Basedow's Disease. Graves's Disease) 343 PART VI. > DISEASES OF METABOLISM. CHAPTER I. DISEASES OF METABOLISM. Diabetes 347 Diabetes Insipidus 347 Diabetes Mellitus 350 Obesity 352 Gout (Podagra. Arthritis Urica) 354 Feather Eating (Feather Pulling in Birds) . . ' 357 CHAPTER II. DISEASES OF METABOLISM AFFECTING PRIMARILY THE BONES. Rachitis (Rickets) 359 Osteomalacia (Brittleness of Bones) . 362 CONTENTS xv PART VII. DISEASES OF THE ORGANS OF LOCOMOTION. CHAPTER I. Articular Rheumatism (Polyarthritis Rheumatica) .... 363 Muscular Rheumatism 365 Fracture of Bones .... 368 Cranial Bones 368 Fracture of the Inferior Maxilla 369 Fracture of the Vertebrae 370 Fracture of the Ribs 371 Fracture of the Scapula 371 Fracture of the Humerus 372 Fracture of the Radius and Ulna . 372 Fracture of the Metacarpal and Phalangeal Bones . . . 373 Fracture of the Pelvis 373 Fracture of the Femur 374 Fracture of the Patella 375 Fracture of the Tibia and Fibula 375 CHAPTER II. DISEASES OF THE ARTICULATIONS. Wounds of the Articulations 376 Sprains and Injuries to the Articulations 377 Dislocation of the Articulations (Luxation) 378 Temporomaxillary 378 Vertebral .- . . 379 Scapulohumeral 379 Humero-radio-ulnar 379 Radio-ulnar-carpal 380 Phalangeal 381 Coxofemoral 381 Patellar 382 Tibiotarsal 383 Caudal Vertebra; 383 Inflammation of the Synovial Membrane and Articulations. (Synovitis. Arthritis) 383 xvi CONTENTS PART'VIII. DISEASES OF THE URINARY SYSTEM. CHAPTER I. DISEASES OF THE KIDNEYS. Examination 385 Congestion of the Kidneys (Hyperemia . ) . - 387 Acute Hyperemia 387 Passive Hyperemia 388 Inflammation of the Kidneys (Nephritis) 388 Acute Nephritis 388 Chronic Nephritis 392 Purulent Nephritis (Kidney Abscess) 396 Inflammation of the Renal Pelvis (Pyelitis) . 398 Uremia 400 Calculi in the Kidney (Nephrolithiasis) 402 Dropsy of the Kidney (Hydronephrosis. Cystic Kidney) . . . 405 Amyloid Kidney 407 Tumors in the Kidney 407 Animal Parasites in the Kidney 407 Dioctophyme Renale (Eustrongylus Gigas) 407 Other Parasites in the Kidney . . 409 CHAPTER II. DISEASES OF THE BLADDER. Examination 410 Wounds of the Bladder 412 Rupture of the Bladder 412 Retention of Urine in the Bladder (Retcntio Urinse Vcsicalis) . 414 Incontinence of Urine 416 Catarrh of the Bladder (Cystitis. Urocystitis) 416 Torsion of the Bladder 420 Calculi in the Bladder 420 Tumors of the Bladder 423 Parasites in the Bladder . . 423 CONTENTS xvii CHAPTER III. DISEASES OF THE URETHRA. Examination 425 Congenital Malformations (Occlusion of the Urethra) .... 425 Wounds of the Urethra 426 Stricture of the Urethra 426 Calculi in the Urethra 427 Inflammation of the Urethra (Urethritis) 420 PART IX. DISEASES OF THE NERVOUS SYSTEM. CHAPTER I. DISEASES OF THE BRAIN. General Considerations 431 Examination 432 Psychic Disturbances 433 Sensibility 433 Hyperemia of the Brain (Congestion of the Brain) 435 Anemia of the Brain (Cerebral Anemia) 437 Meningo-eqcephalitis 438 Cerebral Hemorrhage (Apoplexy) 440 Tumors of the Brain 441 CHAPTER II. DISEASES OF THE SPINAL CORD. General Considerations 443 Examination 443 Meningomyelitis 443 Concussion of the Spinal Cord (Injuries of the Spinal Cord) . . 445 Compression of the Spinal Cord 448 xviii CONTENTS CHAPTER III. DISEASES OF THE PERIPHERAL NERVOUS SYSTEM. Injuries of the Peripheral Nerves 450 Pressure upon the Peripheral Nerves (Compression) .... 450 Paralysis of the Peripheral Nerves 450 Facial Nerve 450 Trigeminal Nerve 452 Auditory Nerve 453 Radial Nerve 454 Brachial Plexus 455 Sciatic Nerve 456 CHAPTER IV. FUNCTIONAL NERVOUS DISEASES. Vertigo (Megrim) 455 Epilepsy 456 Reflex or Secondary Epilepsy 459 Catalepsy 460 Chorea 461 Eclampsia 462 PART X. DISEASES OF THE SKIN. CHAPTER I. NON-PARASITIC SKIN DISEASES. Examination 463 Dandruff .464 Alopecia 465 Dermatitis 466 Acne 468 Eczema 469 CONTENTS xix CHAPTER II. PARASITIC SKIN DISEASES. Fleas 472 Lice 473 Scabies (Mange. Red Mange. Itch) ... T .... 475 Sarcoptes Mite 476 Demodex Mite 480 Dermatomycosis (Vegetable Parasitic Disease of the Skin) . . 482 Herpes Tonsurans (Ringworm. Red Itch) 482 Favus (Honeycomb Ringworm. Comb Disease. White Comb) 484 PART XL DISEASES OF THE EAR. Examination 487 Wounds of the Ear ' 487 Ulceration of the Concha 488 Hematoma 489 Otitis Externa (Otorrhea) 490 Otitis Media and Interna . 493 Tumors (Neoplasms of the Ear) 493 Papillomata 493 Sebaceous Tumors or Cysts 494 Parasites in the Ear 494 Deafness 495 Ear Fistula . 495 PART XII. DISEASES OF THE EYE. CHAPTER I. DISEASES OF THE EYELIDS. Examination 497 Wounds of the Eyelids 497 Inflammation of the Eyelids (Blepharitis) 498 xx CONTENTS Malposition of the Eyelids 499 Entropion 499 Ectropion 500 Ptosis (Blepharoptosis) 501 Paralysis of the Orbicularis Nerve 502 Spasm of the Orbicularis Nerve (Blepharospasm) . 503 Trichiasis 503 Districhiasis 504 Adhesions of the Eyelids 504 Ankyloblepharon 505 Symblepharon 505 Lagophthalmos 506 Tumors of the Eyelids 506 Papillomata (Warts) 506 Chalazion (Meibomian Cyst) 507 Pilosebaceous Cysts 507 Lipoina and Sebaceous Tumors in Birds 508 Enlargement of the Glands of Moll 508 Granulomas 508 Malignant Neoplasms 508 CHAPTER II. DlSKASES OF THE CONJUNCTIVA. Examination 510 Conjunctivitis 510 Catarrhal Conjunctivitis 511 Purulent Conjunctivitis (Blennorrhea) 512 Parenchymatous Conjunctivitis (Erysipelatious Conjunctivi- tis) 514 Croupous Conjunctivitis 516 Follicular Conjunctivitis 517 Exanthematous Conjunctivitis 518 Pterygium 519 Traumatic Lesions of the Conjunctiva 519 Foreign Bodies in the Conjunctiva 519 Wounds of the Conjunctiva 520 Corrosions and Burns of the Conjunctiva 521 Ulceration of the Conjunctiva 521 Tumors and Growths on the Conjunctiva 522 Inflammation of the Membrana Nictitans 522 Wounds of the Membrana Nictitans 523 Tumors of the Membrana Nictitans . 523 CONTENTS CHAPTER III. DISEASES OF THE LACRIMAL APPARATUS. Examination 524 Lamination (Epiphora) 524 Dacryocystitis 525 CHAPTER IV. DISEASES OF THE CORNEA. Examination 526 Keratitis '....-. 526 Non-suppurative Keratitis 527 Superficial Keratitis 527 Vascular Keratitis (Pannus) 528 Keratitis Pigmentosa (PigmentaryjKeratitis; . . . . 529 Keratitis Punctata Superficialis (Facetted Keratitis) . 529 Parenchymatous Keratitis 530 Keratitis Punctata Profunda 532 Suppurative Keratitis 532 Ulceration of the Cornea 532 Abscess of the Cornea 534 Keratitis Xeuroparalytica 535 Keratitis from Lagophthalmus 535 Foreign Bodies and Wounds of the Cornea 535 Opacities of the Cornea 536 Ectasia of the Cornea 537 Inflammatory Ectasia 537 Staphyloma 537 Keratectasia 537 Non-inflammatory Ectasia 538 Keratoconus 538 Keratoglobus 538 Tumors of the Cornea 538 CHAPTER V. DISEASES OF THE IRIS AND CILIARY BODY. Congenital Defects of the Iris 539 Mydriasis 540 Myosis 540 Iritis and Cyclitis (Iridocyclitis) 540 Cysts and Tumors of the Iris . 541 xxn CONTENTS CHAPTER VI. DISEASES OF THE LENS. Examination 542 Cataract 542 Luxation of the Lens 544 CHAPTER VII. DISEASES OF THE RETINA AND CHOROID . . . 545 CHAPTER VIII. DISEASES OF THE OPTIC NERVE. Papillitis 546 Retrobulbar Neuritis 546 Atrophy of the Optic Nerve 547 Amblyopia 547 Amaurosis 547 CHAPTER IX. DISEASES OF THE GLOBE AND ORBIT. Panophthalmitis 548 Glaucoma 549 Hydropthalmus 550 Exophthalmus 550 Luxation of the Eyeball 550 Enophthalmus 551 Strabismus 552 Nystagmus 552 Parasites of the Eye 553 Fracture of the Orbit 553 Inflammation of the Orbit 553 Tumors of the Orbit . . . 553 CONTENTS xxiii PART XIII. HERNIA. General Remarks 555 Umbilical Hernia 557 Ventral Hernia 558 Inguinal Hernia 560 Inguinal Hernia in the Female 560 Inguinal and Scrotal Hernia in the Male 561 Femoral Hernia 562 Diaphragmatic Hernia 563 Perineal Hernia . 563 PART XIV. INFECTIOUS DISEASES. CHAPTER I. ACUTE GENERAL INFECTIOUS DISEASES. Distemper of Dogs 565 Distemper of Cats 577 Typhus of Dogs (Canine Typhus. Hemorrhagic Gastro-enteritis. Dog Plague. Black Tongue) 579 Purpura Hemorrhagica of Dogs 583 Fowl Cholera (Cholera Gallinarum. Pasteurellosis Avium. Fowl Typhoid) 584 Fowl Pest (Fowl Plague. Pestus Avium) 589 CHAPTER II. ACUTE INFECTIOUS DISEASES WITH LOCALIZATION IN CERTAIN ORGANS. Epitheliosis Infectiosa Avium (Contagious Epithelioma. Chicken- pox. Diphtheria. Roup. Canker) 593 Anthrax 599 Foot-and-mouth Disease (Aphthae Epizootics:) 600 Hemorrhagic Septicemia of Cats (Infectious Gastro-enteritis) . . 600 xxiv CONTENTS CHAPTER III. INFECTIOUS DISEASES WITH SPECIAL INVOLVEMENT OF THE NERVOUS SYSTEM. Rabies (Hydrophobia. Lyssa) 603 Infectious Bulbar Paralysis (Pseudorabies) 611 Tetanus (Lockjaw) 613 CHAPTER IV. CHRONIC INFECTIOUS DISEASES. Tuberculosis of Birds (Tuberculosis Avium. Avian Tuberculosis) 616 Tuberculosis of Dogs and Cats 620 Glanders 622 Pseudo-act inomycosis of Dogs (Streptotrichosis Canum. Actiuo- . myces Canis) 623 CHAPTER V. INFECTIOUS DISEASES PRODUCED BY PROTOZOA. Spirochaetosis of Fowls (Spirochsetosis Avium. Spirillosis of Chickens) 625 Enterohepatitis (Blackhead) 627 Infectious Diarrhea of Chicks (White Diarrhea) 629 Piroplasmosis of the Dog (Infectious Jaundice. Biliary Fever. Malignant Jaundice) 633 Table of Equivalents in Weights and Measures 637 DISEASES OF THE SMALL DOMESTIC ANIMALS. PART I. DISEASES OF THE RESPIRATORY SYSTEM. CHAPTER I. DISEASES OF THE NASAL PASSAGES. Examination. The nasal passages are very small and do not admit of a free examination. In some breeds of dogs (English bull) there is an obstruction of the nasal passages which during inspiration produces a peculiar snoring sound. This should not be mistaken for an abnormal condition. In other breeds (Collie) where the nasal passages are longer and less tortuous respiration produces no sound. Dogs breathe freely through the mouth. In the cat the nasal passages are very small and short and can only be examined at their openings. The examination of the nasal passages should be made as follows: Good light such as ordinary daylight or strong artificial light is necessary. A mirror to reflect light into the nasal openings is of little value as the passages are so small that the light will be reflected only a short distance. A very small nasal dilator will be found useful in some of the larger breeds. A small flexible probe with a pledget of cotton securely wrapped around one end, large enough to occlude the nostril when inserted rather high up, will at once 2 18 DISEASES OF THE NASAL PASSAGES induce sneezing and the character of the secretions from the opposite nostril can be more easily determined. The probe is then removed and inserted in the other nostril for a similar examination. The nose in health is moist and cool with a very thin, slight mucous discharge. The mucous membrane is variable in color; in most breeds dark, in others light with dark spots, and in a few breeds pink. Abnormal conditions to be noted are the following: Turn or*. Small papillomas on the skin and mucous membrane at the entrance to the nasal openings are fre- quently seen. Epitheliomas extending from the lips to form a diffuse enlargement which may partially or completely obstruct the nasal openings. Polypoid enlargements on the mucous membrane of the nasal passages are often noted and can be accurately determined by using a small, fine wire snare to pull them toward the nasal opening. Foreign Bodies. Frequently in hunting dogs small pieces of straw, twigs and other foreign material will be found rather high up in the passages. These injure the mucous membrane and often become deeply imbedded in it and the underlying tissues. Parasites. The Pentastoma rhinaria (Linguatula rhinaria) is occasionally found in the nasal passages and when suspected the nasal discharge should be examined microscopically to reveal the presence of the eggs of the parasite. Infectious. Distemper infection frequently takes place in the nasal passages and produces both local and general symptoms. Staphylococcus infection from wounds in the mucous membrane, or as secondary infection following dis- temper, is of common occurrence. In these conditions the nose is usually dry and hot, showing numerous fissures on the mucous membrane and nose at the borders of the nasal openings. Hemorrhage. This occurs often from injuries, as blows over the nasal bones, fractures of the nasal bones; from punctured wounds through the bones and from injury to the turbinated bones. Malformations. Some diseases (rachitis) produce a de- formity of the nasal bones interfering with the free passage ACUTE NASAL CATARRH 19 of air through the nostrils and producing marked enlarge- ment of the nose. Discharge. In acute and chronic nasal catarrh (coryza, rhinitis) the mucous and serous discharge from the nasal passages is greatly increased. The general condition is but little disturbed. ACUTE NASAL CATARRH. Coryza. Rhinitis. Definition. Acute inflammatory condition of the nasal mucous membrane producing a serous or mucous discharge. Etiology. (a) Inhalations of dust or other foreign material. (6) Inhalations of irritating gases or chemicals. (c) Exposure to cold (cold draughts of air). (d) Ordinary infection (staphylococcus, etc.); specific infections (distemper, etc.). (e) Linguatula rhinaria (early stages of invasion) . During the first stages there is hyperemia and dryness of the nasal mucosa, which is soon followed by a discharge that is serous, seromucous, or mucopurulent. This discharge often causes excoriation of the tissues with which it comes in contact. In non-pigmented membranes the congestion is more prominent. The discharge when examined with the microscope shows epithelial cells, leukocytes, bacteria and sometimes the eggs of the parasite, Linguatula rhinaria. Symptoms. Sneezing and the presence of a thin, serous discharge in the early stages, which later is mixed with mucus, becomes dry and adheres around the nasal openings. The nose is rubbed against objects and wiped with the paws. Excoriations appear around the margins of nasal openings. Diagnosis. The presence of the above symptoms and the absence of any general disturbance characterize simple rhinitis. Prognosis. Eavorable. Recovery usually takes place in about one to two weeks. Treatment. Hygienic. The animal should be kept warm and protected from draughts of cold air. 20 DISEASES OF THE NASAL PASSAGES Medical. Spray the nasal passages with a warm boric acid (2 per cent.) or sodium bicarbonate (2 per cent.) solution. Remove the dry discharge from the edge of the nasal openings. Apply vaselin or zinc oxid ointment to those parts as protec- tive agents. EMPYEMA OF THE INFRAOEBITAL FOSS/E OF BIRDS. Definition. A collection of pus in the infraorbital fossae which causes a distention of one or both of them. Etiology. This condition usually occurs during the course of infectious nasal catarrh, diphtheria or parasites (monos- toma). The mucous membrane becomes infected and the purulent material collects in the fossse greatly distending them. Symptoms. A warm painful swelling is noticed in the infra- orbital region, which may affect one or both sides. The enlargement, which is quite firm, protrudes over and closes the eye. Prognosis. Depends upon the primary cause. When the affection is confined to the fossae the prognosis is favorable. Treatment. Surgical. An incision should be made over the enlargement and the accumulated material which is quite hard and firm removed with a curette. The cavity should be washed with antiseptics. INFECTIOUS NASAL CATARRH OF RABBITS. Rabbit Plague. Rabbit Influenza. Rabbit Distemper. Definition. An infectious disease involving the mucous membrane of the nasal passages, which later produces general infection. Etiology. The exciting cause is a small, slender, immobile bacillus, similar in size to the bacillus of cholera in birds. It does not form spores and is Gram-negative. This organism is also pathogenic to guinea-pigs and mice, but rabbits are most susceptible. Infection takes place by inhalation during cohabitation with affected animals, or by being taken in with INFECTIOUS NASAL CATARRH OF RABBITS 21 the food. The organism produces a severe inflammation of the mucosa of the nasal passages and sinuses, and later enters the circulation producing general infection, causing elevation of temperature and in most cases an inflammation of the serous membranes. The infection is often carried directly to the trachea, bronchial tubes and lungs, where it produces an acute inflammatory condition. Necropsy. The nasal, oral and pharyngeal mucous mem- branes .are intensively congested, swollen and covered with a purulent exudate. In the lungs are often found evidences of a bronchopneumonia. The thoracic cavity may contain a serous or purulent exudate with fibrinous deposits on the pleura. The peritoneum will also show inflammation with some exudate in the abdominal cavity. The bacilli can be found in large numbers in the exudate and in affected organs. Symptoms. The incubation period is from four to six days. The first symptoms noticed are depression, a copious discharge of serous secretion from both nasal openings and severe sneezing. The temperature is usually from 104-106 F. and there is complete loss of appetite. This discharge soon becomes thick and tenacious, adhering around the nasal openings and on the hair of the chest and limbs, the animal frequently rubbing its nose with its paws to relieve the intense irritation. With the extension of the inflammation to the larynx and bronchi, dyspnea and coughing result. Exhaus- tion is soon noticed due to the general infection and anorexia. Prognosis. Very unfavorable in acute cases, death occur- ring in three to five days. In subacute and chronic cases in older animals the course is fifteen to thirty days. Complete recovery, however, is rare; chronic nasal catarrh is a common sequel. Diagnosis. The rapid development, high temperature, absence of coccidia (see rhinitis coccidiosa), the acute inflam- mation of the serous membranes and the finding of the specific bacillus in the discharges confirm the diagnosis. Treatment. M edicaL The nasal passages should be sprayed with antiseptic solutions (boric acid 2 per cent, or sodium bicarbonate 2 per cent.), the accumulated crusts removed with warm water and a protective dressing of zinc 22 DISEASES OF THE NASAL PASSAGES oxid ointment or vaselin applied. The use of internal anti- septics (salol 0.12-0.2, etc.) is indicated to combat the general infection. Autogenic vaccines may be used. Prophylaxis. All material soiled by the nasal discharges as well as all animals that die should be burned and well covered with lime; all parts of the hutch and the runways thoroughly disinfected, and a quarantine of at least two weeks imposed upon all newly acquired animals. PARASITIC NASAL CATARRH OF RABBITS. Rhinitis Coccidiosa. Definition. An inflammation of the mucous membrane of the nasal passages and sinuses due to an infestation with coccidia. Etiology . This condition is due to the Coccidia perforans or the Coccidia oviformis, which gains entrance to the nasal passages and sinuses. The discharges of affected animals are infectious. Damp hutches with soiled litter and filth in them favor the spread of the disease. Young animals are more susceptible than those fully matured, the latter usually contracting the disease in a mild form. Symptoms. The clinical symptoms are similar to those of infectious nasal catarrh. The nasal discharge is present, being serous at first, later becoming thick and tenacious. After two or three days the animals become depressed, fre- quently gnashing the teeth and rubbing the nose. The tem- perature, however, is subnormal. In some cases the mucous membranes of the mouth and the conjunctiva exhibit catarrhal symptoms. In cases where the coccidia pass into the middle ear, the semicircular canals become involved causing the head to be carried to one side, staggering gait, and ( in some cases rolling over and over. Spasms of the muscles occur followed by paralysis. Paralysis, however, is a symptom of many irritating conditions in rabbits which in other animals ordinarily cause excitement. Later a pro- fuse diarrhea is noticed followed rapidly by exhaustion and death. CHRONIC NASAL CATARRH 23 Diagnosis. Microscopic examination of the nasal dis- charges reveals the presence of the coccidia. In otodectes cynotis mange, catarrhal symptoms of the mucous mem- brane are absent. Prognosis. Unfavorable. Treatment. The nasal passages, eyes and mouth are cleansed with antiseptic solutions and astringents (boric acid 2 per cent., zinc sulphate 1 per cent., copper sulphate 1 per cent., creolin 2 per cent.). Small doses of sulphur (0.1-0.2) may be given every four to six hours to produce antiseptic and laxative action. Prevention. (See Infectious Nasal Catarrh of Rabbits.) CHRONIC NASAL CATARRH. Chronic Coryza. Chronic Rhinitis. Definition. A chronic inflammatory condition of the mucous membrane of the nasal passages with a mucopurulent discharge. Etiology. Usually follows repeated attacks of acute nasal catarrh; ordinary infection; tumors. Pathology. (a) In the productive or hypertrophic form there is a generalized infiltration of the mucosa, particularly that covering the lower portion of the turbinated bones, which leads to a more or less extensive thickening of the mucous membrane. The mucous glands increase in size, there is a thick, viscid secretion, and the nasal passages become obstructed by enlargement of the lower part of the turbinated bones. The atrophic form follows the course of the hypertrophic. The hyperplastic tissue atrophies, the epithelium of the mucosa and the glands is destroyed, and there is a collection of a yellowish, purulent material on the surface of the mucous membrane. (6) The discharge from the nasal passages contains bacteria, leukocytes, red cor- puscles and epithelial cells. Symptoms. A purulent discharge varying in quantity from both nasal passages. This discharge in severe cases is streaked with blood and has a very offensive odor; it causes 24 DISEASES OF THE NASAL PASSAGES excoriations on the mucous membrane and skin at the nasal openings, where it drys and forms hard crusts. There are frequent paroxysms of sneezing. In cases where the nasal passages are occluded the animal breathes through its mouth. In some cases where infection is severe general symptoms of loss of appetite, dulness and emaciation will be noted. Diagnosis. The presence of the nasal discharge, the chronic course and the mild general symptoms in severe cases. Prognosis. Not so favorable as acute nasal catarrh. It requires several weeks for a complete disappearance of the symptoms. Treatment. Hygienic. The animal should be kept in a warm place free from all irritating materials which might affect the nasal mucous membrane. Medical. The nasal passages should be sprayed daily with creolin (2 per cent.), boric acid (2 per cent.), or sodium bicar- bonate (2 per cent.) solution; the dried crusts may be removed with warm water, and zinc oxid ointment applied to the membranes and skin at the nasal openings. Sera-vaccine. Cultures may be grown from the nasal dis- charge, and a standardized autogenic vaccine made. Two c.c. of this vaccine are injected subcutaneously every five to seven days until the purulent discharge ceases. EPISTAXIS. Definition. Hemorrhages from the nasal passages. Etiology . (a) Injuries to the nasal mucous membrane from foreign bodies (straws, twigs, etc.); probing; injuries to the turbinated bones due to fractures or trephining the sinuses. (6) Carbolic acid poisoning causing necrosis of the mem- brane extending into the nasal passages which opens the vessels. (c) Specific and ordinary infections during the course of distemper and chronic nasal catarrh. (d) Parasitic invasion (Linguatula rhinaria). Hemorrhage occurs during the course of the following disease conditions : PARASITES OF THE NASAL PASSAGES 25 Hemophilia, plethora, leukemia, parasitic anemia and catarrhal pneumonia. Symptoms. A unilateral or bilateral discharge of blood from the nasal passages. When primary the blood is of a bright red color and flows away a few drops at a time or the flow may be copious, and sometimes sufficient to produce general symptoms. When secondary to chronic nasal catarrh or distemper it is mixed with the secretions. As small animals lick the nose the amount of hemorrhage is not easily determined. Prognosis. The prognosis depends on the character and amount of the hemorrhage. Most cases terminate favorably. Treatment. Medical. In mild cases when treatment is necessary use injections of cold water (ice-water) or alum solution (3 per cent.) into the nasal passages. In severe cases when hemorrhage is copious and persistent use injec- tions of adrenalin chlorid (1-1000) solution. Give internally iron and quinin citrate (0.2-0.35) three times daily; or adre- nalin chlorid (1-1000) ten to twenty drops, twice daily. Surgical. When the hemorrhage is continuous and cannot be stopped by medical treatment, it will be necessary to use a tampon made of gauze and saturated in an alum (3 per cent.) or tannic acid (3 per cent.) solution. They should be inserted with a small flexible probe firmly and carefully as far up the nasal passages as possible. In some cases it will be necessary to use the same kind of a tampon inserted in the posterior part of the nasal passage. This is best accom- plished by use of the mouth speculum and a flexible probe bent in the shape of a hook. When a tampon is inserted a free end should be exposed to facilitate removal. As small animals breathe freely through the mouth tampons may be inserted in both nasal passages. PARASITES OF THE NASAL PASSAGES. Definition. Infestation of the nasal passages and chambers by the Linguatula rhinaria. Etiology. History. The infestation of the dog with this parasite is rather rare in the United States. Only a few cases 26 DISEASES OF THE NASAL PASSAGES have been recorded, but in other countries (France, Germany) they are frequently found. The Linguatula rhinaria are white, the body lanceolated, elongated, vermiform and flat- tened above and below, the ventral surface nearly plane, the dorsal surface rounded, anterior extremity broad and rounded, posterior extremity attenuated. The thorax is short and between it and the abdomen there is no distinct boundary. The integuments show about ninety rings or segments, widest in their middle, causing the margins of the parasite to be distinctly crenated. The hooks are sharp, curved, and bi- articulated. Each hook is retractile into a small sheath and is moved by muscular cords arranged in different direc- tions. The mouth is rounded, digestive tube rectilinear. Size: Male, 18-20 mm. long, 3 mm. broad in front and 0.5 mm. behind. Female, 8-10 cm. long, 8-10 mm. broad in front and 2 mm. behind. The eggs are ovoid, 90 mmm. long and 70 mmm. broad. The life cycle of the Linguatula rhinaria is as follows: The female deposits her eggs in the nasal passages of the dog; the eggs are expelled by sneezing and, being surrounded by mucus, they adhere to grasses or whatever they happen to come in contact with. The grasses are eaten by any of the herbivorous animals. The shells of the eggs are dissolved by the gastric juice and the embryos are set at liberty in the intestinal tract. Each embryo is provided with a median stylet and two curved hooks with which it penetrates the walls of the intestines and reaches the peritoneum, mesenteric glands, liver and the lungs where it becomes encysted. During the period of encystment in the organs and glands the embryo undergoes successive changes in its development and becomes a larva (Linguatula denticulatum) . When mature the larvae migrate by means of their hooks and the sharp spiculse on their skin. Some of them pass into the bronchi and trachea reaching the nasal passages where they develop into the perfect parasite. Dogs become infested by eating the viscera of animals containing the larval form which passes from the stomach via the esophagus to the nasal passages where it develops. PARASITES OF THE NASAL PASSAGES 27 Necropsy. In the early stages of the invasion of the Lin- guatula rhinaria they attach themselves to the mucous membrane of the nasal cavities producing an acute inflam- mation. The exudate is increased in quantity and later is mixed with pus covering the surface of the mucous membrane which becomes greatly thickened especially around the turbinated bones and in the nasal chambers. In the later stages necrosis of the turbinated bones and nasal septum may take place. The discharge from the nasal passages often contains the parasites, pus, epithelial cells and large numbers of the ovoid eggs. Symptoms. In the early stages the symptoms are par- oxysms of sneezing; obstruction of the nasal passages; a discharge which is at first serous, later becomes mucopurulent, mixed with blood, and has a very offensive odor. Accumula- tions of the dried discharge form crusts at the nasal openings. In animals of a nervous temperament symptoms of excite- ment are noted from reflex irritation of the nasal passages. Severe hemorrhage is seen from the necrosis opening blood- vessels. ' Diagnosis. The presence of the parasites or eggs in the nasal discharge. Prognosis. Depends upon the number of parasites and the probability of becoming reinfested. Treatment. Medical. Inhalations of small amounts of chloroform, turpentine, or some other volatile oils. Spray the passages twice daily with creolin (2 per cent.), carbolic acid (2 per cent.), or boric acid (2 per cent.) solution. Re- move the crusts from around the nasal openings with warm creolin solution and apply zinc oxid ointment to the excori- ated membrane and skin. Give internally tincture mix vomica (0.3-0.65) daily; iron and quinin citrate (0.2-0.4) daily. Surgical. Irrigation of the nasal passages with a warm solution of creolin (2 per cent.). This can be done by using a small, soft rubber tube inserted as high up in the nasal passages as possible. Attach a funnel to the other end and pour the solution slowly into it using only a small quantity of the fluid. The nasal passages can also be irrigated through 28 DISEASES OF THE NASAL PASSAGES the posterior nares by the use of a hard nozzle bent in the form of a curved hook. Depress the head and allow the fluid to flow out through the nasal passages. NEOPLASMS OF THE NASAL PASSAGES. Papillomata. These are benign tumors having a frame- work of fibrous tissue and bloodvessels covered by squamous epithelium. The surface of the tumor is roughened by many elevations and proliferations. Papillomata are most com- monly located around the margins of the nasal openings and especially at the juncture of the skin and mucous membrane. Sometimes they extend a short distance up the nasal passages and may extend to the skin of the lips and the nose. They are found here in two forms : (a) A hard form which presents smooth, rounded elevations on the skin. (6) A soft form, which is pedunculated, has an irregular, broad surface and cauliflower-like appearance. The soft tumors are found on the mucous membrane. In size they vary from that of a millet seed to a walnut. There may be a large number or only a few present. Treatment. Surgical. They are removed as follows: The animal should be given an anesthetic (morphin subcu- taneously, or ether inhalation). Sterilize curved scissors, forceps and artery forceps; disinfect the surface of the skin, mucous membrane and tumors with boric acid solution (2 per cent.). Grasp the tumor with the forceps and cut off with the scissors, and if the hemorrhage is persistent use the artery forceps. Alum (2 per cent.) or silver nitrate solution (0.25-0.5) may afterward be applied. The after-treatment consists in washing the surface where the tumors are removed with antiseptic solutions. Polypoid Fibromata. These occur as enlargements on the mucous membrane of the nasal passages and frequently interfere with breathing, producing complete obstruction of one or both passages. Treatment. These are best removed with a fine wire snare. Inject astringent solutions (alum 2 per cent.) up the nasal passages to control the hemorrhage. When this method of NEOPLASMS OF THE NASAL PASSAGES 29 removal fails it is best to trephine the superior wall of the nasal passages and extirpate the tumor through the opening. After-treatment consists of warm antiseptic solutions injected daily up the passages. Malignant Tumors. Occasionally in the nasal passages are found epitheliomas, osteosarcomas, and sarcomas which are usually secondary to primary growths having their origin in the buccal mucosa, maxillary bones or lips (epitheliomas) . Symptoms. Malignant growths give rise to distortions of the nasal bones, lips and often result in necrosis of the parts involved. The nasal discharge will contain necrotic material and blood and has a very offensive odor. Diagnosis. To make an accurate diagnosis some of the tumors should be obtained and examined microscopically. Prognosis. The prognosis is very unfavorable. Treatment. Owing to the location of the tumors, their malignant character and the tissues involved, treatment is not to be attempted. CHAPTER II. DISEASES OF THE LARYNX. Examination. (a) With the mouth speculum, laryngo- scope and good light, the anterior portion of the larynx and the surrounding tissues can be readily inspected provided the tongue is drawn well forward. (6) By examining some of the nasal discharge collected with a dressing forceps carrying a pledget of cotton, its character is decided. (c) By palpation, enlargements, injuries and the degree of sensitiveness may be determined. Laryngitis. Two forms of laryngitis are frequently observed in small animals, viz: (a) Acute, and (6) chronic. Acute Laryngitis. Definition. An acute catarrhal inflam- mation of the mucous membrane of the larynx. Etiology. (a) Excessive use of the voice (barking). This is often seen at dog shows; in hounds after hunting; in some dogs when penned up or tied ; during the course of rabies and the nervous form of distemper; excitement. (6) Inhalations of dust, dirt, etc.; injuries (tight collars, etc.). Inhalations of gases and smoke; irritating drugs and chemicals. (c) Exposure to cold. (d) Infections (staphylococcus, etc.) and during the course of infectious diseases (rabies, distemper, etc.). (e) Extension of inflammation from adjacent parts. Pathology. (a) There is an acute inflammation of the mucous membrane which, in the early stages, is covered by a thin serous exudate which later becomes turbid from admix- ture of leukocytes. From the irritation produced by cough- ing small quantities of blood are often raised. When infection is present the secretions are mucopurulent in character. CHRONIC LARYNGITIS 31 (6) The discharge contains bacteria, leukocytes, red cor- puscles and epithelial cells. Symptoms. Hoarseness, change of voice, frequent attempts at deglutition, a harsh, dry cough which later becomes softer and moist as the secretions are increased. The mucous membranes are congested and swollen. Pressure on the larynx, exercise, excitement or drinking cold water induces coughing. General symptoms are rare. Diagnosis. The presence of the harsh, dry cough which is aggravated by exercise and excitement and the absence of general disturbance are characteristic of laryngitis. Prognosis. Favorable. Recovery usually follows in eight to ten days, unless when secondary to rabies, distemper, etc. Treatment. Hygienic. Keep warm; supply plenty of fresh air. Dietetic. Give warm milk and warm liquid foods. Medical. Direct application of medicinal preparations to the mucous membrane is unpracticable and of little value. The following formula should be used to allay irritation and stop the coughing : 1$ Morphini hydrochlorati 0.1 Aquae amygdalae amarse Misce et fiat solutio. Sig. Give teaspoonful three times daily. Surgical. Apply Priesnitz compress or hot antiphlogistin pack over the larynx. Renew twice daily. Chronic Laryngitis. Definition. A chronic catarrhal in- flammation of the mucosa and submucosa of the larynx. Etiology. This is usually the result of frequent acute attacks, and therefore the causes enumerated under acute laryngitis are applicable to the chronic form. Chronic laryn- gitis is often the result of the extension of chronic nasal and pharyngeal catarrh; the presence of papillomata and poly- poid fibromata within the larynx; as a sequel to distemper; may be caused by pressure on the vagus nerve (enlarged mediastinal lymph glands, sarcomas, carcinomas, etc.); to direct irritation of the mucosa by malignant growths; enlarged thyroids. 32 DISEASES OF THE LARYNX Pathology. Chronic catarrh leads to hyperemia of the parts with hypertrophy of the mucosa and the submucosa, together with fibrous tissue proliferation. Localized thick- enings, either flat or wart-like, are often noticed. The sub- mucosa is infiltrated with cells and the mucous glands are swollen and distinct, producing a granular condition. Symptoms. The symptoms are somewhat similar to those of acute laryngitis but not so severe and continue for a longer time. The cough is hoarse, dry, seldom moist, and is aggra- vated by exposure to cold, exercise or excitement. The larynx is less sensitive than in the acute form when examined by external manipulation. After severe attacks of coughing the patients may show nausea and vomiting. Diagnosis. The chronic course, absence of general symp- toms and the cough characterize the condition. Prognosis. Owing to the changes in the mucosa and the submucosa, improvement is slow and complete recovery seldom takes place. Treatment. Hygienic. Keep warm; supply plenty of fresh air. Dietetic. Give warm liquid foods (milk, soups, etc.). Medical. The following formulae may be used to stop the coughing and allay the irritation : H Morphini sulphatis 0.1 Aquae amygdalae amarse 30.0 Misce et fiat solutio. Sig. Give teaspoonful three times daily. 1^ Potassi bromidi 10.0 Morphini sulphatis Aquse distillata . 150.0 Misce et fiat solutio. Sig. Give teaspoonful three times daily. For expectorant action may use the following: 1$ Ammonii chloridi Antimonii et potassi tartras Extract, glycyrrhizae . Aquse feniculae Misce et fiat solutio. Sig. Give teaspoonful every eight to ten hours. CHRONIC LARYNGITIS 33 or 3 Apomorphin. hydrochloras 0.05 Acidi hydrochloric! 1.0 Aquse distillata 250.0 Misce et fiat solutio. Sig. Give teaspoonful twice daily. Syrup of tar or syrup of wild cherry may be given in teaspoonful doses twice daily. Inhalations of medicinal preparations (turpentine, etc.) and direct applications (silver nitrate 1, glycerin 130) may be used in some of the more obstinate cases. CHAPTER III. DISEASES OF THE TRACHEA AND BRONCHIAL TUBES. Examination. (a) By palpation, the upper part of the trachea can be examined for enlargements, deformities of the tracheal rings, constrictions and sensitiveness to pressure. Often when inflammatory conditions are present, slight pressure on the trachea will induce coughing, attempts at swallowing and considerable uneasiness and pain. (6) By auscultation, the condition of the mucous mem- brane and the character of the secretions can be determined. The tracheal and bronchial sounds are most distinct at the entrance of the trachea to the thorax. A phonendoscope held directly against the trachea at this point will greatly assist in the examination. ACUTE TRACHEITIS AND BRONCHITIS. Definition. These are acute inflammatory conditions involving the mucous membrane of the trachea and the bronchial tubes. Etiology. (a) Small particles of foreign bodies (dust, etc.) enter the trachea and bronchial tubes producing excoriations and congestion of the mucous membrane which allow infec- tion to take place. If these substances are putrescent a fetid bronchitis will be produced. (6) Irritating gases (ammonia, etc.) and the fumes of acids (carbolic, etc.) may excite an attack of bronchitis by direct irritation to the mucous membrane. When inhaled in concentrated form and in large quantities they will induce inflammation extending into the smaller bronchioli producing an acute capillary bronchitis. The excretion of toxic sub- ACUTE TRACHEITIS AND BRONCHITIS 35 stances by the bronchial mucosa causes a rapid proliferation of the surface and granular epithelium of the mucous mem- brane and an increased secretion of mucus. The epithelium of the mucous membrane becomes more embryonal in char- acter and therefore less resistant to the invasion of micro- organisms. At the same time these organisms, ordinarily present, multiply more rapidly and increase in virulence, and unless the process is arrested a bronchitis is soon established. Some drugs (iodin, bromin, etc.) when administered in large doses and continued for quite a time may be excreted in sufficient quantities to produce an acute bronchitis. (c) Inhalations of smoke containing various gases and particles of foreign material will irritate the mucous mem- brane of the entire respiratory tract, frequently resulting in an active congestion and later in inflammation of the mucous membrane which favors the growth and development of the infection which is always present. (d) Acute bronchitis develops frequently as a secondary disease following specific infections (distemper, etc.). The specific infection reduces the normal resistance of the mucous membrane thus allowing the secondary infection (staphylo- coccus, streptococcus) to develop rapidly and produce the disease. (e} Parasitic. In severe infestations of the Uncinaria canina, the larval form of this parasite, in its migrations through the body, often burrows along or through the walls of the bronchi and trachea producing an inflammation of the mucous membrane and the underlying tissues. (See Unci- nariasis.) (/) Tracheitis and acute bronchitis are often consecutive to inflammations of the nasal passages, larynx and pharynx. The infection is carried to the trachea and bronchi by inhala- tion where it develops, producing the inflammation. (g) Other diseases (renal affections, endocarditis, diabetes, carcinomas and sarcoma, valvular insufficiency) produce a disturbance of the heart action, enfeeblement of the vaso- motor nerve and reduce the resistance of the mucous mem- brane. It is quite evident that acute tracheitis and bronchitis 36 DISEASES OF THE TRACHEA in most cases develop from bacteria found normally on the mucous membrane. Pathology . The pathological changes that are liable to be found in acute tracheitis and bronchitis are somewhat diverse, the details of the process being considerably modified by the anatomical peculiarities of the parts affected and the different causes that affect them. The inflammation may be restricted to the bronchial structure but is frequently associated with other and more serious disturbances. The condition is usually bilateral, although certain parts are affected more than others. Tracheitis and bronchitis are often associated with laryngitis, peribronchitis and broncho- pneumonia. Symptoms. Coug h. This is the most important symptom and is never absent, although it may be slight or very severe and loud, occurring as isolated coughs succeeding each other with greater or less frequency, or in paroxysms which often end in nausea or vomiting. The cough is dry and harsh in the early stages, later becoming moist as the inflamed mucous membranes produce an increased secretion. Paroxysms of coughing are often induced by excitement (visits of the owner, etc.), exposure to cold, moist air, pressure over the lower part of the trachea or by percussion over the sides of the chest. The object of the cough is to expel the accumulated discharge from the air passages. Discharge, This is always present except in the early stages; it is mucous at first, becoming mucopurulent or puru- lent as the disease progresses. In small animals the discharge is expelled from the trachea and bronchi directly into the mouth and swallowed. Therefore it is impossible to deter- mine the amount and character, and it becomes necessary to observe the animal while coughing to ascertain the condi- tion of the discharge. Dyspnea. The degree of dyspnea depends on the obstruc- tion of the free movement of air through the bronchial tubes. In mild cases it may not be noticed but in other cases, in which the calibre of the bronchi is materially decreased by the swelling of the mucous membrane, it may be quite dis- tressing. ACUTE TRACHEITIS AND BRONCHITIS 37 General Symptoms. Moderate temperature (rise of l-2), pulse quickened, partial loss of appetite and increased thirst. In severe cases, there is complete loss of appetite, high tem- perature (104-105) and general depression. On percussion nothing abnormal is noted, except in cases where the bron- chioli are affected and filled with an exudate where there may be local areas of dulness. Auscultation. In mild cases the vesicular sound is in- creased. In well marked cases the respiratory sounds are harsh with some lengthening of expiration. Absence of sound may be found when obstruction of the bronchi or collapse of lobules occurs. Sibilant and sonorous sounds are typical signs which are due to the irregular narrowing of the calibre of the large and small bronchi respectively. As the secretion becomes more liquid, moist rales are produced in the tubes due to the liquid being driven back and forth by the air currents. The volume of the rale is in proportion to the size of the tube in which it originates. Large, moist, bubbling rales are produced in the large bronchi, and the small, moist rales arise in the smaller tubes. Diagnosis. From the character of the cough, auscultation and general symptoms one may readily detect the presence of acute tracheitis and bronchitis. Careful examination of the animal should be made, however, to determine if the disease is primary or secondary. Prognosis. Favorable in most primary cases; when secon- dary to other diseases the prognosis is not so favorable. In primary cases, the course is usually eight to fourteen days; in secondary it is much longer. Treatment. Hygienic. The animal must be kept in a warm place (70 F.) having good ventilation but direct currents of cold air must not reach it. Dietetic. Light, soft or liquid foods should be used (milk, extract of beef, soups or small amounts of raw or cooked beef). In cases where the animal will not eat, it should be given warm milk to which raw eggs .have been added. Medical. Tor the appetite use compound tincture of gentian (0.8-2.0) or tincture of nux vomica (0.3-0.0 drops). In the early stages while the cough is dry and harsh, 4 /I t? /I 38 DISEASES OF THE TRACHEA expectorant formulae should be used to stimulate the secre- tion of the mucous membrane, as R Ammonii chloridi 5.0 Extract, glycyrrhizae . 10.0 Aquae 150.0 Misce et fiat solutio. Sig. Give a teaspoonful three times a day. or J$ Apomorphini hydrochlorati . 02 Acidi hydrochlorati 1 . 00 Aquae distillata 150.00 Misce et fiat solutio. Sig. Give a teaspoonful four times a day. When severe cough is present, sedatives should be given to reduce the irritation to the nerve endings in the mucous membrane, in the following formula: Ifc Morphini sulphatis 0.2 Aquae amygdalae amarse 20.0 Aquae 150.0 Misce et fiat solutio. Sig. Give teaspoonful every three hours. Counterirritants (oil of mustard and glycerin 1-20) may be applied to the walls of the thorax to stimulate the enervation and circulation in the trachea and bronchi. Inhalations of antiseptics and stimulants (oil of turpen- tine, oil of tar, creolin, etc.) may be used. These are best administered by adding them to hot water and allowing the animal to inhale the vapor. In the treatment of this disease the predisposing causes should be considered more than the infection as antiseptics cannot be applied to produce thorough antiseptic action on the mucous membrane. BRONCHIAL CATARRH OF BIRDS. Bronchitis. Definition. An acute or chronic inflammatory condition of the mucous membrane of the bronchial tubes. BRONCHIAL CATARRH OF BIRDS 39 Etiology. This often occurs from the extension of inflam- mation of the nasal passages, the larynx and trachea. Expos- ure to dampness, cold draughts of air and to sudden and extreme changes of temperature are predisposing causes. Specific infections (infectious nasal catarrh, tuberculosis); parasites (Syngamus trachealis) ; fungi (aspergillus) are all exciting causes and may produce an extensive and severe bronchitis. Symptoms. The birds become somewhat stupid, lose appe- tite, show accelerated respirations and cough. Later the symptoms grow more pronounced inducing severe dyspnea, the mouth frequently held open to facilitate respiration. Auscultation reveals a blowing or whistling sound in the bronchi, which, later, as the secretions accumulate, is bubbling or rattling. Diagnosis. This is made by the dyspnea, cough, stupidity of the patient, and the course of the disease. Prognosis. Favorable unless due to specific infection or parasites. Treatment. Hygienic. Keep the birds in a warm place which is well ventilated and free from cold draughts. Dietetic. Give soft and nutritious food (stale bread and milk, oatmeal and milk, meat scraps) . Medical. Inhalations of vapors from boiling water con- taining sodium bicarbonate (2 per cent.), creolin (2 per cent.) or carbolic acid (3 per cent.). To stimulate the bronchial secretions use the following: 1$ Ammonii chloridi ......... Mellis ........... Aquae feniculi ......... Misce et fiat solutio. Sig. Give teaspoonful three to four times daily. As a laxative and antiseptic: terebinthi nse 40 Oleiricini ........ Misce et fiat solutio. Sig. Give at once and repeat every four to six hours until a laxative action is produced. 40 DISEASES OF THE TRACHEA In treating a large number of birds encourage the appetite with stomachic tonics (iron sulphate) in the food and drink- ing water. MYCOTIC PNEUMONIA. Aspergillosis. Definition. A mycotic disease affecting primarily the respiratory passages, often producing bronchitis and pneu- monia. Etiology. The exciting causes are species of fungi belonging to the genus Aspergillus. These fungi exist abundantly in nature upon all kinds of grain especially during the warm, moist weather. The spores are inhaled with dust or taken with food and lodge on the mucous membrane where they rapidly develop into the fungus, which causes the irritation. The most common species in the domestic birds are the Aspergillus fumigatus, A. nigrescens, A. glaucus and the A. candidus. Other species are rarely found in the respiratory tract of birds. The predisposing factors are bronchitis, affections of the lungs, delicate breeds of birds, or delicate and weak individuals. Pathology. (a) On the mucous membrane of the trachea and bronchi is found a thick membranous mass which bears upon its surface a growth of the fungus. These masses are at first soft but become firmer with age and are yellowish or greenish in color, with some resemblance to a fibrinopurulent exudate. They adhere firmly to the mucous membrane which is thickened and congested. These growths may obstruct the air cells and the smaller bronchi, often being found as caseous or even calcareous nodules, somewhat resembling tuberculosis. The nodules vary in size from that of a pinhead to a pea and may involve the greater part of the lung tissue. Nodules may also be found in the liver, intestines, the mesenteric glands or other organs. In very acute cases the lungs may show simply an acute inflammation with secondary conditions in other organs. MYCOTIC PNEUMONIA 41 (6) Microscopic examination reveals the spores or fila- ments of the fungus in most of the lesions, either acute or chronic. Symptoms. In the very early stages no symptoms are noted, and it is only after the disease has progressed suffici- ently to cause obstruction or irritation to the tissues that symptoms are manifested. The affected birds become weak and depressed, do not follow the flock; the plumage is rough. Respirations are accelerated and during expiration are accom- panied by a rattling or snoring sound. The mouth is held open to facilitate breathing. The temperature is elevated, the appetite diminished and thirst increased. There is often a greenish-yellow discharge from the nasal passages. The birds soon become emaciated, a severe diarrhea develops, and death results from exhaustion. Diagnosis. Made by finding the spores or fungi by a microscopical examination of scrapings taken from the affected parts. Prognosis. Very unfavorable. Treatment. Hygienic. Keep the affected birds in a warm, well ventilated place. Dietetic. Feed concentrated nutritious food. Medical. Treatment is unsatisfactory in well established cases. Inhalations of antiseptics as tar or turpentine are indicated. These substances may be volatilized with boiling water or the tar by placing it on a hot surface. The affected birds are allowed to inhale the fumes for a half hour every day. Potassium iodid (.05-0.1 per bird daily) is also indi- cated; sulphate of iron (4.0 to 1000.0) may be used in the drinking water. Prevention. The healthy birds should be separated from the sick ones and the premises disinfected (lime or carbolic acid 5 per cent.). The straw and grain should be cleaned before given to the birds, as dust is the common carrier of the fungus. Successful disinfection cannot be attained as the spores occur widely distributed in nature. Cleaning of the straw and grain as suggested assists in eliminating the fungus. 42 DISEASES OF THE TRACHEA ANIMAL PARASITES IN THE TRACHEA AND BRONCHIAL TUBES. Syngamosis. Gapes in Chickens. Definition. This is a condition due to the Syngarnus trachealis found most commonly in the trachea and bronchi of birds. Etiology. The only cause is the parasite Syngamus trachealis, genus Syngamus. This is a small, round worm, red in color, and the male is about 5 mm. long and the female 5 to 20 mm. A remarkable feature of these worms is per- manent copulation, which is so intimate that the males cannot be separated from the females without tearing their integuments. This arrangement gives the worms a forked or Y appearance. They attach themselves to the mucous membrane of the trachea and larger bronchi and suck the blood. By so doing they produce considerable irritation. The ova of the syn- gamus are not laid but pass from the body of the female which suffers rupture and usually occurs after death. These ova are hatched in from one to six weeks according to the temperature on damp ground or in water. The embryo does not need an intermediate host in order to become trans- formed into an adult worm. Birds ingest the embryos along with food or water or the adult worm coughed up by an affected bird may be swallowed; earth worms in infested yards frequently have embryos in their intestinal tract and when these are swallowed the embryos are liberated. They then burrow out through the walls of the esophagus and stomach and migrate through the tissues or possibly ma the blood stream until they reach the lungs and trachea. It has been shown that fully developed parasites can be found in the trachea twelve (lays after feeding the ova to healthy birds. Symptoms. This disease is seen most frequently in young birds of from one to four weeks old, and is especially common in chicks. They have a whistling cough, and the most seriously affected open the beak at the same time stretching ANIMAL PARASITES IN THE TRACHEA 43 the neck by a peculiar movement (gaping) in order to facili- tate inspiration. The general signs are loss of appetite, dulness, wings pendant and all evidence of cachexia. Death results from exhaustion or asphyxiation. Diagnosis. The peculiar gaping movement at each inspira- tion, sneezing, and distressed breathing as from obstruction in the trachea. Finding the worms in the trachea or eggs in the discharge from the mouth is conclusive. Prognosis. Unfavorable, but depends upon the number of parasites present in the trachea. A spontaneous recovery is rare, especially in young birds. Treatment. All of the young birds should be treated as soon as the disease is noticed. As much garlic as they can be made to eat when chopped fine and mixed with other food, or powdered asafetida (0.25 per head daily) may be used. The volatile part of the garlic or the asafetida is eliminated with the expired air and acts as a toxicant to the parasites in the trachea. Individuals may be treated by intratracheal injections of sodium salicylate (5 per cent.) using 1 c.c. per bird and injected with a medicine dropper directly into the trachea. This loosens the worms and they can be coughed out. In cases of imminent asphyxia the worms may be with- drawn by the aid of a feather, having the barbules all removed except at the end. Or a horsehair folded and twisted so as to form a small loop may be used. It is introduced into the trachea through the open mouth and turned round and round, the object being to loosen the worms. They may be then withdrawn with the feather or coughed out. This method of ridding the chick of the parasite is dangerous and insufficient, and can remove only those parasites which are slightly attached and in the upper part of the trachea. Prevention. Separate the sick birds from the healthy and clean up all coops, pens and runways, drinking troughs, etc. and disinfect with carbolic acid (5 per cent.) . Lime sprinkled freely throughout the house and in the coops will aid in keeping them clean. Burn all dead birds and provide clean water and food. 44 DISEASES OF THE TRACHEA CHRONIC TRACHEITIS AND BRONCHITIS. Definition. This is a chronic inflammation of the mucous membrane of the trachea and bronchial tubes. Etiology. Chronic tracheitis and bronchitis may occur independently or secondary to some other disease. It may originate from any of the causes of acute tracheitis and bronchitis, especially when their action is persistent or fre- quently repeated. The common causes are: (a) Continued inhalation of irritating dust, dirt, etc. (6) Exposure to cold, damp air (as keeping animals in cold, damp basements having poor ventilation). (c) Parasitic. In severe infestations with Ankylostoma canina, when the animal is being constantly reinfested, the passage of the larvae through the tracheal and bronchial structure produces a chronic irritation. (See Uncinariasis.) Chronic tracheitis and bronchitis often result from the gradual extension of the inflammatory process from the other parts (laryngitis, pharyngitis, etc.). Many cases are secondary to special diseases such as distemper, carcinoma, sarcoma, rachitis and acute valvular insufficiency. Pathology. Chronic tracheitis and bronchitis are practi- cally always purulent, and while in most particulars it closely resembles the acute form, it differs from it in the presence of a more deeply penetrating inflammation and in the production of fibrous tissue. The mucous membrane is swollen, reddened, infiltrated, and covered with purulent secretion. The walls of the bronchi are hypertrophic. Not infrequently the mucosa is thrown into little polypoid excres- cences, due partly to contraction and partly to fibrous prolif- eration. The walls of the bronchi become thickened and there is often a fibrous peribronchitis, which in time may lead to induration of the lungs. Symptoms. This condition is most common in old animals where it frequently interferes with respiration producing so-called asthma. . The most prominent symptom of this dis- ease is the cough. It is usually moist, varying in intensity, depending upon the amount of secretion and extent of mucous membrane involved. Excitement frequently produces par- CHRONIC TRACHEITIS AND BRONCHITIS 45 oxysms of coughing which are often attended by severe nausea and vomiting. In cases secondary to other diseases the cough is modified becoming short, isolated and more spasmodic. This is particularly so in chronic bronchitis due to the parasite, Uncinaria canina, and to valvular insuf- ficiency of the heart. The discharge is mucopurulent in character, and is usually swallowed, but during paroxysms of coughing some of it mixed with mucus will be expelled from the mouth. In severe cases when the discharge is decomposed by putrefaction organisms there is a very offen- sive odor given off with the exhaled air. Dyspnea. This is always present to some extent; in old animals it is well marked. The dyspnea results from the emphysema and interstitial pulmonary fibrosis which always develops, and, when secretion is present in large amounts, the dyspnea is increased accordingly, producing asthmatic conditions. On auscultation there are sibilant or there may be moist rales, depending on the condition of the membranes and the character and quantity of the secretion. Vesicular sounds are increased. Percussion usually gives negative results, and only in the more severe cases are the general symptoms of emaciation, loss of appetite, etc., noted. Diagnosis. The long continued course of the disease, the age of the animal, the absence of general symptoms in most cases and the characteristic cough are indicative. Prognosis. In most cases of chronic tracheitis and bron- chitis the prognosis should be considered unfavorable as complete recovery seldom takes place. During the warm, dry months the symptoms often subside only to reappear with the return of the cold, damp weather. Treatment. Symptomatic treatment can be used to alle- viate the cough and to modify the secretions. The following formula? may be used: T$ Apomorphinse hydrochlorati .... Syrupus pruni virginianse Syrupus picis liquidaj Misce et fiat solutio. Sig. Give tcaspoonful three times daily. 1$ Acidi henzoici Sacchari albse Misce et fiat pulvis No. XX. Sig. Give a powder morning and evening. 46 DISEASES OF THE TRACHEA In general debilitated conditions tonics and alteratives should be used as in the following formula: 1$ Ferri et quinini citratis 10.0 Syrupi 90.0 Misce et fiat solutio. Sig. Give teaspoonful once daily. or !$ Tincture nuces vomicse 7.0 Tincture gentianise 10.0 Aquae 60.0 Misce et fiat solutio. Sig. Give teaspoonful once daily. Daily inhalations of medicated vapors (turpentine, creolin, etc.) are valuable to stimulate the secretions and assist in their removal. CHAPTER IV. DISEASES OF THE LUNGS. Examination. The following things are essential for a complete and thorough examination: 1 . The number and character of the respiratory movements. 2. The size, shape and sensitiveness of the thorax. 3. Auscultation. 4. Percussion. 1. Respiration. In small animals the number of respira- tory movements normally varies greatly. The average number while at rest is 12-24. This is easily and quickly increased by excitement and exercise until they may reach 60-90 per minute. During warm weather even while at rest the respirations are greatly accelerated, owing to the skin glands not being active enough to assist in the respiratory function. In order to overcome this physiological condi- tion the animal breathes forcibly through the mouth, and the frequency of respirations is increased. Respiratory move- ments are also increased in the following diseased conditions: Catarrhal pneumonia, foreign body pneumonia, chronic interstitial pneumonia, usually when the temperature is elevated, in laryngitis, acute and chronic bronchitis, hydro- thorax, pleurodynia, ascites, peritonitis, valvular insuffi- ciencies, eclampsia and during the early stages of some poi- sonings. A lessening in the number of respirations is found in narcotic poisoning, diseases of the brain and its membranes and in the later stages of infectious diseases, septicemia and pyemia. 2. The Thorax. In shape both sides of the chest wall should be symmetrical. Depression on one side indicates fractured ribs or pleurodynia. Distention of the thorax is seen in hydrothorax, and in fluid accumulations (ascites), tumors or when the stomach is distended, causing pressure against the diaphragm. 3. Auscultation is practised by using the phonendoscope or by covering the thoracic wall with a piece of cloth against 48 DISEASES OF THE LUNGS which the ear is placed. With the phonendoscope the sounds are made more audible and distinct. The normal sounds of the lungs are: (a) The vesicular; (6) bronchial, and (c) the expiratory, (a) The vesicular sound normally is a soft, regular, blowing sound caused by the air passing into the alveoli and distending them. It is most dis- tinct in emaciated animals and where the lung tissue is in close contact with the thoracic walls. It is normally increased by excitement or exercise and is always more distinct in puppies than in older dogs. The vesicular sound is modified in the following pathological conditions: Increased in dyspnea in the healthy portion of the lung, in tracheitis and in bronchitis; decreased in stenosis of the upper air passages; in certain stages of catarrhal pneumonia; emphysema of the lungs; hydrothorax; swelling and thickening of the skin and muscles of the thorax and in certain poisonings. (6) Bronchial respiratory sounds are best recognized by placing the phonendoscope directly over the trachea at its entrance to the chest. These sounds are normal in the larynx and trachea, but their appearance in the thorax is significant of disease. Bronchial respiratory sounds are increased by secretions in the smaller bronchi, as in catarrhal pneumonia; compression of the lungs by pleuritic exudate; laryngitis, tracheitis and bronchitis. Irregular bronchial sounds are caused by the secretions being carried to and fro by the passage of the air. They are dry (wheezing) where there is a small quantity of mucus adherent to the mucous membrane. These sounds (wheezing) occur mostly in the smaller bronchi, while the moist, bubbling rales (sonorous) emanate from the larger bronchi where they are produced by the collection of secretions. Cavities in the lungs also produce them. Bronchial sounds are important in determining the existence, extent and character of trache- itis and bronchitis. When sibilant (wheezing) sounds are prominent it indicates that the infection extends into the bronchioli. (c) Expiratory sounds are produced by the rapid expulsion of air from the lungs, and in normal conditions are hardly perceptible, except in puppies. This sound is increased by CONGESTION OF THE LUNGS 49 excitement, exercise, etc. In some diseases it is varied in tone, becoming louder and more prolonged. 4. Percussion. This is performed by the use of the per- cussion hammer and pleximeter or by one hand placed against the chest wall and tapped with the fingers of the other hand. The normal sounds of a healthy lung are heard all over the thorax, the volume of sound depending on the thickness of the lung at the particular part being examined. The normal sound is clear, loud and resonant as distinguished from the tympanitic, dull or solid sound of disease. Tym- panitic sounds are heard in the following conditions: (a) Emphysema, (6) pneumothorax, (c) cavities in the lungs, (d) in collapse of the pulmonary tissue from a retraction of the lungs in the presence of pleuritic exudates. The col- lapsed lung floats upon the surface of the fluid above the line of dulness and on percussion emits a tympanitic sound, (e) In the first and last stages of pneumonias. Dull or flat sounds are heard over hepatized areas of the lungs, chronic interstitial pneumonia; tumors in the lungs, and hydro- thorax. CONGESTION OF THE LUNGS. Hyperemia of the Lungs. Definition. An excessive or abnormal accumulation of blood in the lungs. Hyperemia may be either active or passive. Active Congestion. Etiology. It is found in the early stages of all inflammatory conditions of the lungs and pleura. Occasionally it may be due to inhalations of irritating gases, smoke, acid fumes, etc., or may result from cold. Pathology. The lungs are dark red in color; on cross- section blood escapes from the cut surface. The tissue will float in water. Symptoms. Active congestion of the lungs is characterized by its sudden onset, beginning as a rule with a chill and rapidly developing dyspnea accompanied by a short, dry cough and a rapid, full pulse. The animal often assumes a sitting posture with elbows held outwardly, ribs elevated 4 50 DISEASES OF THE LUNGS and cheeks inflated at each expiration. The temperature may rise to 103-104 F., possibly higher, but it does not persist, falling by crisis in three or four days. Owing to the aeration of the lungs being diminished the visible mucous membranes become cyanotic. On auscultation the respira- tory sounds will be increased, harsh and rough, and rales of various kinds may be heard. At the base of the lung fine crepitant or subcrepitant rales may be distinctly audible, while over other parts sibilant or sonorous rales may be heard. Percussion reveals only slight dulness. Diagnosis. Active congestion of the lungs in the beginning possesses no distinctive characteristics, but resembles broncho- pneumonia. As it progresses it will be readily distinguished from this condition by the absence of hepatization and the occurrence of the crisis on the fourth or fifth day. Prognosis. Usually favorable but in some cases pulmonary edema with fatal results, or pneumonia may develop. The affection is always to be looked upon as serious and one demanding active treatment. Treatment. Hygienic. The animal must be kept in a warm place and it is important that it be well ventilated. Dietetic. Give warm liquid foods (milk, beef tea, soups, etc.). Medical. Magnesium sulphate (8.0-10.0 in cold water) should be used as a hydragogue purgative. To equalize the circulation tincture of aconite (0.01-0.1) or veratrum viride (0.1-0.2) is beneficial and can be given every three to five hours if necessary. Oil of mustard and glycerin (1-20) can be applied to the walls of the thorax as a counterirritant. When the initial intensity of the symptoms yields, then a stimulating expectorant as ammonium chlorid should be used as follows: I^ Ammonii chloridi 5.0 Extract, glycyrrhizae 10.0 Aquae 150.0 Misce et fiat solutio. Sig. Give a teaspoonful three times a day. Passive Congestion. Etiology. This results from obstruc- tion to the free outflow of the blood from the lungs to the CONGESTION OF THE LUNGS 51 heart. It is nearly always due to the lack of force or faulty action of the heart, as stenosis or insufficiency of the mitral valve, dilation of the right ventricle, or fatty degeneration. It may also be caused by pressure on the pulmonary veins by tumors, etc. In the latter stages of long continued dis- eases or in any febrile condition when the heart action is slowed, the blood gravitates to the lower part of the lung producing a hypostatic congestion. Pathology. The lung is somewhat enlarged, its consistency increased, of a dark red color, and on section venous blood escapes. When the condition has persisted for a long time, the lung becomes brown, dense and firm, due to a deposit of blood pigment and a proliferation of fibrous tissue in the septa of the lung, a condition known as brown induration. Symptoms. Dyspnea and a short, hard and usually dry cough which has a tendency to become worse with exercise or excitement. The bronchial discharge varies in amount and in some cases may contain blood. Auscultation reveals rales. On percussion only slight dulness may be noted. The membranes are cyanotic. Diagnosis. The dyspnea, cyanosis, characteristic cough and shallow respirations without rise- of temperature are indicative. Prognosis. Unfavorable, depending upon the cause and extent. Treatment. In the treatment of passive congestion of the lungs, medicinal agents directed against the causative cardiac affection are the ones which will most favorably influence the pulmonary condition. As a heart stimulant the following formula gives good results: R Extract! digitalis fluidi 1.0 Syrupus pruni virginianse 60.0 Misce et fiat solutio. Sig. Give one teaspoonful once a day. In addition to this formula strychnin sulphate (0.001 daily) may be used as a general stimulant. To relieve the cough when severe use: 1$ Morphini sulphatis . Aquae amygdalae amarse . Misce et fiat solutio. Sig. Give a teaspoonful twice daily. 52 DISEASES OF THE LUNGS If the animal's condition will permit the use of a hydra- gogue purgative, magnesium sulphate (8.0-10.0) is useful to modify the circulation and remove fluid from it. This dose may be repeated in twelve hours if sufficient action has not taken place. PULMONARY EDEMA. Edema of the Lungs. Definition. An effusion of serous fluid into the alveoli and interstitial tissue of the lungs. Etiology. Diseases of the heart (valvular insufficiency, etc.) are the most frequent predisposing causes of pulmonary edema, although it occurs as a secondary condition to chronic pulmonary congestion, nephritis, cachexia, anemia and infec- tious diseases (distemper, etc.). In the latter stages of dis- temper pulmonary edema frequently develops when it is often the immediate cause of death. Edema of the lungs occasionally follows the administration of drugs (pilocarpin, etc.) . Pathology. The lung is heavier and firmer than normal, pale in color and pits on pressure. When incised a thin serous fluid escapes. This may be clear or if there is conges- tion present it may be stained with blood. Crepitation is always lessened and small patches may be entirely airless. The bronchi contain a frothy fluid. Symptoms. The symptoms develop rapidly except in those cases occurring as the terminal event in exhaustive diseases in which the course is more gradual and the symp- toms less pronounced. Severe dyspnea, which becomes worse as the exudate accumulates is an important symptom. The pulse is weak and small, the visible mucous membranes are cyanotic and the extremities cold. A short, feeble cough often accompanies the condition. The temperature is sub- normal. There may be a frothy nasal discharge. Upon auscultation various kinds of rales (fine, course or bubbling) will be heard. Percussion reveals diminished normal reso- nance with occasional small areas of tympany, especially over the posterior part of the lungs. BRONCHOPNEUMONIA 53 Diagnosis. The sudden onset, severe dyspnea and the absence of temperature, accompanied by moist, bubbling rales on auscultation are indicative. Prognosis. Always unfavorable, depending upon the cause. Recovery may occur in mild acute cases. Treatment. Treatment must be directed first to relieve the edema which threatens the life of the animal, and sec- ondarily to overcome the cause. For the first purpose use counterirritation to the walls of the thorax, oil of mustard and glycerin (1-20) or Priesnitz compress (applied hot) ; also strychnin sulphate (0.001 subcutaneously) as a heart stimu- lant. Subcutaneous injections of ether (0.8), or camphor (0.1) in ether (0.8) are often useful as prompt stimulants. Atropin (0.002) is of value as a heart stimulant and is espe- cially useful in cases of edema due to pilocarpin, being a physiological antidote. In the treatment for the removal of the cause digitalis fluidextract (0.1) is most valuable to regulate the heart action. Hydragogue purgation (magnesium sulphate 8.0- 12.0) will remove fluid from the blood which tends to reduce the exudation of serum into the lungs; also the use of a diuretic (oil of juniper 0.3-0.5) for the same purpose in cases of renal disease. BRONCHOPNEUMONIA . Catarrhal Pneumonia. Definition. This is an affection of the lungs in which the usual sequence of events is, that an inflammation of the smaller bronchioles in scattered areas is succeeded by the involvement of anatomically related or contiguous vesicles. Etiology. (a) The inhalation of foreign material in the form of small particles of dirt, dust, etc., which irritates the mucous membrane and modifies the secretions, favors the development of infection and leads to inflammation of the bronchioli and alveoli. (b) Irritating chemicals and gases when inhaled produce an active congestion and inflammation of the lungs. How- ever, in most cases when inhaled in large quantities they act 54 as irritants to the mucous membrane and thus favor the development of infection which leads to hronchopneumonia. (c) Cold, damp, changeable weather is a very important predisposing factor inasmuch as chilling the surface of the animal's body modifies the circulation and the secretions of the mucous membrane, reducing its resistance, as well as the general resistance of the body. This favors the growth of infection which may be already present. The effect of cold, damp weather is well shown by the greater incidence of the disease in the winter and spring months. Young puppies, especially, are quite frequently affected with bronchopneu- monia when kept in cold, damp and poorly ventilated kennels. (d) Bronchopneumonia is frequently secondary to specific infections (distemper, etc.) which reduces the general as well as the local resistance. (e) Inflammation of other parts of the respiratory system may produce bronchopneumonia by an extension of the inflammation. This is especially true of acute bronchitis which by extension at first produces a capillary bronchitis and later a bronchopneumonia. (/) During the course of some diseases (nephritis, endo- carditis, diabetes, valvular insufficiencies, sarcomas and carcinomas), the heart action is disturbed, the vasomotor nerve is enfeebled, both of which reduce the resistance to infection. Young puppies infested with parasites, which interfere with the general nutrition, frequently develop bronchopneumonia from the reduced resistance to infection. (gr) Infectious material from the mouth and the nasal passages which reach the bronchial tubes and alveoli will produce a bronchopneumonia. Possibly in no other disease do lessened powers of resist- ance of the animal, from whatever cause, play such an impor- tant part in determining the inception. Pathology. The process in bronchopneumonia is associated with bronchitis, and indeed almost always starts with an inflammation of the smaller bronchioles, which then spreads to the adjacent alveoli. The exudate is at first serous and contains a few erythrocytes, but more numerous white cells. There is also a large number of mononuclear cells with clear BRONCHOPNEUMONIA 55 protoplasm, which are swollen desquamated epithelial cells from the alveolar walls. The disease usually affects both lungs, but may involve only one or even a single lobe or a portion thereof. The affected organ is heavier than normal, somewhat congested, and in its substance can be felt areas of increased consistence. These are friable, of a reddish- gray, gray or grayish-yellow color, contrasting somewhat with the rest of the lung. On pressure a turbid fluid can be expressed, in which can be seen small particles of a gray, grayish-yellow, or purulent appearance. From the sporadic distribution of the consoli- dated areas, the term " splenization" has been given to the condition. On section of the lung, both red and gray stages are recognized. The smaller bronchi and bronchioli show inflammation and are filled with exudate. In the alveolar spaces the exudate consists mainly of serum, a few red cells, abundant leukocytes and desquamated cells. The latter fre- quently contain pigment and bacteria. In the form due to inhalation of infective material, or foreign bodies, the exudate is usually purulent. Such a condition leads to a diffuse puru- lent infiltration of the lungs and abscess formation. Occa- sionally gangrene of some of the lung tissue will be noted. This is especially true in weak and debilitated animals with general circulatory disturbance. Symptoms. The symptoms of primary bronchopneumonia develop rapidly, usually beginning with a chill and the animal appears depressed and restless. The temperature is high (104-105 F.) and falls by crisis. Dyspnea is pronounced, the respirations being short, shallow and very rapid, inflating the cheeks at each expiration. A short painful cough is noticed and the pulse is accelerated (180-200). On auscul- tation the sounds are mostly those of an acute bronchitis (impairment of the vesicular murmur, moist sibilant or sonorous rales). On percussion dulness is noted where there is a large area of consolidation, while in cases where the con- solidated areas are scattered compensatory emphysema may overcome the dulness. In the secondary forms following other diseases (bronchitis, distemper, etc.) the onset is less severe and the symptoms less pronounced. The cough and 56 DISEASES OF THE LUNGS high temperature may be absent, but if temperature be present it falls by lysis. Dyspnea is usually seen indicating a lack of aeration of the lungs. In the course of this secon- dary bronchopneumonia the symptoms are not well marked and depend largely upon the primary disease. Diagnosis. This is made in the primary form by the sudden onset with severe dyspnea, cough and high temperature, while in the secondary form the symptoms, not being char- acteristic, the diagnosis is more difficult, depending mostly upon the dyspnea with its attending conditions. Prognosis. Unfavorable. In the primary form the prog- nosis is determined by the extent of the inflammatory process in the lungs, while in the secondary form it depends upon the causative disease, and as this is usually distemper the mor- tality is high. Treatment. Hygienic. The animal should be kept in a warm, well ventilated room free from cold draughts. Dietetic. The animal's strength should be sustained by the use of appetizing foods (milk, beef extract, etc.) given warm in small quantities every few hours. During convalescence small amounts of lean meat or other nutritious food may be given 3 or 4 times a day. Medical. At the onset a purgative should be given (calomel 0.03 and sodium bicarbonate 0.5) to produce free purgation and stimulate the activity of the kidneys. Expec- torants are useful to modify and aid in expelling the discharge from the bronchial tubes. 1$ Ammonii chloridi 10.0 Extract, glycyrrhizse 20.0 Aquse 150.0 Misce ct fiat solutio. Sig. Give teaspoonful four times daily. Counterirritants to the walls of the thorax in the form of oil of mustard and glycerin (1-20) or Priesnitz compress applied hot around the chest. The heart action should be stimulated in severe cases by the use of digitalis fluid-extract (0.08-0.1) and for general stimulation use strychnin (0.001). Inhalations of medicated vapors (turpentine, oil of tar, creolin in hot water) are useful to stimulate the mucous membrane and to produce antiseptic action. CIRRHOSIS OF THE LUNGS 57 CIRRHOSIS OF THE LUNGS. Chronic Interstitial Pneumonia. Definition. A chronic inflammatory condition of the lungs characterized by an increase in the interstitial tissue and fibroid collections in the alveoli. Etiology. (a) Inhalation of particles of dust when con- tinued for a long period produces h'brosis of the lungs, due to the chronic irritation of the foreign material in the tissues. The degree depends upon the amount and character of the inhaled material. (6) Pressure upon the lungs by neighboring structures, as new growths and diverticula of the esophagus, tumors in the lung substance, all of which produce a reactive inflamma- tion resulting in increased connective tissue proliferation. (c) One of the most frequent causes in small animals is bronchopneumonia. When it terminates atypically fibroid changes occur in some of the involved lobules. In these cases the fibrosis begins as a chronic bronchitis or peri- bronchitis, invading later the surrounding parenchyma of the lung, which results in a great increase in the interstitial tissue. This is a frequent sequel to bronchopneumonia occurring during the course of infectious diseases (dis- temper, etc.). For some unexplained reason resolution does not occur, and the fibrinous exudate collected in the alveoli during the stage of red hepatization is displaced by fibrous tissue. The connective tissue formation necessarily begins in the alveolar walls, as from this source must be derived the new vessels which appear in the intra-alveolar new formations. Proliferative changes in the alveolar epi- thelium may for a time be active during this transformation of the exudate, but eventually the new tissue within the alveoli merges with the thickened, enclosing walls, which take a relatively inactive part in the process, and the area becomes entirely fibroid. Usually this lesion is only in parts of the lobules, but in some cases may extend into a consider- able portion of the lung tissue, involving the interstitial connective tissue which is greatly increased in amount. (d) Localized areas of interstitial pneumonia may originate 58 DISEASES OF THE LUNGS from abscesses in the lungs, sarcomas and carcinomas, or from inflammatory reactions from the pleura. Pathology. Cirrhosis is characterized by the overgrowth of connective tissue in the lungs so that they become hard, traversed by fibrous bands, and more or less shrunken. The condition leads to destruction of the alveolar spaces, some- times with bronchiectasis, and always to marked impair- ment of function. When due to lobular pneumonia, which is the common form of pneumonia in small animals, the fibrous tissue production follows the course of the bronchi and bronchioli. The lung is greatly increased in weight, has lost its spongy condition, and is quite hard. On cut surface it shows grayish-white color, and sometimes caseous nodules of necrosis may be seen. In advanced cases the pleura is thickened and the lungs distorted. The two layers of .the pleura are often adherent and the mediastinum may be indurated. Symptoms. Moderate dyspnea and a chronic cough, with a discharge which may be slight or profuse, and the exhaled air has a fetid odor due to the retention of some of the dis- charge in the bronchiectatic cavities. The temperature is usually normal and no general symptoms are noticed. Auscultation reveals increased resonance and bronchial breathing. Percussion yields dulness except where there are saccular dilatations of the bronchi. Diagnosis. The history of the case and slow development following bronchopneumonia and the presence of severe dyspnea will materially aid in making the diagnosis. Prognosis. Incurable. Treatment. Expectorants and general stimulants may be used to modify the symptoms. FOREIGN BODY PNEUMONIA. Gangrene of the Lungs. Definition. An inflammation of the lungs due to the inhala- tion of coarse material which usually results in necrosis of a part or of the entire organ. Etiology . (a) Inhalation of foreign material (particles of food from the mouth, especially during anesthesia when vomition occurs, also when the pharynx and larynx are par- FOREIGN BODY PNEUMONIA 59 alyzed) ; injury to the lungs from contusions, fractured ribs, penetrating wounds through the thoracic walls or from the esophagus and stomach (swallowed needles, sharp pieces of bone, etc.). (6) Inhalation of irritant medicinal substances when improperly administered (by closing the nasal openings, pulling the tongue forward or holding the mouth open too wide; holding the head too high or in any position which interferes with swallowing, manipulating the larynx or pharynx). (c) The causes enumerated above are to be considered as predisposing factors, inasmuch as infection must be present to complete the process. In addition to the ordinary infection, which is normally present in the lungs, putrefactive organ- isms are necessary to produce gangrene. Pathology. The involvement may be either diffuse or circumscribed, usually the latter, and in the form of irregular areas having a brown, greenish or black color. These are dry and surrounded by a zone of congestion and around this a zone of edema. The gangrene is of the moist variety and gives off a very penetrating odor. Cavities may occur in the lungs when the necrotic material is coughed out. Symptoms. Dyspnea is pronounced and the expired air has a sweet, fetid odor. The temperature is elevated (104- 106 F.) and the pulse is small, rapid and very irregular. In the early stages the symptoms are similar to broncho- pneumonia, but when cavities appear in the lungs the symp- toms rapidly increase in severity. It is at this stage when the odor is a prominent symptom. Diagnosis. This rests upon the characteristic odor of the exhaled air, high temperature and the rapid development. The history of the case often assists materially in the diagnosis. Prognosis. Very unfavorable. Most cases terminate fatally in a few days. Treatment. The animal's strength should be maintained by the use of highly concentrated foods (raw eggs, extract of beef, milk, etc.), given at frequent intervals. Little can be expected of medical treatment. Inhalations (oil of tar, turpentine, or creolin) may be used to overcome the odor and produce antiseptic action. CHAPTER V. DISEASES OF THE PLEURA. PLEURITIS. PLEURISY. Definition. An inflammation of the pleura accompanied by a serous, serofibrinous, hemorrhagic, or purulent exuda- tion into the pleural cavity. Etiology . (a) Penetrating wounds through the thoracic walls, from fractured ribs or sharp foreign bodies in the esoph- agus or stomach; contusion of the thoracic walls; tumors in adjacent parts; in rare cases cysts of tapeworms. These conditions make possible the entrance of organisms directly into the pleura, or by lowering the resistance of the pleura w r hich favors the growth of organisms that are carried to it by the lymph and blood streams. These are quite numerous and consist most often of the following: Bacillus bipolaris, Staphylococcus pyogenes, Leptothrix buccalis, and Strepto- thrix canis. (6) Occurs in cases of nephritis from an accumulation of waste products in the blood or by bacterial toxins which are carried to the pleura by the blood and produce direct irrita- tion to the serous membrane. (c) Exposure to cold and cold dampness are common predisposing factors as they reduce the general resistance to infection. (d) Pleuritis frequently follows bronchitis and pneumonia, the organisms present enter the lymph and blood streams and are carried to the pleural cavity. In some cases of pneumonia where abscesses develop and open* into the pleural cavity a purulent pleuritis is produced. (e) Extension of inflammation of neighboring tissues, viz: Mediastinitis during the course of infectious diseases; acute peritonitis; inflammation of abdominal organs. PLEURITIS PLEURISY 61 (/) Pleuritis is very often found during the course of infec- tious diseases. In the dog it occurs frequently as a secondary disease following distemper, septicemia and pyemia, the infection being carried by the blood and lymph. It is also seen during the course of rheumatic conditions. (g) Other predisposing causes are extreme exertion (hunt- ing dogs, greyhounds), or living under adverse conditions (bench shows, during transportation, etc.) which reduce the natural resistance. Pathology. The involvement in pleuritis may be acute or chronic, local or general, and according to the variety of exudate, serous, serofibrinous, hemorrhagic or purulent. A single case of pleuritis may pass through all of the above stages. In all cases the pleura becomes hyperemic, rough and dull. The roughness interferes with the free movement of the gliding surface producing pain and the characteristic frictional sounds. Later exudation takes place into the pleural cavity. In the fibrinous form there is soon an exudate of fibrin, forming a thin, yellowish layer on the surface, and as this increases it causes the pleural surfaces to adhere together slightly. The exudate is composed of flakes and masses of fibrin containing leukocytes. The exudate may be absorbed completely, but if there has been much fibrin formation adhesions of varying density result. These adhesions later are organized into connective tissue which is at first delicate but soon becomes very dense, and in some cases so extensive as to obliterate almost completely the pleural cavity; or they may be in scattered areas only. In serofibrinous pleuritis there is a large amount of serous as well as fibrinous exudate. It may originate as the fibrinous form, but usually begins with a serous outpouring. This exudate is denser than the transudate seen in hydrothorax, and contains the usual inflammatory products. The amount of fluid will vary with individual cases and in the different small animals from 100 c.c. to 5000 c.c. When present in large quantities the lung is pushed backward and the neighboring organs pressed upon. This pressure on the lungs of the dog and cat is often sufficient to completely occlude the passage of air into the right posterior lobes. 62 DISEASES OF THE PLEURA Hemorrhagic pleuritis is generally the result of infectious diseases and malignant growths on the pleura. The exudate is chiefly serous, with red blood cells present, but at times may be almost pure blood. Purulent pleuritis (pleuritis purulenta; pyothorax; em- pyema) is the result of infection by some one of the many pyogenic organisms (staphylococcus, etc.). It may begin as a purulent pleuritis or it may follow infection of the sero- fibrinous form. In the pleural cavity is found a varying amount of cloudy fluid which contains a great number of pus cells. It may be greenish in color at times, but is usually yellowish. The pleurae are generally thickened and con- gested and covered with flakes of fibrin or degenerated endothelium. The pus may be completely absorbed and the two surfaces unite with dense adhesions; or it may become caseated and undergo calcareous infiltration. The changes are most marked in the visceral pleura, which becomes greatly thickened, at first being soft and edematous while fluid is present, but as .this disappears it becomes indurated. During the course of purulent pleuritis there is always more or less involvement of the lungs which in some cases may result in pleurogenic pneumonia. In some chronic cases of pleuritis (pleuritis granulosa) there are numerous papilloma- like enlargements distributed over the surface of the pleura, and these by becoming confluent may produce extensive masses which interfere with the function of the neighboring tissues and organs. The serous exudate contains endothelial cells, white cor- puscles and small particles of fibrin. The infected exudate contains numerous pus cells, endothelial cells, and various kinds of detritis. A rather high percentage of albumin is found in the serous exudate. Symptoms. In the early stages of pleuritis the symptoms manifest themselves in various ways, depending largely whether the disease is primary or secondary, local or general. In acute, primary pleuritis the disease usually begins abruptly with pronounced general symptoms, viz: A chill, the animal seeking a warm place, twitching and trembling of the muscles, followed in a few hours with an elevation of temperature PLEUR1TIS PLEURISY 63 (103-105 F.) and a small, weak and thready pulse. Cough appears early, is usually dry, and on account of the pain, is partially suppressed. The gait is stiff and they show con- siderable pain when moved. There is little or no appetite, but as a rule the thirst is intense. The visible mucous mem- branes are reddened and congested, and in cases where there is much exudation the membranes are cyanotic. Constipa- tion is often noted, the feces being quite dry and hard. The urine, while the exudate is forming, is voided in small quanti- ties and contains albumin. Later as it is absorbed the urine is increased in amount and of very light color. Dyspnea is quite marked in nearly all cases of pleuritis. In the early stages when the pleura is dry,- the respirations are superficial, rapid and painful, but after exudation takes place they are less painful but labored. When bilateral the animal usually 'assumes a sitting posture, but when only one side is affected, will lie on the affected side. These positions are assumed to assist in fixing the intercostal muscles to relieve the pain which accompanies the elevation and depres- sion of the ribs. The abdominal type of respiration is used, the elbows being held outwardly and the abdominal muscles and the diaphragm brought into action. There is less ex- pansion on the affected side on account of the pain; when both sides are affected the ribs are held in a fixed position. Palpation of affected parts produces acute pain. Percussion. Dulness which gradually rises as the fluid accumulates in the cavity. The upper line of dulness is horizontal and varies with the position of the animal. Above the level of the accumulated fluid tympany will be noted. Auscultation. In the early stages when the inflamed mem- brane is dry, frictional sounds are characteristic and the vesicular murmur is increased, but as the exudate collects the sounds become less distinct or blowing in character, and finally only the bronchial tones will be audible. In the chronic form all the acute symptoms are modified with slight, if any general disturbance, although the tempera- ture may be variable, changing daily from below to above normal (100-103 F.). Auscultation gives negative results. Pleuritic adhesions cannot be diagnosed during life. 64 DISEASES OF THE PLEURA Diagnosis. The diagnosis depends upon the painful respiration, pain on palpation, abdominal type of respiration, and the presence of fluid in the thoracic cavity. History of injury may also aid materially. Prognosis. Usually favorable in mild, acute cases or when local; the generalized purulent forms rarely recover. Treatment. Hygienic. It is necessary that the animal be kept in a warm and well ventilated place but free from draughts of cold, moist air. Dietetic. Concentrated food should be given 3 or 4 times daily, using warm milk, eggs or extract of beef. Medical. In the very early stages of pleuritis when the frictional sounds are present, cold applications to the walls of the thorax are indicated (cold water compresses, ice packs, etc.). The refrigeration from these cold applications pene- trates the walls and contracts the vessels, thus relieving the congestion of the pleura. Later (two or three days) warm, moist compresses are indicated to increase the circulation which will modify the inflammatory process and hasten the absorption of the fluid. In addition to this, counterirritants (oil of mustard and alcohol 1-20, tincture of cantharides, etc.) could be used to continue the same process. When the cough is severe, narcotic agents (morphin sulphate 0.025 daily) can be used to allay the irritation. Quinin sulphate (0.2 three times daily) may be used to control the tempera- ture and pulse if they become too high. Encourage diuresis by using fluidextract of digitalis (0.1-0.2 daily) or diuretin (0.2-0.5 three times daily). If constipation be present catharsis may be produced by the use of calomel (0.05-0.5 daily) or magnesium sulphate (5.0-10.0) to produce a hydra- gogue action. When fluid is present absorption may be induced by the use of potassium iodid (0.2-0.3 three times daily) or pilocarpin (0.005-0.1) except in cases of feeble heart action when they must be used sparingly. Surgical. The effusion will require aspiration under the following conditions: (a) When it excites much dyspnea; (6) when in large quantities; (c) when purulent; (d) when it remains unabsorbed after ten to twenty days' treatment. Thoracentesis is performed by the use of a thoroughly HYDROTHORAX 65 sterilized trocar and cannula or aspirating needle. It is best done with the animal in either a sitting or standing position. Remove the hair from and disinfect a small area on the side of the thorax so that the instrument may be inserted (in a forward direction) at the anterior border of the sixth, seventh and eighth ribs and as low in the cavity as possible. The cavity is reached as soon as resistance to the passage of the needle has ceased. The fluid flows out in a continuous stream at first, then synchronous with respiration. After some of the fluid is out, the air may rush in during inspiration, and to prevent this hold the finger over the tube at the end of each expiration. If the flow ceases suddenly it is due to plugging with flakes of fibrin which can be forced away by reinsertion of the trocar. The amount of fluid removed depends upon the heart action. When it becomes weak and rapid, or when coughing suddenly develops, the operation should be dis- continued. This can be done daily at a different site of puncture until all of the fluid is removed. HYDROTHORAX. Definition. A collection of serous fluid in the thoracic cavity without inflammation of the pleura. Etiology. This condition always occurs as a secondary process and is a symptom of many affections (insufficiency of the heart ; nephritis ; chronic diseases of the lungs) . It usually accompanies ascites, hydropericardium and edema of the skin; also due to obstruction of vessels (vena azygos) ; follows a general anemia, hydremia, chronic infectious diseases, carcinomas and sarcomas. These latter diseases damage the endothelium of the vessels and allow the transudation of fluid from them. Pathology. The transudate is light or reddish-yellow in color and contains a few flakes of fibrin. If the condition develops very rapidly, the transudate contains many rod corpuscles. The specific gravity and albumin content are less than that of blood serum. The pleura may be thickened and pale. 5 66 DISEASES OF THE PLEURA Symptoms. Hydrothorax develops rapidly and on both sides of the thoracic cavity. Dyspnea results from compres- sion of the lungs. In severe cases this compression may be sufficient to cause edema of the lungs. The temperature is normal. The shape of the chest is unchanged except when a very large quantity of fluid is present causing the lower part of the thorax to be depressed. Auscultation reveals hard respiratory sounds due to increased respiration. Percussion over the lower part of the chest reveals dulness, the upper level of which changes with the position of the animal. Above this level tympany is pronounced. Diagnosis. Dyspnea with sudden onset in the absence of other symptoms; percussion, and exploratory puncture. Prognosis. Depends upon the causative disease. Treatment. Medical. Saline purgatives (magnesium sul- phate, 8.0-12.0) may assist in the removal of the fluid by eliminating fluid from the circulation. Surgical. Thoracentesis (see pleuritis), when respiration becomes distressed, and cyanosis is evident. Repeat as often as necessary, using a new site for puncture each time. Further treatment is to be directed to the primary cause. PNEUMOTHORAX. Definition. Air in the pleural sac. Etiology. Mechanical. Perforating wounds from the exterior (injuries, exploratory puncture, etc.); perforation through the diaphragm by abscesses of the liver, stomach or esophagus; perforation from the lung by abscesses or rup- ture of air vessels in the normal lung. Gas-producing organ- isms (B. aerogenes capsulatus) in the pleural exudates are occasional causes. Pathology. Pneumothorax rarely occurs by itself, usually being associated with serofibrinous (hydropneumothorax) or infectious pleuritis (pyopneumothorax), due to infection being carried in with the air. A serous or purulent fluid is found in the pleural sacs and the membranes are inflamed. HEMOTHORAX 67 Symptoms. Dyspnea is usually quite pronounced, the mucous membrane cyanotic and the pulse rapid and feeble. The physical signs are very distinctive. The affected side shows marked enlargement and the heart beat is displaced. On percussion the resonance is usually tympanitic, and depending upon the degree of tension there may be flat tympany, or a full hyperresonant tone like emphysema, while in others with extreme tension dulness will be noticed. There is usually dulness at the lower part due to the effused fluid, w r hich can readily be made to change the level by changing the position of the animal. On auscultation the normal lung sounds are suppressed on the affected side and exaggerated on the other side, which is very suggestive. The rales have a peculiar metallic sound. Diagnosis. The dyspnea, enlargement of the affected side, small amount of effusion in the cavity and cyanotic mem- branes. Prognosis. Depends upon the cause but is usually favor- able. Treatment. In pneumothorax with extreme tension imme- diate aspiration (see thoracentesis) should be performed. Penetrating wounds through the thoracic walls should be occluded (adhesive plasters, bandage, etc.) to prevent further entrance of air and infection into the cavity. A small amount of it will be readily absorbed and if infection has not been carried into the cavity recovery will be prompt. HEMOTHORAX. Definition. An effusion of pure blood into the pleural sac. Etiology. Traumatism, rupture of the vessels from over- exertion especially when the walls of the vessels are diseased (carcinomas, sarcomas, and infections). Pathology. Presence of pure blood in the thoracic cavity and the injury to the vessel wall. Symptoms. The symptoms are those of an acute anemia accompanied by a rapid filling of the thoracic cavity. 68 DISEASES OF THE PLEURA Diagnosis. The above symptoms in addition to thoracen- tesis confirm the diagnosis. Prognosis. Depends upon the extent and nature of the injury. Treatment. Medical. The administration of internal astringents (ergot fld. ext. 2.0-4.0) or adrenalin chlorid (0.6-4.0 of 1-1000 sol.). These can be repeated in one or two hours if necessary. Intravenous injections of normal salt solution to maintain the blood pressure may also be used. PART II. DISEASES OF THE CIRCULATORY SYSTEM. CHAPTER I. DISEASES OF THE PERICARDIUM. Examination. An examination of the circulatory system in small animals is of importance in determining diseases affecting primarily the heart and bloodvessels, and also for assisting in the diagnosis of a number of acute infectious and non-infectious diseases. A systematic examination from a clinical standpoint includes the following: (1) The pulse, and (2) the heart. 1 . The pulse is best examined in the dog by slightly press- ing the femoral artery with the index finger, or the radial artery inside the forearm. In small dogs this is often diffi- cult, and in such cases the hand should be placed against the thorax on the left side just behind the elbow, and at the lower third of the cavity, where the heart beat is readily distinguished. In cats and rabbits this method is the most satisfactory. In birds the pulse is difficult to recognize owing to the vessels being well protected and the heart very small and surrounded with fat and the other organs. A phonendo- scope is best used to detect the heart beats. Clinically we must consider: (a) The frequency, (6) the rhythm or cadence, and (c) the quality of the pulse. (a) The frequency of the pulse varies considerably in different species of small animals and birds, and also in individual animals of the same species.* The size, age, sex, breeding, temperature, time of day, etc., all have a decided 70 DISEASES OF THE PERICARDIUM influence upon it. The average frequency for small animals is as follows : Dogs 60-200 Cats . 100-180 Rabbits . 110-140 Birds 120-180 An abnormal increase in the pulse is found in all elevations of temperature, in severe injuries (fractures of bones, etc.), in mental excitement, valvular defects, severe hemorrhage, and in heart weakness from any cause. A decrease in frequency, or slow pulse, occurs in the later stages of some poisonings, diseases of the brain (chronic and subacute hydrocephalus), tumors in the brain, icterus gravis, collapse, etc. (6) The rhythm of the pulse should be regular, especially in cats, rabbits and birds; in the dog an irregular pulse is found so frequently in apparently healthy animals, that it should not be looked upon as an abnormal condition ; in fact, an irregular pulse in the dog is the rule. An irregular or arhythmic pulse is therefore a physiological condition in some of the small animals. However, in many pathological con- ditions a pronounced irregularity occurs as, during convales- cence from infectious diseases, severe gastro-intestinal dis- turbances, severe weakness, and in some chronic constitu- tional diseases. An irregular pulse is observed often after large doses of digitalis. (c) The quality of the pulse. The pulse beat should be of equal volume, and it varies with the different species of animal. In all small animals the pulse is rapid, strong and hard. In the dog an unequal pulse is frequently observed. The pulse is full and distended after exercise, during the early stages of a number of diseases; empty after severe hemor- rhage, intense heart weakness and collapse. The pulse is hard and full in severe pain, peritonitis, and acute brain diseases. The venous pulse is often observed in old dogs and is usually indicative of some chronic heart affection, or general heart weakness. EXAMINATION 71 2. The Heart. This is best examined in small animals, by (a) palpation, (6) percussion, and (c) auscultation. (a) Palpation. The heart beat is readily felt in all small animals by placing the hand over the cardiac region (between the fourth and seventh ribs, lower third of thorax on either side). The heart beat can be felt on both sides of the chest. This method of determining the frequency of the heart beat is practical especially in very young or small animals, and, as noted, also gives us the frequency of the pulse. The force of the heart beat depends largely upon the con- dition of the animal (emaciated or fat), and whether taken during exercise, excitement or at rest. The force of the heart beat is increased in the following conditions: In hypertrophy of the heart, acute myocarditis, endo- carditis, and pericarditis; some poisons, such as aconite and digitalis; after severe exertion or excitement; after consider- able loss of blood; where the temperature is elevated. The heart beat is weakened in the following: Degeneration of the heart muscle; the later stages of acute infectious diseases; some poisonings; compression of the heart in hydrothorax, hydropericardium, pneumopericardium; emphysema of the lungs, and in the effusion stage of pleuritis. In unilateral pleuritis the normal force of the beat may be more plainly noted on the healthy than on the diseased side. (6) Percussion. This is of little value in diagnosis in small animals. The zone of cardiac dulness is between the fourth and seventh ribs. This zone is normally about two to two and one-half inches in diameter. The zone of cardiac dulness is increased in hypertrophy of the heart; hydropericardium; tumors and induration of the lungs (chronic interstitial pneumonia). The zone is decreased in emphysema of the lungs and pneumothorax. Pain is observed on percussion in acute pericarditis and myo- carditis. (c) Auscultation. This method of examination is of great value in determining the condition of the heart. It is best done in the small animal by placing the patient in a standing position on a table, covering the cardiac region with a cloth, 72 DISEASES OF THE PERICARDIUM and placing the right ear directly over it. A phonendoscope may be used which materially assists in differentiating the heart sounds, the instrument greatly intensifying them. Normally, there are two heart tones. One of these occurs at the moment of contraction of the heart (systolic), and the other at the dilatation of the organ (diastolic). In most small animals the rapid pulse makes it difficult to distin- guish between these sounds. It is therefore best to com- pare the pulse with the heart beat. The interval between the systolic and diastolic sounds is shorter than the one between the diastolic and systolic. In very fat animals it is difficult to distinguish the heart tones with any degree of accuracy. In rabbits and cats the heart tones are often so rapid, the sounds following each other in such rapid succes- sion, that they are indistinguishable. This condition occurs in all animals after excitement or exercise. In very young animals it is normal. In birds the heart sounds are almost impossible to recognize. Both of these heart sounds are increased in hypertrophy of the heart, anemias, and thickening of the lung tissue around the heart. The second or diastolic sound is increased in distention of the arteries, often the result of a congestion of the pulmo- nary circulation combined with hypertrophy of the heart. A decrease in the volume of the heart sounds is observed in heart weakness, such as degeneration of the heart muscle, in hydropericardium, and in emphysema of the lung. In many of these cases the heart sounds are imperceptible. In small animals the various heart bruits (abnormal sounds) are often difficult to recognize. It will require careful and persistent effort on the part of the student to familiarize himself with even the more common bruits which are the following: (1) Endocardial, and (2) pericardial. 1. Endocardial Bruits are divided into: (a) Organic endocardial bruits which are caused either by a narrowing (stenosis) of the valves of the heart, or changes in the valves which interfere with their proper closing (insufficiency). (6) Inorganic endocardial bruits occurring without any PERICARDITIS 73 particular alteration at the orifices or valves of the heart, and are found in the different forms of anemia in animals. 2. Pericardia! Bruits. These bruits consist of friction sounds due to the pericardium becoming rough and dry. These sounds can be distinguished, as they do not occur synchronously with the heart sounds and are often indepen- ent of them. They are noted in pericarditis where there is not sufficient fluid to keep the membranes separated. They must be distinguished from pleural friction sounds, and can be quite readily, as they occur entirely independent of the respiratory movements. From a clinical standpoint, in small animals, further differentiation of the various heart bruits cannot be made. PERICARDITIS. Definition. An acute or chronic inflammation of the peri- cardium. Etiology. Inflammation of the pericardium may originate primarily or secondarily. Primary pericarditis may result from: (a) Trauma, which may originate from within, such as the passage of foreign bodies (needles, pins, pieces of bone, etc.) through the esopha- geal walls. This occurs most commonly in the dog and cat from swallowing needles, pins, etc., during play. It may also result from trauma from without, such as puncture wounds through the thoracic walls, or from falling, being run over by vehicles, etc. In such cases the pericardium is injured directly or indirectly by being pressed upon by the displaced thoracic wall or adjacent organs. (6) Infective processes which in some cases may be primary or at least involve principally the pericardium. Staphylococci, streptococci and the specific virus of dis- temper are the most common organisms found. Primary infection, however, is not a common etiological factor. (c) Cold has frequently been mentioned as one of the causes of pericarditis. This should be considered simply as a predisposing factor in lowering general resistance, which allows the development of infection, etc. 74 DISEASES OF THE PERICARDIUM Secondary Pericarditis. This form may result from a number of conditions: (a) Catarrhal pneumonia, which is common in the dog and cat; simple pleuritis; endocarditis, myocarditis, etc. It may also follow diseases of the medi- astinal lymph glands, the ribs, sternum, and even in some cases the abdominal viscera. (6) In septic processes, such as suppurating wounds, puerperal septicemia, etc. (c) In specific febrile diseases, such as distemper in- the dog and cat, pneumonia, chicken cholera, etc. Necropsy. On postmortem are recognized: (a) Acute fibrinous pericarditis, (6) pericarditis with effusion, and (c) chronic adhesive pericarditis. (a) Acute Fibrinous Pericarditis. This may be local or general. In the mild form dull, rough, lusterless masses of exudate cover the surface of the pericardium with a thin coating of fibrin which is readily peeled off. In the more severe form the exudate is more abundant, the masses of organized fibrinous deposits giving the surface a rough, shaggy appearance. In this form there is usually found a small quantity of fluid in the meshes of the fibrin. The heart muscle is not affected, except in the more severe form where it will be found pale and turbid. (6) Pericarditis with Effusion. This effusion may.be sero- fibrinous, hemorrhagic or purulent. It is most commonly serofibrinous. In this case the pericardial surfaces are covered with a thick fibrin and a collection of serous fluid fills the pericardial sac. The hemorrhagic form is usually found in acute cases which have terminated fatally following injuries, etc. The pericardial sac will contain a varying quantity of serous fluid mixed with blood. When pus is present the peri- cardial surfaces will appear rough, occasionally eroded and of grayish color. This form occurs via metastasis or from internal trauma introducing infection into the pericardial sac. (c) Chronic Adhesive Pericarditis. Chronic adhesive peri- carditis is found occasionally on postmortem. It is char- acterized by marked thickening of the membranes, with adhesions between the membranes themselves, and the adjacent organs. PERICARDITIS 75 Symptoms. Mild cases of pericarditis present, as a rule, no symptoms by which an accurate diagnosis can be made. In the more severe forms, fever is usually present, but the elevation of temperature depends as much upon the primary disease as upon the pericarditis present. Temperature is usually 103-104 F. The respirations are increased, espe- cially when the animal is moved, the slightest exertion causing a marked dyspnea. Palpation over the cardiac region often reveals a distinct fremitus from the pericardial folds rubbing together. Auscultation. The friction sound due to the rubbing together of the pericardial surfaces is distinctly audible, and is the most important diagnostic symptom. The examiner is greatly aided by the phonendoscope, which brings out the friction sounds more prominently compensating for their indistinctness due to the rapid heart beat. As the disease advances, the heart action becomes inter- fered with, and all the symptoms of valvular insufficiency will present themselves. Dropsical conditions from defective arterial tension will be in evidence, especially ascites, and dropsy of the extremities. There are general symptoms of impaired appetite, emaciation and general weakness. Death may occur suddenly or the condition become chronic and last for weeks, depending very largely upon the cause. Diagnosis. An accurate diagnosis in small animals presents some difficulties, and a thorough examination is always necessary. The frictional tones are characteristic, but they are determinable only in the acute fibrinous pericarditis. Prognosis. In the milder cases of acute fibrinous peri- carditis and serofibrinous pericarditis the prognosis while favorable, should always be guarded at least until the etiological factor can be established. Other forms are always to be considered unfavorable. Treatment. Hygienic. The animal should be placed where there is absolute quiet. Prevent excitement, such as by the visits of the owner, or strangers. Have the room moderately warm and well ventilated. Dietetic. Nutritious food (lean meat, raw or cooked ; milk, etc.) should be given to maintain the general condition of the animal. 76 DISEASES OF THE PERICARDIUM Medical. Heart tonics and stimulants are indicated to tone up the action of the heart, and to assist in the elimina- tion of fluid from the body. Digitalis is of value for this purpose, given to dogs in doses of 0.1-0.2 of the fluidextract once or twice daily depending upon the condition of the patient. Laxatives (magnesium sulphate 8.0-12.0, or calomel 0.05- 0.1) are indicated occasionally to regulate the bowels and also to assist in the elimination of fluids. Surgical. When the exudate accumulates to the extent of greatly interfering with the heart action, indicated by dyspnea, small rapid pulse, cyanosis, etc., paracentesis of the pericardium should be performed at once. The operation is not very difficult and is as follows: A rather long, small exploring trocar or aspirating needle is thoroughly sterilized. Shave the hair over the left cardiac region, wash thoroughly with soap and water, and follow with alcohol ; then paint the surface with tincture of iodin. The needle should be inserted at the lowest point in the pericardial sac so as to be able to remove all the exudate and lessen the danger of injury to the heart. Insert the needle slightly downward and forward, and not too deep. The fluid will flow out in a steady stream. Repeated operations on successive days are often necessary. The skin wound should be protected by covering with flexible collodion. HYDROPERIC ARDIUM . Dropsy of the Pericardium. Definition. A collection of serous fluid (transudate) in the pericardial sac not due to inflammation. Etiology. This condition most often accompanies general hydropsy resulting from valvular defects (insufficiencies), myocarditis, diseases of the coronary arteries, chronic nephri- tis, etc. It also occurs from pericarditis (see Pericarditis). Symptoms. The symptoms are similar to pericarditis (see Pericarditis) except it runs a longer and more chronic course. There is absence of temperature, and frictional bruit is heard on auscultation. Treatment. Same as for serofibrinous pericarditis, which see. HEMOPER1CARDIUM 77 HEMOPERICARDIUM. Definition. A collection of blood in the pericardial sac. Etiology. This condition is found in aneurysm of the aorta, cardiac wall, or coronary arteries, and in rupture and wounds of the heart. Dogs and cats are frequently affected from gunshot wounds, being run over, etc. Symptoms. The principal symptoms are those of rapid heart weakness, paleness of the mucous membranes, rapid weakness and in most cases death in a very short time from compression of the heart. In slight hemorrhages the animal may live for several hours or days with a progressive heart weakness, dyspnea and all the physical signs of effusion in the pericardial sac. Treatment. Treatment in most cases is impossible, and in the slow progressive cases usually unsatisfactory. Other diseases of the pericardium, such as pneumoperi- cardium, are of no importance clinically. CHAPTER II. DISEASES OF THE HEART. VALVULAR INSUFFICIENCY AND STENOSIS. Definition. A pathological or anatomical defect in the valves and openings of he heart leading to an irregularity in the circulation of the blood. These conditions are very common in small animals, especially the dog, where often quite extensive alterations in the valves are found on autopsy which failed to produce any marked symptom during life. However, when severe forms of insufficiency or stenosis occur, they are characterized by a marked disturbance in the heart action, circulation of the blood and the general condi- tion of the animal. It is often very difficult and sometimes impossible to differentiate clinically between the various valvular and ostial defects which are found on autopsies. Insufficiency. In general, this condition occurs in two forms: (a) Imperfect closing of the valves which permits a portion of the blood at the contraction of the heart muscle to flow back into the chamber from which it came. This defect may exist in the atrioventricular valves or in the semi- lunar. Improper closing of the semilunar valve allows a portion of the blood which has been forced into the artery to again return to the chamber during diastole; or imperfect closing of the mitral or tricuspid valves during systole allows a portion of the blood to flow back into the auricles again from whence it came. In the early stages of insufficiency, owing to certain compensatory processes, no marked symp- toms will be observed. However, as soon as the heart is not capable of performing the increased labor from lack of nutri- tion, increased disturbance in the valves, or general weakness from anemia, cachexia, etc., marked disturbance in the general circulation will soon become evident. These are VALVULAR INSUFFICIENCY AND STENOSIS 79 manifested by ascites, dropsical effusions, etc., in different parts of the body. (6) Stenosis or contraction of the openings. In this con- dition the opening is narrowed so that the chambers of the heart are improperly filled. At the period of diastole, the blood is held back at the entrance of the affected chamber, and therefore normal filling of the chamber is interfered with. This condition may occur at any of the openings of the heart and will always induce imperfect heart action. Every interference with an arterial opening causes imperfect ventricular contraction; likewise defective venous openings lessen the auricular contraction and power. This abnor- mality in the action of the heart produces more or less general disturbance in the circulation of the blood, and as a consequence the reserve force of the heart is called into action until compensatory hypertrophy can take place to keep the circulation as near normal as possible. As soon as the reserve energy is used, or the compensatory hypertrophy fails to keep up the circulation, serious general symptoms of defective circulation appear as is often observed in old dogs. Etiology. Valvular defects are produced by a variety of causes : (a) Endocarditis is the most common cause (see Etiology of Endocarditis). Endocarditis produces an inflammatory thickening of the margins of the valves leading to their imperfect closure. If the chronic inflammations persist it leads to cicatricial contractions (stenoses), and often there are found in long standing cases in old animals, deposits of calcareous matter on the valves and around the openings. (6) Dilatation of the heart or weakness of the heart muscle will sometimes affect the openings, the dilatation preventing contact of the valve margins and a complete closure. (c) Certain poisons and toxins are causes \vhich lead to alterations in the structure and ultimately the action of the valves. (d) Atheromatous processes may produce the condition. However this is not common in small animals. (e) Occurs during the course of some diseases, such as anemia, pernicious anemia, etc. 80 DISEASES OF THE HEART Necropsy. It has been found that the mitral and aortic valves are the ones most commonly affected in the dog. In the early stages the edges of the valves are slightly thickened and invaded with small nodules. Later are found, as the sclerotic changes increase, contractions of the fibrinous tissue, producing thickening and deformity of the segments of the valves, the edges of which become round, curled and cannot be closed perfectly. In some severe cases the valves become very much thickened, with numerous hard nodules (which may be calcareous), giving them a marked uneven surface. The chordae tendinese are often found thickened and contracted. The apices of the papillary muscles fre- quently show fibrated or calcareous change. Symptoms. In small animals the general symptoms of valvular deficiency are of greatest importance from a clinical standpoint, as it is very difficult during the life of the animal to distinguish with any degree of accuracy the separate valvular insufficiencies. However, some of them present some symptoms which are rather characteristic, and there- fore, a brief description of the most common ones will be given. As general symptoms, the following are the principal ones observed which are common to all valvular defects at some period in their course: Increased heart action; rapid and irregular pulse; palpitation of the heart; venous pulse (observed in the jugular at its entrance to the thorax); dyspnea; cyanosis of mucous membranes; hydrothorax; ascites; edema along abdomen, pectoral region, extremities; general emaciation, partial or complete loss of appetite with marked digestive disturbance. The condition gradually becomes aggravated until there is a general nutritive dis- turbance, weakness, and death from exhaustion. Careful auscultation will reveal the valvular insufficiency. Palpation over the cardiac region will determine the irregular and rapid pulse, and often a distinct fremitus. The temperature in the early stages is usually elevated (103-104 F.); it later becomes normal or even subnormal as the disease progresses. Symptoms of insufficiency of the mitral valves: This is of VALVULAR INSUFFICIENCY AND STENOSIS 81 frequent occurrence in the dog. It is often accompanied by dilatation or hypertrophy of the heart. Pulse rapid and irregular; systolic bruit and increase of the diastolic sound on auscultation; dyspnea; cyanosis; general weakness; dropsical conditions (ascites, etc.). A careful examination is necessary to make a differential diagnosis. The direct effect of aortic insufficiency is the'regurgitation of blood from the artery into the ventricle, causing a disten- tion of the cavity and a reduction of blood pressure in the artery. The amount returning varies with the size of the opening. This regurgitation eventually leads to dilatation and finally hypertrophy. In this way the valve defect is compensated for, and as with each ventricular contraction a larger amount of blood is forced into the arterial system, the regurgitation of a certain amount for a time during diastole does not interfere with the nutrition or with the general circulation. The condition is characterized clinically by: A full pulse; strong heart beat; dyspnea; dropsical conditions (ascites, etc.) ; cough from congestion and edema of the lungs; increased area of dulness in the cardiac region; diastolic bruit, etc. Insufficiencies of other valves are impossible to recognize during life in these animals. Diagnosis. The faulty heart action is not difficult to recognize, but to determine the location of the lesion is very difficult in small animals. In some cases, however, by care- fully observing the symptoms and using the phonendoscope a differentiation is possible. Prognosis. Complete recovery cannot be expected even in mild cases of insufficiency, therefore the prognosis is unfavorable. However, the condition may exist for a long time in individual cases without producing any serious symptoms provided adequate compensation exists. Treatment. (a) During the stage of compensation no medical treatment is indicated. Keep the animal quiet as possible, avoid all undue excitement and exercise, and give nutritious food to maintain the general condition. (b) Stage of broken compensation, when the symptoms of weakness, edema, palpitation, etc., appear, heart tonics 6 82 are indicated. Digitalis fluidextract (0.05-0.15); tinct. strophanthus (0.5-1.5 twice daily); or caff em citrate (0.1-0.2 twice daily). By the use of these preparations an effort is made to reestablish a compensatory action, and should this take place the symptoms of edema, ascites, palpitation, etc., will gradually disappear.' Should this treatment be unsuc- cessful, a symptomatic treatment may be tried such as the use of diuretics and cathartics to relieve the effusions, and in severe palpitation, sedatives (morphin). In cases of severe weakness, where the pulse is very weak and irregular, direct heart stimulants (camphor, ether, etc.) must be given to afford temporary relief. In disturbances of the digestive tract with loss of appetite, tincture of nux vomica (0.2-0.8) or tincture of gentian (1.0- 2.0) should be given twice daily to tone the digestive tract. Other symptoms that develop must be treated according to their importance. MYOCARDITIS. The following forms of myocarditis are observed in small animals: (a) Acute myocarditis, and (6) chronic myocarditis. Acute Myocarditis. Definition. An acute inflammation of the heart muscle (myocardium). From a pathological standpoint two distinct types of this condition are recog- nized, viz.: The acute parenchymatous and the purulent myocarditis. From a clinical standpoint such a differentia- tion cannot usually be made. Therefore, both will be con- sidered under acute myocarditis. Etiology. (a) From severe exertion, such as hunting dogs on long runs, continuous stud service, hard pulling of draft dogs, etc. (6) Exposure to cold, or sudden chilling of the surface of the body, resulting in an unequal distribution of the blood, producing a congestion of the bloodvessels of the heart and occasionally resulting in an inflammatory reaction. (c) Secondary to infectious diseases, such as distemper, pyemia, septicemia, tuberculosis, cholera, and entero- hepatitis in fowls, etc. During the course of the infectious diseases toxins are formed and carried by the blood to the MYOCARDITIS 83 heart muscle leading to inflammation and fatty degeneration. The other organs in the body are often similarly affected during the course of infectious diseases. (d) From poisons (arsenic, phosphorous, silver, mercury, etc.) being absorbed, carried through the circulation to the heart muscle, producing irritation, congestion, and some of them (phosphorous, arsenic) later fatty degeneration of the muscle. (e) Often results by spread of the inflammation from the endocardium and pericardium, especially in ulcerous endo- carditis and suppurative pericarditis, the infection reaching via blood the heart muscle. (/) Direct injuries to the heart which occur quite frequently in small animals from foreign bodies perforating the esoph- agus or chest wall; also by being run over, the heart muscle becoming contused. Necropsy. Pathologically numerous conditions are found, the changes in the myocardium are quite varied, and in acute myocarditis may be classed under two heads as follows: (a) Acute Parenchymatous Myocarditis. This as a primary condition, is not very common, and is usually associated with acute inflammation in other organs. In this form there is found interstitial infiltration, inflammation of the muscle fibers, which are colored reddish-gray, yellowish-white, or even white. The muscle fibers are indistinct and show a more or less homogeneous structure. Microscopically, the fibers show a loss of striation, with small cellular infiltration in the interstitial connective tissue. Large numbers of white corpuscles are found between the fibers. (6) Purulent Myocarditis. This form occurs quite com- monly in the dog, less commonly in cats and birds, and is found mostly in pyemic conditions. Small abscesses are dis- tributed through the connective tissue varying in size from a millet seed to a pea. Sometimes by confluence the abscesses are much larger. Symptoms. In the early stages the symptoms are similar to those of insufficiency or weakness of the heart. The heart beat is very rapid, three to four times normal, throbbing, and 84 DISEASES OF THE HEART in the dog can be seen quite a distance from the animal, the tumultuous throb of the heart shaking the whole body. The heart action soon becomes irregular and very weak. The pulse is very rapid, weak, small, irregular and in later stages imperceptible. The pulse usually becomes so rapid that it is impossible to count it. Respirations are rapid, labored, and the animal soon becomes prostrated. The temperature in the early stages is elevated, the degree depending upon the etiological factor; later it becomes subnormal. In some cases myocarditis takes a very rapid course, the animals dying suddenly from rupture or paralysis of the heart. Diagnosis. This is difficult as the symptoms are quite similar to endocarditis, pericarditis, etc. A careful exami- nation should always be made. When insufficiency of the heart action exists without frictional sounds or bruits, myo- carditis may be suspected. Prognosis. The prognosis is unfavorable, especially in secondary myocarditis, due to infection, or during the course of infectious diseases. Even in primary acute myocarditis there are always degenerative changes in the heart muscle which are impossible to entirely overcome. If recovery occurs it is as a rule only partial (chronic myocarditis). Treatment. Hygienic. The animal should be kept in a quiet place, avoiding all excitement or handling. Medical. The heart weakness should be treated by using heart stimulants and tonics, such as dilute alcohol (2.0- 4.0); fluidextract digitalis (0.075-0.10); caffein citrate (0.5-1.0 subcutaneously every six to ten hours); ether (2.0- 4.0 subcutaneously); oil camphor (1.0-4.0 subcutaneously); or atropin sulphate (0.04-0.075 subcutaneously). The use of these preparations will depend largely upon the needs of the case. In very acute cases there is no treatment that will produce satisfactory results. Chronic Myocarditis. Definition. A chronic inflamma- tion of the myocardium. This condition occurs frequently in small animals but is rarely recognized during life. It is often confused with other heart affections. ACUTE ENDOCARDITIS 85 Etiology. (a) Occurs commonly from mild, acute attacks, especially in those cases where the interstitial connective tissue is primarily involved. (6) During the course of chronic muscular or articular rheumatism in old dogs; also from chronic nephritis, tuber- culosis, pericarditis, endocarditis of dogs, cats and birds. (c) Chronic poisoning by chemicals, toxins, etc., often will produce the condition by interfering with the circulation through the coronary arteries. Necropsy. Throughout the heart muscle appear circum- scribed masses of fibrous tissue which are white in color and of firm to hard consistency. They occur most conspicuously near the apex of the left ventricle. The fibrous areas may be quite dense, like a cicatrix, constituting the so-called " heart- scar." Pigment and calcareous deposits may be present in them. The affected heart wall becomes very thin in places and may bulge forming a so-called aneurysm. Fatty degener- ation may be present. The heart may show hypertrophy with dilatation. ACUTE ENDOCARDITIS. Definition. An acute inflammation of the endocardium, especially involving the part covering the valves. This con- dition occurs very commonly in small animals, especially in dogs and birds. Etiology. 1. The acute endocarditis in the majority of cases results from infection, the toxins of a number of infec- tious diseases irritating the endocardium. The organisms (pus-producing organisms, bipolar bacillus, colon bacillus, Bacterium tuberculosis, etc.), or their toxins, are the ones most commonly accused. An acute, primary, infectious endocarditis is observed occasionally; in the majority of cases, however, it occurs secondary to other diseases, pyemia and septicemia usually producing it. It develops often also after abscesses, wounds on the skin, abscesses in the internal organs, septic metritis, sapremia, etc. The organisms or their products (toxins) are carried by the blood to the endo- cardium where they become lodged, especially along the 86 edge of the valves. They propagate, produce irritation, and assisted by the mechanical action of the valves, an active inflammatory reaction is soon established. The inflammation spreads to the other parts of the endocardium and may cause a general endocarditis. The rapidity of the process depends upon the virulency of the infection or the amount of the toxins present. 2. Spread of the inflammation from adjacent structures or organs may produce the condition, such as from a myo- carditis, pericarditis, pleuritis, or a pneumonia. 3. There are several predisposing conditions which should be considered: (a) ("hilling the surface of the body, such as exposure to cold, or cold baths, carelessness in thoroughly drying the skin of animals after baths, etc., make them more susceptible to infection by reducing resistance. (6) In old animals degenerative changes of the heart muscle, valves, etc., make them less resistant. (c) Young puppies, chicks, kittens, from hereditary influ- ences, often favor the development of the condition. (d) During convalescence from long-continued diseases there is a predisposition to endocarditis. (e) Traumatic conditions over the region of the heart (kicks, blows, fractured ribs, etc.). 4. Mineral poisons (mercury, phosphorus, etc.) or some drugs administered in large doses, or for too long a period, produce direct irritation to the endocardium, or predispose to the condition. In the etiology of endocarditis, infection must always be regarded as the principal causative factor. Necropsy. Macroscopically two forms of acute endocar- ditis are recognized, viz.: (a) Endocarditis Vahularis Vernicosa. This is charac- terized by small enlargements, about the size of a millet seed", on the free edges of the valves, on the tendons and papillary muscles. They are nodular, wart-like in appear- ance, grayish-white or whitish-yellow in color, and their surface covered with blood-stained or colorless stratified epithelium. The-e growths may develop into large polypous proliferations, which often cause stenosis of the openings ACUTE ENDOCARDITIS 87 and insufficiency of the valves of the heart. The endocar- dium in general is swollen, opaque, reddened somewhat, and covered with a thin coagulum; small hemorrhagic foci are found often in the subendocardial tissue, as well as between the fibers of the heart muscle. (6) Endocarditis Ulcerosa.T\\is is the more severe form of the condition, characterized by necrosis and ulceration of the margins of the valves and other portions of the endo- cardium. The ulcers are usually well defined, isolated and vary considerably in size from a pea to several times larger. They are covered with friable, discolored, necrotic masses. These masses are often torn loose by the circulating blood and are carried to the other organs, even to the heart itself, forming metastatic abscesses. In dogs endocarditis verru- cosa is very commonly found on postmortem and although the lesions may be extensive no marked symptoms were noted during life. The aortic or bicuspid valves are most often affected. Symptoms. The symptoms of acute endocarditis vary considerably, depending to a great extent upon the cause, and the nature and extent of the inflammatory process. The early symptoms are those of a greatly disturbed heart action, which is at first palpitating and irregular; later the beat is diffuse. The number of heart beats sometimes exceeds that of the pulse (Frohner) . The heart beat is often so tumul- tuous, especially in dogs, that the entire body is shaken and can be observed some distance from the animal. The pulse is very rapid, intermittent, irregular, and in the later stages becomes imperceptible. The frequency in dogs will be 120-300, and in other animals even more rapid. The heart muscle is at first normal, but soon becomes abnormal, the sounds often blended to a single sound. Later, charac- teristic endocardial bruits are heard, a blowing, stenotic (systolic) noise occurring with the first heart sound, and at times a prolonged rustling and vibrating sound occurs at diastole. The temperature in the early stages is always high (10.T- 105 F.), but in the dog it becomes normal or subnormal. Cats have a high temperature, which remains high for a 88 DISEASES OF THE HEART longer period than in the dog. The respirations are acceler- ated, the dyspnea similar to that of pneumonia, a disease with which it is sometimes confused in making a diagnosis. In the later stages of the condition, circulatory disturbances are quite prominent. These are manifested by cyanosis, venous pulse, edema of the lungs, etc. In the septic form a hemorrhagic diathesis appears with hemorrhages from the membranes, bloody urine, etc. As general symptoms, depression, weakness, etc., come on rapidly, the animal often shows complete prostration. Diagnosis. Acute endocarditis is quite difficult to recog- nize as the symptoms are similar to other diseases of the heart. It may be confused with any acute febrile disease having a sudden onset (septicemia, inflammation of the brain, pneu- monia, etc.). A careful examination of the heart is always necessary for a diagnosis. It is often very difficult, and in some cases quite impossible to distinguish between acute endocarditis and myocarditis, with which it is very closely associated. Between the two forms of endocarditis it is almost impossible to differentiate. In the ulcerous form the onset is more rapid than in the verrucose, and sometimes the primary seat of infection can be located. Prognosis. The prognosis is unfavorable, especially in the ulcerous form. Complete recovery is rare. The valves are usually left permanently impaired resulting in valvular insufficiency. The course of the disease varies. It is sometimes very acute, ending in death in a few hours or days (endocarditis ulcerosa). Or the condition may last for several days or weeks, eventually developing into the chronic form (endo- carditis valvularis verrucosa) . Treatment. The animals should be kept in an absolutely quiet place avoiding all excitement or movement. In the early stages (in dogs especially) cold compresses should be applied over the region of the heart (ice-bag or cold water compress). These should be changed as often as necessary. Regulate the action of the heart by the u.se of digitalis, or if the heart is very weak, it should be stimulated by the use HYPERTROPHY AND DILATATION OF THE HEART 89 of alcohol, caffein citrate or ether subcutaneously. To reduce the temperature acetanilid (dog 0.2-0.5; cat 0.05-0.1) should be given twice daily. In endocarditis from rheumatic conditions, salicylic acid or sodium salicylate (dog 0.2-0.5; cat 0.05-0.1) should be administered twice daily. When general weakness is well marked, stimulants must be administered according to the needs of the patient. Camphor, ether, or atropin are best for this purpose. HYPERTROPHY AND DILATATION OF THE HEART. Definition. Hypertrophy is an enlargement of the heart due to a thickening of its musculature; dilatation is an increase in the size of the heart from an enlargement of its cavities. From a clinical standpoint a distinction between them cannot be made as they nearly always coexist. Hyper- trophy is an active enlargement of the heart, while dilatation is a passive one. Etiology. Generally speaking the causes of hypertrophy of the heart are those conditions which interfere with the circulation of the blood and thus increase the blood pressure. The following are the most common: (a) Increased physical exertion. This occurs in dogs used for hunting (fox hounds, greyhounds) . (b) Adhesions between the pericardium and heart inter- fering with the heart action. (c) Obstruction to the free circulation through the arteries, such as aneurysms of the aorta, stenosis of the aorta, thrombi, atheromatous and arteriosclerotic processes, etc. (d) Defects in the valves of the heart (chronic endocar- ditis). (e) Diseases of the lungs, such as chronic interstitial pneumonia (common in the dog), adhesions, exudations, abscesses, chronic bronchitis, which increase the blood pressure through the right heart. (/) Chronic inflammation of the liver, kidneys, etc., by impeding the free circulation of blood (common in old dogs). (0) Dilatation of the heart usually follows hypertrophy, 90 DISEASES OF THE HEART the hypertrophied heart eventually growing weaker and becoming distended by the abnormally increased blood pressure. It may also develop in an acute form after acute diseases of the lungs, as the circulation through the right heart is greatly interfered with. Necropsy. In both hypertrophy and dilatation the heart is enlarged, in hypertrophy the increase in the thickness of the walls, in dilatation in an enlargement of its cavities. (a) True hypertrophy of the heart appears in several forms, depending upon whether it is general or local, i. e., involving a whole ventricle, or circumscribed affecting only some of the papillary muscles. The left heart is most fre- quently affected. In hypertrophy the shape of the heart will vary. When the left heart is involved it appears elon- gated, cylindrical; when the right heart, it is flatter and broader than normal. If the whole heart is hypertrophied it assumes a round or oval form and is increased in size. The walls are usually two or three times the normal thickness, the muscles firmer, tougher, darker red in color, and the inter- stitial connective tissue occasionally shows marked prolifera- tion. Sometimes areas of fatty degeneration are noted on the surface. (6) In dilatation of the heart the cavities are found much larger than normal, and the w r alls thinner and weaker. In the active form of dilatation the walls are stronger than in the passive where they are relaxed and distended. Dilatation appears oftener in the right heart than in the left. The structure of the muscles may be normal. Usually, however, the organ is anemic, friable, the musculature yellowish- brown in color, often very thin, and due to a complete atrophy of the muscle, in some areas the wall is almost transparent. Symptoms. In true hypertrophy of the heart, especially compensatory, the development is often so gradual that it may exist for a long period without producing marked symp- toms. In severe cases, when accompanying other diseases, it is characterized by a strong, full pulse, very loud, clear heart sounds, and an increase in the area of cardiac dulness. Due to the coexistence of dilatation the symptoms which charac- terize hypertrophy are rarely noted in practice. The most HYPERTROPHY AND DILATATION OF THE HEART 91 prominent symptom of hypertrophy with dilatation is the extension of cardiac dulness, which in dogs may reach as far back as the last rib, or even to the false ribs. Dyspnea, palpitation, disturbances in the circulation, dizziness, etc., are resulting symptoms. A prominent sign is the throbbing of the heart, which often shakes the whole body and may be seen quite a distance from the animal. The heart sounds are usually irregular, the first sound loud, metallic and sometimes vibrating; the second sound very weak and often imperceptible. The slightest exertion will produce a very rapid heart action. The pulse is weak. A venous pulse is common in old dogs. Ultimately, due to insufficient heart action, general cyanosis, ascites, hydro- thorax, etc., develop. Diagnosis. Care should be taken not to confuse hyper- trophy and dilatation with diseases of the lungs, and other affections of the heart. The increase in the area of cardiac dulness, the abnormally loud, systolic sound, arhythmic pulse, and tendency for ascites and edemas are all charac- teristic of dilatation of the heart. A hard, full pulse with increased areas of dulness points to hypertrophy of the heart. These conditions usually can be distinguished from val- vular defects by the absence of the characteristic bruits. Prognosis. Favorable in simple hypertrophy of the heart. Unfavorable in dilatation of the heart, except in the very acute cases. Treatment. Absolute rest and quiet should always be insisted upon. It is important to remove the causes of these conditions if possible. (a) In hypertrophy of the heart with hyperkinesis, seda- tives such as potassium iodid (dogs 0.2-0.8; cats 0.05-0.10) to act as a general sedative may be used for one or two doses. (6) In hypertrophy complicated by dilatation, with a weak, feeble heart action, cardiac tonics and stimulants are indicated. Digitalis fluidextract (dogs 0.1-0.3, cats half the quantity) is probably the most important drug for this condition. These doses may be repeated as often as neces- sary. Good, nutritious food should be allowed at all times. General stimulants are to be used when necessary. 92 DISEASES OF THE HEART RUPTURE OF THE HEART. Etiology. (a) Traumatic influences (kicks, fractured ribs, being run over, falling, etc.). (6) Diseases of the muscular walls of the heart (abscesses, fatty degeneration and infiltra- tion, endocarditis and myocarditis, atheromatous degenera- tions of the aortic walls at their origin, etc.). (c) Shock from operations, and other conditions and diseases. Symptoms. In most cases the animal dies apoplectic. In cases where the rupture is very small, symptoms of internal hemorrhage are noticeable. Death in these cases, however, usually occurs in a few hours. Treatment. No treatment can be given in this condition. PART III. DISEASES OF THE DIGESTIVE TRACT. CHAPTER I. DISEASES OF THE MOUTH. Examination. The examination of the oral cavity requires good light (daylight) or in some cases artificial light (electric- bulb with reflector) is necessary where a careful examination is to be made. In docile animals the mouth can be opened by pressing the lips against the teeth above and below causing the animal to open the jaws. For protracted examination it is necessary to hold the mouth open by the use of tapes placed just back of the canines, one tape above and one below, which are grasped by an assistant ; or a mouth speculum may be used. In vicious animals an anesthetic should be employed (morphin for dogs; ether for cats). For examination of the posterior part of the cavity, the tongue should be depressed with a spatula, or pulled well forward with the fingers or blunt forceps. In examining the mouth, the following should be observed : (a) Odor. An offensive odor is noted from retained or decomposed food; ulcerative or gangrenous stomatitis; gangrene of the lungs; fetid bronchitis; acute* and chronic- gastritis; caries of the teeth; roup in birds. The odor is often characteristic and readily distinguished. In some poisonings the odor of the drug is evident (carbolic acid, hydrocyanic acid, etc.). (b) Secretions. Secretion is diminished in all acute febrile conditions; in some poisonings (belladonna, atropin). Secre- 94 DISEASES OF THE MOUTH tion is increased in parotitis; inflammatory conditions of the mouth; injuries; foreign bodies; poisons (calomel); eruption of teeth in puppies; following injections of pilocarpin. An abnormal quantity of saliva is noted in the mouth in dys- phagia. The saliva which flows from the mouth is in clear strands or in the form of foam from masticatory movements. (c) The Mucous Membranes. An anemic or pale condition is found in chronic constitutional diseases; intestinal para- sites; skin parasites, especially in birds; severe hemorrhage. A hyperemic or congested condition is noticed in all acute inflammatory conditions; in acute infectious diseases with elevation of temperature; occurs during the course of gas- tritis. Cyanosis occurs from chronic heart diseases; inter- ference with respiration or the local circulation. A blue line is seen around the gums in lead poisoning. (d) Foreign Bodies. A. careful examination should be made for foreign bodies which often become imbedded in the mucous membrane or around the tongue or forced in between the teeth. In cats' fishbones, needles or pins are often found in the posterior part of the mouth. (e) Neoplasms. Papillomata are frequently seen on the margins of the lips or on the mucous membrane in various parts of the mouth. Retention cysts often occur under the tongue (submaxillary gland), inner surface of the lips and cheeks (buccal glands). 'Other tumors are occasionally found. In all cases where the mouth is held open, whether from complete or partial paralysis or foreign bodies, dumb rabies should be suspected and the examination made with care. STOMATITIS. Several varieties of stomatitis are met with in practice as follows: (a> Catarrhal; (6) ulcerative; (<) gangrenous; (d) phlegmonous; (e) parasitic. Catarrhal Stomatitis. Definition. An acute or chronic inflammatory condition of the mucous membrane of the mouth. Etiology. Mechanical. Injuries from foreign bodies or sharp material in the food (bones, etc.); from irritation due STOMATITIS 95 to tartar around the teeth; dentition; weed hairs penetrating the membrane (seen in hunting dogs after running in fields). Chemical Irritating medicinal agents administered in concentrated form; poisons (carbolic acid, arsenic, mercury, etc.) ; decomposed food which has been retained in the mouth; internal administration of calomel or lead compounds in too large doses or for too long a time. Thermic. Hot food or drink. Infectious. It occurs in the suckling young of bitches affected with infectious mammitis; accompanies infectious diseases (septicemia, distemper in dogs and cats, diphtheria and roup in birds) ; usually present during the course of gas- tritis, some of the toxins when absorbed into the circulation are secreted with the saliva and thus cause irritation to the oral mucous membrane; produced by extension of inflamma- tion from other parts (pharynx, larynx and salivary glands) . Chronic constitutional diseases (rachitis, anemia and leukemia) are predisposing factors. Pathology. There is at first a superficial redness and dry- ness of the mucous membrane followed by an increased secre- tion and swelling. This secretion collects around the teeth and on the tongue in the form of a dirty gray or brown coat- ing. The lips often become fissured and ulcerated. Symptoms. The animal shows pain during mastication and has an increased thirst. On direct examination the mucous membranes are seen to be red, swollen, and covered with mucus. The redness may be in spots or diffuse, depend- ing on the cause. Saliva often flows from the mouth or hangs in strings from the lips. The swelling of the mucous mem- brane may occlude ducts of the buccal glands, forming cysts which appear as small gray nodules on the inner surface of the lips. Quite frequently there is an edematous condition of the mucous membrane. The upper surface of the tongue shows a brown or greenish-brown discoloration. In cats it is slightly yellow, and the papillae are enlarged and quite prominent. In birds the epithelium is thickened, tongue dry, and a pseudomembrane is often noticed. Diagnosis. The diagnosis is made by the absence of general symptoms, the inflamed and sensitive mucous membrane and the characteristic conditions noted above. 96 DISEASES OF THE MOUTH Prognosis. Favorable in primary cases, healing occurring in about one week; in secondary cases it depends on the causative disease. Treatment. Dietetic. The animal should be fed warm liquid food in small amounts. Medical. The use of antiseptic mouth washes is indicated (boric acid 2 per cent., alum or tannic acid 1 per cent., vinegar and water 1-10) ; in the severe chronic form direct application of silver nitrate (1-2 per cent.) may be found useful. Tincture of myrrh applied direct to the gums is very useful as a deodorant and antiseptic. Surgical. Remove foreign bodies and tartar from around the teeth, using a curette. Ulcerative Stomatitis. Fetid Stomatitis. Stomacace. Sore Mouth. Definition. An acute inflammation of the mucous membrane of the mouth resulting in the formation of ulcers, which appear most commonly on the margins of the gums. Etiology. This disease is found in weak, anemic dogs and cats. It also frequently develops during the course of dis- temper, rachitis and other constitutional diseases. It is found commonly in old dogs and cats with diseases of the teeth (caries) , especially when these animals are insufficiently nourished. The exact causes producing this necrosis of the tissues are not definitely known. The character of the dis- ease process points to infection. In man a similar disease is contagious. The Bacillus septicus has been isolated from the diseased area in dogs, and the Bacillus necrosis and Bacillus coli communis in cats, but have not been proved to be the specific cause. Lack of cleanliness in the mouth, diseased teeth and accumulations around them favor the occurrence of the disease. The internal administration of mercury in large or long continued doses, may produce a similar condition of the gums. Pathology. The gums at first are swollen and dark red in color, but soon become pale yellowish and necrotic. The epithelium is destroyed, deep ulcers form, suppuration ensues and the teeth may become loose and fall out. Symptoms. In the early stages it begins as a severe stomatitis, the gums bleed freely, are swollen and partly STOMATITIS 97 envelop the teeth, but as their margins ulcerate and recede the teeth become more and more exposed. The ulcerative process may spread to the contiguous parts destroying much tissue. Salivation is profuse and the odor of the breath very fetid. Chewing and swallowing are difficult. The tempera- ture is usually slightly increased. In severe cases the afferent lymph glands are enlarged and symptoms of septicemia may be noted. Diagnosis. This condition should be distinguished from scorbutus. The chief differential features are the absence of general symptoms and the free bleeding of the gums, both of which are more marked in scorbutus. The anamnesis will usually differentiate ulcerative stomatitis from poisons; the characteristic general symptoms of the latter are also evident. Prognosis. A favorable termination of the disease is only to be expected in young, healthy animals with mild affection. In such cases, the course is from one to three weeks. In severe cases in weak anemic animals the prognosis is unfavor- able. Complete healing is, however, rare; death may occur suddenly from septicemia. Treatment. Medical. Potassium chlorate seems to be nearly a specific for this condition. It may be administered internally (0.3-0.6) three times daily, and also applied as a mouth wash. As potassium chlorate is toxic, its use should not be prolonged. When there is much fetor, a solution of potassium permanganate (2 per cent.) can be used as a mouth wash and silver nitrate (2 per cent.) applied to the ulcers. In the mercurial stomatitis, a subvariety of the ulcerative, the treatment consists in the removal of the cause and the use of antiseptic mouth washes. Surgical. Examine the teeth carefully and remove all incrustation. Loose teeth should be extracted. Gangrenous Stomatitis. Can ker of the Mouth. Defini- tion. A disease of the mouth characterized by a rapidly progressing gangrene, starting on the gums or lips and pro- ducing extensive sloughing. Etiology. This disease is usually seen in young animals (puppies, kittens, etc.) which have been kept under very unsanitary conditions; or in older animals convalescent 7 98 DISEASES OF THE MOUTH from infectious diseases. It is evidently an infectious dis- ease, probably due to the Bacillus necrophorus. The lack of resistance especially in young animals favors the develop- ment of the organisms. Accumulations of filth in the kennels and injuries to the tissues are predisposing causes. Pathology. The gangrenous area has the appearance of a corroded surface under which the mucous membrane seems transformed into a dry, finely granular or firm mass. It is grayish-yellow in color and bordered by a zone of thickened tissue, slightly reddened and somewhat granulated. The necrotic tissue is very adherent and can be only partially peeled off. The condition may extend to the underlying tissues and even involve the bones. Symptoms. Slight salivation and a disinclination to take food are the first symptoms noticed. An examination of the mouth at this time may show an area of inflammation or possibly an erosion. The latter rapidly increases in size and depth, forming a sharply circumscribed, or at times diffuse area of necrosis, which continuing to spread, may involve any of the adjacent tissues. It often perforates the cheeks forming a fistulous opening, or it may penetrate the hard palate and produce a greenish-yellow nasal discharge'. With the involvement of the nasal passages, the larynx or trachea respiration is disturbed. When life is prolonged for a week or more, necrotic foci may be established in the lungs, giving rise to symptoms of bronchopneumonia. As the disease progresses, salivation becomes profuse, deglutition difficult and the swollen tongue often protrudes from the open mouth. A very offensive odor is exhaled. W'hen the infection becomes general (septicemia), the temperature is elevated (104- 106 F.) and the animal shows extreme weakness. Diarrhea is not uncommon and indicates an invasion of the gastro- intestinal tract. Diagnosis. This is made by the rapid spread of the disease in the tissues of the mouth, fetid odor and the general symptoms. Prognosis. Ordinarily this disease shows no tendency to a spontaneous recovery, and if untreated death usually results. If taken early, however, it usually responds to STOMATITIS 99 treatment. Under such favorable conditions the prognosis is good, recovery occurring in twelve to fifteen days. Treatment. Dietetic. As the animal refuses food on account of the pain when swallowing it should be forced to take some nourishment (warm milk can be given puppies and kittens; milk and soups to older animals). Surgical. In those cases where the lesions are accessible, the treatment consists in removing all the necrotic tissue with a curette. This exposes the causative agent, an anaerobe, to the air which inhibits its growth and development. Medical. The skin around the head, eyes and mouth must be thoroughly cleaned with antiseptic washes (boric acid 2 per cent., potassium permanganate 1-250). The direct application of carbolic acid (5 per cent.), or Lugol's solution to the exposed areas has proved quite beneficial. In obstinate cases silver nitrate (2 per cent.) may be used. Prevention. Prevention of this disease consists in a thor- ough disinfection once daily for a few days, of the mouth and nose of those animals that have been exposed and are pre- disposed by the eruption of the first teeth or the shedding of the milk teeth; or through association with affected animals. All filth should be removed from the kennel and disinfectants freely used. Phlegmonous Stomatitis. Definition. An acute phleg- monous inflammation of the mucous membranes of the mouth, lips and tongue. Etiology. M echanical. Foods containing irritating mate- rials. In hunting dogs sharp projections, such as thorns, spikes, nettles, hairs, etc., on grasses and weeds are causes. Chemical. Carbolic acid, alkalies, ammonia, croton oil, etc., when concentrated, produce an intense inflammation and swelling of the membranes. Infections. It is produced secondarily during the course of diseased processes of neighboring organs (infectious pharyngitis) ; also secondary to infectious diseases (distemper in dogs and cats and diphtheria in birds). Pathology. The mucous membrane is reddened, edematous and covered with a thick tenacious mucus. The subcu- taneous tissues are infiltrated with serum. Desquamation of the epithelium is often noticed from the intense irritation. 100 DISEASES OF THE MOUTH Symptoms. The disease begins with swelling, redness and a very painful condition of the mucous membrane. The local temperature is accelerated. The lips and cheeks become swollen, the lower lip hangs down and strands of saliva hang from the corners of the mouth. Later the mucous membranes on the inner surface of the lips, cheeks and the back part of the mouth are bluish-red in color. The gums are swollen and dark red, the tongue becomes much thickened which interferes with deglutition and forces the mouth open. In severe cases following infectious diseases, the submaxillary and sublingual lymph glands are swollen and very painful to the touch. The general symptoms depend largely upon the primary condition. Diagnosis. Is made by the acute inflammatory condition of the mucous membranes with the swelling of the lips, cheeks and tongue. The anamnesis in some cases will materially assist in making the diagnosis. Prognosis. Usually favorable; in the secondary cases it depends on primary condition. Treatment. Dietetic. All solid food should be withheld for a few days and small quantities of liquid foods given (milk, meat broth, etc.). Medical. The mouth should be thoroughly cleansed twice daily with antiseptic and astringent solutions (alum 1-250; tannic acid 1-250; potassium permanganate 1-250). Parasitic Stomatitis. Thrush. Soor. Aphtha. Definition. An inflammation of the mucous membrane of the mouth produced by the Oidium albicans. Etiology. The Oidium albicans (Monilla Candida, Sac- charomyces albicans) is the exciting cause of this disease which is found occasionally in healthy young animals, most fre- quently in birds. This fungus is widespread in nature, occur- ring especially on decaying vegetable matter as a saprophyte. The mycelia are composed of cylindrical cells, 1-4 microns wide and 10-20 microns long. The filaments show branching and the outer ends are rounded off or club shaped. The rounded ends often contain oval, highly refractive bodies, the gonidia or spores, which are also found free between the filaments. If the free spores come in contact with the oral STOMATITIS 101 mucosa, in which there are slight epithelial defects, they may develop and lead to the formation of thrush spots and pseudo- membranes. In some cases the filaments and spores may penetrate deeper into the tissues, or by metastasis involve the internal organs. Frequently in birds, the spores are taken into the crop where they develop and produce typical thrush lesions. Damp, warm rooms poorly ventilated and filthy, favor the growth of this fungus. Pathology. The affection begins with diffuse redness of the mucosa and the formation of a glistening or shiny adhesive exudate of grayish appearance. Small white or yellowish dots next appear, which stand out prominently against the hyperemic background. These patches may be quite large and when removed the underlying mucosa is congested and eroded. The disease usually begins on the tongue or inner parts of the cheeks, from where it spreads to other parts of the mouth. In severe cases it may extend to the pharynx, esophagus, or even in fowls to the crop and intestines. The microscope reveals filaments, spores, epi- thelial cells and pus. Symptoms. The general symptoms are depression, emacia- tion and loss of strength. On direct examination of the mouth an acid odor will be detected and the characteristic lesions or spots will be seen on the mucosa. These may be in the form of white or yellowish spots, or they may coalesce forming a superficial felt-like membrane which can be readily scraped off. Similar membranes form in the esophagus and crop interfering with the appetite and nutrition. This condition leads to cachexia and death, which is often preceded by convulsions. Diagnosis. The disease is readily distinguished from other forms of stomatitis by the absence of acute inflammation. The diagnosis is made positive by the finding of the filaments or spores of the fungus in the deposits on the membranes. The clinical appearance may be confused with the condition due to the aspergillus fungi. (See Aspergillosis.) t Prognosis. When the disease is localized on the mucous membrane of the mouth, the prognosis is favorable, but when it extends to the esophagus and crop, treatment is unsatis- factory. 102 DISEASES OF THE MOUTH Treatment. Dietetic. Good nutritious food should be given (small meat scraps, oatmeal and milk, etc.) to sustain the strength. Surgical. Carefully curette all the accessible lesions and wash with antiseptic solutions (boric acid 2 per cent., mer- curic chlorid 1-1000, the latter used with care that it may not be swallowed). When the disease extends to the crop, give enough boric acid (2 per cent.) solution to distend the latter, then massage it thoroughly with the head held down so the contents will be forced out of the mouth. Repeat this daily until the appetite is improved. BENIGN NEOPLASMS OF THE MOUTH. Papillomata. These tumors occur on the mucous mem- brane of the mouth and occasionally on the margins of the lips and sometimes they apparently assume a contagious character. Symptoms. They are noticed as small, isolated or confluent growths, usually pedunculated, of a whitish color and often rough (cauliflower-like) on their surface. They are found most commonly at the juncture of the mucous membrane and the skin, and on the inner surface of the lips, but may be generally distributed over the oral mucosa. They rarely inter- fere with mastication, but when present in large numbers or masses they may cause some salivation and from the decomposed food collecting around them a very disagreeable odor is emitted. Treatment. These tumors frequently disappear in a short time without any treatment. However, it is best to remove them by clipping off with scissors. The mouth should be washed for a day or two with antiseptic solutions (alum 1-250; potassium permanganate 1-250). Tannic acid (2 per cent.) applied direct to small papillomata often causes them to slough off after a few applications. Fibromata. These tumors are composed of connective tissue elements which may be a pure or mixed fibrous growth BENIGN NEOPLASMS OF THE MOUTH lO.'i containing cartilage and sometimes spicula of bone. They have their origin in the submucous tissue or the periosteum of the bone, and usually occur as a single growth. Symptoms. The tumor is found growing at the edge of the gums in the form of a hard, reddish enlargement varying in size from a pea to a walnut. Its growth is slow often requiring months to develop into sufficient size to be notice- able. The slow growth and firm consistency assist in dis- tinguishing it from any of the malignant growths. Treatment. Complete extirpation and cauterization of the wound with silver nitrate or thermocautery are curative. Osteoma. These tumors are found growing from the peri- osteum of the maxillae. They are composed of osseous mate- rial and frequently develop after injuries to the periosteum. Symptoms. Osteomas appear as very hard enlargements firmly attached at their base. As a rule the skin or mucous membrane is riot adherent over them. Their hardness and slow growth readily distinguish them from malignant tumors. Treatment. Expose the enlargement by an incision through the soft tissues and dissect down to the base, when it may be removed if not too diffuse, by the use of bone forceps or a small bone chisel. Curette the surface until smooth and suture the skin over it. After-treatment as an ordinary wound, using antiseptics to cleanse it daily. Retention Cysts. Ramda. These are enlargements ap- pearing in the buccal cavity from a stoppage of the ducts of glands which discharge their secretions into the mouth. Co- hesion of openings occurs from inflammations of the mucous membrane, swelling, etc., partially or completely closing the duct. At the same time the glands continue to secrete their fluids which distend the ducts forming the enlargements. Closure or obstruction of Wharton's duct produces an exten- sive enlargement under the tongue. The most common retention cysts, however, are from the ducts of the buccal or sublingual glands. When the obstruction is complete the secretions, as they collect, burrow downward along the neck producing an enlargement which appears subcutane- ously in the submaxillary region, or may extend to the supe- 104 DISEASES OF THE MOUTH rior part of the neck, appearing as a soft fluctuating enlarge- ment. There is an absence of inflammatory symptoms and the skin is not adherent over it. These cysts develop slowly in contrast to a rapidly developing hematoma; the skin is adherent in the latter. The contents of the cysts can be obtained by the use of a large aspirating needle or trocar and examined. The fluid which flows out very slowly is a thick, viscid, honey-like material which makes the diagnosis positive. Treatment. Surgical. Complete removal of the cyst is hardly possible by excision, as the glandular secretion con- tinues, and when adhesion of the edges of the wound takes place, another cyst will develop. The most satisfactory treatment consists in aspirating all of the contents and the injection of Lugol's solution or tincture of iodin to destroy the cyst wall and the secreting gland. The injection should be sufficient to distend the cyst so that some of it will be forced to gravitate into the gland to destroy it. This should be done every second or third day. As soon as the gland , is destroyed, the secretions will stop, the gland will atrophy and the enlargement disappear. This usually takes place in three to four weeks. MALIGNANT NEOPLASMS OF THE MOUTH. Epitheliomata. These tumors appear most commonly on the margin of the lips, involving the mucous membrane, subcutaneous tissue, muscles and skin. They occur most often in old animals. Symptoms. In the beginning they are observed as small flat growths, which later have a tendency to show ulceration on the surface. The surface has a roughened, granulating appearance often covered with a thin dried mass. It grad- ually develops in size until it invades the entire lip and occa- sionally the maxillae. Secondary enlargement of the cervical and submaxillary lymph glands is of common occurrence. Epitheliomata are diagnosed clinically by their rapid, pro- gressive growth, roughened irregular surface and invasion MALIGNANT NEOPLASMS OF THE MOUTH 105 of the entire lip. In cases where a satisfactory diagnosis can- not be made clinically a small portion can be removed for microscopical examination. Treatment. Surgical. Complete excision early as pos- sible. When the tumor is small and involving the lip, a "V-shaped incision should be made through the entire lip removing all of the tissue affected. The wound should be carefully sutured to bring the edges in direct apposition when healing will readily take place. In more diffuse and extensive growths complete excision is difficult but should be attempted if at all possible. When the lymph glands are involved treatment is usually unsatisfactory. After-treat- ment consists in the use of antiseptic washes. Sarcomata. This tumor most commonly affects the maxillse, usually the superior maxilla, as it originates either in the periosteum, the medulla, or the endosteum of the bone. They are frequently quite large and often invade the nasal passages, the orbits and the sinuses. Metastatic processes are common in the adjacent lymph glands and occasionally a generalized sarcomatosis is produced. Symptoms. The growth first appears as a rather firm, oval, reddish colored enlargement in close proximity to the maxilla. Later the surface becomes irregular, lobulated and covered with thickened mucous membrane. The tumor usually has a broad base rather firmly attached, but may in some cases be pedunculated. The growth is quite rapid, beginning as one enlargement around which eventually numerous secondary ones develop; later by confluence the base becomes broad. The teeth are often hidden by the growth or in some cases elevated from their position. Treatment. The removal of the entire growth should be done as early as possible. Under general anesthesia, dissect out the tumor, using bone forceps, chisel or curette, being careful to get out all the affected tissue. When the alveoli are affected, extract the 'tooth and curette and cauterize the cavities to destroy, as far as possible, all the sarcomatous cells. When the lymph glands and the sinuses are involved treatment is practically impossible. 106 DISEASES OF THE MOUTH FOREIGN BODIES IN THE MOUTH. Foreign bodies in the mouth consist principally of such objects as are taken in the mouth with food or during play. Fragments of bone are most common. These either penetrate the soft tissues or are firmly lodged in between the teeth, or, if larger, may be between the rows of teeth. Splinters of wood and pieces of wire are usually found imbedded in the mucous membrane. Needles, pins and fish bones are also common, especially in cats. Birds often have grains of corn, sunflower seeds, etc., lodged under the tongue in the floor of the mouth. Hunting dogs when running through fields often have pieces of twigs or weeds forced in the mucous mem- brane of the mouth. Porcupine quills are common in locali- ties where these animals abound. Symptoms. When the foreign body causes much incon- venience, the animal makes persistent attempts to remove it by pawing at the mouth with the feet and shaking the head. Masticatory movements may be continuous or the mouth may be held open, with some salivation. Smaller objects as needles, pins, etc., may not produce prominent symptoms at first and the former may only be noticed by the presence of a thread attached. Food and drink are either entirely refused or feeble attempts made at eating. Thorough inspec- tion of the mouth reveals the foreign body or the wound in the membrane where it entered. Treatment. Ordinarily objects lodged between the teeth may be readily removed with forceps. Imbedded objects should be observed closely to determine their direction of entrance and removed in the opposite direction. Vicious animals, especially cats, should be etherized to render the operation safe. CHAPTER II. DISEASES OF THE TEETH. Examination. Examination of the teeth can be done by elevating the lips, which readily exposes them, or by the use of tapes or a mouth speculum to hold the mouth open (see examination of the mouth). Careful inspection should be made for malformations, fractures, incrustations of tartar and disease conditions. MALFORMATIONS OF THE TEETH. These are not common in small animals, only occasionally being seen as distortions of the skull bones so affecting the jaws that the teeth do not meet in proper relationship. This may result in excessively long teeth. A few instances of defective dentition are recorded. They are important only when they interfere with mastication and subsequent nutrition. Breeding has been carried to such an extent with some breeds (English bull, etc.) as to amount almost to a malformation of the max- illte with unusual relationship of the teeth in some individuals. Birds occasionally have a deformity of the beak rendering prehension of food difficult. Treatment. Surgical. Surgical intervention is possible only in rare cases to improve the appearance or condition. Prescribe a suitable diet when the animal is unable to masti- cate solid food (meat, etc., should be given in small pieces). Long teeth may be removed or the points clipped off with bone forceps. The long points of malformed beaks should be so shaped, using a sharp knife, that they will assume a more normal form. 108 DISEASES OF THE TEETH FRACTURES OF THE TEETH. Fractures of the teeth with exposure of the pulp cavity sometimes occur, especially in dogs, and are usually due to fighting, falls on hard surfaces, kicks (horses, etc.), being hit with hard objects; often occur during play in attempting to catch a ball or stone when thrown; also due to biting iron bars in their attempts to escape from cages. Treatment. If the fractured tooth is painful, extract it. It is possible to have it filled. INCRUSTATIONS OF TARTAR. Tartar occurs quite commonly on the teeth of dogs and it is due to the precipitation of the carbonates, phosphates and some organic substances from their solution in the mouth secretions. It collects around the neck of the tooth close to the gingival border which is the least exposed part of the tooth, and therefore the deposits are not worn off by eating. By constant accretion, these deposits increase, producing an irritation to the gums and inflammation. As the process continues, it separates the gums from the teeth and often causes the teeth to loosen and fall out. In some severe cases, the tooth may be completely covered with the incrustations. The gums are reddened, swollen and painful, later showing ulceration. A foul odor is emitted from the mouth. Remove all deposits from the teeth with a curette or scaling instrument, being careful not to injure the gums. Extract all loose teeth. Tincture of myrrh applied to the gums is useful as an antiseptic, astringent and deodorant. As this condi- tion usually persists, these cases should have attention every few weeks. ALVEOLAR PERIOSTITIS. Pericementitis . Periodontitis . Definition. This is an inflammation of the alveolar peri- osteum. Etiology. It begins in most cases from the irritation pro- duced by a collection of tartar around the teeth. As the CARIES OF THE TEETH 109 incrustation gradually increases, it causes separation of the gums from the teeth and this leads to suppuration of the peri- dental membrane at the neck of the tooth, and, as the process continues, the entire membrane becomes involved. Pathology. The affected tooth is loosened, slightly raised from its alveolus, and, from disturbance to the vessels and nerves leading to loss of nutrition, it becomes discolored (dark or yellowish.) Injury to a tooth with exposure of the peridental membrane may also lead to a similar condition but in this case only one or a few teeth are affected while in the former several, or in severe cases the entire set is lost. Symptoms. The animal either refuses food or takes only a small amount and this very carefully. Saliva flows freely and the mouth emits a foul odor. The gums are dark red (livid), swollen and bleed easily. Ulcerative stomatitis often accompanies this condition. Treatment. Extract all loose teeth and remove incrusta- tions from the others. Disinfect the mouth daily with anti- septic solutions (potassium permanganate 1-250), or by direct application of tincture of myrrh to the gums. Extrac- tion may be accomplished by the use of dental forceps, a mouth speculum being necessary to open the mouth when molars are to be extracted but not necessary for the incisors. Grasp the tooth as far up the root as possible and for single fanged teeth, loosen with half turn twist each way, and molars with a pressure alternately inward and outward, care being taken to avoid breaking the roots. General anesthesia should be used when the animal is vicious. CARIES OF THE TEETH. Definition. Caries is the true decomposition or disinte- gration of the dental tissues. It is rare in small animals. Etiology. The process always commences on the surface of the tooth where the enamel is inferior or damaged, or at protected parts of the tooth where food particles lodge and decompose. Pathology. The point where this begins may or may not be discolored, and as the dentin is disintegrated more 110 DISEASES OF THE TEETH rapidly than the enamel, a cavity is soon formed within the tooth but having a small opening through the enamel. As this process continues it opens the pulp cavity which becomes infected. As long as the opening through the enamel is free the pus will be discharged without further complication but if it becomes closed with food particles, etc., an abscess develops at the root and the pus burrows out into the adja- cent parts, usually into the sinuses or may break down the sinus wall resulting in a maxillary fistula. The disintegra- tion of the dental tissue is brought about by chemical action from the lactic acid fermentation in the mouth. Symptoms. This condition will be noticed only by careful inspection until the disintegrating process reaches the pulp cavity when it gives rise to sharp pain, depression of the head toward the affected side and careful mastication. When a fistula results the pain is not pronounced. Empyema of the sinuses often causes a distortion of the affected side and a dull sound when percussed. Suspect all fistulse opening in the maxillary region as having their origin in a carious tooth. Treatment. Extract diseased tooth and cleanse the alveo- lus with antiseptic solution (boric acid 2 per cent.). If a fistula is present, it is readily irrigated when the tooth is removed. Thorough irrigation through the entire tract should be done daily. Healing is usually rapid. CHAPTER III. DISEASES OF THE TONGUE. Examination. This can be readily done by opening the mouth (see examination of the mouth) and pulling the tongue forward as far as possible with a blunt forceps or by a piece of tape wrapped around the free end of the tongue, using gentle traction. In paralysis of the tongue, it will be relaxed and protrude from one side of the mouth. The examination should be made for (a) foreign bodies, splinters of bone, needles, pins, etc., which often penetrate the tongue. (6) Rubber bands, pieces of bone or cartilage becoming fixed around the free portion of the tongue, (c) Inflammation of the tongue (glossitis), (d) Necrosis of the free portion of the tongue. (e) Ulcerative processes extending from the mucous mem- brane of the mouth. (/) Edema of the tongue occurring during the course of infectious diseases (distemper, etc.). (g) Inflammation of the glands in the posterior part of the tongue, (h) Deposits on the tongue. GLOSSITIS. Definition. An inflammation of the tongue. Etiology. Mechanical. Injuries by foreign bodies (pieces of bone, needles, etc.) which penetrate it; biting the tongue or being bitten by other animals or insects, cats being fre- quently bitten by rats or mice. Chemical. Medicinal substances taken in too concentrated form (carbolic acid, ammonia, etc.) or given for too long a period or in too large doses will lead to severe glossitis. Thermic. Hot foodstuffs or the tip of the tongue touched against hot objects. 112 DISEASES OF THE TONGUE Infectious. Occurs during the course of infectious dis- eases (distemper, etc.). Glossitis also usually accompanies the various forms of stomatitis. Pathology. The mucous membrane is reddened, swollen and covered with a grayish-white membranous deposit. When foreign bodies are present at the point of entrance, the tongue is swollen and edematous, later becoming a dark bluish color. In severe cases foci of gangrene are seen. Symptoms. The animal refuses food or eats very carefully; the mouth is often held open; saliva, sometimes streaked with blood, runs from the corners of the mouth. The swelling may be so great that the tongue is protruded. Direct ex- amination reveals the swollen and reddened condition of the tongue and quite often foreign bodies are found imbedded in it or around the free end. As a rule no general symptoms are noticed except when due to infectious diseases. Prognosis. The majority of cases terminate in recovery, depending somewhat on the cause and extent of the injury. When due to infectious diseases, the prognosis is less favor- able. Treatment. Dietetic. \Vhen the swelling interferes with mastication, soft or liquid foods should be given (milk, beef broth, etc.). Medical. Antiseptic washes (boric acid 2 per cent., potassium permanganate 1-250, potassium chlorate 1-100) may be used several times daily. When there is severe swelling, astringent solutions are also indicated (alum 1 per cent.). Surgical. In very severe cases or where abscesses develop, make deep incisions in the substance of the tongue followed by the use of antiseptic solutions. GANGRENE OF THE TONGUE. Gangrenous Glossitis. Definition. This is a gangrenous condition of the tongue which may involve the entire free end or appear as small rapidly spreading ulcers. GANGRENE OF THE TONGUE 113 Etiology. M echanical. Obstruction to the circulation from foreign bodies is not uncommon. Rubber bands are occasionally slipped over the tongue by children; rings of cartilage from the trachea or aorta from cadavers upon which the dog has been feeding, have been found around the tongue. Infectious. Gangrene of the tongue may be caused by the Bacillus necrophorus and often is associated with gangrenous stomatitis. Chemical. The action of concentrated drugs may be so severe as to cause a gangrene. Pathology. When the tongue is encircled by foreign bodies which shut off the blood supply that part of the tongue anterior to the foreign body becomes swollen and in a few hours very dark and gangrenous and will slough off in three or four days. In cases of infection, the process begins as a small ulcer which rapidly extends and may involve the entire organ. Chemicals usually cause only small areas of gangrene which do not show a tendency to spread. Symptoms. The animals refuse food and drink, and saliva flows freely. If the tongue is much swollen it may protrude from the mouth. The inconvenience causes the animal to appear depressed. General disturbance is not noticed in the early stages but later, from the absorption of the gangrenous toxins, an elevation of temperature and symptoms of sapremia are seen. Diagnosis. The presence of the foreign body around the tongue partly obscured by the swelling, or in infection the rapidly spreading ulcer. Prognosis. This depends on the degree of compression by the foreign body, and the length of time it has been on the tongue. Complete obstruction of the blood supply for a few hours (4-6) will often result in loss of the tongue. The infectious form is favorable if treated early. Treatment. Remove the cause if a foreign body. When due to infection or chemicals, remove the necrotic material with a curette and thoroughly cleanse with antiseptic solu- tions (see Gangrenous Stomatitis.) After removing the foreign body from around the tongue a few hours should 8 114 DISEASES OF THE TONGUE be allowed for the establishment of the circulation and if it does not occur in that time, the affected part should be amputated. This must be done under general anesthesia. Fix the jaws open with a mouth speculum and draw the tongue forward, using blunt forceps or a tape suture through the healthy tissue to hold it. A pair of dull, heavy scissors can be used to remove the diseased part. A small ecraseur will also do. Control the excessive hemorrhage by twisting the artery with forceps or by ligation. An animal with part of the tongue removed will have difficulty in drinking, and water should be supplied in a vessel of sufficient depth to allow the mouth to be submerged or from a faucet placed at the height of the head. CHAPTER IV. DISEASES OF THE SALIVARY GLANDS. Examination. 1. The glands can be examined by palpa- tion for: (a) Enlargements (cysts, abscesses, tumors, etc.); (6) inflammations; (c) wounds; (d) fistulse. 2. The character and the amount of the secretions. The normal secretion is a mixture of secretions from the parotid, submaxillary, sublingual and the mucous glands of the mouth. It is a thin, slightly viscid, opalescent fluid, having a feeble alkalin reaction and a specific gravity of 1005-1008. An increase in the salivary secretion is noticed in the follow- ing conditions: The different forms of stomatitis; dentition; chorea by reason of the increased masticatory movements; gastric ulcers; nausea; helminthiasis; severe pain; direct nerve stimulation either central or peripheral; uremia; mercurial poisoning; drugs such as pilocarpin which produce direct stimulation to the secretory nerve. The secretion of saliva is diminished in the following conditions : During the course of fevers (pneumonia, septic fever, etc.); after the use of atropin or belladonna; fright and excitement ; severe diarrheas ; cirrhosis of the liver when ascites is developing; atrophy of the salivary glands. PAROTITIS. Mumps. Definition. An acute or chronic inflammation of the parotid gland. Etiology. Mechanical Direct injuries to the gland by being run over by vehicles; struck with stones; kicks, etc.; pulling back when tied and the collar injuring the gland or by being caught in a door. Chemical. The internal administration of potassium iodid in too large doses or the absorption of iodin from local appli- 116 DISEASES OF THE SALIVARY GLANDS cations will often produce it. Lead when given in large doses will sometimes cause acute parotitis which may result in a chronic induration of the gland. Inflammations of the mucous membrane of the mouth from chemicals will reflexly and by absorption produce an inflammation of the glands. Obstruction of the ducts from chemical action or from other causes of stomatitis often leads to a chronic parotitis. From the retention of the secretions, the glands become enlarged and hard and may resemble tumor formation. Infectious. The disease sometimes appears in the form of an epizootic which no doubt is caused by a specific organ- ism. A diplostreptococcus has been isolated from the gland and from Steno's duct during such epizootics. Other organ- isms have also been found but as yet none of them has proved specific. During the course of infectious diseases (distemper, etc.) the parotid is frequently infected resulting in an acute inflammation. Parotitis occurs as a secondary disease in pharyngitis, stomatitis and other local inflamma- tory conditions. Chronic parotitis results from repeated acute attacks or from obstruction to the ducts. Pathology. The acute parotitis in the early stages begins with a swelling, congestion and serous infiltration of the interlobular connective tissue. Later small abscesses develop which become confluent forming one large abscess. In chronic parotitis there is a thickening of the connective tissue and atrophy of the glandular substance which produce a hard, fibrous condition (indurative parotitis). Symptoms. The acute infectious parotitis begins with a swelling in one or both glands, with a collateral edema in the surrounding tissues. The swelling usually develops rapidly, is very painful to the touch and changes the appearance of the head and neck. The head is held away from the affected side or if bilateral is extended. The temperature is elevated (103-105 F.), the animal shows depression, partial or complete loss of appetite, and mastication is slow and careful. The saliva is usually increased in quantity and runs from the corners of the mouth in strands. In a few days abscesses develop, producing a fluctuating enlargement which discharges reddish colored pus when opened. In PAROTITIS 117 parotitis produced by injuries, lesions are often found on the skin. In most cases only one gland is affected and general disturbance will not be noted. When resulting from pharyn- gitis and stomatitis, the symptoms are modified by the swelling of the mucous membrane and connective tissues. There is quite an extensive edema of the lips, tongue and in the tissue around the gland. Chronic parotitis is charac- terized by a firm enlargement of the gland, acute symptoms being absent. Steno's duct may be distended from a closure of the buccal opening. Diagnosis. Acute parotitis may be confused with enlarge- ment of the lymph glands and therefore must be examined carefully. The position, shape and nature of the enlarge- ment are to be considered in making the diagnosis. Prognosis. Usually favorable. When abscesses develop a fistula may result from the opening of some of the ducts. In chronic indurative parotitis, the prognosis is less favorable. Treatment. In the early stages when the glands are enlarged endeavor to hasten resolution, or abscess formation. Later a stimulating liniment (soap or white) may be used with good results. When abscesses develop, they should be opened early so as to secure good drainage. When the incision is made, it should be only through the skin, and the tissues then separated with the fingers in order not to injure the gland any more than is absolutely necessary. Irrigate the cavity daily with antiseptic solutions (boric acid 2 per cent., etc.). In cases where the discharge is persistent and abundant, tincture of iodin or Lugol's solution injected into the gland gives good results (see Salivary Fistula). In chronic parotitis recovery may be hastened by the application of iodin ointment over the surface of the glands. Lugol's solution may be injected directly into the gland. Insert the needle rather deep into the gland substance, being careful that it does not enter a bloodvessel, which will be shown by the free flow of blood. Injections may be made at different parts of the gland and repeated in a few days if necessary. Small doses of potassium iodid (0.05-0.10) given once daily will assist in the absorption of the deposits in the gland. 118 DISEASES OF THE SALIVARY GLANDS SUBMAXILLARY AND SUBLINGUAL GLANDS. These glands owing to their position are not as often injured as the parotid, therefore inflammation due to trau- matism is rare. Occasionally infection develops in the glands by gaining entrance through the ducts and producing an acute inflammation. Symptoms. Enlargement of the glands, profuse salivation with the head held extended. Abscesses often form in the glands which open and discharge a reddish colored pus. The opening may be through the skin or into the mouth. Treatment. See Parotitis . SALIVARY FISTULA. Definition. A fistula which discharges secretions from the salivary glands. Etiology. Mechanical. Injuries (cuts, bites, etc.) in which Steno's duct or any of the smaller ducts are opened so as to permit the escape of saliva; often follows operations for the removal of a calculus from Steno's duct. Infectious. Abscesses which develop within the gland may rupture and leave an opening through which the saliva escapes. Pathology. When the injuries or abscesses open a duct, the overlying tissues heal until there is only a small opening left through which the saliva continues to be discharged. In some cases, however, the healing of the skin is complete and then the accumulated secretions burrow along under the skin. When there is enough fluid to cause necrosis of the skin by the pressure, it opens and thus forms a fistula. This in turn may heal only to reopen in another place. Such openings have been found in the lumbar region. Symptoms. A small opening will be noted partially covered with matted hair and from which is discharged a thin serous fluid (saliva) and occasionally a small amount of pus. When probed, it will be found to be only subcu- taneous unless in the region of the gland when it will be deeper and lead to the gland or duct. A history of these SALIVARY FISTULA 119 fistulse appearing from time to time may extend over several months. In fistula of the duct, the saliva flows freely and increases where food is offered or taken. Diagnosis. The chronicity and the character of the dis- charge are usually sufficient to make a diagnosis. Prognosis. Unfavorable. Treatment. When the fistula is distant from the gland, probe carefully until the origin is reached. Open the skin at this point and apply treatment direct to the opening in the duct or gland. Tincture of iodin applied direct to the opening leads to swelling which occludes the opening. In obstinate cases the thermocautery should be used. When Steno's duct is open, suturing may be attempted. When all treatment fails complete destruction of the gland by repeated injections of iodin directly into the gland or extirpation should be practised. CHAPTER V. DISEASES OF THE TONSILS. Examination. The tonsils can be readily examined in docile animals by opening the mouth (see examination of the mouth) and pulling the tongue well forward. In vicious animals, partial or complete anesthesia is advisable. The tonsils should be examined for acute or chronic inflamma- tions, deposits of mucus on their surface, abscess formation, tumors and foreign bodies. The adjacent lymphatic tissues are frequently involved producing a diffuse enlargement of all the surrounding parts. TONSILLITIS AND LYMPHADENITIS. Definition. An acute or chronic inflammation of the tonsils and the adjacent lymphatic tissues. Etiology. Tonsillitis is not of very frequent occurrence. Some breeds (Boston terrier), however, are occasionally affected. Exposure to wet and cold and bad hygienic surroundings appear to have a direct influence in producing the disease. Chemical. Carbolic acid, arsenic, etc., may produce it by direct irritation. Mechanical. Foreign bodies (sharp pieces of bone, needles and pins, etc.) often penetrate the glands and lymph tissue resulting in acute inflammation. Inflammation of contigu- ous parts will often produce the condition by spread of the inflammatory process (stomatitis, pharyngitis, etc.). Infectious. The tonsils and lymphatic tissues undoubtedly take up a lot of microorganisms, the most common of which are the streptococci and the staphylococci. These organisms by their rapid development in the tonsils produce an acute TONSILLITIS AND LYMPHADENITIS 121 inflammation, and from there, they or their products may enter the general circulation and produce symptoms of a general infection, or toxemia. Further, this condition may appear during the course of some diseases, as distemper, rabies, endocarditis, etc. Pathology. The tonsils and the lymphatic tissues become swollen, reddened, and later covered with a thick, tenacious mucus. Vesicles are frequently formed, and in some instances even membranous exudation, forming a pseudomembrane. The lacunae of the tonsils become filled with a cheesy mass of exudation, often becoming confluent, forming small abscesses. The contents of the lacunae are composed of epithelial debris and micrococci. In the chronic form, the tonsils become hypertrophied due to a multiplication of the glands mainly involving the lymphoid; or in some instances the fibrous stroma is increased and the tonsils become hard and swollen. Symptoms. In the early stages the temperature is elevated 102-104 F., respirations and pulse accelerated. When the glands become much enlarged, the patient breathes with difficulty, holding the mouth open, producing a peculiar snoring sound. Direct examination reveals the reddened and enlarged tonsils. The cervical lymph glands are also frequently enlarged from the infection. In severe cases the tonsils become very much enlarged forming abscesses. However, in the majority of cases the inflammation subsides within a week, the temperature becomes normal, and the local, condition rapidly disappears. In the chronic form the symptoms are milder and are usually overlooked. Prognosis. In most cases favorable; depends somewhat upon the cause. The course is rarely longer than one week or ten days for the acute form, while the chronic form may continue for several weeks. Treatment. Locally the tonsils and the lymph tissues may be treated with a 5 per cent, sodium bicarbonate solution. Astringent and styptic preparations (iron, alum, zinc and silver nitrate) may be found useful. Borax in glycerin (2 per cent.) or thymol in glycerin (3 per cent.) can be used as a deodorant when the mouth becomes offensive. Abscesses 122 DISEASES OF THE TONSILS should be incised freely to allow drainage and antiseptic solutions used. In chronic hypertrophy of the glands and lymph tissues, it often becomes necessary to remove the enlargement surgically. This can readily be done under anesthesia with the aid of a mouth speculum to fix the jaws open when with a sharp curette the growths can quickly be removed. After-treatment with antiseptic solutions (boric acid 2 per cent.) should be continued for a few days. CHAPTER VI. DISEASES OF THE PHARYNX. Examination. The pharynx is easily exposed to view by opening the mouth and pulling the tongue forward. For a more careful examination the mouth speculum may be used to immobilize the jaws, while in vicious animals it is always best to use an anesthetic. PHARYNGITIS. Pharyngitis is divided into (a) acute, and (6) chronic. Acute Pharyngitis. Definition. An acute inflammation of the pharynx. Etiology. Mechanical. Sharp foreign bodies (needles, pins, sharp pieces of bone, etc.) may penetrate the mucous membrane and produce an acute local inflammation. Chemical. Inhalation of gases (smoke, ammonia, etc.) will produce inflammation in the pharynx as w r ell as in the larynx. Drugs administered in concentrated form. Thermic. Very hot liquids or foodstuffs when swallowed frequently produce in dogs a severe pharyngitis. Exposure to cold when the body is heated will produce a congestion in the pharyngeal mucous membrane and this may result in an acute pharyngitis. Infectious. Many of the above causes predispose to infec- tion, the most common of which are produced by the strepto- coccus and the Bacillus necrophorus. A severe form of infectious pharyngitis is occasionally seen in week -old puppies and kittens, in some cases amounting almost to an enzootic, affecting the entire litter. Pharyngitis is secondary to infectious diseases as rabies, distemper, infectious nasal catarrh and cholera of birds. It is often produced by an extension of inflammation from the adjacent organs and tissues (nasal catarrh, bronchitis, stomatitis, etc.). 124 DISEASES OF THE PHARYNX Pathology. (a) Acute pharyngitis is characterized by redness and swelling of the mucous membrane which has a glazed appearance due to the collection of mucus on the surface. Later there is an abundant discharge of a thick mucus or a mucopurulent exudate. Occasionally it may be tinged with blood. In severe cases small erosions appear on the posterior part of the pharynx. The lymph follicles are enlarged and appear as small, round, elevated, reddish nodules projecting through the membrane. (6) The discharge contains bacteria, leukocytes, blood cells and desquamated and degenerated epithelium. Symptoms. One of the first symptoms is difficulty in swallowing food. Frequent attempts at swallowing with the head extended are often noticed in the early stages. Later, in the more severe cases, abundant salivation results from increased secretion. and inability to swallow, while retching and sometimes vomiting will be seen in some cases from the irritation. The head is usually held extended and palpation of the pharynx produces pain. The submaxillary and retro- pharyngeal lymph glands often become enlarged and may produce abscesses. Occasionally in severe cases the salivary glands become involved. On examination of the pharynx the mucous membrane will be found reddened, congested, and covered with mucus or mucopurulent exudate, depending upon the stage of the development of the disease, and in severe cases swelling and congestion of the adjacent tissues. Cough is absent and only occurs when the inflammatory process extends to the larynx. In all cases where infection develops, the temperature is elevated (103-105 F.). In mild cases when the general symptoms are absent, the appe- tite remains good although the animal takes food slowly and with care. In severe cases there is a complete loss of appetite. Diagnosis. The symptoms of acute pharyngitis are very characteristic: The extended head, difficult swallowing and salivation; while direct examination and the temperature readily distinguish it from foreign bodies, tumors and par- alysis of the pharynx. Prognosis. In older animals it is favorable, recovery occurring in one to two weeks. In young animals, when it occurs as an cnzootic, the mortality is high. PHARYNGITIS 125 Treatment. Dietetic. Soft liquid foods (rice soup, milk, extract of beef, etc.) should be given in preference to solids to avoid irritating the mucous membrane. Medical. Local treatment in the form of astringent and antiseptic solutions (2 per cent, silver nitrate solution; 5 per cent, alum solution; iodin and glycerin 1-30) applied directly to the membrane by using a pledget of cotton held in dressing forceps. In milder cases a solution of potassium chlorate (2 per cent.) or iron sulphate in the drinking water is recommended. A Priesnitz compress applied over the pharynx and followed with mild stimulating liniments (soap liniment, etc.) is often beneficial. Internally mild purgatives such as castor oil or cascara should be used. Chronic Pharyngitis. Definition. A chronic inflammation of the mucous membrane of the pharynx. Etiology. This condition may follow repeated acute at- tacks, or is frequently associated with chronic nasal catarrh. It also occurs secondary to inflammation of adjacent tissues. Dogs constantly barking from a nervous temperament or during shows are often affected from the spread of the inflammation from the larynx. Pathology. The mucous membrane is relaxed, the lymph tissue becomes proliferated forming small, round elevations, red or bluish-red in color which project above the surface of the membrane, and is known as pharyngitis granulosa. The secretions are lessened producing a dry, glistening con- dition of the pharyngeal mucosa. Symptoms. The symptoms are similar in many respects to those of acute pharyngitis, but milder in most cases. The swelling of the adjacent tissues and lymph glands is hardly noticeable. The difficulty in swallowing is especially marked when a large quantity of food is taken or when the food is very hot or very cold. Direct examination of the pharynx reveals the bluish-red color and the elevations over its surface. Prognosis. Considered favorable in most cases, depending somewhat on the possibility of removing the causes. In the milder cases it is very often overlooked. Treatment. Direct application of Lugol's solution to the mucous membrane has been found useful in most cases. 126 DISEASES OF THE PHARYNX Tannic acid and glycerin (1-30) may also be used. Chlorid of iron (1-10) in water is of value owing to its astringent and antiseptic qualities. The application of the preparations should be made daily until the symptoms subside. FOREIGN BODIES IN THE PHARYNX. Foreign bodies may find lodgment in the mouth or in the pharynx. When dogs are ravenously hungry large particles of food or food containing foreign bodies are swallowed which may lodge in the pharynx, producing choking. The condi- tion often terminates fatally in a short time. Cats when fed on fish are liable to have fish bones lodge in the pharynx. These bones frequently penetrate the mucosa, producing an edema of the pharynx and larynx, resulting in death from asphyxia. Birds, when eating large seeds (sunflower seeds, corn, etc.) often have them lodge in the pharynx, producing serious symptoms. Various kinds of foreign bodies have been found in the pharynx, the most common being needles, pins, bones, hard food masses, meat skewers, cartilage, etc. Symptoms. The symptoms vary somewhat according to the size and character of the foreign body. Dribbling of saliva from the corners of the mouth; frequent attempts at swallowing; clawing at the mouth with the forefeet, and sometimes retching and vomiting. When the foreign bodies are large they often interfere with the respirations. Diagnosis. The diagnosis is made by direct examination of the pharynx (see examination of the pharynx), the sudden development and the characteristic symptoms. Prognosis. Depends upon the size and character of the foreign body. Where the foreign bodies are small and the animal can be treated at once, the prognosis is favorable. In other cases where edema occurs or where the foreign body is quite large, death may terminate before assistance can be given. Treatment. Surgical. A mouth speculum is used to keep the mouth open and the foreign body often can be easily removed with a long curved throat forceps. Holding the tongue well forward will materially assist in locating accu- CROUPOUS PHARYNGITIS OF BIRDS 127 rately the foreign body. When the foreign body is in the form of a threaded needle, which frequently occurs in cats, the sharp point is usually toward the mouth. Therefore care should be used in removing it to prevent laceration of the tissues. By grasping it with the forceps and pushing it down- ward until the sharp point is free from the tissues, it can then be readily removed. Large food masses often can be broken between the fingers and extracted or pushed down into the esophagus. Where edema of the tissues results from lacera- tion and symptoms of suffocation develop, tracheotomy should be performed at once. (See Tracheotomy.) No after-treatment is necessary except when severe injury to the tissues has taken place ; in these conditions the pharynx should be treated direct with antiseptic solutions (boric acid 2 per cent.), using a dressing forceps with a pledget of cotton firmly attached. In birds the mouth is held open and a small pincette used to dislodge the foreign body. PARALYSIS OF THE PHARYNX. Pharyngeal paralysis occurs mostly during the course of specific diseases (rabies, distemper) and will therefore be described under those diseases which it accompanies. CROUPOUS PHARYNGITIS OF BIRDS. Definition. A croupous inflammation affecting the pharyn- geal mucous membrane of birds. Etiology. This condition is produced by a flagellated infusoria, the Monocercomonas gallinse. This parasite is round or discoid in shape, of a pale color and from 14 to 25 mm. in length and 5 to 7 mmm. in breadth. The disease affects young birds, especially pigeons. Unsanitary condi- tions and cold, damp quarters are predisposing factors. Pathology. Small white elevations are found on the mucous membrane of the pharynx, often extending into the esophagus and crop. Occasionally these lesions are noted at the base of the tongue and on the palate. Surrounding these small elevations are found zones of acute inflammations with considerable swelling and congestion of the membrane. 128 DISEASES OF THE PHARYNX Symptoms. Loss of appetite, dulness and general weakness are the first symptoms observed. The plumage becomes rough, the wings are pendant and the mouth held open. The odor from the mouth is offensive. Examination of the posterior part of the mouth and the pharynx reveals the presence of the small white elevations. A microscopic exami- nation of scrapings made from these white spots will confirm the diagnosis by finding the infusoria. Prognosis. It should be considered unfavorable especially in very young birds. Death occurs in many cases from loss of appetite and exhaustion. Treatment. Where only a few cases are observed, they should be separated at once from the healthy birds and the runways and roosts thoroughly disinfected with lime, or carbolic acid (5 per cent.). The mouth and pharynx should be cleansed with a solution of boric acid (2 per cent.) or creolin to destroy the infusoria. Remove the small elevations with a blunt curette and apply to the surface chlorid of iron (1-10) in water or a solution of tannic acid (5 per cent.) in water, to arrest the hemorrhage and to produce antiseptic action. NEOPLASMS OF THE PHARYNX. Polypoid Growths. Polypoid growths (myxomas) are found occasionally projecting from the pharyngeal mucous .membrane. They vary greatly in size from half an inch to four inches in length. From severe or sudden exertion or swallowing they are often forced into the esophageal opening, interfering with the prehension of food and drink. Symptoms. Sudden interference with deglutition; symp- toms of suffocation ; often rapid recovery ; periodic recurrence of the symptoms and direct examination of the pharynx will reveal the presence of the polypoid growths. Treatment. Surgical. The mouth speculum should be used, the tongue pulled well forward and a small wire ecraseur used to remove the enlargement. It should be removed as close to the base as possible. No after-treatment is necessary. Recovery takes place promptly. NEOPLASMS OF THE PHARYNX 129 Epithelioma. These are found occasionally in old animals, and occur in the pharynx as a primary condition or may he due to metastasis. The retropharyngeal and submaxillary lymph glands are nearly always involved. This condition has been seen secondary to malignant goiter, having extended to the lymph glands by metastasis and from there to the pharynx. Symptoms. Difficulty in swallowing; fetid odor from the mouth; often profuse salivation. Direct examination shows the presence of an ulcerated enlargement on the pharyngeal mucosa. The general condition is in most cases disturbed. Emaciation, especially when due to metastasis; loss of appe- tite. A small portion of the enlargement should be obtained and examined microscopically to confirm the diagnosis. Treatment. No satisfactory treatment can be given. CHAPTER VII. DISEASES OF THE ESOPHAGUS. Examination. The cervical portion of the esophagus is readily examined by palpation over its course along the upper surface of the trachea. The probang affords a means of examining the interior for foreign bodies, strictures, etc., along its entire length. ESOPHAGITIS. Definition. An acute inflammation of the mucous mem- brane of the esophagus. Etiology. (a) Mechanical. Irritation from foreign bodies (bones, needles, splinters of wood, etc.), passing of sounds, etc., lacerating the mucous membrane. External injuries to walls. (6) Thermic. Eating very hot foodstuffs or drinking hot liquids. (c) Chemical. Alkalies and acids, ammonia and corrosive medicinal agents frequently in their passage through the esophagus produce an acute inflammation. (d) Infectious. Occurs during the course of infectious diseases (rabies, distemper). Secondarily it is produced by the spread of the inflamma- tion from the pharynx or stomach. It occurs sometimes spontaneously in very young suckling animals. Pathology. Redness of the mucosa is rarely seen except after injuries or severe chemical irritants. The epithelium is thickened, desquamated and the surface covered with a fine granular substance. The mucous follicles are swollen and sometimes erosions may be seen. In phlegmonous inflammation, the mucous membrane is swollen, with a FOREIGN BODIES OBSTRUCTION IN ESOPHAGUS 131 purulent infiltration in the submucosa. This condition is usually seen around foreign bodies when they penetrate the membranes, and, as a rule, remains localized. Gangrene of the membrane is sometimes seen where the injury or infec- tion has been severe. Symptoms. In the milder forms of esophagitis the symp- toms are unobserved. In more severe forms there is great difficulty in swallowing which act is often soon followed by vomiting. The vomitus contains blood, the solid particles covered or streaked with it. Frequent attempts at swallow- ing, constantly extending the head or moving it from side to side. In some cases where corrosives have been swallowed fragments of the mucous membrane will be ejected with the vomitus. Profuse salivation, blood is often mixed with the saliva. Palpation along the cervical portion of the esophagus produces severe pain. ' When localized in the cervical por- tion the esophagus should be palpated carefully for foreign bodies. Course and Prognosis. In the majority of cases, recovery takes place in one to two weeks. In very severe inflammation complications are liable to occur. Strictures or abscess with perforation of the walls of the esophagus may result. In the latter when the thoracic portion is involved the termination is fatal from infectious pleuritis. Treatment. In the early stages cold milk, or tannic acid (1-2 per cent.) in cold water is indicated to allay the inflam- mation and to produce astringent action. Cold compresses to the cervical portion of the esophagus often have a beneficial action. Inflammations from caustic substances should be treated as early as possible with the proper antidote. When severe pain is shown small doses of morphin should be admin- istered subcutaneously. Tincture of opium in dilute solution may be given per orem. In very severe cases where foods cannot be given via the mouth, enemata should be employed. FOREIGN BODIES. OBSTRUCTION IN ESOPHAGUS. Etiology. Obstruction in the esophagus occurs most fre- quently in dogs. The body 'lodges immediately posterior to 132 DISEASES OF THE ESOPHAGUS the pharynx; at the lower extremity of the cervical portion at its entrance to the thorax; or near the cardiac orifice (at this point the lumen of the esophagus is less than at any other place along its course). Owing to the habit of these animals of taking food in large pieces and without mastica- tion the majority of the obstructions occur just posterior to the pharynx. However, sharp bodies may be found anywhere along its course. In the dog a great variety of substances have been found producing the obstruction, as these animals during eating or at play swallow many substances that would not be found in other animals. The most common substances which are liable to produce the obstruction in dogs are: Bones, cartilage, hard food masses, pieces of tendon, needles, rubber balls, meat skewers, stones, etc. In cats fish bones are frequently found which they get from eating scraps of fish given them without removing the bones. As a rule fish bones lodge in the anterior portion of the esophagus just behind the pharynx. Young kittens while playing occa- sionally attempt to swallow threaded needles, or pins which lodge at some point along the esophageal wall. Large bodies when indefinitely retained often produce a pressure necrosis with perforation of the walls. Symptoms. The early symptoms are those of refusing food, pain during swallowing, paroxysms of choking with retching and in some cases vomiting, salivation, and scratch- ing at the mouth and neck. The head is held extended, the respirations become labored, and the patient evinces severe pain. In cats the mouth is held open, there is profuse saliva- tion, and when the foreign body has penetrated the walls severe nervous symptoms are produced. The foreign body when located in the cervical portion of the esophagus will at once be recognized by the painful swelling which appears along its course, especially in the case of large objects. There is frequently edema of the surrounding tissues which may extend for some distance from the point of injury. Palpation usually reveals the size and character of the obstruction. Often when the objects are located just posterior to the pharynx by opening the mouth and pulling the tongue well forward they can be seen or felt with the finger. In cats, FOREIGN BODIES OBSTRUCTION IN ESOPHAGUS 133 needles and fish bones are often seen by this method. In cases of small obstructions located in the thoracic portion of the esophagus, the symptoms are not so pronounced. Loss of appetite, emaciation and occasional vomiting are the most prominent manifestations of the condition. However, when sharp objects penetrate the walls at this point, various com- plications of a serious nature may be produced. The passage of a sound (horse catheter) is often a valuable aid in arriving at a correct diagnosis. In valuable animals, Roentgen rays may be used to assist in locating hard or metallic substances. Diagnosis. This is made positive by a careful examination together with the above mentioned" symptoms. Care should be taken to exclude rabies as the symptoms are similar. (See Rabies.) Always beware of the dog with "bone in the throat." Prognosis. Foreign bodies located in the cervical portion of the esophagus can usually be removed which is followed by rapid recovery except in those cases where necrosis is produced from pressure upon the walls, or extensive phleg- monous inflammation from perforation. It sometimes happens that needles and pins will penetrate the walls and become encapsuled in the adjacent tissues without producing any further disturbance to the animal. Foreign bodies located in the thoracic portion of the esophagus should always be considered unfavorable owing to their location and the danger of injury to the organs in the thoracic cavity or a purulent pleuritis resulting from perforation. Treatment. Obstructions to the esophagus are removed by: (a) Use of throat forceps; (b) by propulsion with the sound into stomach; (c) by emesis; (d) by esophagotomy; (e) by gastrotomy and sound forcing the foreign body out via mouth. (a) The throat forceps can often be used to an advantage when the object is located in the posterior part of the pharynx or in the anterior part of the esophagus. The mouth is held open with the speculum, the tongue pulled well for- ward, and the object grasped with the forceps and removed. Care should be taken to prevent laceration of the tissues in case of a sharp object or one of an irregular shape. 134 DISEASES OF THE ESOPHAGUS (6) The sound is to be used in those cases where the obstruction is located farther down the tube and cannot be reached with the throat forceps. Various kinds of instru- ments have been devised for this purpose. The horse catheter will answer in a large number of cases. It is introduced by using the mouth speculum, depressing the tongue. Having oiled the instrument, it is passed, holding it firmly against the roof of the mouth and following the posterior wall of the pharynx, into the esophagus. When the instrument reaches the pharynx the animal will invariably swallow, which greatly assists in its introduction into the esophagus. The sound is then brought in contact with the object which is carefully pushed into the stomach. When there is much resistance and the object is firmly fixed, the catheter should be removed and other methods used to dislodge it. The bristle probang is often used to advantage in extracting foreign bodies which do not entirely close the lumen of the esophagus. It is introduced closed so that it may pass the object, and then opened so that the bristles will completely fill the lumen when it is withdrawn bringing the foreign body out in front of it. (c) The act of vomiting, which is easily induced, will often displace the foreign body. This is best brought about by the use of apomorphin (dogs 0.0016-0.006; cats 0.001-0.003). The administration of castor or linseed oil to lubricate the mucous membrane will often assist in removing the obstruc- tion. (d) Esophagotomy is performed in the following man- ner: Secure the animal in the dorsal position with the head extended. Clip and shave the hair over the field of operation and cleanse thoroughly with antiseptic solu- tions (bichlorid of mercury 1-2000; boric acid 2 per cent., etc.). Under general anesthesia, using morphin (0.016-0.21), ether, etc., make a skin incision over the obstructing body and between the muscles, being careful to avoid the large vessels of the neck. When the esophagus is exposed make a longitudinal incision through it of sufficient length to allow the foreign body to be removed. Care should be used to pre- vent laceration of the mucous membrane. W 7 hen the incision STRICTURE OF THE ESOPHAGUS 135 is very long, one or more interrupted sutures should be made in the esophagus and the wound packed with gauze saturated in a boric acid solution (2 per cent.), retained with sutures through the skin. Allow this to remain in position for twenty-four to forty-eight hours, then remove pack, the sutures in the esophageal wall and treat as an open wound, cleansing it daily with boric acid solution (2 per cent.) until healing is complete. Withhold all food and drink for twenty- four hours and then give only liquid foods for a few days. Rectal feeding of milk, eggs, etc., may be used when the swelling of the mucous membrane is sufficient to obstruct the esophagus. (e) As a last resort when the firmly fixed object is located in the thoracic portion of the esophagus and cannot be removed by the methods mentioned, gastrotomy should be performed (see Diseases of Stomach), and the catheter introduced to propel the foreign body out via the mouth. Should the object be located in the cardiac portion of the esophagus, a small dressing forceps is often useful to grasp it and remove it via stomach incision. ESOPHAGISMUS. Definition. A spasmodic contraction of the esophagus. . Etiology. This condition occurs occasionally during the course of some diseases. It has been observed in chorea, epilepsy and in the early stages of rabies. Sometimes foreign bodies, by irritating the membranes, produce a spasmodic contraction of the walls of the esophagus. Symptoms. Very similar to foreign bodies in the esophagus; often foreign bodies are also present. Prognosis. In most cases favorable. Treatment. The passage of the sound is usually sufficient to overcome the condition except in the case of foreign bodies being present. (See Foreign Bodies in the Esophagus.) STRICTURE OF THE ESOPHAGUS. Definition. A constriction of the esophagus due in most cases to cicatricial contraction of the walls reducing the size of the lumen. 136 DISEASES OF THE ESOPHAGUS Etiology. The most common causes of this condition are the following: (a) Cicatricial contraction of healed ulcers, usually due to corrosive poisons; injuries by foreign bodies, etc. ; esophagotomy . (6) External pressure by enlarged lymph glands, enlarged thyroids, other tumors and occasionally pericardial effusion, (c) The growth of tumors in the walls of the esophagus (metastatic sarcomas and carcinomas). The stricture may occur in any part of the esophagus, and in severe cases may involve the entire tube, but usually it is found either near the pharynx or the stomach. Symptoms. Difficulty in swallowing and only small quantities taken. Severe pain immediately after eating. Retching and vomiting are often noticed. Gradual emacia- tion due to the interference with deglutition. Examination of the esophagus in the cervical region by palpation or the passage of the sound to the thoracic region will usually reveal the constricted condition of the esophagus. Prognosis. Should be considered unfavorable in all cases of long standing. Recent cases, depending upon the cause, may recover sufficiently not to interfere much with the animal's general condition. Treatment. By surgical means the cause of the condition should be removed if possible. The passage of the sound, well lubricated, daily for a time will in some cases overcome the constriction. In severe constrictions where a large por- tion of the walls is involved no treatment can be applied that will be of any service. DILATATIONS AND DIVERTICULA OF THE ESOPHAGUS. Definition. Dilatation is a diseased condition whereby the lumen of the esophagus is enlarged (ectasia oesophagi). A diverticulum is a saccular distention of the esophageal wall at a given point along its course (diverticulum oesophagi). Etiology. Dilatation may develop secondary to stenosis of the esophagus, from pressure of food masses retained above the stenosis resulting in paralysis or atony of .the muscular wall; from foreign bodies remaining in the esophagus for sufficient length of time to produce paralysis; injuries; CATARRH OF THE CROP IN BIRDS SOFT CROP 137 esophagotomy. Diverticula may result from overdistention of the esophagus with rupture of the muscles allowing the mucous membrane to protrude; also due to cicatricial con- tractions following inflammatory adhesions to lymph glands. Symptoms. An enlargement will be noticed along the region of the esophagus if it be in the cervical portion. Diffi- culty in swallowing; saliva increased; regurgitation of small amounts of undigested and decomposed food covered with mucus; fetid odor from the mouth; the probang may pass without difficulty although it may be obstructed by the stenosis or stricture at the distal end. The symptoms of a diverticulum are very obscure except when large and in the cervical portion of the esophagus. The retention of food gives rise to retching and vomiting, or from the ensuing ulceration may result in the formation of a fistula. Diagnosis. Careful observation of the symptoms; the absence of gastric secretions in the vomitus; palpation reducing the enlargement which will become refilled after feeding. The use of the probang may assist in the diagnosis by determining the presence of the stenosis or spasm . Prognosis. Diffuse dilatation, or a diverticulum of the thoracic portion of the esophagus, should be considered incurable. The prognosis depends upon the completeness with which nutrition can be carried on. It is always unfavor- able as there is a tendency to ulceration and perforation of the walls with formation of a fistula. Treatment. No satisfactory treatment can be given except in diverticulum in the cervical portion of the esophagus which may be operated (see Esophagotomy) and the diver- ticulum reduced by suturing. CATARRH OF THE CROP IN BIRDS. SOFT CROP. Definition. A catarrhal inflammation of the mucous mem- brane of the crop. Etiology. Irregular feeding is a common causative factor. Birds fed irregularly are quite liable to overload the crop, resulting in distention and partial paralysis of the muscular walls. This condition interferes with the secretion of the 138 DISEASES OF THE ESOPHAGUS glands resulting in fermentation or decomposition of the crop contents which irritate the mucous membrane often pro- ducing a severe catarrhal inflammation. Elating indigestible or decomposed substances (feathers, putrid meat, etc.) often produces catarrh of the crop. Poisons (arsenic, phosphorous, salt, etc.), when taken acci- dentally or given intentionally, often produce a very severe form of the disease. The presence of parasites (Dispharagus nasutus, etc.) in the crop will in most cases produce a catarrhal inflammation, the severity of which depends upon the num- ber present. In pigeons fermentation of an overabundant secretion after the loss of the young will produce a serious catarrhal inflammation of the crop and other parts of the digestive tract. Crop catarrh also occurs during the course of some diseases (diphtheria, thrush, cholera). Symptoms. Distention of the crop is at first the most noticeable symptom. On palpation the crop will be found to be soft and fluctuating, due to an accumulation of liquid, gaseous and solid food material. Loss of appetite, eructations of gases, sometimes retching and vomiting are symptoms. By pressure upon the crop the contents will be expelled via mouth, emitting a very offensive odor. The birds may die from exhaustion. Diagnosis. This is determined quite accurately by a care- ful examination of the crop and the character and condition of the contents. Prognosis. When not a symptom or complication of some other disease (cholera, thrush, etc.), the prognosis is usually considered favorable and the majority respond readily to treatment. When a large number of a flock is affected, indicating a severe catarrhal inflammation, the prognosis is less favorable owing to the difficulty in applying prompt remedial measures. Repeated return of the condition often produces the so-called hanging crop or dilation. Treatment. Hygienic. The birds should be provided with a clean, dry place free from extremes in temperature. Dietetic. In mild cases where the appetite is not entirely lost, solid food should be withheld for a day or so, only a small quantity of liquids being allowed. OBSTRUCTION OF CROP IN BIRDS HARD CROP 139 Medical. Before administering medicinal agents it is necessary to thoroughly empty the crop which -is done in the following manner: The bird is held with its head pendant, and the crop carefully manipulated and compressed between the thumb and fingers, when the contents will flow out via mouth. The crop should be thoroughly compressed from behind toward the mouth until it is completely emptied. Ten to 30 c.c. of a bicarbonate of soda solution (2 per cent.) is then administered to neutralize the acidity of the retained contents and to dissolve the accumulated mucus from the membrane. For a few days small doses of sodium bicar- bonate (0.15) or bismuth subnitrate (0.10) may be admin- istered daily. Only small quantities of food should be allowed for at least four to five days. OBSTRUCTION OF THE CROP IN BIRDS. HARD CROP. Definition. An impaction of the crop. Etiology. The obstruction of the crop is often seen from overfeeding, especially with dry foods (oats, rye, corn, peas, etc.) or with quantities of straw, leaves, grasses, and other indigestible substances swallowed by the bird. In water birds it occurs from eating large quantities of certain grasses (triticum repens, etc.). Turkeys are most commonly affected by eating large quantities of insects (grasshoppers, etc.), straw, grains and grasses. Further, swallowing various kinds of foreign bodies with the food (metallic substances, large stones, pieces of glass, bones, egg shells, or large numbers of very small stones, etc.) often produces impaction of the crop. In some mild cases of catarrh with irritation of the mucous membrane the birds often eat large quantities of indigestible substances leading to an impaction. Animal parasites when in large numbers will produce the same result. Symptoms. The birds are dull, stupid, show rough plu- mage, pale comb and wattles, with a constant opening and closing of the beak; or the beak is held open to facilitate breathing which is often interfered with by pressure of the enlarged crop upon the trachea. A disagreeable odor ema- nates from the mouth, and often quantities of fermented or 140 DISEASES OF THE ESOPHAGUS decomposed liquids and food particles escape from the mouth and nostrils. The appetite in the early stages is lessened and later entirely lost. The crop when examined will be found greatly distended, hard and more or less firm on palpation. In some cases it is very hard, producing the so-called " hard crop." When metallic substances are present, it is possible in some cases to palpate them, or in case of sharp objects they are sometimes found projecting through the muscular walls and skin. With the aid of the Roentgen rays the character and size of the foreign body can often be revealed. Prognosis. This depends upon the character of the impacted material, its duration and the condition of the bird. In most cases if allowed to continue it will result fatally. In some cases, the crop becomes enormously distended, pro- ducing the so-called "hanging crop." Treatment. The early indication in the treatment is to massage the crop and try to remove the contents via mouth. This is best done by suspending the bird head downward, and massaging and kneading the crop carefully which crushes the crop contents so that they may be gently forced into the mouth. Often the entire contents can be removed in this manner. The administration of a small quantity of linseed oil to lubricate the esophagus will often assist when applying the above method. \Vhere this method will not suffice, it will be necessary to open the crop and remove the contents through the incision. The feathers should be pulled out over a space about \\ inches wide and 2-3 inches long at the point of greatest protrusion. The field of operation should be thoroughly disinfected. The incision can be enlarged suffi- ciently to admit of the crop contents being easily removed. A blunt curette or pincette is useful in assisting removal. The crop should be thoroughly irrigated with a sodium bicarbonate solution (2 per cent.), and the edges of the wound disinfected with a boric acid solution (2 per cent.). The wound is then stitched with a single row of interrupted sutures sufficiently close together to prevent the escape of anv contents. The stitches should not be removed for at NEOPLASMS OF THE ESOPHAGUS 141 least eight to ten days. All food and liquids should be with- held for twenty-four hours and for the next four or five days only a small quantity of liquid food given. NEOPLASMS OF THE ESOPHAGUS. Tumors of the esophagus are very rare and those occurring most commonly are: Epithelioma, sarcoma and carcinoma. These occur most frequently via metastasis. Retention cysts are found at the anterior part of the esophagus. Symptoms. Tumors produce a narrowing of the esophagus similar to stenosis (see Stenosis). When this occurs in the cervical portion the condition may be determined by palpa- tion. A differentiation from foreign bodies, diverticula and dilatation is often made possible by careful palpation. Diagnosis. The kind of tumor can only be determined by obtaining some of the enlargement for microscopical examination. Prognosis. When malignant tumors (carcinoma, sarcoma, epithelioma) are present, the prognosis is very unfavorable; retention cysts unless they interfere with nutrition are more favorable. Small ones may be present without being noticed for a long time. Treatment. No treatment should be attempted for malignant tumors. Retention cysts may be reduced by pressure from the outside or esophagotomy (see Esophagot- omy) may be performed and the cyst wall destroyed. CHAPTER VIII. DISEASES OF THE STOMACH. Examination. The stomach can be examined as follows: 1. By the character, condition and quantity of the contents, which may be obtained : (a) By the use of an emetic (apo- morphin 0.0016.-0.003 etc.), (6) by natural vomiting, (c) by the use of a stomach tube or (d) through gastrotomy (see Foreign Bodies in the Stomach). 2. Palpation over the region of the stomach will cause pain in acute inflammatory conditions, although this may be confused with painful conditions of the liver, peritonitis and enteritis. 3. By performing laparotomy and making a direct exami- nation of the stomach. The mucous membrane may also be examined directly by performing gastrotomy. GASTRITIS. Gastritis is an inflammation of the stomach. The following forms are recognized: (a) Acute, and (6) chronic. Acute Gastritis. Simple Catarrh of the Stomach. Acute Dyspepsia. Definition. An acute catarrhal inflammation of the mucous membrane of the stomach which may involve the entire wall. Etiology. Acute catarrhal gastritis is usually due to errors in diet. The ingestion of more food than can be digested, irregular feeding, or eating unsuitable food, which is partially decomposed containing ptomaines (cadavers, garbage, etc.), and hard pieces of bone, cartilage and tendon are very com- mon causes of this condition. Injuries to the epigastrium (kicks, blows, and being run over by vehicles, etc.). Chemical. Various chemical substances (phenol, arsenic, mercury, phosphorus, etc.) when taken accidentally or GASTRITIS 143 given intentionally will produce a very serious form of gas- tritis (toxic). An excess of sodium chlorid given in the food to birds will often produce a severe gastritis. Thermic. Very hot, solid foods and liquids, or very cold, frozen foods will sometimes produce a gastritis. Rabbits eating frozen vegetables are thus often affected. Infectious. Infectious gastritis occurs during the course of most infectious diseases (distemper, rabies, etc.) . Parasites. See Parasites of the Stomach. Pathology. Acute catarrhal gastritis is characterized by a swelling and hyperemia of the mucous membrane which is often corrugated, and intensely red with small ecchymoses appearing over the surface. Small superficial erosions are occasionally noticed. Symptoms. Vomiting occurs early and is the most promi- nent symptom often being quite frequent and in severe cases very persistent. The vomitus in the beginning consists of quantities of undigested and decomposed food material covered with mucus and sometimes streaked with blood, with a very disagreeable odor. When due to chemical causes it often has the characteristic odor of the poison. Later the vomitus consists almost entirely of small amounts of frothy mucus, and when the vomiting is severe there is often an admixture of bile. The appetite in severe cases is completely lost and in mild cases it is variable and vitiated, the animal eating unnatural material. Bowel complications (see Enteritis) invariably follow severe cases of gastritis. On examination the animals show pain on palpation over the region of the stomach, which manipulation often induces vomiting. There is a grayish-white deposit over the dorsal surface of the tongue (furred tongue); the temperature is elevated in the early stages of severe cases (103-105 F.), later the temperature is subnormal (97-100 F.). In milder cases the temperature shows but little variation. The general symptoms in the early stages of severe gas- tritis are those of uneasiness and intense pain (howling, etc.), stiffness and considerable pain which is shown when the patient is moved about. In milder cases the only symptoms noticeable are occasional vomiting and variable appetite. 144 DISEASES OF THE STOMACH Diagnosis. Acute non-infectious gastritis is not very difficult to diagnose as the symptoms are very characteristic and quite often the anamnesis is of value. The primary infectious form, however, may be confused with that due to specific infectious diseases (distemper, etc.), but this can be distinguished by the general symptoms, especially the tem- perature which in the latter cases rises more abruptly and shows less variation than in the former. Prognosis. In primary acute gastritis, due to errors in feeding, the prognosis is usually favorable. When due to poisons, foreign bodies, and injuries, it depends largely upon the extent of injury to the stomach and the possibility of removing the cause. In infectious gastritis, when not due to specific infection, the prognosis is usually favorable, but if accompanying a specific disease it depends on the primary disease. Treatment. Dietetic. In strong animals all food should be withheld twenty-four to forty-eight hours and then only a small amount of easily digested food given at frequent intervals until recovery takes place. In weak individuals easily or predigested food may be allowed unless it induces persistent vomiting when nourishment should be given via the rectum. Medical. Mild cases usually recover promptly following the use of a purgative (ol. ricini, dogs 15.0 to 60.0, cats 5.0 to 20.0; calomel, dogs 0.3-0.4, cats 0.01-0.005; cascara fld. ext. dogs, 5.0-10.0, cats 1.0-5.0). In severe cases unless vomiting has occurred an emetic, such as apomorphin hydrochlorate (dogs 0.005-0.01, cats 0.002-0.005) given subcutaneously is indicated to expel irritating material and foreign bodies which may be present. Following vomiting, irrigation of the stomach with a sodium bicarbonate solution (2 per cent.) is advisable to remove irri- tating material from the surface of the mucous membrane. This can be accomplished by the use of a rubber tube or horse catheter inserted into the stomach. The warm sodium bicarbonate solution (500.0-1000.0) may be introduced into the stomach by elevating the free end of the tube and using a funnel. Allow the tube to remain in the stomach for a few GASTRITIS 145 minutes, then depress it to allow the fluid to flow out again. Repeat this two or three times. To stimulate the functions of the stomach, stomachic tonics are indicated : For Dog. H Ferri et quinnse citratis 4.0 Pepsini 1.0 Sacchari albae 2.0 Misce et fiat pulv. No. XX. Sig. Give a powder every twelve hours. For Cats. One-half the above dose. or For Dog. J$ Tincturse nucis vomicse . . . 7.0 Tincturse gentianse 10.0 Aqua communis 60.0 Misce et fiat solutio. Sig. Give teaspoonful twice daily. For Cats. T$ Tinctura? nucis vomica3 1.0 Syrupi auranti 60.0 Misce et fiat solutio. Sig. Give teaspoonful once daily. or I^ Acidi hydrochlorici 2.5 Tinctura gentianse comp 10.0 Aqua 150.0 Misce et fiat solutio. Sig. Give teaspoonful three times a day. Vomiting is often present in these cases but it is usually stopped by the removal of the irritating material through irrigation of the stomach (lavage), but if it persists it may be controlled by using sedatives. For Dog. }\ Bismuth! subnitratis Opii pulvorati Sacchari alb* ' <> Misce et fiat pulv. No. VI. Sig. Give one powder every four to six hours until vomiting is reduced. 10 146 DISEASES OF THE STOMACH When due to chemicals the proper antidote should be administered (see Poisons). Surgical. When foreign bodies are present and cannot be expelled by emesis or purgation, gastrotomy must be per- formed (see Foreign Bodies of the Stomach) . Chronic Gastritis. Chronic Catarrh of the Stomach. Chronic Dyspepsia. Definition. A chronic catarrh of the stomach with a disturbance in digestion, increased mucus formation, changes in the gastric secretions, partial paralysis of the muscular walls and alterations in the structure of the mucosa. Etiology. Chronic gastritis is a rather common condition especially in the dog. It results very frequently from several repeated attacks of acute gastritis and is therefore produced by causes similar to those found under acute gastritis (see Etiology of Acute Gastritis). It often occurs as a secondary complication to various diseases, such as ulceration of the stomach, gastric tumors, diseases of the liver, chronic con- stitutional diseases (anemia, chlorosis, chronic nephritis, etc.). Parasites, by constant irritation to the membranes for a long period, will produce chronic gastritis (see Parasites). Pathology. The stomach is usually enlarged, the mucous membrane pale, becomes gray in color and its surface covered with a thick, tenacious mucus. The veins are found distended and small hemorrhagic erosions and ecchymoses are seen distributed over the mucous membrane. In the later stages the mucous membrane becomes greatly thickened, especially toward the pyloris, and the mucous glands large and indur- ated from the constant irritation. Microscopically there is every evidence of a parenchymatous and an interstitial inflammation. Symptoms. This affection persists for an indefinite period and like most chronic conditions changes from time to time. In the dog, the animal most commonly affected, the appetite is variable, sometimes greatly impaired and at other times very good. Vomiting and retching are frequent symptoms and are especially noticeable a short time after eating. The vomited material consists of undigested food particles covered with a thick, tenacious mucus and has a very sour, disagree- GASTRITIS 147 able odor. After severe and prolonged paroxysms of vomit- ing, the mucus is frequently mixed .with blood from the rup- turing of small bloodvessels at the seat of the erosions. The chemical analysis of the vomited material shows the presence of abnormal acids, such as butyric or sometimes acetic in addition to lactic acid, while the hydrochloric acid is either absent or greatly reduced in quantity. Digestion, therefore, is delayed and decomposition and gas formation favored which in some cases greatly distends the stomach. Con- stipation is usually present, but in some cases there is diar- rhea and the undigested food passes rapidly through the bowels. The urine is often reduced in quantity, has a high color and a very disagreeable odor. There are general symptoms of disturbed nutrition, resulting in emaciation and general weakness. Diagnosis. A diagnosis of chronic gastritis is not always easy as the symptoms present are also indicative of other conditions. However, by a careful analysis of the symptoms and considering the condition of the animal and a careful examination of the contents of the stomach, the diagnosis may be made with a certain degree of accuracy. Prognosis. A complete recovery in this condition is prac- tically impossible. However, a great number of cases will improve with careful diet and treatment. As a rule an unfavorable prognosis should be made owing to the patho- logical changes which have taken place in the mucosa and muscular walls of the stomach. Treatment. Dietetic. The dietetic treatment is of greater importance in the majority of cases than the use of medicines. A careful regulation of the diet is always to be insisted upon. Only small quantities of easily digested food should be given for the first few days (beef extract, rice soup, white of eggs, small quantities of milk, oatmeal gruel). In cats very small amounts of milk or rice soup show the best results. Medical. A thorough lavage of the stomach witli warm water or a sodium bicarbonate solution (2 per cent.) should always be the first tiling attempted. It can be done readily in the following manner: The animal is placed on a table and held by an assistant; a stomach tube is then iiitro- 148 DISEASES OF THE STOMACH duced into the stomach (see Foreign Bodies in Esophagus) and the free end depressed to allow some of the stomach contents to flow out. Should the contents be too thick to pass out through the tube, some of the 2 per cent, soda solution (about 500 c.c.) is introduced into the stomach by elevating the free end of the tube. Attach a funnel to the tube and gradually pour in the solution. After it has entered the stomach by gravity, allow it to remain for a few minutes, depress the tube and allow it to flow out again. This opera- tion should be repeated until the liquid flows out freely and is clear of food particles and mucus. It is advisable in severe cases to repeat this treatment daily for three or four days and after this at biweekly intervals. Bitter stomachics (tincture gentian compound 4.0; or tincture of Colombo 2.0) are indicated before feeding to stimulate the mucous membrane and the muscular walls of the stomach. Small doses of pepsin and hydrochloric acid are indicated in severe cases to assist in digesting the food. These should be administered shortly after feeding to obtain the best results. Artificial Carlsbad salts (8.0) given twice daily is valuable as a stomachic and anticatarrhal agent for the mucous membrane. Further, in cases where there is considerable fermentation, salicylic acid (0.2-0.5) or creosote (0.1) is useful to arrest the fermentation. These drugs should be repeated at each meal to obtain the desired results. FOREIGN BODIES IN THE STOMACH. Etiology. Dogs often swallow foreign bodies with the food, or during play, which pass into the stomach and pro- duce symptoms of a serious nature. Most commonly the foreign bodies consist of small rubber balls, glass marbles, peach stones, stones, needles, pins, and meat skewers. Dur- ing rabies (see Rabies), owing to the vitiated appetite, dogs eat large quantities of foreign material, such as splinters of wood, pieces of cloth, stones, straw, etc. Cats often take with the food, needles, pins, fish bones, fruit stones, which enter the stomach and remain for some FOREIGN BODIES IN THE STOMACH 149 time producing alarming symptoms. Birds often pick up metallic substances with the food (nails, pins, etc.). These substances after entering the stomach may remain for a long time without producing any marked disturbance. However, as a rule they produce an acute or chronic gastritis and sharp objects may penetrate the walls of the stomach producing an acute inflammatory condition, or peritonitis. Hair balls are occasionally found in the stomach of rabbits and dogs. Symptoms. In a large percentage of cases where foreign bodies are taken there are no symptoms noticeable, espec- ially where the foreign bodies are small and regular in outline. These will often pass out via the intestinal tract or be vomited up without interfering with the function of the stomach or producing general symptoms. When the foreign bodies are of large size, irregular in outline, or sharp, they often produce symptoms of acute or chronic gastritis (see Acute and Chronic Gastritis). Very commonly the foreign bodies produce extensive irritation of the mucous membrane, penetrate the walls of the stomach or obstruct the pylorus producing severe vomiting (which is persistent), complete loss of appetite, intense thirst, hematemesis (from the ero- sions on the mucous membranes or some of the bloodvessels being injured by the sharp objects). Where extensive injury is produced in the membranes, the animals often show excit- able symptoms, howling and other symptoms similar to rabies (see Rabies), stiffness in gait, and w r alk with the back arched. By palpation over the region of the stomach (espe- cially in cats, rabbits and in some breeds of dogs), the foreign bodies can often be detected and their character determined. W T hen perforation of the walls of the stomach is produced by sharp objects, symptoms of acute peritonitis develop (see Peritonitis). Lastly, under symptoms of general weakness, subnormal temperature, and very weak, imperceptible pulse the animals often die from exhaustion. Diagnosis. The characteristic symptoms, the anamnesis and careful palpation make the diagnosis rather easy when foreign bodies are present in the stomach. Direct palpa- tion of the walls of the stomach (explorative laparotomy) 150 DISEASES OF THE STOMACH is to be recommended in some cases where the diagnosis is in doubt. In other cases the Roentgen rays will assist in locating the foreign body. However, this method is rather difficult owing to the location of the stomach and its relationship to the adjacent organs. Prognosis. The prognosis depends upon the character, size and condition of the foreign body, the general condition of the animal and the possibility of its removal. In most cases the prognosis should be made unfavorable. Treatment. Medical. Emetics are often of value in removing foreign bodies from the stomach. Subcutaneous injection of apomorphin hydrochlorate (0.005-0.01) should be administered and the vomitus carefully inspected to determine whether or not the foreign body has been ejected. Should this method fail, surgical means should be employed as early as possible. Surgical. This consists in performing laparotomy and gastrotomy-as follows: Laparotomy. This operation should be performed at the median line whenever it is possible to do so. When the inci- sion is made through the linea alba, healing may not be quite so rapid as if it were made just to one side through the muscular tissue. The former position is to be preferred, however, as there is little or no hemorrhage to interfere with the operation, and, as both sides of the wound are alike, the edges can be more evenly approximated by suturing. The animal being secured in the dorsal position, and under general anesthesia, the skin at the field of opera- tion is clipped and shaved of all hair and cleansed, first with soap and warm water and then with antiseptic solution (boric acid 2 per cent.; creolin 2 per cent.; mercuric bichlorid 1-2000). When the operation is not extremely urgent, it is best to apply an antiseptic pack (boric acid powder) over the field of operation after cleansing for the twenty-four hours preced- ing in order to ensure better antisepsis of the skin. Sterilize the following instruments: Scalpel, probe pointed bistoury, scissors, artery forceps, a full curved needle and suturing material. The incision is made with a sharp scalpel through FOREIGN BODIES IN THE STOMACH 151 all the tissues down to the peritoneum. Considerable care should be taken in going through this in order to avoid puncturing the abdominal organs. It is best to grasp a small part with forceps and clip it out with the scissors, making an opening large enough to insert the probe pointed bistoury and with this enlarge the incision the desired length which depends on the operation to be performed and on the size of the operator's finger. One and one-half inches is sufficient for most cases, although it may be made large enough in a large dog to admit the entire hand. Absorbent cotton or a pledget of gauze moistened with antiseptic solu- tion is useful to keep the wound free from blood, but none of the antiseptic fluids should be allowed to enter the peri- toneal cavity. Sterile water should be used to cleanse any portion of the viscera or peritoneum exposed . To suture the laparotomy wound, use medium-sized silk or linen suture material and make interrupted sutures about one-quarter to three-eighths of an inch apart depending upon the thickness of the abdominal wall. Using a long, slender, full curved needle, start about one-quarter of an inch from the margin of the wound, and pass it through the muscle and peritoneum, having the index finger inserted in the wound to prevent the needle entering the viscera, particularly the intestine or bladder, and bring it out on the other side at the same dis- tance from the margin so that when tied, and swelling occurs, one edge will not be forced above the other. The surgeon's knot, i. e., wrapping the first half of the knot twice, should be used, and if omentum is forced out when suturing it may be pushed back with blunt forceps as the knot is being tied. To avoid a hernia following this operation, be sure ^that the sutures pass through all the layers of the abdominal wall, i. e., skin, muscle, aponeurosis, and peritoneum. Gastrotomy. Perform laparotomy, as above, in the median line and about one-quarter of an inch posterior to the xiphoid cartilage, making the incision about two and a half inches long. Grasp the stomach with the thumb and finger and draw it out as far as possible. Tack it securely with sterile cotton squeezed out with sterile water, or with dry sterile gauze to prevent any of the stomach contents from entering 152 DISEASES OF THE STOMACH the peritoneal cavity when the incision is made. Have an assistant support the stomach by grasping it at either end with thumb and finger. Make the incision at the greater curvature and at right angles to the long axis of the stomach, and at a point where the bloodvessels are few and small. The organ is best opened by puncturing with a sharp pointed bistoury through the muscular and mucous coats and then enlarging it with the scissors, the length of incision depending upon the size of the foreign body to be removed. The removal of large sharp pointed bodies must be done with care and, if possible, they should be crushed to avoid making too long an incision. Blunt dressing forceps are useful to grasp small objects. The division of the muscular coat allows it to con- tract while the mucous coat projects out through the excess of mucous membrane so that its edges may be evenly approxi- mated. Suture the mucous membrane with interrupted sutures one-eighth of an inch apart, then suture the muscular coat in the same way, being careful to bring the edges in close contact. A Lembert suture is then applied over the wound to invert it. This is made by inserting the needle through a small portion of the muscular coat on one side of the wound, carrying it over and inserting the same way on the other side, and these when tied will invert the wound and bring the peritoneal surfaces of either side of the wound in apposition, which favors an early adhesion and prevents the escape of the stomach contents. These sutures will be encapsuled and are not to be removed. Cleanse the surface of the stomach and return to the abdominal cavity. All food should be withheld for twenty-four hours, after which time a small amount of liquid food (milk, beef broth) may be fed for a few days when the regular diet may be given. ACUTE DILATATION OF THE STOMACH. Etiology. This condition is observed more frequently in dogs and rabbits than in other small animals. It is most frequently produced by overloading the stomach, especially when large quantities of indigestible or dry foods are taken. Such substances as potatoes, bread (dry), dog biscuits, blood, ACUTE DILATATION OF THE STOMACH 153 some green foods, grains, etc., afe the ones most liable to produce the condition. Dogs when very hungry, will often eat an entire bird, rat or mouse, without masticating it. When the mass reaches the stomach it will cause a sudden dilatation. Debilitating Condition. Both general and local, such as rachitis, anemia, toxic conditions, infections, diseases of the heart, etc. These conditions may be the result of various influences which alter the tone of the muscular wall, either indirectly by affecting nervous control, or more directly by toxic action on the muscle. Previous gastric diseases often predispose to the condition, usually through fermentation, distending the walls leading to the gaseous form of acute dilatation. Excessive secretions at the same time will assist in the dilatation. Injuries. Such as blows on the abdomen, being run over by vehicles, spinal injuries, abdominal operations (ovari- otomy) have been known to produce dilatation. Pathology. The stomach is usually of enormous size, extending back nearly to the pelvis. The color is bluish, purple-red, or pale, and the wall is often very thin. The dilatation not infrequently involves the duodenum and in some cases may extend to the other small intestines. At times the stomach will be found distended with hard, undi- gested food masses, and in rabbits rupture of the stomach at the greater curvature often takes place from the distention with food and gases. Symptoms. Vomiting is one of the early symptoms and the vomitus consists in many cases of particles of hard food masses, fluids, etc. Owing to the act of vomiting taking place early, some of the material will be ejected, so that in many cases this will be the principal symptom noticeable. However, in some cases where the stomach contents are not removed by vomiting, more serious symptoms develop. There is profuse ptyalism, accelerated pulse, dyspnea, evidences of severe pain such as howling, excitement, etc. In severe cases fermentation often takes place in the intestinal tract, producing severe dysp- nea and death in a short time. In rabbits and some breeds of dogs, by palpation, the stomach will often be found greatly 154 DISEASES OF THE STOMACH distended with food masses, gas, and fluids, which can readily be distinguished through the abdominal walls. Very often the symptoms of this condition are similar to acute gastritis (see Symptoms of Acute Gastritis). Diagnosis. A correct diagnosis requires a careful and accurate anamnesis. This condition is often mistaken for some acute abdominal disease, such as peritonitis, acute gastritis or intestinal obstruction. However, by carefully observing the symptoms, and by palpation, together with the anamnesis, the diagnosis is usually made without much difficulty. Prognosis. In those cases, due to overloading, the prog- nosis is considered favorable; when due to other causes it is unfavorable as complications are liable to ensue which often terminate fatally. Treatment. Medical. When due to overloading the stomach or from foreign material, emetics are indicated early to remove it. Apomorphin (0.005-0.01) should be administered subcutaneously, and the stomach carefully kneaded to break up the food masses and to mix the con- tents with the secretions so that they will be more easily ejected. After the material has been removed by vomit- ing it is advisable to administer sodium bicarbonate solu- tion (2 per cent.) to remove irritating material from the surface of the mucous membrane. (See Treatment of Acute Gastritis). In cases where there is a lack of tone in the muscular walls from pressure by retained food masses, gas, etc., or defective nervous control of the muscle, the administration of strychnin sulphate (0.0005-0.001 daily), or tincture of nux vomica (0.3-0.6 twice daily) has been found advantageous. Surgical. In severe cases where the food particles cannot be removed by emesis, or where foreign material is present, it is advisable to remove it by performing gastrotomy. (See Surgical Treatment of Foreign Bodies in the Stomach). CHRONIC DILATATION OF THE STOMACH. Etiology. While not common in small animals it is occa- sionally observed, and consists of a dilatation of the CHRONIC DILATATION OF THE STOMACH 155 stomach, which is very commonly produced by food masses remaining in the stomach for a long period, producing press- ure on the walls of the stomach leading to a lack of tone in the muscular wall. This allows further accumulation of fluids and gases from the fermentation of the food contained and consequently the stomach becomes dilated. In some individual animals the walls of the stomach are relatively weak, and after eating, the food will remain in the stomach for too long a period, and gradually produce a chronic dila- tation. Many of the causes enumerated under acute dilata- tion, if continued for some time, will result in the chronic condition. Stenosis of the pylorus is one of the most frequent causes of this condition. The etiological factors producing the stenosis are the following: Spasm, gastric ulcer, erosions of the mucous membranes resulting in cicatrix formation. Foreign bodies which may remain in the stomach for a long period, and produce by their constant irritation hyper- trophy of the mucosa of the pylorus, resulting in a nar- rowing or complete closing of the pyloric opening. Tumors, either malignant or benign, extending into the pylorus. Tumors, outside of the stomach (carcinomas, sarcomas) and associated with adjacent organs or tissues. These by producing pressure upon the duodenum will narrow the lumen and result in a stenosis. Inflammation in organs adjacent to the stomach as the liver and pancreas; or omental adhesions which occur commonly after abdominal opera- tions, or by being injured, as blows to the abdomen or being run over by vehicles. The stenosis which is produced by the above causes will interfere with the passage of the food from the stomach where it remains too long eventually leading to chronic dilatation. In old dogs it frequently results from chronic obstipation. Further, debilitating dis- eases will often produce it by interfering with the nervous control of the stomach. Pathology. The stomach is much enlarged and in many cases distorted. When due to stenosis or obstruction to the pylorus, the stomach walls are greatly thickened. The mus- culature is hypertrophic and the mucous membrane is often 156 DISEASES OF THE STOMACH several times its normal thickness, with all the evidences of a chronic inflammation. When no stenosis exists, the dila- tation being produced by other causes, the muscular wall is very thin and atrophic. In some cases the mucous mem- brane shows areas of atrophy and hypertrophy alternating. The interstitial tissue is often infiltrated with fibrous tissue. Symptoms. In dogs the symptoms are very similar to chronic gastritis. There is a partial or complete loss of appe- tite, intense thirst, especially if the pylorus is obstructed, the patients drinking large amounts of water which is after- ward vomited. Constipation is also quite marked in most cases of chronic dilatation. As no water can pass from the stomach to the intestines, the contents of the intestinal tract become hard and dry to be passed with difficulty, or retained as a hard mass in the posterior part of the bowels. When dilatation occurs without stenosis of the pylorus large amounts of water will pass into the intestinal tract producing diarrhea, which may alternate with constipation. Emaciation is usually quite marked, especially in advanced cases, because no nutriment can be absorbed. In some cases where there is only a partial stenosis the emaciation will be more gradual, as some food will be passed to the small intestines. Severe pain, the animal often showing excitable symptoms, howling, etc., is shown a short period after eating, due to the par- ticles of food passing through the narrowed lumen of the pylorus. Where no stenosis exists there is but little pain. Vomiting is a constant symptom, especially in obstruction of the pylorus, and usually occurs shortly after feeding. The patient will sometimes eat the ejected mass again only to repeat the act of vomiting. This symptom is quite charac- teristic coming as it does shortly after eating and continuing in some cases in the same manner for days or even weeks. Gradually the animals become weak, anemic, the tempera- ture subnormal, and die from inanition. Palpation over the region of the stomach will often reveal the enlarged organ with its contents; percussion gives a tympanitic sound. ULCERATION OF THE STOMACH 157 Diagnosis. Diagnosis is rather difficult in most cases. The chronic course, the characteristic symptoms, and the findings of an explorative laparotomy suffice to make the diagnosis. Prognosis. The prognosis should be carefully guarded until the causes and condition of the stomach are thoroughly understood. Complete recovery is possible in both forms of this disease, provided the wall of the stomach is not perma- nently damaged and the general condition of the animal capable of improvement. However, in stenosis of the pylorus, it should always be considered unfavorable when tumors are present. Treatment. Dietetic. Small amounts of easily digested food are to be given at short intervals during the day rather than large quantities at long intervals. In some cases where vomiting is persistent, rectal feeding should be employed giving albumen or predigested foods. Medical. In dilatation accompanied by lack of tone of the muscle stomachic tonics, such as tincture of nux vomica (0.3-0.6 twice daily) or strychnin sulphate (0.0005-0.001), may be used. Massaging or kneading the abdominal wall over the stomach is a valuable adjunct to increase the muscular tone. When stenosis exists surgical interference is the only thing that will give relief; it should be resorted to as early as possible. (See Gastroduodenostomy) . ULCERATION OF THE STOMACH. Ulcus Venlriculi. Definition. This condition is a more or less progressive destruction through necrosis beginning in the mucosa and often extending to and through the deeper layers of the stomach wall. True ulcers appear only where the gastric juice flows. They are found in the dog at the extreme lower end of the esophagus, in the stomach wall itself, and in a portion of the duodenum above the opening of the bile duct. The ulcerations may be acute or chronic. Sometimes a ten- dency to cicatrization and healing is shown. At the point 158 DISEASES OF THE STOMACH where the stomach tissue is destroyed an oval or round opening or depression with irregular margins appears. The more chronic the process the greater the irregularity in outline. Etiology. Simple ulceration of the stomach is due to a destruction of the gastric epithelium caused chiefly by a dis- turbance in blood circulation in the stomach and hyperacidity of the gastric juice. It is often brought about by inflammation of the mucosa or hemorrhages, resulting from poisonous sub- stances, caustics, drugs (when administered in too concentrated form); sharp foreign bodies; during the course of infectious diseases (distemper, etc.), or from an invasion by the Bacillus necrophorus (puppies and kittens), or other local infections. General infection (pyernia) may too be a causative factor. These infections produce an extensive inflammation of the mucosa, often leading to a disturbance in the circulation, interfering with nutrition, and ultimately leading to an ulcera- tive process. Wounds of the mucous membrane from external violence, partial rupture of the stomach walls or parasitic invasion are causes. They are often contributory to the beginning of the ulcerative process. Embolism is also a cause, producing infarcts in the mucosa and submucous tissue. Hemorrhagic erosions and hemorrhages occurring and associated with chronic diseases of the heart, liver or kidneys are probable causes. Hyperacidity may produce gastric ulcer when from any cause the mucous membrane is injured, the acid acting upon the ends of exposed vessels by contract- ing them, thus inducing local anemia and eventually necrosis. Pathology. The typical ulcer is round or oval, extending more or less deeply into the mucous membrane or the wall of the stomach. They have a characteristic funnel shape, and when acute form a rather regular outline, while in ulcers of long standing the margins become very irregular. When chronic ulcers are present, the entire wall is usually thickened. Sometimes a coalescence of the ulcerations or erosions occurs. When ulceration becomes severe and the submucosa is involved, adhesions exist with adjacent organs. Symptoms. In quite a large percentage of cases of mild ulceration or erosions the symptoms are never observed ULCERATION OF THE STOMACH 159 during the life of the animal. In more advanced ulcerations the symptoms are often very similar to chronic gastritis (see Chronic Gastritis). Bloody vomiting is a characteristic symptom. The amount of blood ejected varies depending upon the extent of the injury to the vessels done by the ulcera- tive process. This condition usually persists for a long time with exacerbations and remissions. When the ulcer perfo- rates the wall of the stomach symptoms of acute peritonitis develop rapidly and a fatal termination soon follows. General symptoms of emaciation, weakness, and disturb- ances of the intestinal tract are usually observed. Diagnosis. An accurate diagnosis is very difficult, and can only be made by a careful observation of the symptoms. When ulceration is suspected laparotorny can be performed (see Foreign Bodies of the Stomach) to determine the condi- tion of the stomach. However, when the ulcerative process is slight or only erosions are present, even this examination may not suffice for diagnosis. Prognosis. The prognosis is always unfavorable, as only the advanced cases are recognized clinically. Treatment. Dietetic. Only small quantities of easily digested food (beef broth, milk, small amounts of lean meat finely divided) should be allowed, as there is danger of the wall rupturing at the point of ulceration. Medical. Astringents and hemostatics are indicated (bis- muth subnitrate 0.3-0.5, or silver nitrate 0.05-0.1 well diluted in distilled water) . These preparations can be admin- istered two or three times daily, depending upon the action desired. Where severe hemorrhage takes place, adrenalin chlorid (1.0-2.0 of a 1-1000 sol.) may be given several times daily until the hemorrhage stops. To neutralize the acid secretions in the stomach Carlsbad salts (2.0-4.0) can be used twice daily. In cases where vomiting is persistent small doses of tincture of opium (0.2-0.5) are administered every two hours until vomiting ceases. Surgical. In some cases where medical treatment does not afford relief, laparotomy should be performed (see Foreign Bodies of the Stomach) and the ulcerated area extirpated (see Gastrotomy, under Foreign Bodies of the Stomach). 160 DISEASES OF THE STOMACH HEMATEMESIS. Definition. Hematemesis is the vomiting of blood. It is merely a symptom. The hemorrhage does not always come from the stomach itself, but from structures contiguous to the stomach. In small animals hematemesis is much more common than is usually recognized, but unless large quanti- ties of blood are vomited, it escapes notice. Often scant hemorrhages go unrecognized, the determination of which would be valuable for the diagnosis of some diseases. Etiology. In hematemesis there may be no anatomical lesions on the mucous membrane (diapedesis) ; or the lesions may be very small but numerous and the hemorrhages copious coming from a large surface of the mucosa. On the other hand the lesion in the mucosa may be quite marked (rhexis; ulcer, etc.). In the dog hematemesis is quite common and has the following causes: Local causes: Ulcerations on the mucosa; erosions on the mucosa; acute and chronic gastritis; tumors; trauma which may be direct (foreign bodies, injury from stomach sound) or indirect (straining during vomiting, stomach operations) ; chemicals (poisons, purgatives, emetics). Indirect local causes are further: Obstruction to the portal circulation; pressure on the portal vein; thoracic diseases, disturbing circulation ; organic heart lesions, etc. Hematemesis may occur also from many general causes which produce at the same time hemorrhage from several of the mucous membranes. The following are the most common conditions: Septicemia; autotoxic conditions, uremia, etc.; blood dyscrasias and diseases, hemophilia, scurvy, pernicious anemia, leukemia. The blood may have its origin outside the stomach and come from contiguous abscesses rupturing the stomach wall, or from ulcers and fistula 1 which may open a suppurating tract into the stomach. Hematemesis also occurs during the course of infectious diseases (distemper, rabies). Pathology. The pathological findings depend upon the amount of the hemorrhage. When the hemorrhages prove fatal there is a general pallor of all the viscera; where the HEMATEMESIS 161 hemorrhages have been slow and continuous fatty degenera- tions of the heart, liver, kidneys, gland cells are observed. The original cause will in part determine the nature of the pathological changes. The mucous membrane of the gastro- intestinal tract is pale, and remains of the hemorrhage will be noticed along its course, which is of a dark color and more or less tarry. At the seat of the hemorrhage will be found eroded vessels, and .sometimes imperfect clot formation. Other lesions found are those of ulceration, foreign bodies, depending upon the original cause of the hemorrhage. Symptoms. These depend very largely upon the amount of hemorrhage and rapidity with which it flows. When the amount of hemorrhage is small the symptoms may be entirely overlooked. The vomited blood may be only in small quantities often poorly mixed with the ejected food. The color of the blood depends upon the amount and length of time remaining in the stomach. When fresh, the color is bright and the cells are unchanged; when retained in the stomach some time before it is ejected, it is dark, the oxy- hemoglobin being changed to hematin, and resembles coffee grounds. A microscopic examination of the ejected mass will at once reveal the presence of large numbers of red cor- puscles unless the blood has been retained in the stomach long enough for the red corpuscles to become entirely dis- integrated. When severe hemorrhages take place in the stomach, some of the blood will pass into the intestinal tract to be passed out with the feces. The feces will be of a dark tarry consist- ency, with a disagreeable odor. If examined the blood pigment will be found in large quantities. General symptoms of internal hemorrhage are noticed in the more severe cases. The mucous membranes suddenly become pale and colorless, the pulse very weak and often imperceptible, dyspnea and general weakness appear. If repeated hemorrhages do not result fatally the patient suffers from chronic anemia. Diagnosis. This depends upon the presence of the blood mixed with the vomitus. Tare should be taken in making the diagnosis in the dog as they often eat large quantities of 11 162 DISEASES OF THE STOMACH clotted blood, or lick blood from bleeding surfaces which may produce vomiting. When this is suspected the general symptoms should be carefully considered and a careful anamnesis obtained if possible. A microscopic examination of the contents from the stomach and bowels will in most cases assist in arriving at an accurate diagnosis. It may be differentiated from hemor- rhage of the lungs by the presence of food particles, and the absence of air mixed with the material, and from the fact that it usually has an acid reaction from contact with the gastric juice. Prognosis. This depends very largely upon the cause, and to a less extent upon the severity of the hemorrhage. When resulting from wounds in the mucosa when not too extensive it should be considered favorable. However, when due to ulceration of the mucosa, or resulting from general causes the prognosis is unfavorable. Treatment. The early indication in the treatment is to keep the animal in a quiet place free from all excite- ment or noise. The administration of cold water (ice water) internally or cold applications to the epigastrium in the form of cold water or ice are beneficial. To control the hemorrhage when severe, adrenalin chlorid solution (1.5-2.0 of 1-1000 solution), or ergotin (0.2-1.0) subcutaneously should be given every two or three hours until the hemor- rhage stops. Gelatin given via the mouth has been highly recommended for the same purpose. In less severe cases mild astringents (tannic acid, lead acetate, tannoform, alum) are to be used. W r here general weakness is well marked subcutaneous injections of strychnin sulphate (0.0005-0.001), or caffein citrate (0.06-0.19) are to be used to stimulate the heart action, and as a general stimulant. Saline infusions given as rectal injections, intravenous injections, or intra- peritoneally are indicated in severe hemorrhages to replace the loss of blood in the body. When hematemesis is due to other diseases, the cause should be determined and treat- ment applied accordingly. All food should be withheld for at least two days, and then allowed only in small quantities. Milk or beef broth is useful in this regard. PARASITES IN THE STOMACH 163 PARASITES IN THE STOMACH. The parasites that develop in the stomach of the dog are very rare. The Spiroptera sanguinolenta, a small blood red worm from 5 to 8 cm. long, is the most common. It forms small, tumor-like masses in the mucosa. Occasionally the larvae of the Gastrophilis intestinalis are found attached to the mucous membrane. Ascarides and teenia commonly migrate from the intestines. Tsenia are often found in the stomach of the cat, the Taenia tseniseformis being the most common. The Ollulanus tricuspis, however, is the only parasite proper to the stomach of the cat. The adult Ollulanus tricuspis is about 1 mm. long and has three points at the caudal extremity. The adult worm lives in the gastric mucous membrane and when present in large numbers, seriously interferes with the function of the mem- brane. The embryos are quite large compared with the adult parasite. Some of these embryos are passed with the feces while others burrow through the walls of the intestines and wander to various parts of their host, particularly the pleura, diaphragm, liver and lung, w r here they form cysts. When the free embryos are ingested by rodents they migrate into the muscles and become encysted. It is probable that their development is completed in the digestive canal of the cat that feeds upon the infested rodent. Rabbits are chiefly infested with the Strongylus strigosus, often found in large numbers, and give rise to a fatal anemia. This parasite is 8 to 16 mm. long, body blood red, filiform and transversely striated. The parasites most common in the anterior portion of the digestive canal of birds are the Dispharagus spiralis, Disphar- agus nasutus and the Trichosomum contortum. The dis- pharagi are from 7 to 9 mm. long and the trichosome 12 to 17 mm. and are found either entirely embedded in the mucous membrane or fixed in it by one extremity and the other floating free in the cavity of the organ. The Trichosomum contortum is frequently found in adjacent structures, but is common in the walls of the esophagus. 164 DISEASES OF THE STOMACH Symptoms. The parasites which are proper to the stomach of small animals and to the anterior part of the digestive canal of birds do not as a rule produce any marked symptoms unless present in very large numbers. The Spiroptera sanguinolenta of the dog may give rise to a chronic gastritis with frequent vomiting, an irregular appetite and resulting emaciation. The tumor-like masses in which the parasites live may perforate the peritoneum and occasion a fatal peri- tonitis. Large numbers of the Ollulanus tricuspis in the cat's stomach cause a thickening and ecchymosed condition in the mucous membrane with severe gastric disturbance. As the larvae of this parasite migrate into the adjacent tissues, they can produce extensive inflammatory processes and give rise to pleuritis, peritonitis, bronchitis, etc. The Strongylus strigosus produces a severe anemia in rabbits by abstracting blood from the mucous membrane of the stomach, and by so doing produces a disturbance in the function of the stomach with inanition as a result. In warren rabbits where they are continually subjected to reinfection, this anemia often terminates fatally, at times being epizootic in its extent. The parasites of birds produce the most serious disturb- ance by burrowing in the walls of the esophagus and crop. The food when swallowed becomes impacted through loss of propelling action of the organ and dilatation results often with fatal termination. Diagnosis. An accurate diagnosis of the stomach parasites of the dog and cat is difficult. A microscopical examination of the feces and vomitus for the larva? may reveal their presence. When the general symptoms are indicative of parasitism laparotomy and possibly gastrotomy should be performed, and a direct examination of the tumor-like masses made. In rabbits and birds, as several are usually affected, a postmortem examination of one or two of the most typical cases is recommended. Prognosis. Unfavorable in all cases of severe infestation. Mild cases in dog, cat and rabbit often recover spontaneously or with ordinary treatment. In birds, however, the injury to the walls soon leads to dilatation and quite often to a fatal termination. NEOPLASMS IN THE STOMACH 165 Treatment. No satisfactory treatment can be given for those parasites living within the tumor masses or burrows in the mucous membrane. When such parasites are diag- nosed, all the affected individuals should be removed and a thorough cleaning given all the houses, runways, and grounds to which they have had access. (For ascarides and taenia see Parasites of the Intestines.) NEOPLASMS IN THE STOMACH. Tumors in the stomach especially primary growths are very seldom found in small animals. Occasionally secondary carcinomas or sarcomas occur. Symptoms. The symptoms observed are very similar to chronic gastritis (see Chronic Gastritis). The growth of the tumor is often sufficient to increase the size of the abdomen and can usually be palpated through the abdominal walls. Other symptoms are persistent vomiting, icterus, and loss of appetite. When a tumor of the stomach is suspected laparotomy should be performed and a direct examination made. Prognosis. Unfavorable. Treatment. No attempt should be made to operate malig- nant growths. Tumors involving the anterior part of the stomach are inoperable owing to the location and close attach- ment of the stomach. Fortunately, however, tumors of the stomach usually involve the pyloric end, and in such cases gastroduodenostomy should be performed removing the entire part involved. Gastroduodenostomy must be per- formed with considerable care to prevent infection from the stomach contents and hemorrhage from the large vessels, and also to so place the ligatures as to avoid cutting off blood supply from any part of the stomach not removed. The modus operandi is as follows: Thoroughly anesthetize the animal and secure in the dorsal position. Cover the field of operation with sterile cloths and provide plenty of suture material (linen machine cord No. 40) and medium- sized, straight sewing needles (Emmet's bowel needles). Perform laparotomy at the median line from the xiphoid 166 DISEASES OF THE STOMACH cartilage to the umbilical scar. Grasp the stomach and draw it up through the opening. Ligate the right and left branches of the gastric arteries, the splenic and the gastrohepatic arteries. The location of the ligatures along the arteries depends on the location of the excision. In all cases the ligatures must be close to the excision to avoid having an area of the stomach left without blood supply. Place a gas- trectomy forceps, the jaws protected with rubber tubing, across the stomach just back of the point of each excision, and two others across the part to be removed far enough from the others to allow cutting between them with shears. The forceps protect against hemorrhage and escape of con- tents while the latter prevent escape of material contained in the part to be removed. Remove by cutting between the clamp with scissors and suture both ends with continuous suture over and over the cut edges to control hemorrhage, and invert the ends by putting in Lembert sutures. Remove the forceps and take up a part of the anterior wall of the stomach and apply the forceps, having the part that projects through the forceps about two inches long by one-half inch through. Do the same with the duodenum about three inches from the pylorus. Place the forceps close together and apply sutures through the muscular coat close to the lower jaw of each forceps, and do not cut off the suture. Then make an incision in the stomach close to the line of sutures and one in the duodenum to correspond with the one in the stomach. Then with a new suture join the distal edges of the wound with Council's sutures, the forceps being loosened but left in place to support the stomach. These latter sutures invert the cut edges and the first suture can now be continued over the Connell suture as a Lembert suture. Return the organs and suture the laparotomy wound. After forty-eight hours feed liquid food for several days. CHAPTER IX. DISEASES OF THE INTESTINES. Examination. The intestines can be easily palpated through the abdominal wall in most small animals, when they are not too fat, and this greatly assists in making an accurate diagnosis, especially of foreign bodies, fecal accumu- lation (coprolith), etc. This is best done by placing the animal in the standing position using both hands, one on either side of the abdomen. When necessary to make a more careful examination, as for perforating wounds, volvulus, etc., explorative laparotomy should be employed. The intestines are best reached by making the incision at the median line in the middle of the distance from the xiphoid cartilage to the anterior border of the pelvis, and of sufficient size to permit of a thorough examination of the entire length of the intestine. The Roentgen rays can be employed to detect foreign bodies. The feces should be carefully examined for the following: Frequency, color, odor, quantity, consistency, presence of blood, parasites or their ova, mucus, foreign bodies, undi- gested food. The peristalsis is important and can be exam- ined by placing the animal on its side, covering the abdomen with a towel or cloth and applying the ear. The phonendo- scope is of great assistance for this purpose. Percussion is important in differentiating accumulations of fluid or gas in the abdomen or intestines. ENTERITIS. Two forms of enteritis are recognized in small animals, viz.: (a) Acute, and (6) chronic. Acute Enteritis. Definition. This is a catarrhal inflamma- tion of the mucous membrane of the small intestine, as well 168 DISEASES OF THE INTESTINES as the upper portion of the large bowel. In small animals it is impossible from a clinical standpoint to recognize the condition as affecting different parts of the bowels as: Duodenitis, ileitis, jejunitis, etc. P^nteritis very frequently accompanies acute gastritis, the causes producing acute gastritis often extending into the intestines. Etiology. The etiology is in many respects similar to that of acute gastritis: (a) Foreign bodies which irritate, such as sharp pieces of bone, needles, pins, etc. These when swal- lowed pass through the stomach into the intestines, often producing extensive irritation to the mucosa, resulting in an acute inflammation. Enteritis may result also from opera- tions, such as laparotomy when the bowels are roughly handled, rectal injections and manipulations, etc. Powdered glass is sometimes given intentionally to small animals, and it produces a very severe form of enteritis. (6) Chemical substances (carbolic acid, arsenic, phos- phorus, mercury, etc.) produce a very severe form of enteritis by their corrosive action on the mucous membrane. Chemical irritants contained in food when eaten by the animals will produce the same condition. Sometimes excessive quantities of foods, or digestive disturbance may occasion fermentation in the intestinal tract and the formation of irritants that directly excite an inflammatory condition. Also foods (meat, fish) may contain preformed toxic bodies, such as ptomaines or other products of bacterial action, which may occasion violent inflammation of the bowels. Cats are frequently affected by eating fish partially decomposed. Birds, from eating substances containing rather large quantities of sodium chlorid, suffer from a severe form of inflammation of the bowels as the result. (c) Exposure to cold, or sudden cooling of the surface of the body may produce an enteritis by interfering with the innervation and circulation in the intestinal walls; also taking large quantities of cold water, frozen or very cold foods will induce it. (d) Bacteria probably rarely cause inflammation of the bowels directly, but their action upon the intestinal contents causing fermentative changes are causes of enteritis. Ente- ENTERITIS 1G9 ritis is an essential complication in certain infectious diseases (distemper, enterohepatitis, etc.). , (e) Severe infestations with animal parasites can produce acute enteritis by the irritant action of the parasites upon the mucosa producing congestion and in some cases by attaching themselves to the membrane or burrowing into its walls. The severity of the inflammation produced depends very largely upon the number and species of parasites present. This condition is observed most often in puppies and kittens. Acute enteritis also occurs secondarily to other diseases, such as septicemia, septicemic diseases of birds, peritonitis, coccidiosis of rabbits and birds, etc. Pathology. The mucous membrane of the bowel may be involved in its entire length with almost equal severity, but usually certain portions are more seriously affected than others. The mucosa is swollen and reddened, the surface usually covered with mucus, which may be tinged with blood, and sometimes the submucosa is edematous with hemor- rhagic extravasations. The lymphatic follicles are enlarged and project out from the mucosa prominently as light patches against the inflamed surface of the mucosa. In severe cases pseudomembranous or diphtheritic inflammations of the mucous membrane of the intestines may be seen occurring usually secondary to infections originating elsewhere or from the action of corrosive poisons which are very common in dogs and birds. In all of these cases the mucous mem- brane is covered with an extensive, dirty yellow or grayish deposit, appearing as a coating over the surface or as a firmly attached pseudomembrane. This pseudomembrane may be found in the entire length of the bowel. Areas of the necrosis and deep ulceration are often seen where the pseudomembrane has been dislodged. Hemorrhages are often found under and from the mucosa, the blood mixing with the intestinal contents forming a dark red mass. The feces are very thin even in the large intestine and have a disagreeable odor. The mesenteric lymph glands are swollen and edematous. Symptoms. The clinical symptoms in enteritis vary with the intensity of the cause and the part of the intestinal tract 170 DISEASES OF THE INTESTINES involved. In milder cases the symptoms are those of diar- rhea due to functional disturbances of the bowels. In severe cases the symptoms come on suddenly and are of great severity. In dogs there is usually constipation in the early stages followed in a few hours by diarrhea. The feces, as a rule, are liquid, brownish in color and of more or less offen- sive odor, depending upon the extent of the putrefactive changes and the intensity of the inflammation. In severe inflammations due to corrosive poisons, etc., the feces are mixed with blood, sometimes passed in quite large quanti- ties, and in the form of clots. When due to poisons, the odor of the poison is often noticed in the feces. Colicky pains are noted and in severe cases intense abdom- inal pain is one of the most prominent symptoms. The abdominal muscles are tense, contracted, often giving the animal a "tucked up" appearance. In severe inflammation of the bowels the dog will often lie stretched out on its abdomen, showing intense pain by howling, crying, nervous- ness, etc. Sometimes the nervous symptoms will be promi- nent enough to simulate rabies. Vomiting is a common symptom provided the stomach is involved. The vomitus usually consists of food particles, mucus, blood, bile, and in rare cases feces from the small intestines. There is loss of appetite except in the very mild cases. Fever is more or less high in the early stages, while later in the dog it becomes subnormal. The temperature, as a rule, cannot be depended upon to determine the severity of the condition, as it may be increased in slight cases, and in severe, be normal or subnormal. The general symptoms are those of weakness, in proportion to the degree of inflamma- tion, complete prostration or collapse. The surface of the body becomes cold, the mucous membranes cyanotic, there is well marked dyspnea and a weak, rapid pulse. In cats the diarrhea is a very prominent early symptom. The feces are liquid and often mixed with blood. Complete prostra- tion takes place early under symptoms of dyspnea, general weakness, and a very rapid weak pulse. In birds enteritis begins with diarrhea. The feces are of a thin consistency, of a yellowish or greenish color, and ENTERITIS 171 very offensive odor. The feathers in the region of the cloaca become soiled, matted together, retaining a quantity of the feces which often becomes dried and forms a hard mass around the anal opening. There is usually loss of appetite, general weakness, the wings are held pendant and the patient completely prostrated. In the more severe cases due to ptomaines, toxins, etc., the symptoms develop very rapidly, and there is but little noticed except subnormal temperature, narcosis and coma. Death occurs in a large percentage of those cases due to ptomaines, toxins, etc. Diagnosis. The recognition of acute enteritis offers no great difficulties in most cases. The anamnesis, sudden onset, abdominal pain, and the severe diarrhea are all quite characteristic. Only when diarrhea is absent would the diagnosis be difficult. A careful examination should always be made to determine if possible the cause of the enteritis, whether it is a primary condition or secondary to some other disease. Examination of the feces should be made both macro- and microscopically to determine their condition, the presence of blood, foreign material, or of parasites. Prognosis. In ordinary cases of enteritis the prognosis is usually favorable. However, it depends very largely upon the cause, and all cases should be considered serious until the cause can be determined. "When due to corrosive poisons, ptomaines, toxins, etc., the prognosis should be considered very unfavorable depending upon the amount of the material ingested. In cats the prognosis should be guarded as these animals are very sensitive to intestinal disturbances. Treatment. Hygienic. The animals should be placed in a warm, dry place which is well ventilated and free from all noise and excitement. Not too many birds or small animals should be allowed in one room, and the floors, roosts, etc., should be thoroughly cleaned (daily) and disinfectants, such as carbolic acid (5 per cent.) freely used. The drinking water should be kept fresh, and the food, when allowed, free from dirt, dust, and not contaminated with bowel discharges. Collections of feces on the hair and feathers should be removed daily with warm water or bicarbonate of soda solution (2 per cent). The mouth may be washed with clean 172 DISEASES OF THE INTESTINES water to remove all food particles which might remain to decompose and eventually be swallowed to perpetuate the intestinal disturbance. Dietetic. In most cases of acute enteritis, all food is withheld for at least twenty-four to forty-eight hours. After this time, when improvement begins to be noticeable, dogs may be given small amounts of lean, meat finely divided, milk, beef tea, rice soup, etc., once or twice daily. Rabbits should be fed small quantities of roasted oats, corn or barley, or roasted bread. For birds small amounts of cooked rice, oatmeal, cornmeal or bread and milk may be given once daily. Green foods should be withheld at first and only allowed in small quantities several days after improvement is noted. They tend to increase the diarrhea by their laxa- tive action. Medical. In mild cases of enteritis, due to errors in feeding or irritating foodstuffs, etc., small doses of laxatives are indicated to remove the irritating material from the bowels. Castor oil (dogs, 15.0-40.0; cats, 3.0-15.0; rabbits, 5.0-10.0; birds, 1.0-8.0), or calomel (dogs, 0.3-0.4; cats, 0.1-0.15; rabbits, 0.2 ; birds, 0.05-0.2) can be administered. Magnesium sulphate (dogs, 10.0-15.0; cats, 1.0-5.0; rabbits, 1.0-3.0; birds, 1.0-2.0) is frequently used for the same purpose owing to its increasing the fluids in the bowels and flushing them out more promptly and thoroughly. It is best administered in solution with warm water. In more severe cases where the diarrhea is persistent after the use of laxatives, it is necessary to administer styptics, such as opium (dogs, 0.1-0.5; cats, 0.005-0.2; rabbits, 0.05- 0.1; birds, 0.05-0.1). In cases where severe pain is present, especially in dogs, morphin sulphate is indicated. It may be given (for dogs, 0.02-0.15) as a subcutaneous injection dis- solved in water (5.00). Astringents are sometimes of value in controlling the persistent diarrhea and tannic acid is often administered for that purpose in the following dosage: Dogs (0.1-0.5), cats (0.05-0.2), rabbits (0.05-0.2), birds (0.01-0.05). Where fermentative processes continue in the bowels disinfectants may be administered: Lysol (0.5-2.0), creolin (0.5-2.0), salol (0.2-0.8). ENTERITIS 173 It is often advisable in dogs to wash out the intestinal tract with bicarbonate of soda solution (1 to 2 per cent.) followed by alum, tannic acid or iron sulphate solutions (1 to 2 per cent.). This can be done quite readily in the dog by the use of a flexible rubber tube inserted as far up into the bowels as possible. The free end is elevated and a funnel attached. The solution is poured into the funnel and allowed to gravitate slowly into the bowels. When there is no obstruction the fluid will flow into the stomach and be ejected through the mouth. In birds it is best intro- duced with a small syringe, being careful to avoid using too much force. In very severe cases, where general weakness is apparent, stimulants are advisable. Subcutaneous injec- tions of caffein citrate (0.1-0.5) may be used as a heart stimulant. Normal salt solution, at the body tempera- ture (100 F.), is of great value in severe weakness from hemorrhage or narcosis. It may be introduced intravenously, subcutaneously, intraperitoneally or per rectum. Chronic Enteritis. Definition. This is a chronic inflam- mation of the small intestines involving the upper part of the large intestines, but often extending to all parts of the intes- tinal mucosa. Frequently there is extensive ulceration at different places along the intestinal tract. In some cases the stomach mucosa is involved from the same causes that pro- duce the chronic enteritis. Etiology. Chronic enteritis most commonly develops from repeated acute attacks or from the same causes acting mildly producing gradually a chronic inflammatory condi- tion. (See Acute f^nteritis.) Chronic enteritis also occurs secondary to other diseases, such as chronic diseases of the heart, lungs, and liver which cause interference with the circulation in the walls of the intestines. Chronic infectious diseases, such as chronic distemper, chronic constitutional diseases, rachitis, etc., have at times chronic enteritis associated with them. Para- sites in the intestinal tract are common causes. Pathology. The intestines always present evidences of long-continued inflammation of the mucosa, the surface being covered with excessive secretions of mucus or muco- 174 DISEASES OF THE INTESTINES purulent material. There are extensive areas of thickening in the mucous membrane; erosions and atrophy may too be present. Ulcerations and cicatrices are often noted. Ulcera- tions may lead to perforation of the bowel wall producing a localized area of adhesive peritonitis, or in some cases a generalized peritonitis. The mucous membrane is usually bluish-red and at various points will be noted light and dark points due to the pathological changes in the structure of the membrane. The intestinal contents are usually liquid, of a slate gray color and emit a very offensive odor. Some- times when constipation is present the feces will be dry and hard in the large bowels, and of a grayish color. Symptoms. The most conspicuous symptom is a continu- ous or intermittent diarrhea. However, diarrhea may alter- nate with constipation. The general symptoms are dulness, gradual emaciation, rough hair coat and inanition which is marked owing to the lost or variable appetite and the inter- ference with digestion and food assimilation. From time to time the bowels are distended with gases from the fer- mentative processes in the intestinal tract. This is especially marked when constipation is present and the peristalsis reduced. At other times large quantities of gases, feces mixed with mucus and often streaked with blood, are passed during the period of diarrhea. In most cases there is little evidence of abdominal pain, except when ulceration of the bowel wall takes place and an adhesive or a general peritonitis is produced. Then all the evidences of inflammation of serous membranes are present. (See Peritonitis). Diagnosis. The long-continued course, the intermittent diarrhea, the anamnesis and the general condition of the animal will be sufficient in most cases to make a compara- tively accurate diagnosis. However, a careful and thorough examination should always be made to determine if possible the cause of the enteritis. This is valuable especially for a proper prognosis and rational therapeutics. The feces should be carefully examined for parasites and their ova, as these form a frequent cause. INTESTINAL HEMORRHAGE ENTERORRHAGIA 175 Further, as this condition is often secondary to other diseases, a differential diagnosis should always be attempted. Look for chronic constitutional diseases, diseases of the liver, heart and lungs and chronic infectious diseases. In birds an examination should be made for infectious asthenia and parasites. Prognosis. Chronic enteritis whether of primary or sec- ondary origin should be considered unfavorable owing to the pathological changes which have taken place in the mucous membrane. Complete recovery can hardly be expected even in mild cases. In mature animals the prog- nosis is considered more favorable than in young animals. When it occurs secondary to other diseases the prognosis depends largely upon the primary disease. Treatment. A careful regulation of the diet (see Acute Enteritis) is of great importance and should be thoroughly impressed upon the attendant. Medical. The action of the bowels should be kept as regular as possible by the use of castor oil, magnesium sulphate, etc. (See Acute Enteritis.) When diarrhea becomes persistent astringents are indicated as in acute enteritis. Washing out the bowels (see Acute Enteritis) is especially valuable in chronic enteritis to remove irritating material, mucus, fecal matter, etc. If parasites are present proper anthelmintics should be employed. (See Parasites in the Intestines.) To encourage the appetite and to aid in digestion, bitter stomachics (gentian, nux vomica) are indicated. In the treatment an attempt should always be made to remove the cause; when secondary to other diseases treatment should be given to promote the removal of the fundamental disease. INTESTINAL HEMORRHAGE. ENTERORRHAGIA. Definition. This is a condition where hemorrhage takes place from the intestinal mucosa. It may be due to a definite 176 DISEASES OF THE INTESTINES change in the structure of the mucosa or occur during the course of certain diseases attended by hemorrhagic diatheses. Etiology. The causes of intestinal hemorrhage are quite numerous: (a) Mechanical agents, such as sharp foreign bodies which penetrate the intestinal mucosa and injure the bloodvessels, producing a more or less severe hemorrhage. Parasites, by their irritating action on the mucous membrane, or by burrowing into the mucosa, will produce the same result. Injuries, such as being run over by vehicles, kicks, blows, etc., over the region of the abdomen will often rupture some of the vessels in the intestinal mucosa, resulting in hemorrhage. Powdered glass, when administered to destroy animals, will produce severe hemorrhage by the fragments of glass penetrating the mucosa and opening the vessels. (6) During the course of poisonings by chemicals or caustic substances, severe hemorrhage often takes place due to the corrosive action on the mucous membrane. Drugs, when administered in large doses, may produce a congestion of the bloodvessels of the mucosa, resulting occasionally in over- distention and rupture. (c) Hemorrhage takes place sometimes from an engorge- ment of the intestinal circulation from diseases of the heart and liver, hemorrhagic infarction of the bowel from embolism or thrombosis of the mesenteric vessels, intussusception or strangulation of the bowel, or hernia. In these cases the hemorrhage may result from an overdistention of the blood- vessels. (d) During the course of some diseases severe hemorrhage in the intestinal tract occurs, as in anemias, severe infections (distemper) and certain degenerations. (e) Tumors (carcinomas) and ulcerations on the mucous membranes may lead to severe hemorrhage by destruction of some of the bloodvessel walls. Hemorrhoids, collections of feces, etc., may produce hemorrhage in the large bowels. Symptoms. Hemorrhage in the intestinal tract is often difficult to recognize, unless the quantity of blood is sufficient to distend the bowels, or be ejected through the rectum. In mild cases of hemorrhage only general weakness and paleness INTESTINAL HEMORRHAGEENTERORRHAGIA 177 of the mucous membranes may be recognized. When the hemorrhage has been severe from the small bowels the feces will be very dark and of a tarry consistency; from the large bowels and rectum the color is a bright red the blood being well preserved. In severe hemorrhage the symptoms are those of extensive hemorrhage from any source. Sudden paleness of the membranes, rapid weakness, etc., are the most prominent symptoms observed. Repeated small hemor- rhages, such as occur during ulceration, action of parasites, etc., may produce different grades of anemia, depending upon the extent of the hemorrhage. Diagnosis. This can only be made after a careful examina- tion of the animal and the discharges from the bowels. When slight hemorrhages take place, a microscopic examination of the discharges may be necessary to determine the presence of blood. Prognosis. This depends upon the cause, and the extent of the hemorrhage. In most cases bowel hemorrhage should be considered serious, as it is often impossible to determine the cause or extent of the hemorrhage. Treatment. The cause should be determined if possible, as the treatment depends very largely upon this factor. Opium is often of great value to suppress peristalsis. The tincture may be used in the following dosage: For dogs (0.5-1.0), cats (0.2-0.5), rabbits (0.2-0.5), birds (0.1-0.2). Astringents, such as tannic acid, etc., are also indicated. They should be administered in rather large doses, and repeated every hour or so. Adrenalin chlorid is most useful in severe hemorrhage: The dose for dogs is 2.0 of a 1-1000 solution given every hour; other animals one-half the quantity. Ergot may also be used. Hemorrhage from the rectum or large bowels is best treated by injections of gelatin dissolved in hot water, astringents (alum 2-5 per cent.), or cold water. The injections should be repeated as often as necessary to control the hemorrhage. When there is great loss of blood, normal salt solution (500.0) should be administered intraperitoneally or per rectum. Further treatment depends upon the symptoms that develop. 12 178 DISEASES OF THE INTESTINES DIARRHEA. Definition. This term is applied to a too frequent discharge of more or less fluid feces. The condition may vary greatly in small animals from a slight increase in the daily evacua- tions to repeated evacuations of large quantities of liquid feces. It is important to note that often repeated evacuations of small amounts of liquid feces may occur even when an actual obstruction of the bowels ' (fecal impaction) exists. Etiology. The essential condition in diarrhea is an abnor- mal increase of fluid in the feces. The causes, therefore, will be found to be those which occasion a rapid evacuation of the bowel contents, or a reduction in the absorption from the bowels; or an oversupply of fluid in the bowels either from the ingestion of large quantities of water or any over- abundant secretion from the mucous membrane. Normally the contents of the small bowels are fluid. They pass from the stomach to the large bowels in a few hours. The contents of the large bowels become gradually hardened from the absorption of the water during their passage through this part of the intestinal tract, which requires in small animals, from twelve to twenty hours. Any conditions therefore that hasten the movements of the contents through the large bowels would tend to make the feces softer or liquid. The same result may occur from a variety of conditions which disturb the process of absorption and keep the feces in a liquid state. Occasionally conditions that influence the absorption from the mucous membrane, such as irritations of various kinds, at the same time excite the secretion of considerable quantities of fluids. These same agents may also increase peristalsis and thus hurry the contents through the bowels. The most common causes of diarrhea therefore are: (a) Drinking excessive quantities of water or eating large quan- tities of fat meat, lard, or butter will result in diarrhea. The unabsorbed fat or its decomposition in the intestinal tract acts as an irritant and greatly increases intestinal activity. (6) Foods will sometimes produce diarrhea by their irri- tating action on the mucous membrane. Such substances as table scraps containing fruit stones, parings, or fish, DIARRHEA 179 .cheese, milk, etc., may undergo fermentative changes in the intestinal tract or from their decomposition contain preformed toxic substances which excite diarrhea. Excessive amounts of food may set up a diarrhea as a result of derangement of the gastric digestion and secondary bacterial fermentations. (c) A large number of purgatives, when administered in large doses, will produce diarrhea by acting upon the muscle of the bowel and the nervous mechanism stimulating peri- stalsis and thus hastening the contents through the bowels before absorption can take place. Salines (magnesium sulphate) increase the amount of fluid in the bowels, and also stimulate peristalsis. Some foods in which bacterial decom- position has taken place will have an action similar to salines greatly increasing the amount of fluids in the bowels by excit- ing secretion from the glands in the mucosa. (d) In some animals (cat) the nervous mechanism of the stomach will be greatly influenced by shock, fright, excite- ment, etc., and severe diarrhea may result. (e) Diarrhea may result from diseases of other organs. In diseases of the stomach, when undigested food is passed into the intestines, the resulting irritation may induce severe diarrhea. In valvular insufficiencies or other heart lesions a congestion of the mucous membrane of the bowel results and an excessive secretion follows. Diseases of the kidney may also produce diarrhea by vicarious excretion of urea ma intestinal tract. The urea decomposes producing free ammonia which irritates the mucosa causing a severe form of diarrhea. (/) Various infections in the bowels (distemper, etc.) are associated with a more or less intense diarrhea. Infections with lesions at some distance from the bowels may have diarrhea as a consequence due to the elimination of toxic substances from the intestinal mucous membrane, which can result in severe diarrhea. An overproduction of bile during the course of some diseases of the liver can have the same effect. (g) Organic diseases of the bowels (catarrhs, ulcerations) often lead to diarrhea from the irritation and resultant products of decomposition. 180 DISEASES OF THE INTESTINES (K) The normal contents of the bowels contain numerous varieties of organisms, which under abnormal conditions may multiply sufficiently or increase in virulence as to bee me pathogenic, producing diarrhea. (i) Various specific organisms (coccidia, etc.) produce diarrhea. They will be considered under the diseases caused by them. Symptoms. The clinical symptoms of diarrhea depend largely upon the part of the intestine affected and the nature of the causative agent. When due to errors in feeding and the upper part of the intestine is involved, diarrhea may not occur if the posterior bowels remain normal. In diarrhea the discharges from the bowels consist of portions of undigested food, mucus, etc., and are yellowish or greenish in color, due in part to unchanged bile or to pigment derived from fermentation. Excessive acidity, which has not been suffi- ciently neutralized in the small intestines, may produce inflammation in the lower bowel, due to its irritant action upon the mucous membrane. In cases where both 'the small and the large bowels are involved the discharges are more abundant and liquid. The feces will be very thin and of a yellowish or a dark brown color. When the large bowel is particularly affected, the animal shows frequent attempts at defecation, and only a small amount of feces and blood mixed with quantities of mucus will be passed. In the more severe forms of diarrhea colicky pains are often observed and in some cases the pain becomes intense. There are frequent attempts at defecation, and tenesmus is not unusual. When severe diarrhea is present it frequently produces extreme prostration and in cats complete collapse. The extremities become cold, the mucous membranes at first pale, later cyanotic and every evidence of extreme weakness appears. The temperature as a rule becomes subnormal ; however, in the very early stages it is often elevated one or two degrees. The severity of the symptoms and the course depend very largely upon the causative agents producing the diarrhea. In mild cases it lasts only a few hours; in the severe forms several davs. DIARRHEA 181 Diagnosis. This is established mainly by determining the cause. The history of the case is of great service in this regard. A thorough examination of the animal and feces is necessary for a differential diagnosis to distinguish this condition from specific diseases of the bowels. Prognosis. The prognosis is favorable in most cases but depends largely upon the cause. Diarrhea is a symptom and not a disease. Until the cause is determined an accurate prognosis cannot be made. Treatment. Dietetic. All food should be withheld for at least twenty-four to forty-eight hours, especially where but little weakness or prostration is apparent. Should weakness develop small amounts of milk, or milk and egg beaten together, should be given every four to six hours. Later when the symptoms of diarrhea begin to disappear a little lean meat may be allowed. Cats may have small quantities of rice and milk, or salmon. Birds should be allowed only small quantities of oatmeal or seeds. Avoid the use of laxa- tive foods, or foods containing irritating material of any kind. Medical. The first indication in the treatment of diarrhea is the evacuation of the irritating material from the intestinal tract. In a large percentage of cases the spontaneous evacua- tions are sufficient to rid the bowels of this material. How- ever, as a general rule, it is advisable to assist nature by the administration of a laxative to ensure the prompt removal of all irritating ingesta. Castor oil (dogs, 15.0-40.0; cats, 5.0-10.0; rabbits and birds, 1.0-4.0) is valuable. After thor- ough evacuation of the bowels opiates are indicated to con- trol the excessive peristalsis and secretions. Useful is tinct- ure of opium (dogs, 0.5-1.0; cats, 0.2-0.5; rabbits, 0.2-0.5; birds, 0.1-0.2). These doses can be repeated every few hours if necessary. Small doses of lime water are of value to neutralize exces- sive acidity which is often a common condition in small animals. Where severe pain is present, which is rather common in the dog, small doses of morphin sulphate (0.05-0.10) may be given subcutaneously. Where the diarrhea becomes persistent, it should be treated as in acute or chronic enteritis. 182 DISEASES OF THE INTESTINES CONSTIPATION. OBSTIPATION. INTESTINAL OBSTRUCTION. Definition. An infrequent or difficult evacuation of feces which are abnormally dry or hard; or may be retained. Etiology. The common causes of constipation in dogs are lack of exercise and feeding dry food. Dogs kept in the house or kennel often withhold the feces until they become hard and dry. Usually in old dogs the peristalsis becomes slowed and there is lack of tone in the muscular wall with some dilatation of the large bowel which causes constipation. The passage through the intestine may be blocked by fecal masses (coproliths), foreign bodies, calculi, parasites or hair balls, the latter being more common in cats as they lick off and swallow loose hair. The lumen of the intestine may be narrowed as a result of chronic inflammation, cicatricial contraction, stenosis, tumors within the wall, or hemorrhoids. Causative conditions external to the bowel are hernias, fibrous adhesions or tumors. Other causes are chronic inflammation of the liver with suppression of bile; chronic diseases of the spinal cord; enlarged prostates in old dogs; chronic inflammation of the anal glands; agglutination of the hair with feces at the anus in long-haired dogs. Rabbits are commonly affected by eating too much dry food. Hair balls or masses of hair and feces are often found in these animals. Birds occasionally swallow feathers which accumu- late in the intestines interfering with the passage of the con- tents. The most common causes are dry feed and foreign bodies. Pathology. The feces are dry, hard, usually of a light gray color and sometimes covered wLh mucus or streaked with blood. Coproliths or calculi or impactions of large size often result in necrosis of the intestinal wall with perforation and peritonitis. Symptoms. Mild cases show only difficult defecation at long intervals (two to four days). The feces are very dry, hard and may be streaked with blood from injuries produced in the rectal mucosa. In severe cases the retained feces decompose producing CONSTIPATION OBSTIPATION 183 toxins which are absorbed and intoxicate the patient. The animal will show depression, loss of appetite, increased tem- perature (103-104 F.), and thirst. Frequent efforts at defecation are made, the attempts inducing cries of pain. There is a characteristic carriage of the tail which is arched as when defecating, and a fulness of the abdomen. Vomiting is not uncommon especially in the more acute cases, the vomitus containing some bile and feces. Rabbits often show paralysis of the posterior parts. Birds make frequent attempts to pass feces and usually sit or stand in an upright position. By palpation large hard masses in the posterior bowel can be determined. Digital examination per rectum or over the abdomen will often reveal sensitiveness and the impacted fecal masses. Diagnosis. The frequent attempts to defecate, the condi- tion of the evacuated material, and the presence of fecal masses on digital examination will readily identify the con- dition. Prognosis. Favorable in mild cases when due to errors in feeding; otherwise depends entirely upon the causes. Treatment. Mild cases of constipation may be relieved by the use of a purgative given in full doses (castor oil I). 15.0-40.0, C. 5.0-10.0; calomel 0.05-0.15), while in chronic- cases after these purgative^ clear the bowel small doses of laxatives (extract of cascara sagrada, 2.0-10.0; tincture rhei, 5.0-10.0) must be given for some time to prevent a recur- rence of the condition. Tincture of mix vomica (0.3-0.6) or strychnin sulphate (0.001) is useful to stimulate peristalsis, especially when there is enervation from diseases of the cord, and to increase the tone of the muscular wall in dilatations. In obstinate cases large quantities of warm soapy water, or oil and water, introduced with a soft rubber tube and irri- gator well up into the rectum, will stimulate peristalsis, lubricate and soften the fecal masses and facilitate removal. A blunt irrigating curette can be used to break down the hard masses. Manipulation of the abdomen while irrigating is often beneficial. Rabbits may be relieved by the use of purgatives (castor oil, 2.0-4.0; tincture rhei, 0.3-0.6) and a diet of green foods, vege- 184 DISEASES OF THE INTESTINES tables, etc., should be supplied. Chickens may be treated with enemas of glycerin, or warm soapy water, and massaging over the abdomen. Fecal masses, calculi or foreign bodies that can- not be evacuated by any of the above methods may be removed by laparotomy and enterotomy. This operation should be performed early before necrosis occurs in which case enter- ectomy must be resorted to and the necrotic portion of the intestine resected (see Enterectomy) . The modus operandi is as follows: Perform laparotomy (see Laparotomy) at the median line just posterior to the umbilicus and withdraw the intestine containing the obstruction. Ligate the bowel with a heavy suture or tape on either side of the obstruction to prevent escape of contents and control hemorrhage by ligating all vessels supplying the part to be operated. Make an incision lengthwise of the bowel opposite the blood supply and of sufficient length to remove the obstruction which must be done carefully. Cleanse the bowel, and suture the mucous membrane, and then the muscular coat with con- tinuous sutures applied very close to the edge and then apply continuous Lembert sutures over these. By suturing the two layers separately, there is less tissue in the part to be folded on by the Lembert sutures. Remove the ligatures from around the bowel and the vessels, cleanse and return to the cavity. Constipation due to cicatricial contraction or stenosis may be alleviated by entero-enterotomy. Perform laparotomy as for enterotomy, withdraw the part of the intestine involved and apply a long bowel clamp lengthwise across a curved portion of the bowel, clamping off about three inches above the affected area, and another below, having not less than eight inches between the two clamps. Bring the clamped- off portions in apposition, making a circular loop in the bowel, thus having the peristalsis in the same direction. Apply continuous sutures through the muscular and serous coat of the clamped off portion just above the clamps, bringing the two parts in contact and leave the suture. Make an incision from one to one and a half inches long of same length and position in each bowel. Apply continuous suture over the free edges in contact. Loosen clamps but leave in posi- VOLVULUS 18,5 tion, and continuing with the latter suture, apply Council's sutures closing the opening. Then beginning with the first suture apply Lembert sutures around to the point of begin- ning. Remove vessel ligatures, cleanse and return to the abdominal cavity. Following these operations all food must be withheld twenty-four to forty-eight hours and then only small amounts of liquid food for several days. Tumor formations in the bowel are rare but when causing trouble must be removed by enterectomy (see Enterectomy) . VOLVULUS. Definition. An intestinal obstruction due to a twisting or knotting of the bowel. Etiology. This condition is rare in dogs owing to the short mesentery. It may occur following falls or rough handling by children during play, or by a portion of the bowel passing through an opening in the mesentery caused by an injury or following operations (enterectomy). Pathology. Volvulus of the bowel is more or less obstructive owing to twisting or kinking which it produces. In other cases a loop of intestine is twisted about another like a bow knot or slipped through an opening in the mesentery which partly obstructs the passage of the contents. Gas formation soon dilates the bowel further obstructing it and also the blood- vessels. When the obstruction is complete the bowel above is much distended while the part actually involved, having the circulation arrested, will appear dark red and later become necrotic leading to peritonitis. Symptoms. As the condition is acute the symptoms appear suddenly and are very pronounced. They are abdominal pain, accompanied by vomiting, great prostration and a hard, rapid pulse. Palpation of the abdomen may or may not produce much pain; sometimes no change in the intestine can be detected. Diagnosis. The acute abdominal pain, the sudden onset, rapidly increasing severity of the symptoms, vomiting and 186 DISEASES OF THE INTESTINES rapid pulse, serve to identify volvulus and differentiate it from other more chronic forms of intestinal obstruction. Prognosis. Unfavorable unless recognized early when a prompt operation affords relief. Treatment. Injections of large quantities of warm water or of air into the rectum may be beneficial in some cases. However, owing to the rapid changes taking place in the bowel, laparotomy should be performed early, and an attempt made to reduce the volvulus. Should the involved part of the intestine be necrotic, enterectomy must be employed to remove the entire part affected. INTUSSUSCEPTION. Definition. The invagination of a part of the intestine into an adjacent portion. Etiology . The exact causes are not known, although from the conditions under which it occurs and by experiments it is believed to be due to irregular innervation by which a given spot is contracted while immediately below it there is a dilatation, thus permitting the latter to invaginate the former. It may be produced by supercatharsis, increased production of bile (icterus), or the taking of cold water immediately following severe exercise, all of which excite innervation or produce sudden increase in peristalsis. Pre- disposing causes are constipation; dilatations following removal of fecal masses by enterotomy; end-to-end enterec- tomy, the circular cicatrix being incapable of contraction or dilatation which favors invagination; tumors in the intestinal wall. Intussusception may involve any part of the small intestine. The small intestine may pass in the ileocecal valve. Invagination of the colon or rectum may also occur. Pathology. Intussusception is a condition in which one part of the bowel slips into another forming a sausage-like enlargement of varied length. The enlargement is slightly curved from tension of the mesentery. As a result of the constriction, blood circulation is interfered with and often entirely arrested. In the early stages there is slight redden- ing, later the parts are swollen, congested and of bluish color. INTUSSUSCEPTION 187 Adhesions occur between the adjacent layers in a few hours and finally the parts become necrotic and may perforate leading to peritonitis. The rapidity with which these changes occur depends upon the extent of the intussusception as the farther the invagination the greater the pressure on the bloodvessels; if the circulation be completely obstructed, necrosis will occur in a few hours. Symptoms. Intussusception manifests itself early by abdominal pain, the tension on the mesentery producing the first symptoms. It has been noticed in a few cases that the animal will lie on its back in order to ease the pain from mesenteric tension. Later symptoms of acute enteritis become prominent, the feces frequently show the presence of blood, there is tenesmus, colicky pains and occasionally vomiting, and the vomitus may be mixed with feces. Palpation of the abdomen will often reveal an elon- gated enlargement of the bowel and slight pressure will cause pain. Palpation is difficult in very fat animals or those having a very thick-walled abdomen. Diagnosis. The presence of the painful enlargement of the bowel, bloody stools, tenesmus and the sudden occur- rence are the principal diagnostic features. Prognosis. Unfavorable in all cases not operated early. If recognized early and reduced or the portion excised (enter- ectomy) a good recovery may be expected. Spontaneous healing may occur by sloughing of the invaginated portion and adhesion at the anterior part. Treatment. Intussusception of the posterior part of the bowel may be reduced in the early stages by dilating the bowel with rectal injections of large quantities of warm water, using as much pressure as can be applied safely. Air may also be used in the same manner. Purgatives or specific stimulants to peristalsis should not be used as they only serve to increase the invagination. Operative measures should be at once resorted to when other efforts fail. A laparotomy should be performed at the median line just posterior to the umbilical scar, the enlarged portion of the bowel sought and attempts made to reduce it by careful manipulation. A small blunt probe or scalpel handle may 188 DISEASES OF THE INTESTINES be inserted between the adhered peritoneal surfaces to break down the adhesions which hold the two layers together. If this is impossible enterectomy must be performed. Place ligatures of heavy suture material around the bowel a short distance above and below the affected area and cut off the bowel with scissors making the incision diagonally across the intestine. Cut off the mesentery supporting the part to be removed, ligating each vessel as it is reached. Bring the parts of the bowel in end-to-end contact and suture with Council's sutures or if preferred a lateral anastomosis may be used. After-treatment is the same as for enterotomy. WOUNDS OF THE INTESTINES. Definition. Wounds of the intestines frequently occur in small animals, especially the dog, which is more subject to injury than the cat, rabbit or bird. Etiology. The most common causes are: Falling from a great height, being run over by vehicles, kicks, or severe blows over the abdomen. Punctured wounds of the abdomen often penetrate the intestines, such as gunshot wounds or those produced by sharp objects (forks, etc.) which penetrate the abdominal walls. Penetrating wounds should always be considered serious, as the extent of the injury in the abdom- inal cavity is difficult to determine. There is also danger of infection being carried into the abdominal cavity from with- out, or from within, the bowel contents escaping into the cavity and causing septic peritonitis. Symptoms. Injuries to the intestines are often difficult to recognize, especially those produced by kicks, blow r s and other forms of external violence. The most prominent symp- toms of intestinal wounds are hemorrhage and collapse. Often the abdomen will become distended with blood when the bowel is ruptured. The anamnesis, paleness of the mucous membranes and the sudden enlargement and dis- tention of the abdomen usually suffice for diagnosis. However, an accurate diagnosis cannot be made, unless an explorative WOUNDS OF THE INTESTINES 189 laparotomy is performed, and the cavity most thoroughly inspected. Other organs in the abdominal cavity may also be injured by the causes mentioned. The symptoms produced by punctured wounds depend very largely upon the extent of in- jury to the intestines or other organs. Gunshot wounds when of small caliber will not produce any very marked symptoms other than tenderness over the abdomen. Healing may follow readily. Small wounds may not penetrate farther than the mucosa which may pouch outward through the opening and prevent the escape of the intestinal contents. Later adhesions take place preventing septic peritonitis. Larger wounds, however, usually prove fatal under symptoms of collapse from hemorrhage or septic peritonitis, unless an accurate diagnosis is made and the proper treatment immediately applied. When punctured wounds are observed, the animal's general condition should be noted at once. Avoid the use of probes owing to the danger of carrying infection into the cavity. Treatment. The first indication in the treatment of intes- tinal wounds is to perform laparotomy (see Laparotomy) as early as possible. A generous incision should be made in the median line to allow a complete and thorough examina- tion of the entire intestinal tract and other organs. The intestine should be thoroughly examined the entire length, and any wounds found closed with Lembert sutures. If the wound is extensive, as a rupture of the bowel, it should be closed as in enterotomy. In some cases where the bowel wall becomes torn or has an uneven surface, a portion should be removed. (See Enterectomy.) The organs should also be inspected and any wounds in them sutured. The abdominal cavity should be thoroughly irrigated with a boric acid solution (2 per cent.), or normal salt solution, especially in those cases where intestinal contents have escaped or blood is present. Should the animal be weak from loss of blood, stimulants should be given, such as strychnin sulphate (0.001) repeated as often as necessary. 190 DISEASES OF THE INTESTINES CROUPOUS ENTERITIS OF CATS. Membranous Enteritis. Definition. A croupous or membranous inflammation involving the mucous membrane of the intestines. Etiology. Croupous enteritis is observed most frequently in kittens occurring as an epizootic in certain districts during the winter and spring seasons of the year. The exact etio- logical factor has never been determined. It is possibly due to a virulent form of the colon bacillus aided by a reduction in resistance from exposure to cold, irregularities in diet, parasites, etc. Older animals are also occasionally affected but not in such large numbers. Pathology. The principal pathological changes are noticed on the mucous membrane of the bowels, the muscular walls, and the mesenteric lymph glands. The mucous membrane is highly congested, reddened, swollen, and the surface covered with a thick membranous exudate. Often the epi- thelial surface and even the submucosa will become loosened from the other tissues. The wall of the bowel is edematous, and the serous covering shows inflammation. The mesen- teric lymph glands are enlarged, edematous, and show acute inflammatory changes. The liver, spleen and kidneys show similar changes. The contents of the bowels are liquid, and contain considerable blood. Symptoms. The early symptoms are: Vomiting and a severe diarrhea which come on suddenly and usually affect several animals at the same time. There is a complete loss of appetite, depression, and in twenty-four to forty-eight hours the animals will become very weak, comatose and die from exhaustion. Diagnosis. The epizootic character of the disease, the sud- den onset and the age of the animal affected are indicative. It can be easily mistaken for various kinds of poisonings; the anamnesis therefore should be carefully ascertained to assist in the differential diagnosis. Prognosis. Should be considered unfavorable; the largest percentage of cases terminate fatally. INFECTIOUS ASTHENIA .OF BIRDS 191 Treatment. Treatment of croupous enteritis is as a rule unsatisfactory. Little can be done except the administration of general stimulants and bowel disinfectants. As prophy- lactic measures, all feeding pans should be thoroughly cleaned and sterilized, and the discharges of the bowels carefully taken care of to prevent further contamination of the food. INFECTIOUS ASTHENIA OF BIRDS. Definition. This is a chronic disease found in birds, which affects primarily the duodenum in the form of a chronic catarrhal inflammation. Etiology. The cause is a microorganism known as the Bacterium asthenia?. It develops principally in the duo- denum, producing an irritation to the mucous membrane, which gradually leads to chronic inflammation. Pathology. The characteristic lesions are: Extreme ema- ciation of the muscular system with an almost complete absence of fat. The bowels are empty, containing only a small quantity of slimy mucus. The walls of the duodenum are reddened, thickened, and show all the evidences of a catarrhal inflammation of the mucous membrane. The duodenal feces will contain large numbers of the Bacterium asthenia 1 . Symptoms. Infectious asthenia is observed most com- monly in young birds one to six months old. It is charac- terized by extreme emaciation, variable appetite, paleness of the comb, wattles and membranes. The course is chronic and the termination usually fatal in about three months. The extreme emaciation which comes on gradually has led to the term "going light" being given it. During the course of the disease the birds become weak, anemic, the plumage rough; there is general depression which causes them to sit in one position for a long time. Death occurs from cachexia. Diagnosis. The large number of birds affected, the age of the birds, the long chronic course, and the characteristic lesions found on postmortem are usually sufficient to estab- 192 DISEASES OF THE INTESTINES lish the diagnosis. The finding of the Bacterium asthenise in several of the birds will confirm the diagnosis. Prognosis. Owing to the infectious nature of the disease, the chronic course, and the pathological changes which have taken place in the duodenal mucosa, the prognosis is unfavor- able. Where the disease has reached an advanced stage it is advisable to destroy the bird and thoroughly disinfect the premises. Treatment. Medical. Small doses of laxative, castor oil (1.0-4.0) or calomel (0.01-43.05) should be given. As a stomachic and tonic iron sulphate may be given in the drinking water (1-1000). The aromatic seeds (fennel, coriander, anise) may be used once or twice daily with the food to stimulate the secretions of the stomach and intestines. Prevention. The healthy birds should be separated from the sick ones at once. All parts of the houses (roosts, floors, etc.) should be thoroughly cleaned and disinfected with a carbolic acid solution (5 per cent.). CHAPTER X. PARASITES IN THE INTESTINES. HELMINTHIASIS. In small animals parasites in the digestive tract are very numerous. They pass rapidly through the anterior portion of the digestive tract, which prevents their becoming fixed; also in this portion of the canal secretions for their proper development are lacking. In the stomach, owing to its acidity, they do not remain long, but are either destroyed or pass into the small intestines. In a few instances, how- ever, they may burrow underneath the mucosa of the stom- ach. The intestines are favorable for the development of parasites, owing to their length, the presence of an abun- dance of fluid, and the slow peristaltic movement of the bowels which does not materially interfere with their fixation and development. The majority of the parasites are found in the small intestines; fewer are found in the cecum, colon and rectum. Each species of parasite has its particular location, and unless in unusual numbers, or under abnormal conditions, they will be found infesting an exclusive portion of the bowel. Parasites are frequently found in very large numbers, and produce serious disturbances in the intestinal tract, depending upon the species of parasite and the animal infested. The most common parasites found in the intestinal tract belong to the animal kingdom, and are: Cestoda; Nematoda; Acanthocephala; Coccidia. TJENIASIS. Cestoda. The dog is the favorite host of the tirnitv. They occur in this animal in considerable numbers, sometimes so as to 13 194 PARASITES IN THE INTESTINES excite wonder at the continued good health of the host. More than 50 per cent, of the dogs examined harbor worm parasites. It is essential for the taenise to have an intermediate host to complete their life cycle. The following animals serve as intermediate hosts for most of them: Sheep, ox, pig, horse, goat, rabbit, and even man. The head (scolex) of a tsenia is generally expanded and supplied with suckers ; some species in addition are provided with hooks. From this head, by proliferation, is formed the neck, a thin non-annulated constriction, which, continuing and becoming wider produces the body or strobila. The body is in the form of a long, narrow band divided into more or less distinct segments, and as these become mature they are cast off gradually from the distal end of the parasite as new segments develop from the head. Each of the segments contain numerous eggs (ova) which pass out with the feces. Before becoming detached the segments can also liberate ova through an opening on the lateral wall or ventral surface, called the genital pore, forming two ways of disseminating the ova. When deposited in a suitable medium, preferably warm, moist soil, or filth, the ova undergo a series of compli- cated changes which finally result in the first larval form. In this form they are ingested by the intermediate host, most commonly with the food or water. They burrow through the intestinal walls and migrate into the adjacent tissues, or w r ith the blood stream are carried to remote parts where they develop into cysts. During the development of the cyst in the various organs serious conditions, such as " gid" in sheep, echinococcus disease of man, etc., may arise in the new host. As the dog is the harborer of the parent tsenia, treatment should be given not only to reduce the disorders they occasion in other hosts but also to lessen the injury they produce in the dog. The cyst form is the limit of development in the inter- mediate host. The life cycle can be completed only in case the cyst is ingested by and reaches the digestive tract of another host in which it can develop. Dogs harboring the adult tsenia cannot become reinfested by ingesting the larval form, but the larval form may migrate from the intestines TMNIAS1S 195 into adjacent tissues and there develop new cysts. This is the limit of their growth, however, in the host of the adult worm. Taenias in Dogs. The most common tsenise found in the dog are as follows: (a) Dipylidium caninum (Tcenia cucum- erina), a worm 30 to 40 cm. and 3 mm. at its greatest breadth. Its club-shaped head is provided with four suckers and four rows of very small hooks. The neck is long and narrow. The first segments are narrow, the others are longer than they are wide and like melon seeds in form (cucumis). Genital pore double and opening toward the middle of each side of the segments on a slight prominence. Ova are globular, from 37 to 46 microns in diameter, and pass from the segments massed in a small group enclosed by a capsule (cocoon) . The cyst form is the Cryptocystis tricho- dectis and the intermediate hosts are the dog flea (Cteno- cephalus canis), dog louse (Trichodectis canis) and the flea that lives on man (Pulex irritans). These intermediate hosts become infested by ingesting the ova of the tsenise which are always present on the skin or hair of the dog by having fecal discharge mixed with the bedding in the kennel. The cysts develop usually in the abdominal cavity of the intermediate hosts which are in turn swallowed by the dog with water and food, or while licking or biting the skin to relieve the irrita- tion which they produce. They then attach themselves to the walls of the intestine where they develop into the adult worm. (b) Tcenia pisiformis (Tcenia serrata). This parasite is about 1 meter long, head a little broader than the neck, and armed with 24 to 38 hooks. Segments at first are much shorter than broad, about square in the middle portion while the mature segments are 10 to 17 mm. long by 4 to t> mm. broad. Genital pore on the lateral border, and very promi- nent, causing the border to appear convex and the segment to be wider in the middle than at the ends. Posterior borders straight and the angles uneven which gives the strobila a saw-like appearance. Eggs are ovoid and 30 to 40 microns long and 31 to 30 microns broad. The cyst form is the Cys- ticercus pisiformis and is frequent in the peritoneal cavity 196 PARASITES IN THE INTESTINES of hares and rabbits. Dogs become infested by eating the viscera and in twelve days the tsenise are 2 to 3 cm. long, and matured in two months. The ripe ova given to rabbits become cysticerci. (c) Tcenia hydatigena (Tcenia marginata) . This is the largest tsenia found in the dog, being 1.5 to 2.0 m. long. The head is scarcely wider than the neck and has 30 to 44 hooks. The segments are nearly square with the genital pore on the lateral border which begins to develop in the seg- ments about one-fourth of the distance from the head. The posterior border of the segments is slightly wavy, and received into the succeeding segment. Mature segments when detached are about 15 mm. long by 7 mm. wide. The ova are almost spherical and from 30 to 36 microns in diameter. The cyst form is the Cysticercus tenuicollis and is commonly found in the peritoneum, pleura and even in the pericardium of domesticated animals, especially ruminants. It requires four to five months to fully develop into the mature worm. (d) Multiceps multiceps (Tcenia ccenurus). This worm rarely exceeds 1 m. in length. Head small, slightly broader than the neck and armed with 22 to 32 hooks. Segments narrower than any of the preceding species, becoming square with the genital pore developed about the 125th segment, 15 to 20 cm. from the head. Mature segments 10 to 12 m. long, 3 to 4 m. wide. Eggs spherical 31 to 36 microns in diameter. The cystic form is the Multiceps multiceps (Coenurus cerebralis) which is developed in the cerebro- spinal cavity of sheep; more rarely in other domesticated animals, causing the disease commonly called "gid." The cyst is polycephalic, the ingestion of one cyst producing numerous taenise. The tsenia requires about two to three months to reach maturity. (e) Multiceps serialis (Tcenia serialis}. This parasite is 45 to 75 cm. long, head wider than the neck and having 26 to 32 hooks. Segments similar to those of the M. multi- ceps. The ripe segments are 10 to 16 mm. long and 3 to 4 mm. wide, the posterior border being straight. Eggs ovoid and 34 microns long and 27 microns wide. The cyst form is TMNIASIS 197 the Multiceps serialis and its intermediate hosts are some of the rodents and warren rabbits. This tsenia develops more rapidly than the others requiring but a few weeks. (/) Echinococcus granulosiis (Tcenia echinococcus). This species is distinguished from all others by its size. It is only 4 to 5 mm. long, and composed of 3 to 4 segments, the last of which contains the mature ova. The head is armed with a double row of 28 to 50 hooks. Eggs ovoid, 34 by 25 microns. The cyst form is the Echinococcus granulosus (E. polymorphus) and is found in most of the organs of the herbivora and even man, but is more common in the liver and lungs of ruminants and pigs. It requires one month to fully develop. This cyst is polycephalic and polysomatic. Tseniae in the Intestine of the Cat. Three species of taenise have been found in the cat. (a) Tcenia tceniceformis (Tcenia crassicollis^.This is the most common tsenia found in the cat. It attains a length of 15 to 50 cm. and in appearance is similar to those found in the dog. The head is armed with a double crown of 26 to 52 hooks and is about as wide as the neck. The posterior segments are 8 to 10 mm. long and 5 to 6 mm. wide. Ova are globular and 31 to 37 mm. in diameter. This tsenia is repre- sented in the vesicular or bladder form by the Cysticercus fasciolaris which inhabits the liver of rats, mice and other rodents. This cysticercus, which is always coiled up in a cyst it has itself produced, is elongated in form, the body composed of segments, and from 3 to 20 cm. long, while the vesicle is ovoid and frequently no larger than a pea. (6) Tcenia elliptica and (c) Tcenia pseudo-elliptica have been described as a variety of the Dipylidium caninum of dogs; they are unimportant. (d) The Bothriocephalus felis has also been mentioned. Little is known about it and no disturbance in the cat has been ascribed to its presence. TaeniaB in the Intestine of Rabbits. Cestodes are rare in these animals and all belong to one species, the Cittotenia denticulata (Moniezia denticulata). These may attain the length of 8 cm., head small and supplied with suckers. Seg- ments 1 cm. broad and not so long. Two genital pores are 198 PARASITES IN THE INTESTINES in the posterior part of the segment. The cyst form and intermediate hosts are unknown. T sendee in the Intestines of Birds. In the intestines of the fowl, nine species of cestodes have been found eight tsenia and one bothriocephalus. The tsenise are difficult to distin- guish from one another, and as they are rare, little work has been done to establish their complete history. Outbreaks do occur, however, in which so many fowls are infested as to amount to an epizootic tseniasis. (a) Choanotcenia infundibuliformis, length 20 to 130 mm., armed and supplied with suckers. Intermediate host said to be the common house fly. (6) Dicranotcenia sphenoides, length 2 mm., head armed and supplied w r ith suckers. Intermediate host the earth- worm. (c) Davainea proglottina, length 1.0-1.5 mm., head armed, and supplied with suckers. The segments of this taenia are cast off as soon as mature. They continue to live and develop, greatly increasing in length. Intermediate hosts are various species of mollusca. (d) Davainea cesticillus, length 9 to 45 mm., head unarmed. Intermediate host unknown. (e) Davainea echinobothrida, length 50 to 100 mm., head has suckers and is armed. Intermediate host unknown. (/) Davainea tetragona, length 25-100 mm., head has suckers and armed. Intermediate host unknown. Very little is known of the other species. ( mm. long. Same characteristics as those found in the dog. 222 DISEASES OF THE RECTUM AND ANUS (c) Oxyuris ambigua, found in the rabbit. The male is 3 mm. to 5 mm. long, and the female 8 mm. to 11 mm. They are white fusiform worms the body terminating in a sublated or suddenly tapering tail. Sympt Dins. These parasites, by producing irritation to the rectal mucosa, induce severe pruritis, causing the animals to bi^e or lick the anus and often slide along on the floor to relieve the intense itching. The parasites are often seen projecting from the anal opening, or observed being passed with the feces. Aside from the disagreeable symptoms in- duced they do not effect much change to the mucosa, and no general symptoms are observed. Treatment. Oleaginous or saline infusions injected into the rectum with a syringe are usually sufficient to destroy them. These injections may be repeated every few days until the symptoms disappear. NEOPLASMS IN THE RECTUM. Tumors of the rectum and around the anal opening are occasionally observed, more commonly in dogs than in any of the other small animals. The most common tumors found in the rectum are adenocarcinomas or adenomas. Epithe- liomas also occur located outside the anus and originating from the skin. Occasionally are found fibromas and sarcomas originating from the periproctal connective tissue. Symptoms. The adenomas or adenocarcinomas found on the rectal mucosa or margin of the anal opening interfere with defecation and cause straining. They usually appear as fungus-like growths with ulcerated, bleeding surfaces. Their rapid development is characteristic. Epitheliomas occur as a wart- or cauliflower-like growth with a rough uneven surface situated in the skin around the 1 margin of the anal opening and often involving the anus, skin and periproctal connective tissue. These vary in size, may appear singly or multiple and often show an ulcerated surface, with a fetid discharge. Fibromas are usually quite large and grow from the peri- proctal tissue on one side of the anus. They may be two or three inches in diameter, and are characterized by their SUPPURATION OF THE ANAL GLANDS 223 slow growth, smooth surface and firm consistency. They greatly interfere with defecation. Diagnosis. While an approximate diagnosis may be made from the symptoms, the growth and the general appearance of enlargement, an accurate diagnosis depends upon the microscopical examination. Prognosis. Obviously the prognosis in all malignant tumors is unfavorable, because of the danger of recurrence and the difficulty of a complete removal. Benign tumors when not too extensive take on the other hand a favorable prognosis. Treatment. Tumors should be extirpated early. Under general anesthesia, and strict antiseptic precautions, they should be carefully dissected out, including some of the normal tissue to be sure the entire growth is obtained. A ligature is applied firmly around the base of them to con- trol the hemorrhage, when they may be removed with the scissors or knife. Sometimes it is advisable to cauterize the base of the tumor with a thermocautery. Other methods of procedure in the removal of these growths will depend very largely upon the location, size and character of the tumor. SUPPURATION OF THE ANAL GLANDS. This condition has been observed quite frequently in the dog. The anal glands secrete a grayish or brownish material of fetid odor and acid reaction, discharged through a circular Opening on either side of the margin of the anus. In .old animals the secreting membrane often becomes inflamed or irritated from constipation, foreign bodies, infection, etc., which changes the character of the secreted material. From infection, the secretion becomes purulent and the orifice partially or completely closed giving rise to a retention of the secretion, and swelling. In some cases an increase of the secretion may result causing discharge which collects on the margin of the anus or soils the hair around the anal region. Sometimes when the orifices become closed, and no outlet is left for the escape of the discharge, the skin perforates over the enlargement forming an exit for the escape of the 224 DISEASES OF THE RECTUM AND ANUS discharge. Thus a fistulous tract may form. Painful defe- cation is noted, or, if the pain is great, severe constipation results. There are frequent attempts at defecation, and pruritis. Direct examination reveals the presence of a hot, sensitive, fluctuating enlargement or there may be a fistula present. The discharge is noted when it collects on the hair around the anus and tail which it stains, and an offensive odor is emitted. Diagnosis. Usually not difficult as a direct examination will reveal the condition. Treatment. When the enlargement is present, the contents of the sac should be expelled by pressure with the thumb and finger. This should be repeated daily for several days in case the sac shows a tendency to refill. If necessary to stop the discharge, Lugol's solution or tincture of iodin should be injected with a hypodermic syringe, enough of either to slightly distend the sacs. This treatment can be repeated in a few days if necessary. Should a fistulous tract be found, it should first be thoroughly cleansed with an antiseptic solution (boric acid 2 per cent.) to remove all of the secretions, etc., then injected with Lugol's solution to destroy the secreting membrane. This treatment should be repeated every few days until the discharge ceases. CHAPTER XII. DISEASES OF THE LIVER. Examination. The liver is examined by: (a) Palpation. This method is not very satisfactory owing to the well protected position of the liver, and the thickness of the abdominal muscles over it. However, when the liver is much enlarged from acute inflammation, etc., it is possible to palpate it through the walls. (6) Laparotomy. When a thorough examination of the liver is desired this method is much more satisfactory than by palpation. The incision is made just posterior to the xiphoid cartilage, same as for gastrotomy, and long enough to admit of a thorough examination. The liver should be examined for inflammations, atrophy, cirrhosis, foreign bodies, abscesses, tumors, injuries, etc. ICTERUS. JAUNDICE. Definition. Icterus (jaundice) is a term applied to staining of the tissues with bile pigments. It is characterized clini- cally by a yellowish or greenish-yellow discoloration of the skin, mucous membranes, and the presence of the bile pig- ments in the urine. This is not a disease in itself, but merely a symptom of a number of conditions, indicative of a disturb- ance in the secretion or excretion of bile, which is significant of a disease of the liver. Etiology. Icterus evidently results from two general conditions: (a) An obstruction at some point in the course of the biliary ducts in consequence of which the bile becomes absorbed by the lymphatics or the bloodvessels, producing icterus by stasis or hepatogenous icterus. This form of icterus is very common in the dog and has a number of 15 226 DISEASES OF THE LIVER etiological factors, which are: Catarrhal inflammations of the mucous membrane of the stomach and duodenum, the inflammation being sufficient in a number of cases to close the orifice of the duct by the swelling of the mucosa; foreign bodies in the duct producing irritation and swelling; parasites; gall-stones; inflammatory conditions of the duct; neoplastic formations in the duct; cicatricial stenosis of the duct; compression of the duct from without by tumors on or in the stomach, intestine, lymph glands or mesentery. Adhesions after operations (gastrotomy), fecal accumulations, aneu- rysms of the arteries, interference with the outflow of bile by torsion of the ducts which sometimes occurs during preg- nancy, tumors in the abdomen, etc.; localized inflammatory processes in the liver (abscesses), and primary and secondary new growths in the liver are further etiological factors. Obstruction of the bile ducts causes the bile to be retained in the liver, the hepatic cells continue to secrete bile and to convert into bile pigments the free hemoglobin brought thither. From the resulting accumulation the pressure in the smaller biliary capillaries increases causing them to rupture into the lymph spaces to be eventually carried through the lymph vessels to the general circulation. (6) Disturbance in the function of the liver cells, diverting the bile from the biliary capillaries to the lymphatics or blood- vessels producing icterus by hemolysis or hemohepatogenous icterus. This form of icterus occurs most commonly from the following: In many infections, such as the different types of infectious icterus; distemper (partly obstructive, by producing a catarrhal inflammation of the duodenum); pyemia; in the different forms of intoxications, poisonings by ptomaines, mineral poisons (phosphorus, arsenic, coal-tar products, etc.); pernicious anemia; hemoglobinemia; disturb- ance of the circulation, such as passive congestion; some nerv- ous diseases, whereby the function of the liver is modified. Pathology. Yellow discoloration of all the organs and tissues by the bile pigment with the exception of some of the nervous and corneal tissue, characterizes the postmortem. The discoloration varies from a slight tinge of yellow to a deep greenish yellow, depending upon the amount of bile ICTERUS JAUNDICE 227 pigment deposited. Catarrhal inflammation of the stomach and duodenum is often observed, the mucous membrane swollen, the bloodvessels congested, and as a rule the mouth of the hepatic duct will be found closed from the swelling of the mucosa. The duct itself is often found occluded from a swelling of its membranes from infection, parasites, foreign bodies, gall-stones, etc. The duct is usually partially filled with a thick, syrupy, or semisolid mass of bile and mucus. The liver is usually found enlarged, and varies in color from a diffuse light yellow to yellowish-brown, or the color may be irregularly distributed causing a mottled appearance. The boWtel contents are light gray or slate gray in color, owing to the absence of bile, and emit a fetid odor. Symptoms. The early manifestations of icterus depend largely upon the underlying causes of which jaundice is merely a symptom. All of the tissues and organs, with the exception of the nervous, are stained with biliary pigments; in very severe cases where infection is the cause the nervous system may also be stained. The discoloration is most noticeable in the skin and mucous membrane. Mucous Membranes and Skin. Icterus is first manifested by a yellowish discoloration of the eye involving the con- junctiva and sclera. In very mild cases a slight tinge of yellow noticed on the conjunctiva may be the only symptom of the condition. As a rule, as the disease progresses the other visible mucous membranes will also show the yellowish discoloration. In the dog the entire membranes of the mouth will be colored yellow. The skin, especially if non- pigmented, becomes a characteristic light yellow, or greenish- yellow depending upon the amount of bile pigment distribut- ed. The discoloration is seen early on the skin of the abdo- men, thighs, and ultimately over the entire body. In dark skinned animals the condition can also be observed, the skin assuming a dark olive green color. The color of the skin may assist somewhat in arriving at the possible etiological factor, as the discoloration is usually light in the toxic or hemo- hepatogenous icterus, while it usually is darkest when the ducts are completely obstructed hepatogenous icterus. The intensity of the external symptoms, therefore, is in pro- 228 DISEASES OF THE LIVER portion to the completeness of the obstruction to the ducts and to the extent of the rupturing o*f the biliary capillaries. The symptoms develop on the external membranes, as a rule, in a few hours, although in some cases of slow development three to four days may be required depending upon the degree of infection or obstruction of the ducts. The Urine. This is changed in color to a yellowish-green, dark green, yellowish-red, or greenish-brown, depending upon the amounts of bilirubin, biliverdin (oxidation prod- ucts), or urobilin (reduction product). These bile pigments are often observed in the urine before any discoloration takes place in the tissues, therefore the urine furnishes an e&rly important symptom. The urine when it comes in contact with organic matter will stain it the color of bile, or upon shaking or agitating the urine it will form a foamy liquid, which is quite characteristic. Gmelin's test may also be used for recognition of icteric urine. In addition to the bile pigments the urine often contains a number of hyaline casts (indicating nephritis) and desquamated epithelial cells. (>astro-intestinal Tract. The absence of bile from the intestinal tract results in most cases in the passage of pale, grayish, clay colored, or slate gray feces, having a fetid odor, and containing undigested fat, and hydrobilirubin. The pale color is due partly to the absence of bile, and partly to the imperfectly digested fat which may be increased from the normal 20 to 50 per cent. The fetid odor of the feces is ascribed to the absence of bile which when present limits fermentation of the intestinal contents. Constipation is the rule in the majority of cases. However, diarrhea may be present in some cases due to the imperfect digestion of the fats and to the laxative action of free fatty acids which are formed. The constipation is due no doubt, when present, to defective motility of the muscular walls of the bowels, from lack of the normal stimulating properties of the bile. In- creased acidity of the stomach is observed in many cases, the obstruction to the flow of bile apparently causing an increase in the activity of the gastric secretion. Nervous System. Serious nervous symptoms are often observed. The bile salts present in the circulation are at ICTERUS JAUNDICE 229 once carried to the nervous system, and, when accumulated in sufficient quantities, will produce by irritation of the nerve cells marked symptoms of active delirium, convulsions, etc. This period of excitement and delirium, as a rule, lasts only a very short time, terminating in depression, muscular de- bility, somnolence, and eventually deep coma and death from a general paralysis. The general symptoms (loss of appetite, increased thirst) are noticeable from the beginning. Usually a subnormal temperature (96-100 F.) exists, depending upon the severity of the condition. Examination of the liver by palpation is unsatisfactory, as pain or enlargement of the liver is rarely noted. Diagnosis The recognition of this condition offers no difficulties, as the symptoms are very characteristic. How- ever, the cause in many cases is hard to determine. In dogs digestive disturbances, often resulting from errors in diet, etc., produce the largest percentage of cases. Here the anamnesis is valuable. From infectious jaundice a differen- tiation can in most cases be made from the fact that this condition occurs mostly in young dogs (puppies) and in an enzootic form, affecting all the puppies of a litter. Prognosis. The prognosis in icterus is generally speaking unfavorable. A large percentage of the cases in the dog terminate fatally. In mild cases, due to catarrhal inflamma- tion of the mucous membrane of the duodenum, recovery usually takes place. The cause, if possible, should be ascer- tained, and the conditions thoroughly considered before making a prognosis. Treatment. Dietetic. In the milder cases where the appetite is retained small quantities of lean meat should be given, avoiding all fats for a few days. In severe cases to conserve the animal's strength eggs, given in small quantities of milk, are useful. During convalescence foods should be allowed only in small quantities, avoiding fats and irritating foods as much as possible. lied ical. When icterus is the result of catarrhal inflamma- tion of the duodenum, it is advisable to irrigate the stomach with bicarbonate of soda solution (2 per cent.), repeating this 230 DISEASES OF THE LIVER operation until all mucus is dissolved and the liquid flows out clear. This treatment should be used at least once or twice daily. Following the stomach lavage Carlsbad salts (0.5-2.0) are useful to stimulate secretions and to dissolve the mucus accumulated on the mucous membrane of the stomach and duodenum. In some cases this will be sufficient to. allow the escape of the bile into the duodenum. Injections of warm water or warm bicarbonate of soda solution (2 per cent.) into the rectum as high up as possible are often valuable to stimulate peristalsis, encourage defeca- tion, and to produce alkalinity of the intestinal contents. Should constipation be present calomel (dog, 0.3-0.4; cat, 0.1-0.15) should be given and repeated in twelve to fifteen hours if catharsis has not been established. Magnesium sulphate (dog, 8.0-16.0; cat, 1.0-4.0) or castor oil (dog, 15.0-16.0; cat, 5.0-20.0) may be used for the same pur- pose. In severe cases it is advisable to try to overcome the obstruction to the duct and empty the gall-bladder, either by mechanically compressing the liver by manipulation or by the use of emetics. The latter method has proved to be the most satisfactory. The action of the emetic by contracting the abdominal muscles will often exert enough pressure upon the liver and gall-bladder to force the bile out into the bowel. An obstruction, such as mucus, parasites, foreign bodies, etc., can thus also often be removed. When the bile pigments are deposited in the body in large quantities, or the blood contains a large amount of unde- posited bile salts, its elimination should be encouraged by the use of diuretics. Potassium acetate or nitrate (dog, 0.20- 0.50; cat, 0.05-0.10) is to be given twice daily. General stimulants, such as camphor or ether, are indicated when general depression and coma are observed. In severe cases normal salt solution given as an intravenous injection is useful to assist in the elimination of bile and to produce general stimulation. Faradization of the liver has been tried but its usefulness is questionable. CONGESTION OF THE LIVER 231 CONGESTION OF THE LIVER. Two forms of this disease are distinguished: (a) Active, and (b) passive. Active Congestion. Definition. An engorgement of the liver with blood resulting from an increased circulation through the portal vein or hepatic artery. Etiology. There are a number of etiological factors in active congestion of the liver: (a) During the process of digestion there is a physiological increase in the amount of blood carried to the liver by the portal vein. This, however, usually subsides after digestion is completed. In small animals, owing to the great variation in the amount and quality of food taken, and the fact that the food often contains irritating material, toxins, ptomaines, etc., all of which increase the functional activity of the liver, a more or less permanent active congestion results. (6) Various poisons provoke a severe form of congestion of the liver. These include many autogenic poisons carried to the liver from the intestinal tract by the portal vein, or certain ptomaines preformed in the food before it is ingested. Min- eral poisons (arsenic, mercury, phosphorus) can produce it. Some of the toxic products of infections, which develop in the intestinal tract, will sometimes be carried to the liver in sufficient quantities to excite an acute congestion, (c) Con- gestion of the liver may also result from the specific products of certain infections (virus of distemper, staphylococci and streptococci) that may reach the liver via the general circula- tion, (d) Dogs, when kept indoors, fed on highly nutritious food, and not receiving the proper amount of exercise, will often develop active congestion of the liver. Many of the causes mentioned are also the chief etiological factors in producing inflammation of the liver (hepatitis) of which congestion is the first stage. Pathology. The liver is enlarged, feels firm or hard, contains an increased amount of blood, and is of a dark red or reddish-brown color. On cut surface, the blood drips or flows off freely. 232 DISEASES OF THE LIVER Symptoms. -Due to the fact that excretion is interfered with, which leads to a general intoxication of the body, general symptoms of stupidity, depression, loss of appetite, etc., appear. Nausea and vomiting are often observed. Constipation is the rule. The feces are clay colored and have a fetid odor. Jaundice, which is nearly always present, is first noticed in the conjunctiva; the urine is stained yellow with bile pigment. The liver is usually enlarged and by palpation it may be distinguished through the abdominal walls; also is often quite painful to the animal when com- pressed by digital pressure. The urine is highly colored (often green), of high specific gravity, and shows precipitates of urates and uric acid. The body temperature is either normal or subnormal. Diagnosis. An accurate diagnosis presents some difficul- ties. The causes (history), the disturbance of the digestive tract, the jaundice, and the enlarged and painful liver, should be considered in arriving at a definite conclusion. In atypical cases an accurate diagnosis is impossible, although enough symptoms may develop to suspect the acute congestion. Prognosis. The prognosis is usually favorable, except in those cases produced by poisons and infections. In these the prognosis will depend largely upon the character of the infection or the nature and amount of the poison. Course. In most cases the course is short, rarely lasting over two to four days. Treatment. Dietetic. All irritating food should be with- held. The diet should consist almost entirely of milk given only in small quantities with long intervals between meals. Lime water added to the milk, to make it alkaline, will have a beneficial action on the mucosa of the stomach and intestines. Medical. Free purgation is indicated early. Magnesium sulphate (dog, 10.0-15.0; cat, 1.0-5.0) has proved to be the most satisfactory. These doses .should be repeated until free catharsis has been established. Calomel may also be used, but is not as good as magnesium sulphate, as its action is more cholagogic which would be contraindicated where con- gestion of the liver exists. When nausea and vomiting are present, indicating an irritated condition of the stomach and CONGESTION OF THE LIVER 23! 5 intestinal muco.su, sodium bicarbonate (dog, 0.5-1.0; cat, 0.2-0.8) given three to four times daily is beneficial. Am- monium chlorid (dog, 0.5-1.2; cat, 0.2-0.5) given three times daily will assist in the excretion of the urea, uric acid, etc., and relieve the intestinal catarrh. During convalescence bitter stomachics are indicated to stimulate secretions and to assist in digestion. Intestinal antiseptics, such as salol, are also often indicated. Passive Congestion. Definition. A congestion of the liver due to some impediment in the efferent circulation of the blood in the liver. Etiology. This condition may result from the following: (a) Defective heart action, whether it be acute or chronic, such as valvular insufficiencies. (6) During the course of some diseases of the lungs which increase the work of the right side of the heart, eventually weakening it. Examples are emphysema, chronic bronchitis (common in old dogs), compression by pleural exudates, adhesive pleuritis, tumors of the mediastinum, etc. (c) Local obstructions to the circula- tion of blood through the hepatic veins and posterior vena cava. The most common are: Pleural or peritoneal effu- sions (when in large quantities, displacing the heart or com- pressing the veins), tumors of the liver (carcinomas and sarcomas in older animals), adhesions around the liver from abdominal operations, injuries, etc. Pathology. The congested liver in the early stages is somewhat increased in size, depending upon the amount of blood contained. The organ is firm, dense and of a bluish or dark purple color. Cut section shows a more or less uniformly congested, dark-blue or purplish color, and presents a mottled appear- ance with light areas. In the advanced stages there is an excess of blood, and the liver presents the characteristics of the "nutmeg" liver; the intralobular and sublobular venules being distended and filled with blood, appearing as dark blue, purplish or reddish spots, while the liver cells are pale yellowish, or whitish, showing fatty infiltration and biliary pigmentation, which gives the marked contrast in color ("nutmeg" liver). In the most advanced stages, the 234 DISEASES OF THE LIVER liver becomes smaller, and may be smaller than normal. It is firm and dense, but still retains the characteristic nutmeg appearance. Connective tissue develops around the central veins; the adjacent hepatic tissue is atrophic and pigmented, and invading it are fine fibrous connective tissue trabeculse. The capsule is often thickened and opaque. Symptoms. The symptoms vary greatly, depending largely upon the causes. When due to primary cardiac or pulmonary disease, the symptoms are complicated with these condi- tions, those of the primary condition usually predominating. The local symptoms are principally loss of appetite, dis-. turbance in digestion, nausea, vomiting, and more or less obstinate constipation. Jaundice is a common symptom. It may be moderate. The cyanosis which is present in the conjunctiva with the jaundice produces a peculiar bluish- green color of the mucous membranes. In cases where infec- tion develops rapidly, the jaundice increases, often producing nervous symptoms such as excitement, convulsions, etc. Ascites is a common symptom in the later stages resulting from the extensive interference with the circulation. A large amount of fluid is often found in the abdominal cavity, especially in dogs. In the early stages the liver is enlarged, while in the more advanced cases it may be atrophied. Examination of the liver, therefore, by palpation may not reveal any characteristic condition. An accompanying gastro-intestinal catarrh develops which interferes with digestion; the chronic course leads to general weakness and emaciation. Diagnosis. The diagnosis depends upon finding the primary disease of the heart or lungs, the condition of the liver, and the local symptoms' of icterus, gastro-intestinal catarrh, etc. An accurate diagnosis is somewhat difficult. A careful examination of the patient and the prolonged chronic course of the disease will assist in arriving at an accurate conclusion. Prognosis. As a rule unfavorable, especially in the dog. It depends upon the primary condition, the stage of the disease and the condition of the animal. HEPATITIS 235 Treatment. Dietetic. Treatment affords only temporary relief. Encourage the animal to eat, by giving small amounts of lean meat, milk, etc., which may be given in conjunction with alkalies (sodium bicarbonate) to conserve the strength. Medical. For defective circulation, due to diminished heart action (valvular insufficiency), digitalis fluidextract (dog, 0.1-0.3; cat, 0.025-0.05 once or twice daily) is the most efficient drug, especially when used in the early stages. Magnesium sulphate should be given in constipation. Stomachic tonics (gentian, nux vomica) are also indicated. HEPATITIS. Definition. An acute or chronic inflammation of the liver. This comprises a series of most diverse conditions varying from active congestion, acute or chronic inflammation, to localized foci of necrosis or to the different forms of icterus gravis. Etiology. Hepatitis may result from the many causes enumerated under active congestion of the liver (see Conges- tion). The only real difference between the conditions is in degree. A clinical differentiation, therefore, may be difficult. Acute hepatitis is most commonly due to the absorption of toxins during the course of infections or specific infectious diseases. It may also result from the absorption of toxic materials, such as poisons, from the intestinal tract (common in dogs) . Chronic interstitial hepatitis may develop from the acute or from valvular disease of the heart. Pathology. In acute hepatitis the pathological changes are varied. The whole phenomena of inflammation (congestion, cloudy swelling, focal necrosis, etc.) may be present. In mild cases the liver appears as in active congestion with cloudy swelling. In severe cases the pathological changes are intensified. The liver is enlarged, swollen, softened, and rather pale in color; the cut surface is pale, opaque, and shows mottling depending upon the degree of inflammation. Symptoms. The symptoms are very similar in many res- pects to those of active congestion of the liver of which acute 236 DISEASES OF THE LIVER hepatitis is a more advanced stage. As a rule the symptoms are more intensive than in acute congestion. Nausea and vomiting are more pronounced and usually more persistent; the vomited material often contains a quantity of bile color- ing the material a greenish color. Blood may be vomited up along with the other material, from the irritation of the mucous membrane. Constipation is nearly always present. At certain periods in the course of the disease diarrhea may appear. The fecal discharges are very fetid, yellowish or clay colored. Icterus, noticeable on the conjunctiva, mucous membrane of the mouth, and sometimes in the non- pigmented skin, will be a prominent symptom. The liver is found enlarged and sensitive on palpation. The urine is usually concentrated, highly colored, of increased specific gravity, and contains a high percentage of urates and uric acid as well as bile pigment. The temperature in the early stages of acute hepatitis is usually quite materially elevated (103-104 F.). The fever temperature assists in differentiating the condition from simple congestion. However, in the later stages, the tem- perature may be found normal, or even subnormal, due to retained toxins, bile salts, etc. The general symptoms are dullness, intense thirst, and gastro-intestinal disturbance. Diagnosis. The diagnosis depends on the causes, the elevation of temperature, the enlargement and sensitiveness of the liver, and the general symptoms. To distinguish between acute congestion and inflammation of the liver is difficult and depends upon the severity of the symptoms. Prognosis. The prognosis is unfavorable. In some of the milder cases recovery takes place, but when advanced it nearly always proves fatal. Treatment. The treatment for active congestion of the liver is applicable. (See Active Congestion of the Liver.) In chronic hepatitis treatment is valueless. Suppurative Hepatitis. Abscess of the Liver. Definition. An inflammation of the liver resulting in abscess formation, which occurs under a variety of circumstances and in several forms. Liver abscesses are commonly divided into two kinds : (a) The large single abscess; (b) the small multiple abscess. HEPATITIS 237 Fundamentally, however, the two kinds may not differ from each other, since the large single abscess may become multiple by infecting adjacent liver tissue giving rise to the develop- ment of secondary abscesses. By coalescence a number of small abscesses may by peripheral extension form a large single abscess. Etiology. Liver abscess is always the result of infection by microorganisms (staphylococci, streptococci) which reach the liver in one of several ways: (a) Traumatism. In small animals injuries, direct or indirect, frequently give rise to abscess of the liver. Direct injuries, such as punctured wounds, gunshot wounds, etc., permit the entrance of pyogenic organisms. Indirectly contusions or rupture of the liver, which reduce the resistance to infecting organisms which may be circulating in the hepatic or portal blood. Such usually produces a single, small or medium-sized abscess. (6) Diseases of contiguous organs often occasion the forma- tion of abscess in the liver. Examples are: Gastric or duodenal ulcer with perforation; abdominal organs which have been operated and infected, and suppurative conditions of adjacent organs. (c) Infection via the portal or hepatic circulation. Multi- ple abscesses result from gangrene or abscess of the lungs, purulent pleuritis, purulent and fetid bronchitis, etc. These processes give rise to many infectious einboli which lodge in the liver forming abscesses. (<7) Infection via the biliary ducts. Here abscess forma- tion is due to the infection carried in through the bile ducts, or by direct extension of ulcerative and suppurative processes in the biliary tract to the adjacent liver tissue. (c) In some cases infection may take place through the lymphatics. Pathology. Tin- appearance of the liver will vary greatly, depending upon the mode of infection, the virulence of the infecting material, and the location and number of abscesses. Abscesses resulting from traumatism, ulcerative and suppurative processes in adjacent organs are usually single, small or of moderate size, and mostly superficial. These abscesses are in isolated areas, a focus of inflammation sur- 238 DISEASES OF THE LIVER rounded by a zone of intense hyperemia. In or near the center liquefaction necrosis of the exudation begins which spreads by peripheral extension until a smaller or larger area of softened or fluid purulent material, surrounded by a more or less well defined zone of limitation, results. The softened material consists of leukocytes, red cells, necrotic and degenerated liver tissue, infection, etc. The abscesses are very commonly situated near or on the surface of the liver. The surface of the liver is, therefore, involved (peri- hepatitis), and extensive adhesions may bind to it the contiguous organs. In some cases (especially after opera- tions) the abscess is on rather than in the liver (suprahepatic, infrahepatic) . When small, multiple, metastatic abscesses are present, the liver is usually enlarged, swollen, opaque, and shows evidence of parenchymatous degeneration, or cloudy swelling. On section the organ reveals numerous grayish or yellowish, softened spots surrounded by hyperemic zones; the spots vary considerably in size depending upon the stage of develop- ment of the condition. In some cases the numerous small abscesses, by peripheral extension, become confluent and form a large abscess which may involve a whole lobe or in some cases the entire liver. The purulent contents are usually thick, creamy, yellowish, or thinner and seropurulent, or stained with blood or bile; the surrounding liver tissue is in most cases stained a greenish-yellow tint. The pus often has an offensive odor especially when due to gastric or duo- denal ulcers. Symptoms. The early manifestations are not very charac- teristic. Therefore, unless the condition is well established involving a large portion of the liver, or interfering severely with its function, it is apt to be overlooked. In traumatic abscess, and abscesses due to spread of infection from adjacent organs, the patient usually shows pain in the region of the liver, especially when the animal is handled or moved about. Jaundice, due to compression of the biliary ducts, and enlargement of the liver can usually be determined by palpation; fluctuation may also be evident. In multiple abscess the diagnosis is difficult,, as there are HEPATITIS 239 no characteristic symptoms. The temperature is variable, usually slightly elevated; chills may 'be present. Examina- tion of the blood often reveals leukocytosis, which is not always present, especially in chronic, well encapsulated abscesses. The urine is concentrated, highly colored, specific gravity increased, with an abundant deposit of urates and uric acid. When there is much destruction of the liver tissue the amount of urea is diminished, and albumin is often present. Spontaneous rupture of the abscesses often takes place, especially in those cases resulting from traumatism, causing serious symptoms to suddenly develop. As in most cases the rupture occurs into the peritoneal cavity, a generalized peritonitis follows which soon leads to death. Diagnosis. An accurate diagnosis is usually quite difficult. The most suggestive signs are progressive enlargement and tenderness of the liver, jaundice, chills and fever, leukocytosis, and the consideration of the etiological factors. When an abscess is suspected an accurate diagnosis can be made with safety (especially in the dog) by making an explorative laparotomy. Prognosis. Abscesses of the liver even in the single supra- hepatic form should always be considered unfavorable. The small multiple abscesses are almost always fatal, death occurring in one to two weeks. Treatment. The early indications in the treatment are surgical. Under general anesthesia and strict antiseptic- precautions, an explorative laparotomy should be per- formed. The incision in the abdominal wall should be made large enough to admit of a careful and free examination of the liver. Should the abscess be suprahepatic, or single in the liver substance, that portion of the liver is carefully brought out through the incision. It is very important that the liver be carefully manipulated to prevent rupturing the abscess. Should the abscess be of large size, it is often advisable to aspirate most of the contents before it is manipu- lated to prevent rupture of the sac and also to facilitate its withdrawal through the abdominal incision. \Vhen the affected portion of the liver is withdrawn, it should be sur- 240 DISEASES OF THE LIVER 4 rounded on either side with sterile gauze to prevent any of the pus entering the cavity while operating. A free incision is made directly over the abscess its full length, the contents of the cavity thoroughly washed out with boric acid solution (2 per cent.) and the abscess wall thoroughly curetted to remove all of the necrotic tissue and detritus. If necessary some of the tissue is removed with the scissors or knife to straighten the edges of the wound, and also to be sure to remove all of the necrotic tissue. The wound in the liver is sutured with a deep continuous suture. Should the hemor- rhage interfere it should be controlled by ligating the larger vessels. Should the abscess be suprahepatic or infrahepatic, the affected parts should be carefully withdrawn, the adhesions broken down and the entire wall of the abscess completely extirpated. All exposed portions should be thoroughly irrigated before returning to the abdominal cavity. When multiple abscesses are found surgical treatment is rarely of value. The external wound is sutured as in gastrot- omy. (See Gastrotomy.) ATROPHY OF THE LIVER. Definition. A term generally applied to a reduction in the size of the liver. In most conditions where there is a reduc- tion in the size of the liver it is due to degenerative changes. Etiology. Atrophy of the liver occurs most commonly from the following: (a) Pressure upon the liver, by tumors, enlargement of adjacent organs, passive congestion, amyloid disease, etc. These causes may produce a true atrophic condition of the liver with subsequent replacement fibrosis, or atrophy and degeneration (fatty degeneration and necrosis) as in passive congestion and amyloid disease. (b) From a stenosis or occlusion of the portal vein, general hepatitis, advanced passive congestion, etc., a general atrophy of the liver may develop. (c) A reduction in the size of the liver, which is not a true atrophic condition, follows many degenerative processes, FATTY LIVER 241 such as poisoning by phosphorus, arsenic, mercury, chloro- form, etc. (d) Reduction in the size of the liver frequently occurs, to which the term atrophy is applicable, in inanition, cachexia, etc. In this case the liver participates in the general atrophic process. Pathology. The liver is smaller than normal, dark in color, dense, of increased specific gravity, and dry. These changes are the result of the increase in the connective tissue and the decrease in the parenchyma. On cut section the surface is dry, and the liver substance very dense and firm. Symptoms. The symptoms are not very characteristic. There will be noticed inanition, cachexia, etc. The patient shows digestive disturbances, and the feces are light colored. The liver is very small ; owing to its location it is difficult to palpate. Diagnosis. An accurate diagnosis is in most cases impos- sible during the life of the animal. The etiological factors may assist somewhat in making a diagnosis. Prognosis. The prognosis should always be considered unfavorable, owing to the structural change which has taken place in the liver, and the difficulty of removing the causative factors. Treatment. Satisfactory treatment is hardly possible, although treatment for the removal of the cause would be indicated. FATTY LIVER. Definition. A term applied to the excessive amount of fat' in the liver. It includes fatty infiltration, in which there is an excessive deposit of fat without the liver cells becoming much altered, and also fatty degeneration, in which the liver cells are converted into fat cells. Etiology. The causes are: (a) Feeding of animal for a long period on fats and carbohydrates, without the proper amount of exercise. This tends to produce obesity (which is common in house dogs), of which fatty liver is a common symptom. The fatty deposit is probably due to the incom- plete oxidation of the excessive amounts of food. (6) Anemia, 16 242 DISEASES OF THE LIVER and cachexia, occurring in the later stages of chronic diseases, carcinomatosis and sarcomatosis, general inanition, etc. These conditions result in an insufficient supply of blood, therefore incomplete oxidation, (c) Passive congestion of the liver due to valvular insufficiency of the heart, (d) Poisonings, such as phosphorus, arsenic, mercury, etc., which are very common in small animals. Ptomaines from meats will produce a similar effect, (e) Infections developing in the intestinal tract, as distemper, infectious diarrheas, etc., the toxins of which are carried to the liver through the portal vein. General infection, such as by pyogenic organ- isms, will produce the same effect on the liver. It is quite evident that the majority of cases of fatty liver develop through a deficient oxidation. Pathology. The liver is enlarged, often twice the normal size, the specific gravity lessened, and the resistance reduced. It is pale yellow in color, or yellowish areas or streaks are seen on the surface. The surface is smooth, and the edges somewhat rounded. On cross-section it is usually pale, anemic, and fat globules which adhere to the knife are often noted. In cases of passive congestion the characteristic appearance of nutmeg liver is observed (dark center and light periphery of the lobules). Symptoms. The symptoms of fatty liver are very obscure, and not sufficient in most cases to make an accurate diagnosis intra mtam. AMYLOID LIVER. Definition. A degenerative process of the liver charac- terized by the conversion of the proteins of the tissues into a structureless, homogeneous substance called lardacein. Etiology. This condition results most commonly in animals from the absorption of the toxins of pyogenic organisms. It requires for its production a long time and a persistent and continuous infection. It is not a very common condition in animals, and usually accompanies a general amyloid degen- eration of other organs. Pathology. The liver is enlarged, sometimes two or three times its normal size, and the edges are rounded or blunt. CIRRHOSIS OF THE LIVER 243 The color is grayish-brown, and on cut section shows white points. Microscopic examination reveals the amyloid degen- eration. Symptoms. Difficult to recognize during the life of the animal, and is only of importance to the pathologist. Other degenerative conditions. which have been observed on post- mortem in small animals are only of importance to the student in pathology and will not be described here, as a diagnosis can only be made on postmortem. CIRRHOSIS OF THE LIVER. Chronic Interstitial Hepatitis. Definition. A chronic inflammation of the liver with an increase in the interstitial connective tissue. Etiology. The exact causes are not definitely known. Infection no doubt plays an important role, bacterial toxins from the intestinal tract being carried direct to the liver. It may be produced secondarily from other diseases of the liver, such as acute and chronic hepatitis, congestion, etc. Parasitic invasion has been known to produce it in certain districts. Pathology. In the early stages the organ is usually en- larged; in later stages often atrophic. The liver maintains its shape, the surface is smooth, or in some cases granular. The color varies somewhat from a light green to a dark olive green, and the liver nodules are separated by connective tissue. The consistency of the liver is greatly increased, and when incised it cuts hard and grates under the knife, due to the excessive amount of connective tissue. The bile passages are usually found normal. Symptoms. The symptoms are those of a chronic condi- tion, with which is associated a disturbance in the intestinal tract. Jaundice, which is usually mild, producing only a slight tinge of yellow in the mucous membranes; bile in the urine, giving it a greenish color; nausea and vomiting are often observed in the dog. An enlargement of the liver can be readily detected by palpation. In the advanced stages of 244 DISEASES OF THE LIVER the disease there is often ascites, enlargement of the spleen, and eventually general cachexia. Diagnosis. In animals a diagnosis is very difficult. The condition is usually first noted on postmortem examination. An explorative laparotomy in the dog is recommendable. Prognosis. The prognosis is unfavorable owing to the changes which have developed in the structure of the liver. Treatment. Dietetic. Small quantities of easily digested food (raw, lean meat, milk, etc.) should be given to sustain the condition of the animal. Medical. Salines (magnesium sulphate, dog 8.0-12.0) are indicated to produce a laxative action. Should ascites be present diuretics are indicated to assist in the removal of the fluid from the abdominal cavity. Surgical. Thoracentesis abdominis is indicated. (See Ascites.) NEOPLASMS OF THE LIVER. Tumors of the liver are not very common, except second- ary to malignant growths in other organs. These consist mainly of carcinomas and sarcomas, which have become generalized (carcinomatosis and sarcomatosis) . Benign tumors are occasionally met with, viz.: Adenomas and angiomas. Symptoms. Tumors of the liver are difficult to recognize during life, and only in those cases where they become very large, producing distention of the abdomen, will they be recognizable. Palpation, when done carefully, will often reveal the tumor which will be freely movable in the cavity. If the tumor is malignant (sarcoma and carcinoma) it will lead to symptoms of anemia and cachexia. An accurate diagnosis can only be made after laparotomy. Treatment. When malignant tumors are found, no treat- ment is of value. Benign tumors may be removed by carefully ligating all vessels, and preferably removing an entire lobe of the liver where affected. Hemorrhage is usually severe when the tissue of the liver is incised. There- fore operations on the liver are always considered serious. CHOLELITHIASIS GALL-STONES 245 CHOLELITHIASIS. GALL-STONES. Cholelithiasis is quite rare in animals. Only a few cases have been reported where free concretions were found in the biliary ducts and these occurred most commonly in the gall-bladder and ductus choledochus. Gall-stones are the result of a catarrhal inflammation of the membrane of the duct or gall-bladder causing a desquamation of the epithe- lium and a collection of bile salts, gradually forming con- cretions. Infection or parasites gaining entrance via the duct and producing irritation are common causes. Symptoms. Gall-stones may exist for some time without producing any marked symptoms, depending upon the location of the concretion. When in the gall-bladder but little disturbance will be produced, but when the concretion passes out into the ductus choledochus, severe colicky symp- toms are observed, and by completely blocking the exit of the bile, obstruction or hepatogenous icterus is produced. (See Icterus or Jaundice.) A diagnosis is difficul: and, when suspected, an explorative laparotomy should be performed. Treatment. Surgical means should be employed early. Under general anesthesia laparotomy is performed, as for gastrotomy (see Gastrotomy) making the incision longer, if necessary. The portion of the liver containing the gall- bladder and duct is brought out through the incision. A careful examination should be made to determine the location of the concretion. When located, an incision is made down upon the concretion just large enough for its removal. Care should be taken to prevent the bile from running into the cavity. After all the concretions are removed the wound is stitched carefully with a fine suture using a small, straight needle. A continuous suture is first used to bring the edges of the wound in apposition, and then a Lembert suture to completely close the opening and to bring the serous membranes together for rapid healing. The parts should be thoroughly cleansed before returning to the abdominal cavity. The laparotomy wound is sutured in the regular manner. (See Laparotomy.) 246 DISEASES OF THE LIVER RUPTURE OF THE LIVER. i Ruptura Hepatw. Apoplexia Hepatis. Etiology. Owing to the structure of the liver being very friable and easily torn and its blood supply great, it is not uncommon that rupture of this organ takes place. The common causes are injuries, such as being run over by vehicles, penetrating rib fractures; severe exertion (running, jumping, falling, etc.), or during the course of infectious dis- eases when there is a severe congestion or inflammation of the liver. Predisposing factors are: Degenerative processes in the liver, such as fatty liver, amyloid liver, etc., or diseases of the heart and vessels. Pathology. The postmortem lesions depend largely upon the extent of the rupture. Small hemorrhages are often found showing through the capsule of the liver, greater may occur in the form of a large hematoma. In most cases, how- ever, the capsule also becomes torn and the blood is allowed to flow out into the abdominal cavity. The liver when examined will reveal the rupture. The other tissues and organs will be pale and anemic. Symptoms. Small hemorrhages in the liver will not pro- duce any marked symptoms. If severe there will be all the symptoms of internal hemorrhage, such as paleness of the mucous membranes, general weakness, anxious expression, weak rapid pulse, and dyspnea; the extremities and skin become cold, trembling of muscles, and finally coma. Death often takes place very suddenly or within ten or twelve hours, depending upon the extent of the rupture. Small and con- tinuous hemorrhages will be observed where the rupture is very small or where a hematoma is forming showing symp- toms of weakness, paleness of the membranes and often some icteric symptoms. Such cases often recover in a few days or death may occur from exhaustion in four to ten days. Diagnosis. An accurate diagnosis is very difficult. The anamnesis may assist in arriving at a definite conclusion. Prognosis. Should be considered unfavorable as most cases, especially where the hemorrhage is severe, terminate RUPTURE OF THE LIVER 247 fatally. Where slight hemorrhage takes place, the prognosis is more favorable, although if there is some disease of the liver present, fatal hemorrhage may recur at any time. Treatment. The treatment must be given as early as possible and is the same as for any internal hemorrhage. Subcutaneous injections of ergotin (dog, 0.1-0.3) or adrena- lin chlorid (0.5 to 1.0 of a 1-1000 solution) are useful. These doses can be repeated in a half to one hour if necessary. To stimulate the heart action strychnin sulphate (0.001) or caffein citrate (0.1-0.3) should be given every few hours. Otherwise the treatment is symptomatic. CjHAPTER XIII. DISEASES OF THE PERITONEUM. General Remarks. The peritoneum is a serous sac, and, considering all of its reflections and fossae, it covers a surface very nearly as great as that of the skin. In the female it differs from other serous cavities in that it has an indirect external opening through the uterine tube; in the male there is no opening. The peritoneum through the lymphatics and bloodvessels has great power of absorption as has been demonstrated on numerous occasions. The dog or rabbit will absorb fluid equal to 10 per cent, of the body weight in a half hour. Fluids and soluble substances are readily taken up and car- ried away by the blood, while insoluble substances, including microorganisms, are taken up by the lymphatics with the aid of the phagocytes. In health, the secretion of fluid into the peritoneal cavity and the absorption therefrom is just sufficient to keep the surfaces moist and free from infection. In disease this normal equilibrium becomes disturbed, and either produces a dry condition of the membrane, from absorption being greater than secretion (acute inflammation), or secretion being in excess of absorption (ascites). The presence of the fluid in the peritoneal sac has a further action than preventing friction to the surface, and that is by exert- ing a bactericidal action. The lymphatic absorption is carried forward by the lymphatic trunks to the mediastinal glands. Experiments have shown that microorganisms can be removed from the peritoneal sac via the lymph stream, and carried into the mediastinal glands in six minutes after their injection into the abdominal cavity. The peritoneum covering the dia- phragm and the omentum is most active in this process of GENERAL REMARKS 249 absorption, removing inert bodies and also microorganisms from the peritoneal cavity. The omentum is, further, an important factor in preventing peritonitis, in that it removes the microorganisms from the abdominal cavity before they can produce their pathogenic action. The omentum also has the great faculty of localizing inflammation and infection by attaching itself to any inflamed organ or possible source of infection. It becomes fixed around the margin of the inflammatory or infected area, where it adheres, preventing generalization. The omentum is an important protective mechanism after surgical work on the organs in the abdominal cavity. Another point worthy of mention is the fact that abscesses which develop following operations, puncture of abdominal walls, etc., usually open to the outside rather than in the abdominal cavity, due no doubt to the great defensive powers of the peritoneum as compared to the other tissues. The visceral peritoneum is not very sensitive to pain while the parietal is very sensitive. Therefore, the reason for extreme sensitiveness to pressure over the abdomen in acute peritonitis. The visceral peritoneum even in inflammatory conditions is not very sensitive. The natural resistance of the peritoneum varies greatly in the different animals. The dog seemingly has the greatest resistance, and, therefore, abdominal surgery can be practised on this animal with a much greater degree of safety than in other animals. The cat is slightly less resistant than the dog. However, it must always be remembered that there is a great variation in the natural resistance of individuals of the same species depend- ing to a great extent upon their physical condition, etc. As a summary, the defensive powers of the peritoneum are of great importance and are: (a) Its great absorbing power, removing organisms before they can multiply suffi- ciently, produce toxins, and excite inflammation, (b) The phagocytic action exerted by leukocytes, polymorphonuclear leukocytes and the endothelial cells, (c) The faculty of the omentum in walling off local infections and inflammations preventing diffuse peritonitis, (rf) The antitoxic and bactericidal properties of the peritoneal fluid. Thi- thud is increased when necessary. 250 DISEASES OF THE PERITONEUM PERITONITIS. Definition. An inflammation of the peritoneum. From the standpoints of intensity and duration peritonitis may be classified into: (a) Acute, and (6) chronic. .Acute Peritonitis. Definition. An acute inflammation of the peritoneum. From a clinical standpoint acute perito- nitis may be divided into: (a) Circumscribed or localized, and (6) general or diffuse. Other divisions are hardly recog- nizable during the life of the animal. Even the most severe cases of peritoneal infection often show the least evidence of inflammatory reaction. The inflammatory reaction which takes place in peritonitis is often a salutary process, by pre- venting excessive absorption from the peritoneum, leading to the destruction of microorganisms that have gained entrance, and by the formation of fibrin and adhesions preventing the spread of infection to the entire serous membrane. Etiology. From the standpoint of cause acute peritonitis may be divided into : (a) Primary, and (6) secondary. (a) Primary, acute peritonitis is applied to those cases where there is no local focus in the abdomen to account for the infection of the peritoneum; it is assumed that the infection has reached the abdomen by the blood or lymph stream, or from some injury to the abdominal wall, such as blows, kicks, gunshot wounds through the abdominal walls, bowels, etc., or operations of various kinds on the organs in the abdominal cavity. (6) Secondary, acute peritonitis is due to infection at some localized area in the abdomen, or in the immediate neighbor- hood, which develops rapidly producing a diffuse or circum- scribed inflammation. This form of peritonitis is very common in animals and results from a number of conditions. It may be due to infection from the abdominal viscera, following perforation of their walls, or to inflammation and the infection passing through the walls. The following con- ditions are frequent causes: Perforation of gastric or duodenal ulcer; acute toxic gastro-enteritis; mycotic gastro- enteritis; traumatic rupture of the stomach or bowels; strangulation of the bowels, volvulus; intussusception; PERITONITIS 251 foreign bodies in the bowels; iinpaction of the bowels; rupture of abscesses in the liver, spleen, omentura, lymph glands, etc.; rupture of the bladder when inflamed; acute phleg- monous, or gangrenous cholecystitis; metritis and para- metritis after parturition; injuries to the uterus during parturition; abscess of the prostate gland, etc. These con- ditions allow the free entrance of microorganisms, or reduce the resistance of the peritoneum so that organisms develop readily. Numerous organisms are found producing peri- tonitis, such as staphylococci, diplococci, streptococci, Bacillus bipolaris, Streptothrix canis, Bacillus pyogenes, Bacillus coli communis. In chickens, peritonitis is often found as a prominent condition in cholera, and also from different species of fungi, such as Aspergillus fumigatus, Aspergillus glaucus, etc. A fungoid peritonitis has also been observed in the dog produced by the Sporotrichum beurmani. Parasites (Pleurocercoides bailletis) when severe invasions take place will often produce peritonitis. Exposure to cold, and unsanitary conditions are often predisposing causes, especially in dogs and birds. Pathogenesis. As soon as the defensive powers of the peritoneum (the phagocytic action of the endothelial and other cells, the bactericidal power of the peritoneal fluid depending on the presence of antibodies, and absorption which destroy and remove organisms) are neutralized by any of the etiological factors mentioned, the membrane becoming dried and exposed during operations, etc., or the presence of solid bodies, particles of food, blood clots, etc., the resistance of the peritoneum is lowered and its absorbing and bactericidal power interfered with. This allows the organisms to develop, produce their toxins and an acute peritonitis. Pathology. According to the character of the exudation, peritonitis can be classified as fibrinous, serofibrinous, fibrino- purulent, suppurative and hemorrhagic. The character ot the inflammation depends greatly on the nature of the infec- tion. In cases of low virulence, such as are occasionally- observed, the serous surfaces present little more than a slight loss of luster, with some slight deposits of delicate fibrin. In 252 DISEASES OF THE PERITONEUM the ordinary form, in the early stages, there is marked congestion of the serous membrane, later the serous surface becomes dull, lusterless, and the contiguous surfaces become slightly adherent through the depositing of yellowish-white flakes of fibrin (peritonitis fibrinosa). In some instances there is but little effusion of fluid, but in most cases there is a copious effusion of exudation, somewhat turbid containing floc- culent masses of a yellowish color (peritonitis serofibrinosa) . The quantity of fluid varies considerably from a few cubic centimeters to several liters. In other cases the exudation is more turbid and contains purulent material (peritonitis purulenta) . The peritonitis following rupture of the bowels is very virulent, the exudation is purulent and contains bowel contents. In the abdominal cavity a quantity of dirty, brown, turbid fluid of offensive odor is found. In all cases of peritonitis with effusion more or less blood is always present (peritonitis hemorrhagica) . When the peritonitis results from rupture of the bladder, urine will be present in the abdominal cavity, and the odor will be detected in the abdominal contents. Symptoms. Acute, diffuse peritonitis, when due to inju- ries, rupture of the bowels, abscesses, etc., usually develops rapidly under symptoms of marked general disturbance. In the most severe infections the symptoms are principally those of a septicemia or toxemia. In the beginning there is abdominal pain, restlessness, stiff unnatural gait, and " tucked up" abdomen. Palpation over the abdomen reveals intense contraction of the abdominal muscles, and con- siderable sensitiveness. When the peritonitis is .diffuse the sensitiveness is noted over the entire abdomen; when cir- cumscribed only local areas of tenderness are evinced. The pain is often severe enough in small patients (dog and cat) to cause them to groan and cry. Pain is a prominent symptom, and is usually continuous, except in cases where a general toxemia exists. The respirations are of the costal type. In most cases they are diminished, but if fluid is present there is severe dyspnea. Vomiting is an early and characteristic symptom of peri- tonitis in the dog and cat. It is usually one of the first PERITONITIS 253 symptoms, and is very persistent. The vomitus consists mainly of mucus, food particles, bile, and, if severe, of fecal matter. There is complete loss of appetite noted early in the course of the disease. The urine is decreased in quantity, highly colored, and contains a large amount of indican. There is often severe straining as if to urinate (tenesmus vesicae). In the early stages there is diarrhea followed later by constipation with considerable tympany. In the very early stages the temperature in the dog and cat is elevated (104- 106 F.). The temperature, however, remains high for only a few hours when it drops rapidly and becomes subnormal (96-100 F.). In small animals the temperature in perito- nitis is usually normal or subnormal. The pulse is rapid, small, hard and often wiry. In the later stages the pulse becomes very weak, irregular, and finally imperceptible. 'The extremities grow cold, the mucous membranes cyanotic, and there is every evidence of a deficient heart action. Effusion of fluid (ascites) is usually present except in some of the more acute cases which are rapidly fatal. The per- cussion sound is flat, the area of dulness shifting as the patient's position is changed. A friction sound may be present in the early stages, but due to the effusion which forms early, soon disappears. In some cases of peritonitis, due to severe septic infection (rupture of abscesses), the course is very rapid and the general symptoms of toxemia are the only ones noticed. Peritonitis following rupture of the stomach or bowel, from severe injury, such as being run over, kicks, etc., runs a very rapid course. General weakness, coldness of the extremities, and coma may be the only symptoms noted. The symptoms of circumscribed peritonitis are similar to those of diffuse, except that they are so mild at times as to be overlooked. Course. The acute, diffuse peritonitis usually terminates in death. The most intensive forms usually produce death in thirty-six to seventy-two hours; however, most commonly death results in five to eight days. Some of the milder cases 254 DISEASES OF THE PERITONEUM terminate in recovery, or chronic peritonitis, which runs a long chronic course. Diagnosis. In typical cases the sudden onset, the sensi- tiveness over the abdominal region, the fever, the wiry pulse, the development of effusion, the collapse and the vomiting, present a rather characteristic picture. In some cases of rapid development the diagnosis is very difficult and is hard to differentiate from septicemia or toxemia. In the latter stages of the disease, where deep coma is present, an accurate diagnosis is impossible. Often circum- scribed, acute peritonitis is overlooked. A careful examina- tion, therefore, is necessary to determine the exact condition. Prognosis. The prognosis in acute, diffuse peritonitis is unfavorable, especially if it follow rupture of the stomach, bowel or abdominal abscesses. Such cases invariably terminate in death. In circumscribed fibrinous or sero- fibrinous peritonitis the majority of cases make a complete recovery. Circumscribed peritonitis, however, due to local infection should be looked upon as dangerous, as the abscess may rupture into the abdominal cavity eventually terminat- ing in death from diffuse peritonitis. Treatment. Medical. In the early stages, diarrhea is present and fhe peristalsis active. In order to prevent friction between the peritoneal surfaces, which tends to spread the inflammation, small doses of opium (dog, 0.1-0.3; cat, 0.05-0.1), or morphin sulphate (dog, 0.016-0.12) subcu- taneously are indicated. Cold applications, if applied early to the walls of the abdomen, are indicated (cold water compress or ice pack) to relieve the intense congestion of the serous membrane. Later counterirritants may be used in the form of oil of mustard mixed with olive oil (1-10). Apply by rubbing well into the skin of the abdomen. Hot water applications may also be used. Should constipation be marked laxatives should be given, such as castor oil (dog, 15.0-30.0; cat, 5.0-8.0) or mag- nesium sulphate (dog, 10.0-14.0; cat, 2.0-5.0). Warm water infusions into the rectum will be useful to remove feces and also to produce a soothing action on the membranes. General stimulants (strychnin sulphate, dog 0.001; cat, \ PERITONITIS 255 the quantity subcutaneously) are employed to combat symp- toms of general weakness and coma. Alcoholic stimulants or camphor may also be used for the same purpose. Surgical. When severe infection is present, and in the early stages, it is advisable to irrigate the abdominal cavity in the following manner: Laparotomy should be performed (see Laparotomy) and a sufficient amount of sterile, normal salt solution introduced at the body temperature to thoroughly irrigate all parts of the cavity. This should be followed by a boric acid (2 per cent.) or a salicylic acid solu- tion (2 per cent.). The value of this method will depend largely upon the thoroughness of the application. Before irrigating a thorough examination of the organs and tissues in the cavity should be made for ruptures, etc., and if found, proper treatment should be applied. When an excessive amount of effusion is present it should be removed. (See Treatment for Ascites.) Chronic Peritonitis. Definition. A chronic inflammation of the peritoneum which may be either diffuse or circum- scribed. As a rule chronic peritonitis is rarely found equally well marked over the entire abdominal cavity. From a clinical standpoint it is difficult to separate the two condi- tions, therefore, they will be described as one. Etiology. Chronic peritonitis may be due to a number of different causes, the most important of which are: Intra- abdominal lesions, such as diseases of the liver (hepatitis, abscesses), the kidneys, spleen, etc., which may reduce the resistance of the peritoneum; or from gastric or duodenal ulceration providing a focus for peritoneal infection. In these cases a general chronic peritonitis results instead of a local inflammation, owing to the reduced resistance of the membrane, or the low virulency of the infection. Chronic venous engorgement from defective heart action would produce much the same effect. Chronic peritonitis may result from the acute fibrinous form when complete resolution does not take place, or the infection is mild. In some cases it may result from disease of the pleura by spreading through the diaphragm. Chronic peritonitis may also result from disturbances of the intestinal tract. 256 DISEASES OF THE PERITONEUM Ascites, when due to disease of the heart, may produce chronic peritonitis by lowering general resistance, or through organisms which gain entrance during paracentesis abdom- inis. Parasites (Linguatula denticulatum, Plerocercoides bailleti, Echinococcus granulosus) in the dog and cat may cause chronic peritonitis by the constant irritation to the peritoneum they produce. Pathology. The postmortem lesions vary somewhat de- pending upon the causes, and the extent of the process. The peritoneum is covered by a thick membrane, which is dull white or glistening, pearl-like in color; pigmentation is some- times present. In very severe cases of long standing this membrane becomes very thick, especially over the visceral peritoneum, and can be peeled off from the organs. Adhe- sions between the folds of the visceral peritoneum are often found, which may bind together several organs into one mass. The formation of this membrane is due mainly to an organ- ization of the exudation and not to hyperplasia of the peri- toneum itself. Symptoms. The symptoms are somewhat similar to ascites. The onset is gradual; usually no symptoms are noted until distention of the abdomen develops. There is no pain or tenderness on manipulation. On percussion a dull sound is emitted, and on auscultation, especially if the abdomen be tapped on the opposite side with a finger, the presence of fluid can be detected by the splashing sound produced. There are usually general symptoms of dullness, and lack of energy, shown by the animal lying down a great deal and refusing .to move about. The patient has, as a rule, a good appetite unless constipated. Respirations are increased owing to the pressure against the diaphragm. The character of the fluid varies somewhat. It has a specific gravity of about 1015, is of a yellowish or turbid color, from the presence of large numbers of cells, and when allowed to stand it usually becomes thick and forms large amounts of floccuhv. The temperature in the dog and cat remains normal or slightly subnormal. The pulse is^often lapid and irregular. ASCITES 257 Diagnosis. The character of the fluid in the abdomen is one of the chief diagnostic symptoms, and some of it should be obtained and examined for its specific gravity, cells, etc. A careful examination of the animal must be made to distin- guish this from ascites due to other causes. The anamnesis may also assist in making the diagnosis. Prognosis. The prognosis is unfavorable, the course chronic. Complete recovery is hardly to be expected, although a number of cases have been reported where appar- ent recoveries- have taken place. Death is usually the result of heart failure. Treatment. The cause should be ascertained if possible, and the treatment given accordingly. If the cause cannot be determined, symptomatic treatment is given. Diuretics, such as caffein citrate (0.1-0.3) or diuretin (0.15-0.4) are indicated to assist in removal of the fluid. Paracentesis abdominis (see Ascites) should be performed whenever necessary to remove the fluid from the cavity. The dog, as a rule, responds more readily to treatment than the cat. ASCITES. Hy drops Abdominis. Hydrops Ascites. Hydrops Peritonei. Definition. A collection of serous fluid in the abdominal cavity. This condition is quite common in dogs, and also occurs in cats and birds. Mild cases of ascites are often overlooked during life, and are only found on postmortem or during operations on the abdominal cavity. Etiology. 1. Local Causes. (a) Chronic inflammation of the peritoneum, either simple, carcinomatous, sarcomatous, or by cysts of parasites (Plerocercoides bailleti, Linguatula denticulatum, etc.). (6) Obstruction to the portal vein, either in its terminal branches in the liver, such as by cirrhosis, chronic, passive congestion, etc., or by compression of the vein in the gastrohepatic omentuin, such as by pro- liferative peritonitis, abscesses, tumors (sarcomas, carci- nomas, etc.), or by aneurysm. (c) Thrombosis of the portal vein. (fT) Tumors in the abdominal cavity in general, (e) 17 258 DISEASES OF THE PERITONEUM Cysts of the ovaries (common in cats). (/) Occurs in the secondary stage of acute circumscribed or diffuse peritonitis. 2. General Causes. Ascites often occurs as a symptom of general dropsy, the result of mechanical effects, as in heart diseases, chronic indurative or interstitial pneumonia. In some heart diseases the effusion is confined to the abdominal cavity, in which case it is no doubt due to secondary changes in the liver. Ascites also occurs in chronic diseases of the liver. In young dogs (puppies) ascites is frequently observed, and often disappears as the animal develops, apparently without any particular cause being found. Pathology. The presence of fluid in the abdominal cavity, of varying quantity from a few cubic centimeters to 15-20 liters. This fluid has a specific gravity of 1012-1015, a light or yellowish color, clear, and contains, as -a rule, but a slight amount of fibrin, or flocculent precipitate. The chemical reaction of the fluid is alkaline or neutral; the albumin con- tent is about 2 to 5 per cent. Sometimes the fluid w T ill be of a reddish color, due to slight hemorrhages, or to some of the red cells passing out with the serum. This is especially noticeable in obstruction to the portal vein. A greenish" cast is noticed when the liver is secondarily affected. The precipitate when examined will be found to contain a small number of leukocytes, fatty endothelial cells, flakes of fibrin, and sometimes red cells, and in rare cases numbers of small cysts of parasites. In dogs and cats the fluid often contains numerous fat cells and has a milky appearance. The peritoneum is usually pale, glistening, thickened, especially in cases of long standing or those due to chronic peritonitis. The organs in the cavity are usually anemic, dull on the surface and sometimes atrophic. Symptoms. An enlargement of the abdomen is usually the first indication of the disorder. Until the accumulation of fluid becomes great enough to cause a distention of the abdomen, the symptoms will not be positive enough to make a diagnosis. As the amount of fluid in the abdomen varies greatly, the symptoms will vary considerably in individual cases. The fluid distends the abdominal wall, causing the muscles and skin to become tense, and the abdomen to assume ASCITES 259 a characteristic pear shape. When the animal assumes a standing posture, the fluid collects in the lower portion of the abdomen and the amount can be rather accurately deter- mined by percussion. Above the line of dulness will be noticed a tympanitic sound. Changing the position of the animal causes a shifting of the horizontal line which marks the upper limits of the area of dulness. On palpation the resistance is fairly uniform. By placing one hand on the side of the abdomen, and tapping gently on the other side with the other hand, a plain undulation will be felt. As the amount of fluid increases, pressure is produced on the diaphragm, interfering with the function of the organs in the thoracic cavity. Severe dyspnea with cyanotic mem- branes is noted in some cases. The pulse is weak and rapid. As the cases progress, emaciation appears. The appetite is impaired, the digestive tract disturbed and occasional attacks of vomiting occur. The temperature is normal; in the later stages it may be subnormal. The urine is reduced in amount, and often highly colored in the dog; otherwise it is normal. The animal may die from general exhaustion, or from asphyxia. Diagnosis. The diagnosis is not difficult, provided a care- ful examination is made of the patient, its history obtained, and all the symptoms carefully noted. However, there are quite a number of conditions with which ascites might be confused. It might be mistaken for acute or chronic peri- tonitis with effusion. By puncturing the abdominal wall with an explorative trocar and obtaining some of the fluid, a dif- ferential diagnosis can be made. Excessive accumulation of fat (obesity) might be confusing. However, obesity occurs mostly in old animals, and the shape of the abdomen is more apple (broad back, well rounded barrel) than pear shaped. Advanced pregnancy can be . differentiated by careful palpation which will reveal the presence of the fetuses. Tumors in the cavity can be differentiated by their consist- ency and their permanent position. Distention >t the bladder produces an enlargement which remains in the same position at all times, and when palpated can be felt as a 260 DISEASES OF THE PERITONEUM large body within the cavity. Passing the catheter will reduce the enlargement by removing the urine. Rupture of the bladder, when distended, will produce a sudden distention of the abdomen, and general symptoms of stupor and coma often with convulsions. Puncturing the abdomen will reveal the presence of urine. Prognosis. The prognosis depends largely upon the cause. As a rule, it is unfavorable. Treatment. Medical. The cause should first be deter- mined, if possible, and measures taken to eliminate it. Should the heart action be deficient, digitalis would be indicated (dog, 0.05-0.10; cat, ^ quantity) to stimulate the heart and overcome venous stasis. This drug is further of great value owing to its diuretic action, which assists in the elimination of fluid from the body. Caffein citrate (dog, 0.1-0.5; cat, 0.05-0.1) has a similar action. The resorption of the exudate may also be aided by the use of diuretics: Potassium acetate (dog, 0.5-0.8; cat, 0.05-0.1) ; bulbous scillee in powder form (dog, 0.05-0.2; cat, 0.01-0.05) ; diuretin (dog, 0.5-1.0; cat, 0.01-0.05) every two or three hours, or agurin (dog, 1.0-2.0; cat, 0.02-0.08) daily. Laxatives should be administered occasionally to keep the bowels open which also assists in removing the fluid. Magnesium sulphate (dog, 8.0-14.0; cat, 1.0-4.0) is best for this purpose. Dia- phoretics may also be administered, although not so impor- tant in small animals as in large ones, as the skin glands are less developed. Pilocarpin hydrochlorate (dog, 0.005-0.01) can be used, but there is some danger of edema of the lungs or paralysis of the heart from its use. Surgical. If the fluid produces severe dyspnea and inter- feres with the action and function of abdominal and thoracic organs, it should be removed surgically by performing para- centesis abdominis. The operation is as follows: The animal is placed in a standing position, or on its side on the operating table and the hair shaved from a small area at the most pendent portion of the abdomen, usually near the umbilicus. The surface should be thoroughly disinfected by washing with bichJorid soap, followed by alcohol, and tincture of iodin painted over the surface where the puncture ASCITES 201 is to be made. A small exploring trocar is used, which should be sterilized, and inserted through the abdominal walls. When the stylet is withdrawn, the fluid will usually flow out in a stream. Sometimes the end of the cannula becomes blocked by omentum or bowel. This can be over- come by moving the cannula slightly or by re-inserting the stylet. The fluid should be collected in a vessel to note its character. The amount of fluid to remove depends largely upon the condition of the animal. Should, however, symp- toms of dyspnea, cyanosis, and rapid, weak pulse appear, the cannula should be at once removed. The operation may be repeated next day. The punctured wound resulting from the operation should be protected by covering with collodion and a small pledget of cotton. Death occurs occasionally from collapse following the operation. There- fore the patient should be carefully watched and the removal of the fluid stopped, and general stimulants given, when signs of collapse appear. PART IV. DISEASES OF THE REPRODUCTIVE ORGANS. CHAPTER I. DISEASES OF THE PENIS AND PREPUCE. Examination. The prepuce should be examined by observ- ing the discharge at its opening, and the condition of the mucous membrane. Frequently there will be found a more or less extensive mucopurulent discharge which indicates a catarrhal inflammation of the prepuce. The preputial open- ing should be dilated and the mucosa examined for foreign bodies, tumors, ulcerations, secretions, etc. The penis may be examined in the following manner: The animal should be placed in the dorsal position, and either held by assistants, or securely fastened to the table with hopples. With the left hand, the prepuce is gently pushed downward and backward, exposing the free end of the penis. The penis is then grasped with the fingers of the other hand and pulled as far out of the prepuce as possible. A piece of tape should be placed around the penis just posterior to the glans, and with gentle traction the penis can be exposed for a considerable distance. The penis should be examined for inflammations, tumors, venereal granulomata, rubber bands, wounds, fractures of the os penis, etc. WOUNDS OF THE PENIS AND PREPUCE. There are quite a variety of injuries which are found involving these structures. Principally, injuries result from 264 DISEASES OF THE PENIS AND PREPUCE the bites of other animals, and different degrees of the con- ditions are found, from small cuts of the prepuce to extensive laceration of the tissues. Rubber bands are occasionally found on the penis just back of the glans. These, if left on very long, result in extensive edema and necrosis of a portion of the penis. Injuries also occur during coition as the penis is retained in the vagina until the semen is ejaculated, which requires several minutes in the dog, and during which time the movement of the female will often cause torsion or twisting of the penis with subsequent edema. Frequently dogs are roughly handled at this time and the penis lacerated or cut. The prepuce is often found split from being cut by sharp objects, or perforations occur which allow the penis to prolapse through the opening. Symptoms. The symptoms depend to a great extent upon the kind of injury and the amount of damage done to the tissues. Attention to wounds of the prepuce will be drawn by the hemorrhage and swelling. Examination reveals the extent of the wound. In edemas of the penis, the animal shows difficulty in urination, the penis often projecting from the prepuce, swollen, reddened, and if strangulated will be of a dark color (venous stasis). Thorough examina- tion should be made to determine the degree of injury, and to discover any foreign bodies which might be present. Prognosis. Favorable in most cases, as wounds in this location respond to treatment readily. Not so favorable in cases of strangulation of the penis with subsequent necrosis. Treatment. The parts must be thoroughly cleansed, washed with an antiseptic solution, and the character of the injury determined. Wounds in the prepuce, such as cuts or perforations, are sutured after thorough disinfection and all ragged edges removed with the scissors. Injuries to the penis should be looked after carefully, as they sometimes lead to sufficient swelling to interfere with the discharge of urine. In such cases, the catheter is introduced and the urine withdrawn. Should this procedure fail, make an opening in the urethra at the ischial arch to temporarily take care of the discharge of urine. Applications of antiseptic solutions for a few days will reduce the inflammation and PREPUTIAL CATARRH 205 infection. When the penis is strangulated and necrotic, it is advisable to amputate the affected portion. This is done in the following manner: The animal is anesthetized, placed on the table in a dorsal position and securely hoppled. The parts should be thoroughly cleansed with soap and water and disinfected. Pull the penis out of the prepuce as far as possible, and apply a rubber tourniquet at a point above the seat of operation to control the helnorrhage. Incise the penis with a scalpel, and if it is necessary to amputate through the os penis a saw should be used for this portion. The urethra is protected by a catheter previously inserted, and left about one-half inch longer than the stump of the penis. It is split with the scissors on its dorsal surface back to where the penis was incised. The flaps of the urethra are then securely stitched to the stump of the penis to prevent a stricture forming at this point. All vessels should be ligated, and the parts again washed with an antiseptic solution. The tourniquet is removed and the penis allowed to retract back into the prepuce. Cleanse daily with antiseptics. CONGENITAL MALFORMATIONS. Malformations of these structures are not common. Arrested development of the penis or prepuce is seen occa- sionally. Hermaphrodites are not common among dogs. Congenital closure of the prepuce is observed sometimes in puppies, which must be opened with a scalpel and the edges of the skin stitched back to prevent adhesions. PREPUTIAL CATARRH. Balanitis. Definition. A catarrhal inflammation of the mucous membrane of the prepuce. Etiology. Preputial catarrh may be produced by several different factors: (a) Principally local infection. (6) Develops in a number of cases secondary to other diseases; venous stasis; phimosis; paraphimosis; injuries, or foreign bodies. 266 DISEASES OF THE PENIS AND PREPUCE (c) Sequel to specific infectious diseases, as distemper. (d) Follows in some cases of mange and eczema. In all of the above causes we find that the condition is brought about by infection either as a primary cause, or due to reduced resistance of the tissues by other diseases which allows secondary infection to take place. In some, accumu- lations of dirt will favor injury to the mucosa with subsequent infection. Symptoms. The mucosa of the prepuce will be injected, swollen, and there is present at the preputial opening a dis- charge of pus of a yellowish or greenish color. Some of the material accumulates around the preputial opening aggluti- nating the hair, drying and forming crusts. Examination of the mucosa shows a marked catarrhal inflammation. Prognosis. The condition is not serious as in most cases it remains local. When treatment is applied, recovery takes place after a few weeks. Treatment. The parts are thoroughly cleansed and all long hairs removed with the scissors. The prepuce should be washed thoroughly once or twice daily with antiseptic and astringent solutions (alum, 2 per cent.; silver nitrate, j per cent.; zinc sulphate, 1 per cent.). PfflMOSIS. Definition. A contraction of the prepuce in front of the glans penis, preventing the projection of the penis, interfering with coition, and in some cases the escape of urine. Etiology. Phimosis is a congenital defect in puppies. It may cause in some cases almost complete occlusion. It results frequently from trauma of various kinds, the subse- quent cicatricial tissue formed leading to constriction. Acute infectious inflammation (balanitis) with severe swelling will produce a temporary closure, and in some cases, owing to the change in the structure of the tissues, a permanent contraction. Symptoms. In puppies it will be noticed that urine cannot be discharged; there may be frequent attempts at micturition, with only a small quantity passed or there may be complete PARAPH I MOSIS 267 suppression. In mature animals the same symptom of difficulty in passing urine is often present. There is a narrowing of the preputial opening; sometimes it is exceed- ingly small. Animals suffering from phimosis are unable to copulate. Treatment. In phimosis surgical relief should be given promptly. There are two methods employed: (a) The patient is placed in a dorsal position on the table and the parts disinfected. A longitudinal incision of sufficient length is made on the inferior portion of the prepuce to allow the penis to protrude. The two portions are temporarily stitched back to the skin to prevent adhesions and a recurrence of the condition. The wound should be treated daily with antiseptics. (b) The animal is placed in the same position as above and local or general anesthesia given. A circular incision is made completely around the prepuce, removing about one- quarter to one-half inch of its end. The hemorrhage is usually slight. The mucosa should be stitched to the skin for the entire distance around the prepuce. This will insure a preputial opening of sufficient size. Care must be taken in this operation not to remove too much of the prepuce, as it would allow prolapsus of the penis. After-treatment consists in cleaning and disinfecting the parts daily. PARAPfflMOSIS. Definition. A contraction of the* prepuce around the penis, preventing the penis from assuming its normal position. Etiology. Paraphimosis can result from coition. The prepuce becomes inverted when the penis retracts, but the resulting swelling prevents complete retraction. As a result of coition, with subsequent swelling, the penis becomes too large to pass through the preputial opening. It is further observed in some cases of paralysis of the penis, organic- changes having taken place in the tissues from exposure. Neoplasms, such as granulomata, are sometimes productive of the same condition. 268 DISEASES OF THE PENIS AND PREPUCE Symptoms. The exposed penis becomes swollen, edema- tous and discolored and when strangulated, gangrenous. The animal will have difficulty in voiding urine due to the swelling and compression of the urethra. There is stiffness in walking. Examination of the parts will at once reveal the exact nature of the condition. Prognosis. In early cases, resulting from coition, the prognosis is favorable. In cases of long standing, after strangulation, or in paralysis, the prognosis is unfavorable. Treatment. In early cases of paraphimosis, following coition and before much swelling has taken place, it is possible in most cases to correct the inversion of the prepuce and return the penis to its normal position. This is best done by cleansing and disinfecting the parts thoroughly, lubricating the penis and preputial ring with some bland oil (olive), and by manipulating the parts by pressing on the glans penis. If at the same time the prepuce is pressed for- ward, the parts will often be reduced without much difficulty. Should this procedure fail, it is advisable to reduce the con- gestion of the glans penis by bathing in cold water, applying alum solution (2-5 per cent.), or by applying tape tightly around the glans. After the congestion has been reduced, manipulation as above will often reduce the condition. These manipulations will not suffice in cases which have become greatly swollen or edematous. It is then necessary to resort to an operation, which consists in simply splitting the prepuce longitudinally on its lower surface, making a slit of a sufficient length to relieve the strangulation and allow the penis to retract. Where gangrenous conditions have developed, amputation of the penis must be resorted to. After-treatment in these cases consists in applying antiseptic solutions freely. TUMORS OF THE PENIS AND PREPUCE. Various forms of tumors, both benign and malignant, are found in this location. The following varieties are most common : TUMORS OF THE PENIS AND PREPUCE 209 Papillomata. These in most cases involve the prepuce. They are small, benign growths, appearing usually as pedun- culated warts. Sometimes they are found in large numbers with irregular or cauliflower-like surfaces and are usually found at the juncture of the skin and mucous membrane. Symptoms. They produce, as a rule, no marked symptoms of any kind, except in some cases a catarrh al inflammation of the prepuce (balanitis) . Treatment. Tumors should be removed with scissors as close to the base as possible. Cauterize the base with silver nitrate. A recurrence is unusual. Sarcomata, Epitheliomata and Carcinomata. These are occasionally found involving the prepuce and penis. These tumors are malignant and show much the same character- istics from a clinical standpoint. Symptoms. In most cases these tumors involve the pre- puce. They are characterized by their sudden development, irregular outline, degenerative changes, and tendency to spread into the adjacent tissues. They usually present a raw, ulcerating surface, show a tendency to bleed, etc. Diagnosis. The diagnosis depends upon the characteristic growth, and the microscopic findings. Treatment. In case a diagnosis of malignant tumor is positively made, the results of treatment are only temporary. Removal of the tumor is advised, and the incised portion should contain not only all of the malignant growth but also include a small portion of adjacent normal tissue. Malignant tumors are liable to recur in a short time. Venereal Granulomata. This is a specific, infectious tumor formation affecting the penis and prepuce of the dog. It is transmitted in most cases by the act of copulation. Affected stud dogs transmit it during coition. It may be transmitted in rare instances by intermediary agents. It is far more common in Europe than in the United States where it has been introduced by imported stud dogs. The growth seems to confine itself to the prepuce, penis, and immediately adjacent tissues with involvement of the efferent lymphatics. Symptoms. Venereal granulomata are usually found only in the best bred dogs. The early symptoms are redness, 270 DISEASES OF THE PENIS AND PREPUCE swelling and a reddish colored discharge from the prepuce. Micturition is frequent, and the penis is protruded from the prepuce. On palpation the prepuce will be found swollen and irregular in outline. On exposing the penis, it will be tumified, purplish or dark red in color, and on its surface presents a number of vegetative growths. These growths may be found also on the prepuce. They are characterized by their soft friable condition, tendency to bleed at the least touch; they may be sessile or pedunculated. The growths first appear in the form of small vesicles, which soon develop into pimples at first of a firm consistency, but as they grow become softer and more friable. Their growth is slow. In six months to one year they can involve most of the prepuce and penis. Examination of the inguinal lymph glands often reveals enlargement and secondary changes. Diagnosis. This must be based mainly on the infectious character of the growth (its spread by coition), and its char- acteristic development. Prognosis. The tendency to reappear after removal and the spread to other animals make the prognosis unfavorable. Often when the growths are removed from one area they reappear on another. Treatment. Complete removal of the growths surgically is recommended when possible. On account of the tendency to recur, they should be completely dissected out, even includ- ing some of the normal mucosa. It is advisable to cauterize the surface after their removal, and to treat the wounds with antiseptics. In all cases the patient must be closely observed and at the first sign of recurrence of the growths, promptly operated. In advanced cases, with extensive involvement of both the penis and prepuce, and where general symptoms of emaciation and weakness are present, the penis should be amputated even including a portion of the prepuce. CHAPTER II. DISEASES OF THE TESTES AND SCROTUM. WOUNDS AND INJURIES OF THE TESTES AND SCROTUM. In the dog and cat wounds and injuries of these organs are of frequent occurrence, partly accidental and partly intentional. Attempts at castration with the escape of the animal before completion of the operation is a common con- dition. There will be incised wounds of the scrotum and in some cases even exposure of the testes. Bites from other animals, such as dogs, cats, and rats, produce a variety of wounds and injuries to the testes. Being run over by vehicles is a common source of injury to these organs. Symptoms. Hemorrhage from the scrotum will be noted in the case of wounds, which should always be examined carefully to determine the extent of the injury. Contused wounds or bruises are always characterized by swelling, stiffness, straddling gait, and pain on manipulating the testes. Prognosis. Wounds in this location are not as a rule unfavorable, although, if extensive, castration of the animal may be necessary. Slight wounds heal rapidly. Treatment. Small, incised wounds of the scrotum should be. cleansed thoroughly with antiseptics, at least once daily. If the wound is recent it should be cleansed, the hemorrhage controlled, and sutured. Cover the sutures with an imper- vious dressing like flexible collodion. In case the testicles are exposed, they should be removed. (See Castration.) Contusions must be treated as in orchitis. ORCHITIS. Definition. An inflammation of one or both testicles. Etiology. Orchitis occurs in the dog and cat from bruises, or bites of other animals. Being run over by vehicles is a 272 DISEASES OF THE TESTES AND SCROTUM cause. Orchitis may be a sequel to wound infection, to distemper in the dog and cat, and the spread of infection from adjacent organs and tissues. Symptoms. The first symptoms noticed are those of enlargement of one or both testes; pain on manipulation of the organs; and a stiff, straddling gait. We should not mis- take thickening of the scrotiun, a common condition in old dogs, for orchitis. If due to infection there will be more or less elevation of temperature, and other symptoms of the primary condition. The local temperature is also increased. Prognosis. In orchitis from injuries, most cases terminate favorably. In the infective form the gland may be destroyed, or becomes chronic and the patient impotent. Treatment. In the early stages cold packs should be applied, as cold water or a small sack filled with cracked ice. The ice or water pack can be held in place by a bandage passed around the abdomen just anterior to the pelvis, and fastened over the back and between the limbs. It should be renewed after a few hours to keep up the refrigeration. After the swelling and pain have subsided, the pack can be gradu- ally discontinued. In subacute or chronic cases of orchitis, hot packs are indicated, best in the form of hot water, applied in the same manner as above. Massaging with a small amount of anti- septic ointment is recommended, following the hot packs. In the infective form hot packs should be used with hot water to which has been added some antiseptic. Abscesses must be opened and treated with antiseptics. Should they involve the testicles it is best to remove them. (See Cas- tration.) TUMORS OF THE SCROTUM AND TESTES. Several forms of tumors are found in these organs: (a) Fibromata. In old dogs a marked thickening of the scrotum is common. It is due either to an eczema, or from the constant irritation from sitting on the testicles. The latter is characterized by absence of hair on the scrotum, the CASTRATION ORCHECTOMY 273 presence of a dark, thickened pad of tissue, and the increase in the size of the scrotum. Fibroid thickening of the stroma of the glands is observed as a sequel to orchitis of different forms. The glands have lost their normal resiliency, are hard and non-sensitive. After a time the animal becomes impotent and the glands atrophic. (6) Retention cysts are found occasionally in the testicles of the cat and dog. They are characterized by the increase in size of the testicles, and by their soft, elastic feel. A small exploring needle can be used to determine their contents. (c) Sarcomata and carcinomata occur occasionally in the testicles, as secondary growths from other parts of the body. These may develop as unilateral or bilateral tumors. Most cases observed have been unilateral-. They are characterized by their rapid growth, their irregular outline, adhesions between the testicles and the scrotum, and their enormous size in some cases. They are always accompanied by acute inflammatory symptoms. Treatment. Castration is the best means of relief, even in the malignant form. PARASITES IN THE SCROTUM AND TESTES. Cuter ebra Emasculator. In some localities a fly (Cuterebra emasculator) has been observed which makes punctures in the scrotum in which its eggs are deposited. The larvae develop and induce a reactive inflammation which leads eventually to swelling and destruction of the testicles. The infestation has been observed in several species of animal; it is quite common in squirrels in certain districts. Castration of the animal, or if found early the removal of the larva 1 , is recommended. CASTRATION. ORCHECTOMY. In the dog and cat castration is performed in some cases to relieve pathological conditions of the testicles; in others as a remedial measure in enlargement of the prostate gland (chronic prostatitis). It has been proved quite conclusively 18 274 DISEASES OF THE TESTES AND SCROTUM that enlarged prostates in the dog are materially reduced by castration. The operation is also quite extensively practiced in cases where the organs are normal, but to correct vicious habits (onanism) or a disposition to wander away from home. In chickens castration, or caponizing, is becoming quite general in certain sections. It not only changes the disposi- tion and habits of the birds, but makes them develop more rapidly. They become much larger, and the texture of the flesh much finer. Hence the operation is of considerable economic importance. Castration of the Dog. The operation can be performed at almost any age, but is less dangerous before the dog reaches maturity. Between the ages of three to ten months the operation is safest as it causes less constitutional disturbance during the early period of the animal's life. The disposition of the animal is changed less, and there is not the tendency to obesity when castration is performed at an early age. However, when pathological conditions, onanism, etc., exist the operation may be performed at any time. When the testicles are found in the scrotum, the operation is as follows: The animal is anesthetized by using morphin 0.06-0.2 subcutaneously, or chloroform inhalation. Place the patient in a dorsal position, with head lowered, and hind limbs spread apart on the table. This exposes the testicles and makes them easy of access. The scrotum should be thoroughly scrubbed with soap and water, followed by liberal use of antiseptics. The testicles are grasped between the thumb and index finger of the left hand and gentle pres- sure used to make the scrotum tense. With a scalpel or castrating knife in the right hand, an incision is made parallel to the long axis of the testicle, cutting through the tunica propia. The testicle is grasped with the right hand which exposes to view the epididymis and tunica reflexa. There are several methods used to remove the testicles. The cord may be ligated above the epididymis and tunica reflexa by using a sterile, silk ligature (No. 10). This is a safe method, as it removes the possibility of hemorrhage, provided the ligature is securely applied. The other testicle is removed C ASTRA TIONORCHECTOM Y 275 in the same manner. The emasculator also gives excellent results. The instrument should be allowed to remain in position for a few moments after the cord is severed. Occa- sionally hemorrhage will follow the emasculator, but is usually not serious. If severe, the vessels should be ligated. After the testicles are removed the wound in the scrotum may be left open, or a retaining suture put in to prevent the entrance of foreign material. The incisions in the scrotum should be carried forward sufficiently to afford thorough drainage. The scrotum should be kept clean for a few days, and the wound washed with antiseptics. Union takes place in a week or ten days. It is well to observe the animal, note the temperature and pulse for a few days, and if the tem- perature is found elevated, examine the scrotal wound for retention of pus and secretions. Castration of the Monorchid and Cryptorchid Dog. In monorchids one testicle is removed the same as in ordinary castration. The retained testicle in the abdominal cavity must be removed by making an incision through the abdom- inal walls about two to four inches anterior to the pubis, and to one side of the penis (note the side of retention!). The incision is made large enough to admit the index finger freely. The cord is then searched for in the sublumbar region, and when found, withdrawn through the opening, the testicle following. The cord may be ligated or the operation per- formed with the emasculator. The abdominal wound is approximated with two or three interrupted sutures. An antiseptic pack and bandage should be applied to protect the wound and changed daily until healing takes place. The bandage is applied so that it does not interfere with micturi- tion. Cryptorchids are operated in the same manner; both testicles may be removed through one opening, or two abdominal incisions made if found necessary. The patient should be properly prepared by dieting and administering a laxative twenty-four hours before the operation. Castration of the Cat. The same rules in regard to age, etc., apply as in the dog. Castration of the cat is best per- formed under complete anesthesia. The animal is placed on the table in the dorsal position, well hoppled and stretched 276 DISEASES OF THE TESTES AND SCROTUM out so that it cannot squirm loose. Ether is administered until complete anesthesia is established. The hair is clipped off with a scissors, and the scrotum washed with soap and water and boric acid (2 per cent.) solution. The testicles are grasped between the thumb and index finger of the left hand, and with the other hand a scalpel is used to make the scrotal incision. Two methods of removal are used : The first method is to make the incision down to the testicle exposing it, pulling it out of the scrotal sac, and removing it with the emasculator or by ligation. Care should be taken in this method to pull the testicle up far enough to include the epididymis and tunica reflexa. The other testicle may be removed in a similar manner. The second method is to perform the "covered" operation. This is done in much the same manner as the other operation, except that the incision is made down to the tunica vaginalis which is not incised but drawn out with the testicle. The cord, including the tunica vaginalis, is then ligated above the epididymis, and the testicle and its enveloping tunic removed. Hemorrhage and infection are not so liable to follow this method. Castration of Birds. Caponizing. Castration is com- monly practiced on male fowls. A castrated rooster is called a capon. The best results are obtained by operating on the early hatched birds as it gives them more time for develop- ment. Two to three months is the best age to operate. When the bird reaches the age of four or five months the mortality is much higher and the male characteristics more pronounced. The fowl is restrained on an operating table, barrel, or box with a cord looped around the wing and one around the legs, to each of which a one or two pound weight is attached. The bird is then laid on its right side; the weights serve to hold it in position. Other mechanical devices made and used for this purpose have proved satisfactory. The instruments for this operation are made up in special sets known as caponizing sets. A set consists of a scalpel for making the abdominal incision, spreaders or retractors for keeping the abdominal CASTRATION ORCHECTOM Y 277 wound open, and a special, spoon-like hook for removing the testicles. The technic of the operation is as follows: The feathers are plucked from the field of operation, which is between the last two ribs extending from the cartilage of prolongation of the ribs to a point about one-half to one and a half inches from the back. The skin over this region should be disinfected, best by painting with tincture of iodin. The incision is then made through the abdominal wall observing the following points: The skin should be pulled to one side before the incision is made, so that following the operation, the skin and deeper wounds will not cover one another. The incision should follow closely the border of the last rib in order to avoid cutting the intercostal artery, ("are must be taken to avoid injuring the cartilages of prolongation of the last ribs. Should they be cut, which is easily done, the healing of the wound will be delayed. Further, the incision through the walls should be made carefully to avoid punctur- ing the lungs. After the retractors are placed in position, and the incision dilated, the testicles are located just anterior to the kidney. The upper one will be found without difficulty; the lower one is brought into view by separating the mesentery with the handle of the scalpel or other blunt instrument immediately below the upper testicle. Remove the lower testicle first. The spoon-hook or scoop is applied around the testicle by being slipped over the spermatic cord. Care should be taken to prevent injury to the large bloodvessels. The testicle is removed by torsion. A few turns of the instrument will sever the testicle from its attachments when it can be lifted out. The other testicle is then removed in a similar mariner. The entire testicle should be removed, for if a portion is left in the fowl will develop into what is commonly known as a "slip" and the object of the operation defeated. After the spreaders or retractors are removed the ribs will assume their normal position closing the incision. Xo further treatment of the wound is necessarv; it closes without difficulty in a week or 278 DISEASES OF THE TESTES AND SCROTUM ten days. The operated birds must be kept quiet for a few days following the operation, and fed a light diet. The wound should be observed occasionally until complete union takes place. In a few cases collections of air under the skin, form- ing "wind puffs," will develop. If these occur they are opened and the air forced out. The mortality from caponiz- ing should not exceed 1 per cent. CHAPTER III. DISEASES OF THE PROSTATE GLAND. Examination. In the dog this gland is best examined by digital palpation, and in some cases, when the gland is much enlarged, by palpation through the abdominal walls. The finger is inserted in the rectum and if any enlargements are present they can be distinctly felt by pressing in a downward direction; if acute inflammation is present the slightest pressure will produce severe pain. PROSTATITIS. Definition. An acute or chronic inflammation of the pros- tate gland. In the dog this disease is nearly always found to be of a subacute or chronic type. Acute prostatitis is very rare in these animals. Etiology. Prostatitis is produced by microbic invasion, either via the urinary tract, the blood or lymph streams. It may occur from the spread of the inflammation from other portions of the urinary tract. Symptoms. Prostatitis usually develops gradually. The early symptoms are painful defecation and micturition. The animal will make frequent attempts at urinating, the urine voided in small quantities, or there may be complete suppression. Defecation is painful; sometimes impossible. The bladder is found distended. The passage of the catheter is often difficult due to the pressure of the enlarged glands upon the urethra. Gentle pressure on the catheter will cause pain, but in most cases it will gradually pass through the constricted portion into the bladder. The urine will then flow out. Digital examination with the index finger inserted in the rectum will reveal the enlarged glands. Should pus be present in the glands they will be somewhat soft and fluctuating. 280 DISEASES OF THE PROSTATE GLAND The abscesses sometimes rupture, either into the urethra, the abdominal cavity or through the skin in the perineal region. More or less irregularity in the temperature is noted. Prognosis. Although complete recovery cannot be hoped for, owing to the changes which have taken place in the glands, partial recovery is possible. Treatment. M edical. Purgatives should be administered at once, such as castor oil (15.0-30.0) or magnesium sulphate (8.0-15.0). Small doses of morphin may be given in case pain is severe. Surgical. The bladder is examined and if found distended, the catheter should be passed and the urine withdrawn. If this is impossible, on account of the compression of the urethra, immediate puncture of the bladder with a trocar may be made. The prostate gland must be examined care- fully, and if found fluctuated, indicating abscess formation, make an attempt to relieve it by pressure with the finger inserted into the rectum. This method is often satisfactory. Should this fail, a long exploring trocar is introduced into the gland either through the rectal wall or through the peri- neum. In either case the finger should be retained in the rectum to guide the insertion of the trocar, and also to exert some pressure on the gland to force the contents out. Pros- tatic abscesses are sometimes found with an opening out through the perineum. The opening should be enlarged sufficiently to afford good drainage, and syringed out with an antiseptic solution. Rupture of the abscess into the peri- toneal cavity results in peritonitis, and death in a short time. TUMORS OF THE PROSTATE GLAND. Hypertrophy of the Prostate Gland. Hypertrophy is common in old dogs, and is occasionally observed in young animals. In hypertrophy, the normal glandular tissue is gradually replaced by fibrous connective tissue, which leads to an atrophy of the tubules and muscle fibers greatly increasing in the stroma of the gland. The gland gradually loses its function of secretion, becomes much TUMORS OF THE PROSTATE (1LAXD 2X1 larger, and firmer than normal. In the dog the prostate gland lies at the neck of the bladder, almost surrounding the urethra, and when hypertrophied it causes compression of the urethra making the passage of urine difficult. Symptoms. The most pronounced symptoms of hyper- trophy of the prostate gland are: Obstruction to the passage of urine. The animal makes frequent attempts to urinate but either only a small quantity or none at all is passed. The straining induced may cause hematuria. The hemorrhage results from the pressure on the venous plexus of the gland exerted by the hypertrophic tissue. The bladder will be found distended and the animal showing considerable dis- tress. There is always danger of rupture of the bladder from overdistention. A complication of conditions is often found ' in these cases of long standing, such as hydronephrosis, cystitis, etc. Constipation is practically a constant symptom owing to the interference with defecation. Xo febrile symp- toms are observed in hypertrophy of the. gland. Passing the catheter will reveal the urethral obstruction. This may be so pronounced that it will be impossible to get the catheter beyond the prostate. It is possible to palpate the enlarged gland by inserting the finger in the rectum, or in very thin subjects the gland may be felt through the abdominal walls. Diagnosis. The diagnosis is made by observing the symp- toms, passing the catheter, and digital palpation. We must differentiate hypertrophy from abscess and inflammation of the gland. The difference in the temperature, the age of the animal, the size and consistency of the gland, and the ehron- icity of the process are indicative. Prognosis. The prognosis is unfavorable. Treatment. The bladder should be examined, and it' found distended, emptied either by passing the catheter or by the use of the trocar. Laxatives should be given (see Inflammation of the Pros- tate Gland). Internal administration of potassium iodid (0.1-0.2) daily has been used with success in some cases. At the same time injections of Lugol's solution directly into the gland may be employed. The injection is made with a small calibered, hypodermic needle, which is inserted into the 282 DISEASES OF THE PROSTATE GLAND gland, either through the rectum or perineal region, the syringe attached and the injection made. Two to four c.c. of the solution are sufficient. Castration is distinctly remedial as it is followed by a reduction in the size of the gland. Obviously it cannot be employed in stud dogs. (See Castration.) Experimentally it has been proved that in a short time following castration the gland begins to atrophy. The activity and function of this gland depends to a large extent upon the function of the testicles. Some few cases have been successfully treated by castration. Sarcomata and carcinomata have been found in this gland, but are not common. When found, no treatment can be given. CHAPTER IV. DISEASES OF THE OVARIES. Examination. Several methods of examination are used to detect abnormal and pathological conditions of the ovaries. (a) By abdominal palpation. This method has not proved very satisfactory on account of the small size of the ovaries, and the amount of tissue necessary to palpate through. In emaciated subjects or when glands are enlarged, palpation is useful. In cats with large ovarian cysts, the cysts may be felt through the abdominal walls. For abdominal palpation the animal is placed in a standing position. The manipulator should stand either immediately in front of or in the rear of the animal with one hand on either side of the abdomen; the ovaries may be felt in the sublumbar region. This method is of value in a general way, but for accurate diagnosis it does not suffice. (6) By observing the animal to note any symptoms of excitement, etc. Cats with ovarian cysts will often show evidences of nervous excitement, epileptiform convulsions, etc. (c) Direct inspection of the ovaries can be made with but very little danger. Therefore in doubtful cases laparotomy should be performed and the ovaries examined for inflamma- tion, tumors, cysts, etc. INFLAMMATION OF THE OVARIES. Oophoritis. Definition. An acute or chronic inflammation of one or both ovaries. Oophoritis is not observed very often in animals. It should not be mistaken for the normal hyperemia of the glands during the estral period. However, acute and chronic inflammations are found involving these glands. 284 DISEASES OF THE OVARIES Etiology. Results from injuries, such as being run over by vehicles. The compression of the organs may be suffi- cient to crush them, or it may lead to inflammation. Extension of the inflammation from adjacent organs and tissues, as from the uterus and uterine tubes. Infection of the ovaries may take place in some of the infectious diseases (distemper in the dog and cat), or it may be due to some" non-specific infection carried to the ovaries by the circulatory system. Symptoms. In dogs oophoritis may not be noticed. The patient will show stiffness in walking and pain on palpation over the glands. In cases where infection has taken place in the glands, abscesses may develop, and febrile symptoms be present. In subacute or chronic inflammations no marked symptoms will be observed beyond an enlargement of the glands. In cats epileptiform convulsions may result. Diagnosis. In the mild forms an accurate diagnosis is difficult without making an explorative laparotomy. In cats it should be differentiated from ovarian cysts. A careful examination must be made in all cases. Prognosis. Favorable, except when produced by infection. In the chronic form sterility is a common sequel. Treatment. Not much treatment is needed. In the severe forms, or when abscesses are present, it is advisable to remove the ovaries (oophorectomy). TUMORS OF THE OVARIES. Cysts. Cystic formation in the ovaries is of very frequent occurrence, and perhaps much more common in cats than in any of the other animals. They consist in most instances of unruptured Graafian follicles, and are found either single or multiple. Unless they are of considerable size they do not produce any marked symptoms. In fact, where they are fre- quently found as multiple cysts, and when degeneration of the ovary has taken place, marked nervous symptoms will be noted. These are excitement, prolonged estrum, and in some instances epileptiform convulsions. OOPHORECTOMYOVARIECTOMY 285 Diagnosis. The diagnosis is difficult in most cases. Unless the cysts are of large size, and the nervous symptoms marked, the condition is usually not suspected. Laparotomy should be performed and the ovaries inspected to make the diagnosis positive. The cysts appear as enlargements projecting from the ovary. Their consistency is fluctuating; their contents transparent. Prognosis. The prognosis is unfavorable so far as relieving the condition and preserving the ovary are concerned. The symptoms can be relieved by removal of the glands. Treatment. The treatment is surgical and consists of the removal of the diseased gland. (See Ovariectomy.) Other tumor formations in the ovaries are uncommon. Dermoid cysts have been found in a few instances. Adenoma and adenocarcinoma occur as secondary growths. When found the entire gland or glands should be extirpated. OOPHORECTOMY. OVARIECTOMY. Oophorectomy is extensively practiced to correct certain pathological conditions which are found in the ovaries to suppress the sexual desire and prevent the female from becom- ing pregnant, and to make more desirable house dogs and pets as they are more contented and peaceful. Cats, when operated during the first few months of their life, become much larger, and are much more desirable animals to have about the house. All female animals should be operated if possible before the advent of the first estrual period, as it has been proved by experience that some females will continue to show sexual desire following complete removal of the glands. Such cases are observed in older females, especially those that have given birth to young, and these that have estruated normally for some time. However, we must take into consideration that in a number of cases where estruation follows removal of the glands, is due to the fact that a small portion of the ovarian tissue has been left in, which develops and frequently becomes cystic. The effect of this operation on females is worthy of note. 286 DISEASES OF THE OVARIES Young animals operated before the periods of estrum are present, show no appreciable change in their development. They are active, develop regularly, and in every way make very desirable animals. The most marked change occurs when older animals are operated. They often become fat, lazy, and inactive. Certain breeds of animals show these changed characteristics more than others. For this reason the operation should be performed before the animal reaches sexual maturity. Oophorectomy in the Dog. This is one of the most fre- quent operations performed on dogs. It is a safe operation provided the following precautions are taken into considera- tion : (a) The operation should be performed when the dog is about three to five months old, and before it has had an estrual period. (6) The animal should not be operated during estruation, notwithstanding the prevailing belief of the laity to the contrary. As the ovaries and other portions of the generative tract are congested at this time, the danger of hemorrhage and inflammation is greater. One should wait two or three weeks after the period of estruation so that the organs can return to their normal condition, (c) The prep- aration of the animal before operating is of special impor- tance. The bowels should be empty. For this purpose castor oil (15.0-60.0) should be administered twenty-four hours previous to the operation. All solid food is withheld, but small amounts of milk and water only may be allowed. The field of operation should be prepared twenty-four hours pre- viously; the hair removed, the skin washed with soap and water, and an antiseptic pack applied. This pack is best made of cotton of gauze with boric acid; it is applied to the operating field and held in place by a special bandage made of a wide piece of muslin so as to extend from in front of the forelimbs to a point back of the field of operation, and tied over the back. This pack should be kept in position until the animal is ready for the operation. This will ensure a sterile operating field. As a last precautionary measure, just previous to making the incision, the operating field is painted with tincture of iodin. An anesthetic or narcotic should be given. In the dog various methods of anesthetiza- OOPHORECTOMYOVARIECTOMY 287 tion and narcotization have been employed with equally good results. Morphin given as a subcutaneous injection about twenty to thirty minutes previous to the operation has been used with most excellent results. The value in this method of narcotization lies in the fact that it will cause vomiting in most cases, defecation in some, removing mate- rial from the stomach and bowels. Further, it will keep the animal quiet for several hours following the operation. It may be considered a perfectly safe narcotic, which to dogs can be administered in large doses. The amount to be administered will depend to a great extent upon the size of the animal. Usually from 0.016-0.2 are to be given. Chloroform and ether may be used as a general anesthetic; both are safe when administered properly. After anesthe- tization the animal should be placed in a dorsal position, well hoppled and the table tilted to lower the head as much as possible. This assists the operator, as the bowels will descend toward the diaphragm which lessens the tendency for them to protrude through the incision. The incision may be made either at the median line or in the flank region. There are good reasons for choosing the median incision. There is less hemorrhage at this location, it is much easier to locate the cornua and the removal of both ovaries through one opening can be done with less difficulty. The exact location for the incision in the median line is at a point about one to one and a half inches posterior to the umbilicus. The incision should be made of sufficient length to allow the index finger to be inserted, or it may be enlarged so that light can be thrown into the abdominal cavity. The incision is made through the skin, separating the muscles down to the peritoneum. In making the incision through the peritoneum it is best to pick up a small portion of it with a forceps, nick with the scissors and enlarge with a probe-pointed knife. By this procedure injury to the bladder or other abdominal organs is avoided. The index finger of the right hand is then inserted through the opening; follow the left abdominal wall pushing the bowels back until the finger reaches the bottom of the cavity. At this point the finger will come in contact with the left cornu, which is hooked over the finger and drawn out of 288 DISEASES OF THE OVARIES the cavity. Be careful to keep the finger in constant contact with the abdominal wall so that the cornu will not slip off. When once outside of the cavity the ovary can be located easily by following the course of the cornu. The ovary is distinguished by its consistency. In most cases in the dog it will be found imbedded in a capsule of fat. There are two methods of removing the ovary, and the choice of them will depend somewhat upon the condition of the gland. In young females, before the ovaries have fully matured, and in older ones between the periods of estrum, it is safe to remove them with an emasculator, unless considerable congestion is present. Where there is danger of hemorrhage, the ligation method is used. When this method is employed, sterile silk or linen is best which should be put on securely so that it will not slip off after removing the ovary. Ligation should be made at two points, around the cornu posterior to the ovary, and around the vessels and the broad ligament anterior to the ovary, ("are must be taken that all of the ovarian tissue is removed. Otherwise the females will again estruate, and the success of the operation will be incomplete. \Vhen removing the gland with the emasculator it must be pulled up sufficiently so that it will include all of the ovarian tissue. It is best to allow the instrument to remain in position a few moments. The cornu is then returned to the cavity. The other ovary is obtained by inserting the index finger of the left hand and following along the right abdominal wall as was done on the opposite side. The location of the ovaries is not difficult when the animal is properly prepared. Small, fat patients, with a short abdom- inal cavity, will present the greatest difficulties. The intro- duction of a probe or catheter through the vagina may be used by the beginner. The abdominal incision is cleansed thoroughly and approxi- mated by using two or more interrupted sutures. Suturing the abdominal walls may be done by using two rows of sutures one row including the peritoneum, and the other the skin and muscles, or may be closed by a single row including all of the tissues. This method has proved satisfactory. The abdom- inal walls should be accurately approximated as it facilitates adhesions and healing. POULARDIZING THE FEMALE CHICKEN 289 An antiseptic pack is applied and the regular bandage used to hold it in place. Dress the wound daily and in four to six days the sutures may be removed. Sometimes animals are observed to estruate following this operation, and in such cases they should be reoperated, as it results in most instances from a small amount of ovarian tissue being left in. Cysts will form in such cases leading to a continuance of the estrual period. Oophorectomy in the Cat. Cats are operated to correct pathological conditions, particularly cystic formations in the ovaries, which are very common in these animals, and also to prevent them from becoming pregnant. They should be operated if possible prior to sexual maturity, and the best time is between the ages of three and seven months. The same preparation should be made for the cat as in the dog. The most satisfactory anesthetic is ether. The opera- tive technic is the same as in the dog. It has been claimed that this operation is more dangerous in the cat than in other animals, but when done under proper conditions the mortality is very low. POULARDIZING THE FEMALE CHICKEN. This operation is performed on the female fowl to prevent egg formation, and to ensure quick growth and a finer quality of meat. The operation is not practiced as extensively in this country as in some of the European countries. Undoubt- edly, however, the operation will become more popular than at present. The best age to operate is after two to three months. The same preparation should be made as in caponizing. (See Caponizing.) The operation is performed as follows: Securely fasten the bird on a table or other suitable place, and remove the feathers from the field of operation, which is between the last two ribs. Thoroughly cleanse and disinfect. The incision is made between the last two ribs, using the same precautions as in caponi/ing. Retractors are used to spread the incision. The egg cluster will come into view at once. ID 290 DISEASES OF THE OVARIES A section of about one to .one and a half inches of the oviduct should be removed with the forceps and scissors. Care must be taken to prevent injury to the large bloodvessels which lie in close proximity to the egg cluster. The removal of a portion of the oviduct prevents further egg production. After-treatment is the same as for caponizing. CHAPTER V. DISEASES OF THE UTERINE TUBES. Examination. Examination of the uterine tubes is quite difficult, except by explorative laparotomy. They should be examined for inflammation, tumors, cysts, and pus accu- mulations. In some cases, when the animal is much emaci- ated, and the tubes large, it is possible to palpate them through the abdominal wall. SALPINGITIS. Definition. Inflammation of the uterine tubes. Etiology. Salpingitis occurs as a secondary condition following inflammation of other portions of the generative apparatus. Symptoms. The diagnosis is difficult unless laparotomy is resorted to. Other reproductive organs are usually also involved complicating the symptoms. Treatment. Very little can be done except complete extir- pation of the affected tubes. PYOSALPINX. Pyosalpinx is a purulent inflammation of the uterine tubes. It is secondary to other diseases of the reproductive organs. Removal of the uterine tubes is recommended. TUMORS. CYSTS. These are found occasionally and when present should be extirpated. CHAPTER VI. DISEASES OF THE UTERUS. Examination. There are three principal ways in which an examination of the uterus may be made : (a) By abdom- inal palpation; (6) by obtaining the discharge from the uterus and noting the condition of the vulva and vagina; (c) by laparotomy. (a) In abdominal palpation it is possible to determine various conditions involving the uterus. The patient should be placed in a standing position. With one hand on either side of it over the postero-inferior abdominal region, the operator by gentle pressure with the finger can feel the uterus when distended, as an elongated, suspended body,, within the abdominal cavity. Palpation may be used to detect pregnancy, pyometra, hydrometra, tumors and inflam- mation. Sometimes in order to differentiate between these conditions it is necessary to make a general examination of the animal. (6) In some of the conditions involving the uterus, there is a discharge from the vulva. The discharge should be collected and examined carefully, noting whether or not it consists of blood, mucus, pus, membranes, bacteria, etc. The microscope may be employed if necessary. (c) By laparotomy it is possible to make a direct inspec- tion of the uterus. It is advisable when there is evidence of serious involvement of the organ, and where the diagnosis is in doubt. The incision through the abdominal walls is made in the median line just anterior to the pubis, extend- ing forward a sufficient distance to allow the uterus to be drawn out. The uterus may be enlarged. The external or serous covering should be observed for evidences of inflam- mation, hemorrhage, and rents or tears in the walls, Note METRITIS 293 the relative size of the two cornua, as compared to the size of the body of the uterus, their position and attachments. Tumors, pregnancy, etc., should be looked for. The con- sistency of the organ is important as it is modified by the character of its contents, whether fluid, or solid material. The entire organ should be carefully palpated for differential diagnosis between pregnancy, tumors, proliferative or fibroid endometritis, pyometra, hydrometra, etc. After a careful examination the uterus may be returned to the cavity or operated as the condition indicates. METRITIS. Definition. An inflammation of the uterus which may be () acute, or (6) chronic. Acute Metritis. Definition. An acute inflammation of the uterus. In most instances it is to be regarded as an acute inflammation of the mucosa (acute endometritis). In some cases the musculature and serous coverings are involved (metroperitonitis) . Etiology. Metritis is a condition in which infection of various kinds is found to be the primary etiologies! factor. There are various conditions which occur in small animals that favor uterine infection and ultimately lead to an acute inflammation. These are: (a) The retention of the fetal envelopes. If not expelled after the normal time has elapsed they constitute a source of danger to the animal, as they form a favorable medium for the growth of bacteria. The retained membranes keep the cervix of the uterus open, which favors the introduction of bacteria, and interferes with the normal involution of the organ. Retained placenta is not so common in small animals as the membranes are usually passed with the fetus. (6) Infection is introduced into the uterus at the time of parturition by the use of infected instruments or ringers used in cases of dystocia. (c) Wounds of the mucosa of the vagina and uterus greatly facilitate the entrance of infection. Depending upon their depth, wounds may lead to metroperitonitis. 294 DISEASES OF THE UTERUS (d) The retention of a fetus or fetuses which decompose, irritate the mucosa, and, if allowed to remain for a long period, often produce grave symptoms of local inflammation and sapremia. In some cases the uterine mucosa is greatly changed by the infection. The uterus may be converted into a cavity filled with pus (pyometra) . (e) Slowness in the involution of the uterus from lack of muscular tone favors the introduction and development of infection. For the same reason individuals weakened from delayed parturition, systemic diseases, etc., are predisposed. (/) In bitches and cats that are kept in cold, damp kennels, metritis is occasionally observed, and no doubt results from the general reduction in resistance, and from the weakened condition of the highly sensitive reproductive organs. This favors the development of microorganisms. (g) In small animals injuries of various sorts are common, such as being kicked, run over by vehicles, or roughly handled by persons, especially during the latter stages of pregnancy. The uterus may be injured, sometimes torn or lacerated, and inflammation with infection is the common sequel. Pathology. In fatal cases of acute metritis, marked patho- logical changes are observed in the generative tract, and par- ticularly in the uterus. The uterus is dark colored, in some cases almost black, the mucosa showing necrotic areas. In some instances the necrosis extends to the other tissues of the walls of the uterus causing perforations. The walls of the uterus are thickened, edematous; the serous covering is often inflamed as are the adjacent organs and tissues in contact with it. Occasionally abscesses are found in the uterine walls, or in the surrounding tissues. In the virulent cases of metritis there will be found evidences of thrombosis of the bloodvessels of the uterus, leading to embolisms in the vessels in distant parts of the body, producing in some cases pyemic arthritis, etc. The vulva and vagina are swollen and necrotic, and a greenish colored exudate of offensive odor is present. The other organs and tissues will show the usual postmortem lesions of septicemia or pyemia. The blood is dark colored and fails to coagulate. The kidneys and liver METRITIS 295 are soft and congested. The musculature in general is pale, friable and soft. Symptoms. The first indication of metritis is a marked swelling and congestion of the vulva. On ( digital examination the parts will be found sensitive, very hot, and present on the mucosa a greenish or brown or blood-stained discharge which has a very fetid odor. The vagina is swollen, very hot, and in the early stages, reddened and congested. Later it becomes dark or dark bluish, and in some cases almost black in color, with a foul smelling exudate. This discharge is more copious at times, as it is forced out of the uterus at different intervals. Frequently the animal shows marked symptoms of strain- ing, the abdominal muscles become tense, and quantities of a thick, dark colored exudate are discharged from the vulva. The temperature during the early stages is elevated (106 F.). Later, as the toxins are absorbed, the tempera- ture drops to normal, often subnormal. There are general symptoms of suppression of appetite, vomiting, general stiffness in walking and pain on palpation over the region of the uterus. The animal in most instances assumes the recumbent position. In mild cases the symptoms will gradually disappear and terminate in complete recovery, or in chronic metritis. Diagnosis. The condition appearing as it does following parturition, with the characteristic discharge from the vulva, and the painful and sensitive condition of the uterus, makes the diagnosis rather easy. Careful examination should be made in all cases to establish a correct diagnosis and espe- cially to differentiate acute metritis from puerperal septicemia and pyometra. Prognosis. In small animals, owing to the difficulties encountered in the treatment, and the retention of the exudate in the cornua, the prognosis is unfavorable. The milder cases recover but there is always danger, even in the mild cases, of chronic metritis or pyometra developing. Treatment. Medical. Owing to the small uterus and the long cornua, irrigation is a more difficult problem than in 296 DISEASES OF THE UTERUS larger animals. However, it should be attempted as good results often follow thorough irrigation. Boric acid (2 per cent.) ; creolin (1 per cent.) ; lysol (1 per cent.) ; or theropogen (2 per cent.) may be used as follows: A small metallic catheter or flexible human male catheter is inserted into the uterus and a rubber tube and funnel attached to the free end. The antiseptic solution is allowed to flow into the uterus by gravity. After \ to 1 pint of the solution is intro- duced the tube should be lowered and the fluid allowed to flow out. The catheter is introduced into each cornua. This treatment should be applied every three or four hours to keep up the antiseptic action, to remove the exudate and to prevent absorption and the resulting general symptoms. Small doses of ergot or other ecbolics should be adminis- tered once daily to stimulate the uterus and to hasten its involution. Surgical. In severe forms of acute metritis, and in cases where medicinal treatment does not relieve, it is advisable to remove the uterus and ovaries by performing laparo- hystero-oophorectomy. Chronic Metritis. Pyometra. Definition. A chronic in- flammation of the uterus, characterized by the formation and collection of pus in the uterine cavity. In case the cervical canal becomes closed, retaining the pus, the uterus may be converted into a veritable abscess. Chronic metritis occurs quite frequently in the bitch; less commonly in cats. It makes its appearance in most cases following parturition, at any period in the animal's life, but may be found in females that have never given birth to young. Etiology. (a) Commonly a sequel to acute metritis, the acute symptoms disappearing, leaving behind bacteria of a low virulence, which keep up a constant irritation to the inucosa resulting in chronic inflammation with pus formation. (6) Infection gaining entrance to some portion of the reproductive organs which may find its way to the uterus direct, or by extension of the process from other parts or adjacent tissues, leading to a primary inflammation of chronic type. (c) Following parturition it frequently happens that a METRITIH 297 small portion of the placenta is retained leading to a slowly developing inflammation with pus formation. (r/) Injuries of a mild character during parturition, or at other periods, reduce the general resistance of the animal and particularly the local resistance of the uterus allowing infection to develop. In these cases we will often find that the female has never been pregnant. Such cases tend to develop into uterine abscess. (e) Anything which reduces the resistance of the repro- ductive organs or the animal's general resistance has a tendency to favor the formation of this condition. Exposure is a predisposing factor. Pathology. The presence of pus in varying quantity in the uterus. The pus is thick, viscid, dark or reddish, some- times reddish-gray in color and of offensive odor. The walls of the uterus are much thickened, dilated, and in some cases enormously distended with pus (uterine abscess). The mucosa is dark in color, soft, spongy, and shows numerous elevations of various sizes. The process can extend into both cornua. In general the animal will show emaciation, the muscles are pale, soft and friable. Secondary abscesses are often observed in the kidneys, liver and lungs. Symptoms. The most prominent symptom is the chronic discharge from the vulva, which varies in quantity, being more copious at certain times than at others. This is due to the fact that it accumulates in the uterus until a certain distention of the organ is reached, when it will be ejected. The discharge is grayish-red, or dark red in color, and of fetid odor. It soils the tail, limbs, and hair around the vulva. In uterine abscess, with occlusion of the cervical canal, the discharge will be absent. Enlargement of the Abdomen. In all cases, and particu- larly in uterine abscess, there is a marked increase in the size of the abdominal cavity which may simulate pregnancy. Careful palpation should be made especially in distention of the uterus with no discharge from the vulva (uterine abscess). General Symptoms. In all cases of chronic metritis systemic disturbances are noted. They are general emacia- 298 DISEASES OF THE UTERUS tion, weakness, rough hair coat, a variable appetite and temperature. Diagnosis. Diagnosis does not present much difficulty as the symptoms are quite characteristic. Uterine abscess should be differentiated from pregnancy, distention of the bladder, ascites, tumors, etc. In doubtful cases, laparotomy is advisable. Prognosis. Usually favorable, especially so when the animal's condition is still good, and proper treatment pos- sible. Such animals cannot be used for breeding as the condition in the uterus, which cannot be entirely relieved, prevents conception. Treatment. Medical treatment is of little value. Irrigation of the uterus with an antiseptic solution may be tried. How- ever, surgical treatment is necessary in order to properly over- come the general symptoms. An early removal of the uterus and ovaries will prevent metastatic abscesses developing in the kidneys, liver, etc. The operation is as follows : The animal should be given a general anesthetic and placed on the oper- ating table in the dorsal position with head lowered. The incision is made in the median line, beginning just anterior to the pubis and extending forward a sufficient distance to allow the uterus to be drawn out of the abdominal cavity. Sterile silk ligatures (No. 10) are applied around the broad ligament at the distal portion of the ovary, and around the uterus just anterior to the cervix. The ligature around the uterus should be placed in sections, and then around the entire part to prevent it from slipping off and fatal hemorrhage resulting. The entire portion between the ligatures is then separated with knife or scissors, and the stumps returned to the abdom- inal cavity. The abdominal incision is cared for in the regular way. In case of collapse or weakness following the operation small doses of strychnin (0.001) should be given. PUERPERAL SEPTICEMIA. Definition. A common disease in small animals in which either bacteria or their products are introduced into the PUERPERAL SEPTICEMIA 299 general system. Puerperal septicemia accompanies to a greater or less extent most forms of septic infection of the reproductive organs during the puerperal state. Etiology. Puerperal septicemia results invariably from retention of placenta, a fetus or fetuses, or from wounds acquired during or following parturition. Putrefaction changes in the retained placenta occur rapidly, other infection is introduced, and the products of bacteria or the bacteria themselves are taken into the circulation producing a general septicemia or sapremia. This disease may follow normal birth, dystocia, etc. Pathology. The changes in the reproductive organs are often slight as compared to the severity of the symptoms. The blood is thin, does not coagulate readily. The muscles are pale, soft and friable. Ecchymoses are observed on the serous membranes, particularly in the abdominal cavity. Parenchymatous degeneration is noted in the liver, kidneys and spleen. Symptoms. The symptoms develop rapidly, usually in from one to three clays following parturition. There is great depression, the animal lying down most of the time; elevated temperature (106-107 F.), increased respirations and pulse. Later appear great prostration, subnormal tem- perature, cold extremities, etc. Locally the generative organs show marked changes in some cases, such as swelling of the vulva, the mucosa of the vagina; in others little change will be found. There is nearly always a copious discharge from the vulva, consisting of a greenish colored pus, containing shreds of placenta and other material. This discharge has a very offensive odor. The bowels are irregular, in some cases constipation will be present and in others a severe diarrhea. The symptoms usually increase in intensity, the animal reaching a stage of coma or collapse. In the milder forms of infection, and particularly in sapremic conditions, the symptoms gradually disappear and the animals make a complete recovery. Diagnosis. This is made on the sudden onset, the severe general symptoms, the high temperature in the early stages, and the characteristic involvement of the reproductive organs. 300 DISEASES OF THE UTERUS Puerperal septicemia should be differentiated from acute and chronic metritis which can be made by a careful examination of the patient. Prognosis. The prognosis is unfavorable, most cases ter- minating fatally. Mild cases often recover; more severe ones may recover if treatment can be applied early. Treatment. Medical. In cases of marked collapse, sub- normal temperature, etc., stimulants, such as aromatic spirits of ammonia, spirits of camphor, oil of camphor, or strychnin should be administered early. Surgical. As local applications in the form of irrigation with antiseptics have proved unsatisfactory, an early opera- tion is advised. Before operating obviously the genital tract should be flushed with antiseptics. The animal should be anesthetized and operated as in chronic metritis. (See Chronic Metritis.) Care must be exercised in preventing infection of the serous membrane of the abdominal cavity. The stump of the uterus should be inverted and thoroughly disinfected before it is returned to the abdominal cavity. The after-treatment is very important, and prompt remedial agents (stimulants) should be administered. Irrigation of the vagina should be done at regular intervals to control local infection. Normal salt solution should be used in cases of collapse following the operation. It is best injected intraperitoneally (250 to 500 c.c.). EVERSION OF THE UTERUS. Prolapse. Inversion of the Uterus. Eversion of the uterus is not common in the small, multip- arous animals, particularly in the dog and cat. The small uterus and long cornua present an anatomical arrangement which tends to prevent eversion except in rare instances. It is occasionally observed in the bitch following parturi- tion. The eversion in most cases consists of an invagination of the anterior extremity of the cornu into the succeeding portion, and should the process continue, it will appear at the vulva or even project outside. In most cases the pro- lapsed portion will consist of one cornu and a portion of the E VERSION OF THE UTERUS 301 uterus. However, in a few instances there .will be found a complete eversion of both cornua, the body of the uterus and a portion of the vagina. The prolapse of one cornu through the uterus usually prevents the other one following. Symptoms. The early indications are the expulsive efforts of the animal, which are very similar to those noted in par- turition. The animal becomes uneasy, looking at its sides, licking the vulva, etc. When such symptoms occur following parturition, the uterus should be examined. The local symp- toms after the uterus appears at the vulva, are quite charac- teristic. There is a rounded enlargement between the lips of the vulva, at first only slightly congested and swollen, later considerably swollen and changed in colbr to a dark red or almost black. When the organ has been prolapsed for some time, the mucosa becomes darker, covered with a thick greenish or purulent exudate, and in some cases extensively gangrenous. General symptoms of anxiety, restlessness, dyspnea, increased labor pains, and later septicemia are observed. Diagnosis. In small animals care should be taken to differentiate eversion of the uterus from prolapse of the vagina or its mucosa, tumors, etc. This can be done by inserting the finger around the periphery of the enlargement to determine its point of origin. Further, the characteristics of the prolapsed portion will assist in the diagnosis. In later stages, when necrosis has developed with much swelling of adjacent tissues, the diagnosis is more difficult. Prognosis. Several things tend to alter the prognosis. More favorable are those cases of recent development, and especially before extensive pathological changes have taken place in the uterus. The prognosis is unfavorable if amputa- tion of the uterus is necessary on account of the danger of septicemia. The prognosis is unfavorable from the stand- point of breeding. Treatment. In case the prolapse is of recent development reposition should be attempted at once. The parts should be thoroughly cleansed with antiseptics and astringents. Reposition should be attempted by gentle pressure on the prolapsed portion. Patience is often necessary to effect 302 DISEASES OF THE UTERUS reposition. In case this does not succeed, it is advisable to perform laparotomy under anesthesia, and pull the uterus back into position. Care should always be taken to avoid tearing the tissues, and it is best to have an assistant manipu- late the parts in the vulva, and at the same time exert some pressure so that the entire prolapsed portion will at the same time go back into position. It is advisable to suspend the uterus to the abdominal wall after it has been withdrawn in order to prevent further prolapsus. This can be done easily by simply including the serous and muscular coats of the uterus in the sutures when closing the abdominal walls. In case the prolapsed portion is necrotic or gangrenous it should be amputated at once. The parts are cleansed thoroughly with antiseptics, and the prolapsed portion drawn out from the vulva until healthy tissue appears. A ligature is applied around the entire mass as high up as pos- sible. It should be placed in position by drawing it tight to avoid postamputation hemorrhage. The mass is then removed with a scissors or knife. Hemorrhage should be controlled, if present. The stump is thoroughly washed with antiseptics and returned to the vagina. The vagina should be irrigated with antiseptics for a few days following the operation. The ligated portion will slough away in a few days. TORSION OF THE CORNUA UTERI. This is a condition occurring occasionally in bitches pre- vious to or at the time of parturition. A twist occurs at the junction of the cornua with the body of the uterus, prevent- ing the birth of the fetuses. Symptoms. No special symptom of torsion of the cornua will be observed. It may be necessary to make a careful examination to reveal the exact condition; in some cases an explorative laparotomy must be made. Treatment. The torsion can be reduced by performing laparotomy. In case it is found that the circulation has been so disturbed as to cause necrosis, it will be best to amputate the entire organ. TUMORS OF THE UTERUS 303 RUPTURE OF THE UTERUS. Rupture of the uterus has been observed in both the bitch and cat. It may be due to unequal uterine contractions, or to the rough use of instruments at parturition. The rupture may be small, simply allowing some of the fluids from the uterus to escape into the abdominal cavity, or may be of sufficient size to allow the fetus to pass through. This is usually a serious condition on account of the infection getting into the abdominal cavity, producing septic peri- tonitis. Symptoms. The stoppage of the labor pains, and the sudden prostration of the animal are the most characteristic symptoms. Examination should be made by inserting the finger through the vagina into the uterus and at the same time with the other hand pushing upward and backward on the fetus. If there is membrane between the fetus and finger, one should suspect that the fetus is in the abdominal cavity. Laparotomy should be performed at once to make a positive diagnosis. Prognosis. The prognosis is unfavorable owing to the danger of peritonitis. Treatment. Prompt surgical treatment should be given. The fetus and membranes should at once be removed, and the abdominal cavity flushed thoroughly with normal salt solution. The rent in the uterus is closed with Lembert sutures. Gauze is placed between two of the sutures in the abdominal wall to afford drainage. In thirty-six hours this may be removed. TUMORS OF THE UTERUS. Various forms of tumors have been observed involving the uterus in the bitch and cat. The usual varieties are : Fibro- mata, myomata, cysts, and hydrometra. Malignant neo- plasms are very rare. Fibromata. These are benign tumors found involving the muscular wall of the uterus. In the majority of instances they consist in part of fibrous tissue, and myomatous ele- 304 DISEASES OF THE UTERUS ments. In older animals there is a preponderance of fibrous tissue. They develop gradually within the muscular walls, and project into the lumen of the organ in some cases, while in others the growth is mainly toward the peritoneal cavity. When extensive, and when the growth is toward the lumen of the organ, they may be found projecting through the os into the vagina. They are characterized by their slow devel- opment. Symptoms. The first indication of the presence of fibro- mata will be an increase in the size of the abdomen, simulat- ing pregnancy. However, on examination by palpation, the difference will be apparent at once. Frequently on inserting the finger into the vagina the tumor will be recognized, and it should be observed whether the tumor projects from the os, or is attached to the vaginal wall. No general disturbances are noted, except when the tumor becomes of sufficient size to interfere with the function of the abdominal or thoracic organs. Diagnosis. The enlargement of the abdomen, which comes on gradually, the lack of general symptoms, and the location of the enlargement differentiate it from pregnancy. Further, through laparotomy the uterus may be examined direct. Prognosis. Favorable. Treatment. Surgical. Surgical interference by complete removal of the uterus and ovaries is indicated. When the tumors are found projecting through the os into the vagina, they should be withdrawn into the abdominal cavity and extirpated. Myomata. In myomatous tumors of the muscular walls of the uterus, the symptoms, diagnosis, and treatment are the same as for fibromatous. Hydrometra. Definition. A collection of transudate or other sterile fluid in the uterus. Etiology. Occlusion of the cervix, or any portion of the uterus which prevents the escape of fluid. Inflammation of the cervix (endocervicitis) resulting from wounds and injuries during parturition. Pressure of inguinal hernia producing occlusion. It may be produced by ligation of the uterus, as is done DYSTOCIA 305 occasionally to prevent pregnancy. It may develop as a simple hydrometra, in which case there will be no serious effects upon the animal. Symptoms. Distention of the abdomen^ which becomes pronounced and simulates pregnancy. Its persistence and the absence of lactation differentiate it from pregnancy, however. There are no general symptoms, no pain on manip- ulation of the abdomen, and no change in the other parts of the reproductive organs. Diagnosis. Hydrometra should not be confused with pregnancy, tumors of the uterus, ascites, and pyometra. A laparotomy may be necessary to make an accurate diagnosis. Prognosis. Favorable. Treatment. If due to an inguinal hernia, a surgical opera- tion is necessary for relief. In other cases the entire uterus together with the ovaries should be removed. DYSTOCIA. Definition. Difficult parturition. Dystocia is of frequent occurrence in the bitch and cat. Etiology. Many etiological factors produce dystocia: 1 . In a mechanical way we find numerous obstacles which interfere with the expulsion of the fetus. (a) Lack of expelling power of the uterine muscles. This is frequently due to general weakness, anemia, etc. (6) A narrow and undilatable pelvic canal, which is too small for the fetus to pass. (c) Constriction of the os uteri, which prevents the pas- sage of the fetus. (d) Torsion or displacement of the uterus, closing the uterine exit. (e) Abnormal development of one or more of the fetuses which are too large to pass through the pelvic canal. (/) Malpresentation or position of the fetus which pre- vents it entering or passing through the pelvic canal. (g) Deformity or abnormality in the development of the fetus. In some instances, as in hydrocephalus, ascites, or 20 306 DISEASES OF THE UTERUS monstrosities, they are too large to pass through the pelvic canal. (h) There is frequently a narrowing of the pelvic canal from tumors in the vagina, fractures of the pelvic bones with enlargement, etc. 2. It has been observed frequently that environment has a great deal to do with producing dystocia in the bitch. Animals that are kept closely confined, fed highly nutritious food, and are not exercised, are more predisposed to parturi- tion difficulties. Some breeds are more often affected than others, perhaps due in most cases to the manner in which they are cared for. 3. Mating animals of extremes in size, particularly a small female bred to large male. The young will be too large in some cases to be expelled. 4. Young females at the first birth are more commonly affected with dystocia than at later periods. 5. Females when bred before reaching complete maturity often will have difficulty at the time of parturition. Symptoms. In normal parturition it requires from three to thirty-six hours for the birth of the young. It depends somewhat on the number of fetuses, and the condition of the animal. Therefore it is sometimes difficult to determine accurately the time at which dystocia begins. The principal symptoms of dystocia are: Extreme restlessness; severe labor pains at first, later their cessation; discharge from the vagina; general weakness. Examination of the patient will determine the condition. The following examination should be made in these cases: Note the general condition in regard to pulse, respiration and temperature. Note the physical condition. Palpate the abdominal region to determine whether any young are present. Differentiate between the presence of fetuses and other enlargements commonly found in this location. Note the condition of the external genitals; the discharge from the vulva. I )isinfect the fingers and palpate through the vagina. If the fetus has been presented at the pelvic inlet, it can be felt. If still in the uterus it mav not be determined DYSTOCIA 307 by vaginal palpation. In palpating note the condition of the pelvic canal, whether constricted, tumors present, etc. Diagnosis. If the labor pains are normal and no impedi- ment to the passage of the young through the pelvic canal is apparent, and the animal is in good physical condition, we should allow more time to elapse before assuming it to be a case of dystocia. However, if the animal is weak, the general condition disturbed, labor pains absent, etc., we are justified in diagnosing dystocia. Prognosis. Favorable in most cases. Will depend upon (a) the condition of the animal, (6) the length of time in labor, and (c) the condition of the fetus and membranes. Treatment. A thorough examination of the patient should be made at once to determine the proper treatment to use. There are three lines of treatment recommended in dystocia. Medical. This is indicated in cases when there is no apparent impediment to the passage of the fetus, and when the labor pains are weak and insufficient. Extract of ergot (0.5-2.0) or pituitrin (3.0-10.0) depending on the size of the animal may be given. These doses may be repeated in a few hours if necessary. Pituitrin is being used quite successfully in such cases. Forced Extraction of the Fetus. Examination is made of the condition of the birth canal and the position of the fetus noted. Various forms of instruments have been recom- mended for this work. Perhaps the most satisfactory ones are the smallest forceps, a rather blunt vulsellum forceps, and a wire snare. These instruments should be thoroughly disinfected, and the vagina washed with an antiseptic and lubricant solution (creolin, 2 per cent.; lysol, 1 per cent.). The method of manipulation will depend upon the position, presentation, and condition of the fetus. All manipulating with the instruments should be done carefully to avoid injur- ing the vaginal mucosa. An assistant who exerts pressure on the abdominal walls in a backward direction will often help in keeping the fetus in position until the instrument is firmly attached. Gentle traction should be used. This method when done carefully will often overcome the diffi- cult v. 308 DISEASES OF THE UTERUS Hysterotomy.Aher examination of the patient it is found that it is impossible for the fetus to be born, or after the other methods of treatment have failed, it is advisable to perform hysterotomy as early as possible. Delay in performing the operation is often fatal on account of the infection in the uterus from resulting sapremia or septicemia. The animal is anesthetized, placed on the table in a dorsal position, well hoppled. An incision is made through the abdominal walls in the median line just anterior to the pubis and extended forward about three to four inches. The uterus will at once be seen as a voluminous body. It is withdrawn carefully from the cavity well surrounded by sterile gauze to prevent fluids from flowing back into the abdominal cavity. An incision is made through the walls of the uterus of sufficient size to allow the fetus or fetuses to be withdrawn. If there should be any fetus in either of the cornua they can be removed through the same opening. The membranes and any other material should be removed from the uterus. The incision in the uterus is closed with Lembert sutures and returned to the abdominal cavity. The abdominal incision closed as usual. General stimulants should be administered following the operation. Hysterectomy is advisable in cases where there is evidence of puerperal infection. (See Chronic Metritis.) CHAPTER VII. DISEASES OF THE VAGINA AND VULVA. Examination. It is possible to make a thorough examina- tion of the vagina and vulva by direct inspection. The animal should be placed in a dorsal position with the hind limbs hoppled forward. The vulva can be inspected directly by separating the labia with the fingers. The condition of the mucosa should be observed, any wounds or injuries carefully examined to determine their depth and extent. Note the color of the mucosa. It should be remembered that in the bitch there is often a normal pigmentation of the mucosa which should not be mistaken for some diseased condition. Papillomata and fibromata are commonly found at the junc- ture of the skin and mucous membrane. The vagina may be inspected by using a speculum to dilate the vulva and a portion of the vagina so that the mucosa can be seen. It is best to use an artificial light with a reflector to observe the mucosa farther into the pelvic canal. The mucosa should be examined for wounds and injuries which are common sequels to dystocia, inflammation, tumors, prolapsus, con- strictions, etc. CONGENITAL MALFORMATIONS. Various forms of malformations have been observed in the bitch and cat. Stenosis of the vagina is seen occasionally. Imperfect development of the vulva, vagina and anus during fetal life has been noted. These conditions may interfere with copulation and impregnation. When found an attempt should be made to correct them surgically. VAGINITIS AND VULVITIS. Definition. An acute or chronic inflammation of the vagina and vulva. These are very common conditions found in both the bitch and cat. 310 DISEASES OF THE VAGINA AND VULVA Etiology. Mechanically there are a number of conditions which bring about inflammation of these parts. Anything causing bruising of the mucosa will result in an inflammatory condition varying in degree and depending upon the extent of the injury. Lacerations and abrasions of the mucosa make possible the entrance of bacteria with resultant inflamma- tion. During dystocia, wounds, and lacerations of the vulva and vagina are very common from rough manipulations and sharp instruments. At this time the animal's general resist- ance is materially reduced and serious infection and infiltra- tion of the tissues can take place. Infection is frequently introduced by infected fingers or instruments. Another factor of importance in these cases following dystocia is the fact that in the extraction of the fetus, or the discharge of the secretions from the uterus, the vagina is further exposed to infectious material. Foreign bodies finding their way into the vagina will pro- duce inflammatory conditions depending upon the kind of foreign body and the extent of the injury done by the same. Tumors in the vaginal wall usually produce a chronic inflam- mation. Symptoms. Acute inflammation of the vulva is apparent from the swelling of the labia and the congestion of the mucous membrane. The color of the mucosa is at first red, later of a bluish, or greenish-black, depending upon the stage of the inflammatory process. At first there is no discharge, but later a mucous or mucopurulent discharge is observed. In acute vaginitis the mucosa will be red in color, swollen, and in most cases the seat of the injury or infection will be observed. The animal will be restless, often shows symptoms of straining as if to urinate. General symptoms of elevation of temperature, disturbances in the circulation and respira- tion are often observed from the absorption of the toxins, or the presence of microorganisms in the blood. In chronic vaginitis the principal symptom is the chronic, whitish, purulent discharge from the vulva. Examination reveals the chronic inflammatory changes of the mucosa of the vagina and vulva. In most of these cases it is difficult to make a distinction between the two conditions as they are nearly always associated except in injuries. PROLAPSE OF THE VAGINA 311 Diagnosis. This is made by a direct inspection of the mucosa. Prognosis. Favorable in most cases, unless general symp- toms of septicemia are present, or in some cases of extensive laceration of the mucous membrane. Treatment. The parts should be thoroughly cleansed with mild antiseptics (lysol, 2 per cent.), followed by weak solu- tions of astringents (silver nitrate, 0.25 per cent., or silver citrate 0.5 per cent.). These applications should be made daily. In case any foreign bodies are present, they should be removed and antiseptic treatment applied. When the vulva or vagina is found lacerated the extent of the wound should be determined by probing, all loose fragments removed with the scissors, and antiseptics used as above. In gangrenous conditions of the vulva or mucosa, all such portions must be removed promptly, and the surface treated thoroughly with antiseptic solutions. It is sometimes neces- sary in recent wounds of the vulva to apply one or more sutures to properly approximate the torn edges to prevent improper union. PROLAPSE OF THE VAGINA. A true prolapsus of the vagina is uncommon in small animals. A hypertrophic condition of a portion of the mucosa which protrudes through the vulvar opening is frequently mistaken for prolapsus. This, however, is not a true prolapsus, but inasmuch as it simulates the condition, it will be described with prolapsus. Etiology. Prolapse of the vagina often results from injuries during copulation, the penis, which is forcibly withdrawn before ejaculation has taken place, pulling the vaginal mucosa out with it. Results also from severe straining, and from inflammation of the mucosa. Hypertrophy of the mucosa is observed frequently in some of the larger breeds, Great Danes, St. Bernards, and becomes a chronic and especially prominent following the estrual period. It consists of simply a chronic inflammation which is most marked during estruation. 312 DISEASES OF THE VAGINA AND VULVA Symptoms. The condition is characterized by an enlarge- ment appearing at the vulvar opening. At first the prolapsus is a red, congested mass, which later, on exposure, becomes dark in color and gangrenous. In hypertrophy of the mucosa it appears as a rounded enlargement of rather firm consist- ency projecting through the vulvar opening and coming from one side of the vaginal wall. In some cases it will remain outside of the vulva, becoming dark in color and gangrenous on the surface; or it may not protrude beyond the vulvar opening and appear only at intervals. Usually there are no general symptoms. There may be some interference with micturition. Diagnosis. This is not difficult in most cases. A thorough manual examination should be made to determine the exact conditions present. Prognosis. Favorable. Treatment. In prolapsus of the vagina an attempt should be made to replace it. The parts should be cleansed, disin- fected and if there is much congestion, astringents (alum, 2 per cent.) may be used. In some cases this will be sufficient, in others when there is a recurrence of the condition without necrosis or gangrene, it should be returned and if necessary held in place by temporary sutures through the labia of the vulva. They should be placed so that the urine can be voided. Remove them in twenty-four to forty-eight hours. When gangrene sets in, amputation of the prolapsed portion becomes necessary. This is done by grasping the mass and withdrawing it until the normal mucosa appears. If the prolapsus involves only a portion of the circumference of the vagina it may be ligated. The ligature should be inserted through the base of the mass and drawn securely to control hemorrhage and stop absorption. In case the vagina is prolapsed, throughout its whole circumference sectional suturing will be necessary. Care must be taken in all cases to avoid injuring the urethra. In hypertrophy of the mucosa amputation of the mass is necessary. This is done by thor- ough cleansing and disinfecting the parts, withdrawing the mass from the vulva, and ligating through its base. The mass should be removed with the knife or scissors and the TUMORS OF THE VULVA AND VAGINA 313 stump returned to the vagina. The vagina should be cleansed daily with antiseptics until the discharge has ceased. RUPTURE OF THE VAGINA. During dystocia from rough manipulation, or from sharp instruments the vagina may be torn or ruptured making at once an opening into the abdominal cavity. This will allow septic material to gain entrance which usually produces peri- tonitis. In some cases after rupture of the vagina, and when straining is induced, or still present from the dystocia, there may be a prolapsus of the bladder through the rent. When this occurs the bladder becomes displaced and projects from the vulva. It will be recognized as a fluctuating enlargement appearing suddenly between the labia of the vulva. An exploring trocar may be used to determine its contents if the diagnosis is in doubt. Laparotomy should be performed at once (see Laparotomy) and the displaced organs returned to their normal position. If possible close the opening in the vagina. If septic infection has developed little can be done. TUMORS OF THE VULVA AND VAGINA. The majority of the neoplasms found in the vulva and vagina are benign growths consisting in most instances of fibromata, papillomata, or a mixture of fibromata with myxomatous, myomatous, or lipomatous elements. Malig- nant tumors are uncommon in the vagina, but do occur occasionally as secondary growths, or in the form of venereal granulomata. Fibromata. These are found in most instances projecting from the walls of the vagina, or from the cervix. They appear as hard, firm enlargements, usually smooth on the surface, show no tendency to degeneration or necrosis, except when they project through the vulva and become irritated from exposure. Diagnosis. Made by the character of the enlargement, its slow growth and finally by a microscopic examination. Prognosis. Favorable in most cases. 314 DISEASES OF THE VAGINA AND VULVA Treatment. Complete amputation should be done as early as possible. Ligation, the same as for hypertrophy of the mucosa, is perhaps the most satisfactory method. Papillomata. These occur at the juncture of the skin and mucous membrane of the vulva. They appear as small, rounded, pedunculated (usually) tumors. They often have a roughened surface. Treatment. Papillomata should be removed with the scissors, and the bases cauterized with silver nitrate. They rarely reappear. Sarcomata. These are found occasionally on the vaginal- mucosa. They are characterized by their rather rapid growth, uneven surface, and tendency to spread to adjacent structures. If possible a small section should be obtained for microscopic examination. Treatment. Treatment is unsatisfactory and should not be attempted. Venereal Granulomata. Venereal granulomata have been described under venereal granulomata in the male animal. In the female they appear on the mucosa of the vulva and at the posterior portion of the vagina. They consist of pro- gressive neoplasms varying in rapidity of growth. Treatment. Complete removal should be attempted, except in very advanced cases. CHAPTER VIII. DISEASES OF THE MAMMARY GLANDS. Examination. These glands may be examined by observing their size, condition, and by palpation to note their consist- ency or the presence of wounds, inflammation, abscesses, etc. WOUNDS AND INJURIES OF THE MAMMARY GLANDS. In the bitch and cat, wounds and bruises of the mammary glands are quite common. They result in most instances from being run over by vehicles, by falling, from bites of other animals, or the glands may be punctured by sharp objects. The degree of injury will vary greatly. In some cases it will consist in a simple, slight contusion of the gland- ular substance; in others bruising with hemorrhage into the gland producing a hematoma, and in some cases abscesses result. A careful examination should be made to determine the degree and extent of the injury. Treatment. The treatment will depend to a great extent on the condition of the glands. In slight contusions but little treatment is necessary, while in more extensive bruising, warm applications should be applied in the form of a warm antiseptic pack containing lysol (2 per cent.). In open wounds their extent should be determined and treated with antiseptics. An antiseptic pack may be applied when the animal interferes with the wound by biting or licking it excessively. When abscesses develop in the gland, they should be opened freely to allow good drainage and the wound treated as above. In most cases recovery takes place promptly. If fistula or necrosis of the gland should develop, it may be amputated. 316 DISEASES OF THE MAMMARY GLANDS CONGESTION OF THE MAMMARY GLANDS. A normal condition occurring at the end of the gestation period, and during lactation. It has been observed in non- pregnant and virgin animals. The glands become enlarged, hot, and sensitive. No treatment is necessary. MAMMITIS. MASTITIS. Definition. An inflammation of the mammary glands. The inflammation may involve one or more of the glands. Mastitis is a common condition in bitches and cats shortly after parturition. Etiology. In the majority of cases mastitis is due to infec- tion. Pyogenic organisms enter usually through the teat canal to the acini of the gland, and from this point spread to the perilobular lymphatics. Premature removal of the young seems to be a predisposing factor as it permits the milk to collect, congesting the gland as is often noted in cats. Streptococcus infection of the mammary glands of the cat has been quite often observed. It frequently has the appearance of a specific disease appear- ing as an enzootic in catteries. Wounds and contusions of the gland will produce mammitis and the degree will depend upon whether or not there is infection. Chronic mammitis is observed occasionally in the bitch and cat, resulting either from acute mammitis, or occurring independently. Symptoms. One or more of the mammary glands are swollen, hot, and very sensitive on palpation. As there are no milk cisterns in the gland, the condition extends immedi- ately to the glandular tissue producing marked inflammation and edema of portions of the gland. On palpation the portion aft'ected can be detected. Later as the infection develops the milk will be found changed into a grayish, purulent mass sometimes mixed with blood. Abscesses, often multiple, frequently develop. They open and dis- charge a reddish, purulent mass. General symptoms are quite marked in some cases, especially in cats. The toxins absorbed produce general intoxication which is often fatal. TUMORS OF THE MAMMARY GLANDS 317 In the chronic form the glands become indurated and the milk canals obliterated. The gland tissue becomes fibroid in character. Prognosis. The prognosis is favorable in animals other than the cat. When general symptoms are present the prognosis should be guarded. Treatment. The milk is removed, and the glands thoroughly massaged to remove as much of the infective material as possible. Hot antiseptic packs or fomentations of hot antiseptic solutions should be applied. These should be changed every few hours if feasible. Avoid coal-tar products in cats. Should abscesses develop in the glands they are incised to give free drainage. Follow with antiseptics. Small doses of castor oil, or magnesium sulphate are indicated to assist in the elimination of toxins. In chronic mammitis with fibrosis which may also involve the teat, it is best to remove the gland. An anesthetic should be given, and the animal placed on the table in the dorsal position. The hair is shaved from around the gland and the skin thoroughly disinfected. The gland is then dissected out, which is not difficult, and the vessels ligated. The skin should be trimmed so that the edges approximate accurately. A regular bitch bandage is applied to protect the wound. Recovery is prompt. TUMORS OF THE MAMMARY GLANDS. Neoplasia of the mammary glands is of frequent occur- rence in bitches. Both benign and malignant types are met with in practice. Benign Tumors. Fibromata. A very common form of benign tumor found in the mammary gland of bitches. It consists of fibrous tissue elements proliferating around and into the glandular acini, isolating portions of the gland cells. Their development is slow but progressive, ultimately involving the entire gland. The tumor may appear as a pure fibroma or be mixed with other varieties. 318 DISEASES OF THE MAMMARY GLANDS Symptoms. Fibromas occur as hard, sharply defined enlargements which show no inflammatory symptoms nor tendency to degenerate. The size of the tumors varies from a pea to several inches in diameter. When mixed with other tumors, they are softer and take on some of their charac- teristics. Progn osis. Favorable. Treatment. Extirpation of the gland. Lipoma. Fatty tumor found in old bitches, especially in those afflicted with obesity. Symptoms. They are soft, well-defined tumors of the gland. Prognosis. Favorable. Treatment. Removal of the gland is advisable. Malignant Tumors. Carcinomata. A very common form of malignant growth found in the mammary gland. They are frequently mixed tumors, appearing as adenocarcinoma, fibrocarcinoma, etc. Symptoms. Carcinomas are characterized by their growth, slow at first but with sudden, rapid development, lobulated appearance, and tendency to degeneration and abscess formation. A small portion of the tumor should be examined microscopically. Progn osis. Unfavorable as they are apt to recur. Treatment. Removal of the gland should be done as early as possible. When metastasis has taken place, no treatment is successful. Sarcomata. Sarcomata occur usually in conjunction with other varieties of tumor, as fibrosarcoma, adenosarcoma, etc. Symptoms. Sarcomas develop rapidly with acute, inflam- matory symptoms. Diagnosis. A diagnosis can be made only by microscopical examination. Treatment. Same as for carcinoma. Other varieties of tumors which involve the mammary glands are rare and of minor importance. PART V. DISEASES OF THE BLOOD AND BLOOD PRODUCING ORGANS. CHAPTER I. ANEMIA. Definition. A reduction in the total volume of blood or of its corpuscles, oligocythemia, or of certain of its more important constituents, such as albumin and hemoglobin. Two forms of anemia are recognized, viz.: (a) Acute, and (6) chronic. Occurrence. Very frequently observed in dogs and cats. The most common form is the acute. The chronic form following various diseases is also of common occurrence. Etiology. (a) Many cases of acute anemia are the direct result of loss of blood. The condition develops rapidly following epistaxis, intestinal hemorrhage, rupture of blood- vessels in the lungs, hemorrhage of the uterus, parenchy- matous hemorrhage, or any external, severe hemorrhage. (6) Chronic anemia develops slowly and gradually. Several different causes are found producing this type: Insufficient food, or food of poor quality in which the essential nutritive elements are deficient; diseases of metabolism in which the nutritive processes are modified and the food elements not utilized in the body. In small animals anemia often follows diseases of the digestive tract (catarrhal inflam- mation) producing either a loss of appetite or an interference in the digestion and assimilation of the food. This may 320 ANEMIA occur following distemper in dogs, presence of parasites in large numbers, or other diseases affecting the mucous mem- branes in a similar manner. Large numbers of chickens are sometimes found with anemia from infectious asthenia, and other diseases of the digestive tract. Parasites of the blood are occasionally the cause. Young chicks are frequently affected with white diarrhea resulting in a severe form of anemia. Many of the general diseases are accompanied by anemia. Pathology. The most characteristic feature of acute anemia is the paleness of all the tissues and the absence of blood. The respiratory passages show evidence of lack of blood by their pale, pink color. The heart and bloodvessels are only partially filled with a loose coagulated blood. In chronic anemia the membranes are found pale and colorless, the blood present in the vessels and tissues low in coloring matter, and usually reduced in total volume. Fatty degen- eration of the heart, liver, kidneys and other organs is often observed. Owing to the general weakness and emaciation, transudation of serum takes place and is found present in the thoracic and abdominal cavities in varying quantities. Lesions of the primary condition producing anemia are often apparent. Symptoms, (a) Acute Anemia. The symptoms of acute anemia, when due to hemorrhage, come on suddenly, and depend upon the amount of blood lost. The patient becomes very weak, may be unable to stand, or if standing does so with difficulty. In attempts at walking the animal will show muscular incoordination and frequently falls down. Depres- sion, subnormal temperature and increased respirations are prominent symptoms. The mucous membranes are pale or colorless and the heart action may be very weak or imper- ceptible. In some instances evidence of the hemorrhage will be present by the discharge of blood either from the nasal passages, mouth or wound. Many cases terminate fatally in a few minutes, or hours, when the hemorrhage is severe. (b) Chronic Anemia. In chronic anemia the symptoms come on more slowly and gradually with more or less emacia- tion and general debility. The hair coat or plumage becomes ANEMIA 321 rough, and the eyes sunken. The animal is easily fatigued, and unsteady in its movements. It will lie down much of the time and refuses to move or get up when called. The mucous membranes are pale or colorless. The heart action is irregular, the pulse weak, and the respirations shallow and accelerated. The appetite becomes variable and entirely suppressed in some cases ; in others it is retained but weakness and emaciation continue. The blood when examined will show a reduction in hemoglobin content and the number of red corpuscles diminished in proportion to the number of white. Later as the disease progresses edematous swellings are found along the abdomen, under the neck, and on the limbs. Other symptoms may be present depending upon the complicating conditions present. Course. The course of acute anemia is short, lasting in the majority of cases only a few hours. In the chronic form the course is much longer lasting for several weeks or months. In this case the course will depend very largely upon the cause of the condition. Diagnosis. The diagnosis does not present any difficulty. This is particularly true in the acute form. A differential diagnosis is necessary in some cases to distinguish it from diseases of the heart, or leukemia. In the former the examination of the heart will reveal the difference, while in the latter case an examination of the blood will at once make clear the distinction between the two conditions. Prognosis. The acute form, providing the animal does not succumb from the hemorrhage, will disappear promptly. The elements of the blood will soon be normal from the drinking of large quantities of water and ingesting nutritious foods. In the chronic form the prognosis is not considered very favorable. It will depend largely upon the primary factor producing the anemia. A careful examination should be made in all cases to determine if possible the actual condi- tions. Many patients will recover completely after the elimination of the causative factor. Treatment. In acute anemia when hemorrhage is taking place an attempt should be made to arrest it at once. If it is 21 322 ANEMIA external, the vessels should either be ligated or, if this is impossible, pack the wound and apply a bandage to compress the vessels. Internal hemorrhage may be controlled by administering hemostatics. Adrenalin chlorid solution (1- 1000), using 1-2 c.c. intravenously. This may be repeated in thirty minutes if necessary. Ergot and fluidextract of hydrastis may also be used. Rectal injections of normal salt solution are recommended. Inject the solution as high up into the rectum as possible. The solution should be at or near the body temperature. Intravenous injection of salt solution in small animals is unsatisfactory. In the chronic form determine the cause of the condition if possible and apply treatment to correct it. The diet is an important thing in the treatment of anemia. Foods should be given that are rich in protein. Meat and meat scraps, milk and eggs have proved of great value. These substances should be given frequently and in small quantities to obtain the maximum benefit. Later the amount and the time between the feeding periods can be increased. Numerous medicinal preparations have been used, but the iron compounds have given the best results. Iron and quinin citrate in doses of 0.1-0.5 twice daily are of great value as a general tonic and alterative. Reduced iron, saccharated carbonate of iron, and sulphate of iron have been used successfully. Small doses of these preparations can be given for a few weeks if necessary. Fowler's solution of arsenic in doses of 0.1-0.8 daily is excellent. Carlsbad salts should be given in small doses along with the iron prepara- tions. Good hygienic conditions should always be observed. LEUKEMIA. Definition. A disease characterized by an increase in the white corpuscles, together with changes in the spleen, lymph glands, or bone-marrow. Two forms are recognized, viz.: () Myelogenous, and (b) lymphatic. The distinction is based on whether there is an increase in the leukocytes or lymphocytes. Combination of the two conditions may be LEUKEMIA 323 found, or variations and degrees of either of the two forms may be present. Occurrence. This disease occurs most frequently in dogs, occasionally in cats. Etiology. Nothing is definitely proved relative to the cause of leukemia. The disease is probably of an infectious origin, but experiments conducted along this line have given negative results. Toxic agents have been given as the cause, as have injuries and various other factors. Pathology. On necropsy in leukemia it is often difficult to make a distinction between the two forms as the lesions of both occur concomitantly in the majority of cases. It is characterized by enlargement of the spleen, lymph glands, liver, kidneys and distinct changes in the marrow of the bones. The spleen is enlarged (in some instances three to four times its normal size), dense and often easily torn. Fre- quently nodules are seen projecting from its surface. The color is dark red, and on cut surface dry, and shows numer- ous whitish colored, enlarged follicles each of about the size of a wheat grain. The stroma of the gland and the capsule are thickened. The lymph glands are found enlarged. They are harder or softer than normal, of a whitish or gray color, sometimes showing small red points over a cut surface. The surface when scraped gives off a yellowish, creamy material. The majority of lymph glands will be found affected. The bone- marrow is of a dark red or gray color, and soft consistency. On examination the bone-marrow will be found very rich in white corpuscles. The liver is enlarged and shows numerous small nodules of lymphoid tissue. The kidneys are enlarged in the same manner. Small nodes will be found throughout the serous membranes, lungs and other tissues in the body. Symptoms. The early development of leukemia is usually not observed. Very often the disease is not recognized until the symptoms become prominent and it has reached the advanced stage. The early symptoms are very similar to those of anemia, and the differential diagnosis may be very 324 ANEMIA difficult until decided changes take place either in the blood or lymphatic system. The mucous membranes are very pale or white in color, the animal becomes weak and edema- tous swellings may appear. The enlargement of the lymph glands comes on gradually and is found involving practically all of the palpable glands. The enlargements vary in size, but stand out in some cases very prominently. The glands are firm, non-painful and well circumscribed or defined. The glands in the submaxillary space, at the pharynx, chest and inguinal regions show most enlargement. The move- ment of the animal may be interfered with on account of the increase in size of the lymph glands. Respiratory disturb- ances may be present when the glands become large enough to compress bloodvessels or nerves. Extensive edemas are often present from the same cause. Ascites is a common symptom in dogs from enlargement of the mesenteric glands. The spleen is enlarged but difficult to palpate on account of its position; the enlargement of the abdomen may be the result of the enlargement of the spleen or liver, or both. Percussion of the abdomen may assist in determining the character of the enlargement. Owing to the involvement of the bone-marrow the animal is lame and shows stiffness and soreness in movement. Pressure on the long bones frequently shows marked sensi- tiveness and pain. Characteristic alterations are found in the blood. It appears pale red, or even brown, indicating a reduction in hemoglobin. When allowed to stand and coagulate (which it does slowly) it separates into two layers, the lower consist- ing of red corpuscles, while the upper is composed of white corpuscles and fibrin. The number of white corpuscles is always increased; in some cases equal in number to the red ones. A decrease in the number of red corpuscles can be demonstrated in most cases. A differentiation may be made between the two forms of leukemia by the blood examination. In lymphatic leukemia the lymphocytes are found increased, while in myelogenous leukemia the leuko- cytes are found in much larger numbers. Clinically the disease develops gradually, emaciation more prominent, and INFECTIOUS LEUKEMIA OF CHICKENS 325 more or less extensive hemorrhages occur in the various organs. Course. The disease is usually chronic. The acute form is very rare in small animals. The course usually extends over a long period, and complications are common. Diagnosis. The characteristic involvement of the lymph glands, spleen and liver, and the increase in the number of white corpuscles, will make the diagnosis comparatively easy. A microscopic examination of the blood is necessary in order to make the diagnosis accurate. The differentiation between the forms of leukemia is determined definitely in this manner. Prognosis. Very unfavorable. When the disease -is once established there is little hope of recovery. Treatment. Owing to the pathological changes present not much can be expected in the way of treatment. In some cases the patient's general condition may be improved by allowing plenty of nutritious food and administering altera- tives and tonics. Iron and quinin citrate (0.2 to 0.4 twice daily) have given the best results. Transfusion of blood has proved unsatisfactory in small animals. INFECTIOUS LEUKEMIA OF CHICKENS. Definition. An infectious disease of chickens probably produced by an ultramicroscopic virus. It is characterized by an increase in the number of leukocytes, an atrophy of the marrow of the bones, and an increase in the size of the spleen and liver. In many cases the number of red blood corpuscles is reduced and the white ones increased. Occurrence. Up to the present time the disease is found only in chickens. Other fowls are not affected. It often appears in an enzootic or epizootic form when large numbers in a flock or community will be affected. Etiology. From rather extensive investigations made with this disease it is evidently due to a virus found in the affected organs, viz.: The spleen, lymph glands, and bone- marrow. The disease is easily transmitted by intraperi- toneal or intravenous injections, while subcutaneous injec- 326 ANEMIA tions prove negative. Animals other than chickens are not susceptible to the disease. Pathogenesis. The method of development of infectious leukemia has not been definitely proved. The virus of the disease by irritation produces an increase in the number of white blood cells in the capillaries of the spleen, bone-marrow and liver. Pathology. The most pronounced lesions are found in the spleen, liver and marrow of the bones. The spleen and liver are much enlarged, and the bone-marrow reddened and congested. The lymph glands are also enlarged occasionally. The blood is lighter in color than normal (less hemoglobin) and contains a larger proportion of leukocytes than normally. General anemia is apparent by the wasted tissues. Symptoms. The period of incubation is approximately thirty to sixty days. The disease develops very slowly and insidiously. Some cases may assume an acute form, the birds succumbing in about two weeks. The early indications are anemia as indicated by the paleness of the comb and wattles and a decided loss in weight. Later as the disease continues there is a tendency for hemorrhages to take place even from slight wounds, indicating a hemorrhagic diathesis. Examination of the blood reveals the true condition. There will be found a great increase in white corpuscles and a material reduction in the number of red. The latter may be reduced to one-fourth their normal number. The hemo- globin content of the blood is also reduced giving it a pale color and reducing its staining properties. The condition when chronic develops gradually and the chicken often dies from exhaustion. Course. The course of the disease is quite variable. Many cases apparently run a very rapid course after the appearance of the first symptoms, lasting from one to three weeks. Others may linger longer or from one to four months. Diagnosis. The diagnosis can be established only by necropsy and a microscopic examination of the blood to deter- mine the ratio of the white to the red corpuscles. Differen- tial diagnosis may be difficult, but considering the lesions PSEUDOLEUKEMIAHODGKIN'S DISEASE 327 and the fact that a number of fowls may be affected at the same time, assist in arriving at the diagnosis. Prognosis. Very unfavorable. Recoveries are very rare. Treatment. No treatment has proved of any value. Dis- infection of the premises and destruction of all affected birds are advisable. PSEUDOLEUKEMIA. HODGKIN'S DISEASE. Definition. A disease characterized by a progressive enlargement of the blood-forming organs (spleen, liver, lymphatic glands) and nodular growths in these and other organs. It resembles leukemia in many respects. A notable exception is that the white corpuscles are not increased as in leukemia. Occurrence. The disease appears most commonly in dogs, cats and chickens. It is more common, however, in dogs and chickens than leukemia. Etiology. The true character of the disease is not known. The etiological factors are believed by some authorities to be identical with leukemia. Others are not in accord with this belief. Pathology. The lesions found in pseudoleukemia resemble very much those found in true leukemia. Enlargement of the spleen, liver and lymph glands is observed in most cases. Symptoms. Progressive anemia and enlargement of the lymph glands are the prominent early symptoms. Examina- tion of the blood will show that the ratio between the red and white corpuscles is nearly normal. Other symptoms are practically the same as in leukemia. Diagnosis. A diagnosis can be made only by a micro- scopic examination of the blood. It should be differentiated from leukemia, malignant tumors and tuberculosis. Prognosis . I 'nf a vorable . Treatment. Treatment is unsatisfactory. Iron and quinin citrate (0.2 to 0.4 twice daily), or Fowler's solution of arsenic (0.2 to 0.6 once daily) may be tried. Potassium iodid in small doses is also recommended. 328 ANEMIA HEMOPHILIA. A constitutional defect in which there is a tendency for uncontrollable hemorrhage from slight wounds. It may occur after slight injuries, congestions, or apparently spon- taneously. The coagulation of the blood is retarded or absent. Hemophilia is very rare in animals. For further information the reader is referred to other works. SCURVY. SCORBUTUS. Definition. A disease characterized by marked debility and weakness, spongy and ulcerative condition of the gums with bleeding and a tendency to hemorrhage in the various organs. Occurrence. Scurvy is not very common in animals. A few cases have been found in dogs. Ulcerative stomatitis is often mistaken for true scorbutus. Etiology. There are several factors which contribute to the 4 production of this disease, viz.: (a) The diet, when restricted to certain foods for a comparatively long time, will produce the disease by disturbing general metabolism, the body being deprived of food elements necessary for its normal maintenance. (6) Unsanitary conditions, such as damp cellars, badly kept kennels, exposure to cold and dampness are important predisposing causes, (c) One of the most important causes in dogs is ptomain poisoning, resulting from eating spoiled meats, fish, etc. (d) There is some question as to the disease being produced by infection. Infection is, of course, a possible cause. Pathology. Small hemorrhages are found in the tissues and organs of the body. These are most noticeable under the skin, in the muscles, on mucous and serous membranes, in the joints, liver, spleen and kidneys. Along the margin of the gums will be found distinct ulcerative processes. The gums are dark, almost black, or reddened, and show separation from the teeth. Shreds of the membrane may be removed easily with the forceps. The spleen is enlarged and of a soft consistency. The lymph glands of the mesentery SCURVY SCORBUTUS 329 are enlarged and congested. Changes in the blood may leave it thin and pale in color. Symptoms. Anemia and emaciation are early symptoms of the disease. The patient becomes very languid, and does not care to exercise or move about. The appetite is sup- pressed either partially or completely, and the thirst is increased. Marked changes are observed on the visible mucous membranes, those of the mouth showing the most pronounced lesions. The mucous membrane around the margin of the gums becomes discolored red, later dark bluish-red, and even almost black. Hemorrhages are present in many cases, or the least manipulation of the gums causes bleeding. The membranes become swollen and very sensitive to the touch. The patient when eating will often stop abruptly and show marked pain from the food irritating the involved membranes. Distinct ulcerative processes are observed in the later stages, the gingival membrane becoming separated from the teeth and often the teeth themselves become loose and fall out. Hemorrhages are also found on the conjunctiva! membranes, in the nasal passages, and under the skin. Vomiting is a common symptom. The vomited stomach contents are often mixed with blood indicating gastric hemorrhage. Bowel discharges may also contain blood. The disease is progressive and the symptoms increase in intensity until the animal is exhausted or some complication, such as septicemia, pneumonia, or extensive hemorrhage develops. Diagnosis. A differential diagnosis is necessary in dogs in order to distinguish scurvy from ulcerative stomatitis. The main points of difference are: (a) The absence of general symptoms and hemorrhages in ulcerative stomatitis, (b) The localization of the condition in ulcerative stomatitis, while in scurvy other parts of the body are affected. In long-standing cases of ulcerative stomatitis the differentiation may be somewhat difficult. Prognosis. This will depend a great deal upon the progress the disease has made. If the cause can be removed in the very early stages, the prognosis is more favorable than in 330 ANEMIA cases where the ulcerative processes are well established. When general symptoms of anemia and cachexia are evident the prognosis is bad. Treatment. This disease can be readily prevented when a variety of food is allowed and good sanitary conditions prevail. The early indications in the treatment are to change and regulate the diet. Give the patient nourishing food, such as meat, milk, eggs, etc. Iron preparations (iron and quinin citrate, pulverized iron, saccharated carbonate of iron) are the most satisfactory for the anemia which is nearly always present. Tincture of nux vomica (0.3 to 0.5 daily) or tincture of gentian (0.5 to 0.8 twice daily) is useful as a tonic. Local applications should also be used. Swab the gums and other affected mucous membranes of the mouth with tincture of myrrh once or twice daily. When hemorrhages are present they must be controlled by appropriate treatment. ANIMAL PARASITES IN THE BLOOD. Filaridoe. Mdastrongulincp. Several species of animal parasites have been found infesting the blood and circulatory organs in small animals. The dog is most frequently affected. In several districts of the United States, Canada and Mexico, the condition has been reported a number of times. The Dirofilaria immitis, Hematozoon Lewisi, Hsemostrongylus vasorum and the Spi- roptera sanguinolenta are the most important ones found. Dirofilaria immitis (Filaria immitis}. Occurrence. This blood affection has been observed very commonly in the dog, particularly in Japan, China, and in some sections of North and South America. The United States is fairly free from the infestation, but it is quite possible that many cases have been overlooked. Etiology. The Dirofilaria immitis is a long, white worm, the male being 12 to 18 cm., and the female 20 to 30 cm. long ANIMAL PARASITES IN THE BLOOD 331 The posterior portion of the male parasite shows a curvature or spiral bending. The female gives birth to living embryo. The mature parasites live in heart (right half) in the major- ity of infestations. The left heart and bloodvessels harbor them in some cases. The number of parasites vary from a few to several hundred. They are usually found entangled in a round ball-like mass. The females give birth to embryos which are each about j mm. long, and are set free in the blood in large numbers. The sexually mature parasites may be found at the same time in other parts of the body. The manner in which infestation takes place has not been fully proved. It is probably from the drinking water which contains the larvae. These embryos reach the heart before they mature. They may be discharged from the animal either in the urine, nasal discharge, blood, or with the feces and contaminate food or water again. Pathogenesis. The mature parasites located as they are in the heart or large vessels produce more or less of a mechan- ical disturbance in the action of those organs, or direct inter- ference in the flow of blood through them. Formation of emboli in the vessels, which often results, brings on various complications in part due to necrotic foci in the lungs or other organs. The presence of the embryos in the blood ultimately leads to anemia with leukocytosis. Pathology. On necropsy the right heart is usually found to be partially or completely filled with the parasites sur- rounded by a coagulated mass of blood. The endocardium is found more or less thickened and inflamed. The heart is often dilated, the walls thin, and some cases ruptured. Very frequently the lungs show small foci of necrosis, or nodules in the center of which embryos are found. Similar lesions occur in the liver, kidneys, skin and muscular tissues. General anemia is present. Symptoms. The symptoms will depend a great deal upon the number of adult parasites and embryos infesting the circulatory system. When small numbers are present the animal may not show any particular manifestations. When the number is great, anemia and marked emaciation develop. Hemorrhages are proved to appear in the mucous membranes, skin, lungs, intestinal tract and other organs. 332 ANEMIA Various complications will be observed from the emboli affecting the different functions in the body. The most pronounced complicating symptoms are in connection with the heart, lungs and brain. The blood shows evidence of anemia and leukocytosis. There is absence of fever, and a gradual progressive anemia which may continue for several months. Diagnosis. A correct diagnosis can be made only by a microscopic examination of the blood for embryos. These are easily recognized by their shape and peculiar snake-like movements. Treatment. Very little can be done in the way of treat- ment. Nutritious food and iron preparations are recom- mended. Atoxyl in small doses has been used successfully to reduce the number of embryos in the blood. Complicating symptoms are treated as they develop. Hematozoon Lewis!. This parasite is found infesting the circulatory system in much the same manner as the Diro- filaria immitis. Dogs are most commonly affected. A micro- scopic examination of the blood is necessary in order to establish the diagnosis. The embryos attach their heads to the cover-glass and move their bodies very rapidly when viewed under the microscope. Little is known concerning the life history of this parasite. It is supposed to be taken into the body from fleas and lice in which the larvse of this parasite have been found. Treatment is the same as for Dirofilaria immitis. Haemostrongylus vasonun. This is a fine, thread-like worm infesting the right ventricle of the heart and the pulmonary artery and its branches. The male parasite is about 13-16 mm. long, and the female 17-20 mm. It forms small nodules in the lining membrane of the vessel wall and thrombi in the smaller vessels. The female parasite lays eggs which lodge in the finer vessels, which, like the embryos, lead to the formation of small nodes. The embryos migrate into the bronchi and are coughed up and taken in by other animals. Symptoms. The symptoms are mostly those of a progres- sive anemia and are not characteristic. ANIMAL PARASITES IN THE BLOOD 333 Diagnosis. The diagnosis is only made by finding the parasites on autopsy or the eggs and embryos in the expecto- ration or blood. Treatment. Unsatisfactory . Spiroptera sanguinolenta. This is a small, thread-like worm found in different parts of the body, but more particu- larly in the heart and large arterial branches. It is of minor importance as the infestation is of rare occurrence in small animals. The symptoms are those of anemia and heart weakness and are not characteristic. A microscopic exami- nation or a necropsy is necessary in order to confirm the diagnosis. CHAPTER II. DISEASES OF THE THYROID GLANDS. Examination and General Consideration. Diseases involving these glands are of considerable importance in dogs in which animals all forms of goiter are found. Other small animals are very seldom affected. The two thyroid glands, one on either side of the neck, are situated in the upper third of the cervical region. They are normally small but easily palpable. When diseased they usually grow larger and tend to descend downward toward the thoracic inlet. The position of the diseased glands will vary, therefore, with their size and the breed of dog. An important thing to be considered in connection with the thyroid glands is the presence of small glandules closely related to them. These glandules are often found in close contact with the thyroid glands occurring in the adjacent tissue or they may be quite a distance removed from them. They consist of small, nodular glands, composed of true thyroid or lymphoid tissue, and are considered accessory glands to the thyroids. Normally they are very small, but usually become much enlarged when the thyroid glands are involved. These small glandules seem to be closely associated with the thyroid glands in function, and will replace to a certain degree the secretions necessary, when the true glands are diseased or destroyed. CONGESTION OF THE THYROID GLANDS. At or near the time of puberty the glands are often found enlarged; during the estrual periods the same condition is commonly observed. This temporary congestion will disap- pear in a few days in the majority of cases and the glands ACUTE THYROIDITIS 335 assume their normal size and condition. A temporary con- gestion may also occur from collars being too tight, or dogs pulling on the leash, which disturbs the circulation in the glands. Swelling of one or both glands may result from this and last for several days simulating goiter. As soon as the cause is removed the circulation will return to its normal state and the congestion gradually disappear. Direct injuries to the glands are not uncommon and congestion and edema result. Examination will often reveal the presence of a wound or a contused area. Permanent enlargement of one or both glands may result from injuries, due to fibrous formation. ACUTE THYROIDITIS. Definition. An acute inflammation of one or both thyroid glands. This condition has been observed in dogs. Etiology. The majority of cases are secondary to other diseases, such as distemper, local infection in the adjacent tissue, or from direct injuries. Symptoms. The glands are first noticed to be prominent, enlarged, sensitive on palpation, and the local temperature elevated. In severe congestion the gland will often show pulsation. A differentiation should be made between this condition and the various forms of goiter. The sudden development, local heat, and marked reaction in the glands will assist in making the differentiation. The history of the condition following distemper or injuries should also be taken into consideration in making the diagnosis. Prognosis. The termination of acute thyroiditis is usually favorable. The inflammation subsides and the gland resumes its normal function. Some few cases terminate in a degenera- tion and suppurative condition which may destroy a part or the whole gland. It is possible also to have the condition become chronic and produce a firm fibrous growth simulating some forms of goiter. Treatment. During the acute stage cold applications should be applied either in the form of cold water or ice packs. This followed by a hot Priessnitz compress and continued until resolution takes place or degeneration and abscess 3.36 DISEASES OF THE THYROID GLANDS formation occur. Should the function of the gland be disturbed for a prolonged period either potassium iodid in small doses or thyroid extract has proved to be of consider- able value. When abscesses occur they should be opened, drainage effected, and an iodin pack applied. GOITER. STRUMA. BRONCHOCELE. Definition. A hypertrophy or enlargement of the thyroid glands which occurs sporadically. It is very frequent in dogs. In some instances goiter is congenital and whole litters of puppies are affected. The enlargement of the glands in these cases may be of sufficient size to interfere seriously with parturition. Very often the glands will be six to ten times larger than normal, seemingly as large as the puppy itself. The lobes and isthmus of the glands are so intermingled that no distinction can be made between them, the whole forming one large mass in the inferior cervical region. The disease is also acquired in a great many cases, coming on at different periods in the development of individual animals. Occurrence. The occurrence of goiter in the various breeds of dogs seems to be in about the same ratio, although in certain districts pointers, bull dogs, and bull terriers, seem to be affected in larger numbers than other breeds. Many forms of goiter are recognized in dogs, viz.: (a) Parenchymatous; (6) cystic; (c) fibrous; (d) vascular; (e) malignant; (/) exophthalmic. Parenchymatous Goiter. Definition. A diffuse paren- chymatous enlargement of the gland with an increase in the stroma and a collection of gelatinous colloid material in the follicles. Occurrence. This form is by far the most common and occurs more frequently in puppies or young dogs. Symptoms. The first symptom noticed is the enlargement of one or both thyroid glands. The enlargement may not be equal in both glands. One is frequently much larger than the other. This form of goiter often develops suddenly GOI TERSTR UMABROXCHOCELE 337 and the glands assume enormous proportions. Puppies are often born with this particular form or develop it during the first few weeks of their lives. In many cases no marked symptoms of any general disturbance are observed, the animal developing apparently normal except the presence of the enlarged thyroid glands. In other cases, when the glandular secretion is materially interfered with, cretinism and myxedema are prominent symptoms. This is evidenced by marked nervous disturbances and degeneration of the various tissues in the body. The animal becomes emaciated, weak, a mere shadow of its former condition. Young animals as a result of this glandular disturbance do not develop normally, the head may be larger than normal, and other parts of the body undeveloped, or vice versa. Respiratory disturbances often result from the enlarged glands pressing upon the trachea, or from compression of the vagus and sympathetic nerves. The latter condition no doubt accounts for the larger number of cases in which labored respiration and spasm of the glottis are prominent symptoms. Hemi-r plegia laryngis is produced in a similar manner by pressure on the recurrent nerve. Circulatory irregularities are not so common in parenchymatous goiter. Direct examination of the glands will reveal the enlargement, its smooth regular outline, moderately firm consistency, and absence of local heat or pain. The isthmus of the glands can be palpated, except when the glands are greatly enlarged. In many cases no general symptoms of deranged appetite, elevation of temperature, or cachexia will be noticed. Diagnosis. The diagnosis of goiter in general is quite easy, but in some cases it is difficult to make a definite distinction between the various forms. Goiter should be differentiated from abscess, hematoma, and various cyst formations. This can be done as a rule very easily after carefully palpating the enlargement. In order to make a positive diagnosis of the variety or form of goiter present, it is necessary to consider the character of the enlargement, its consistency, the condition and age of the animal. Palpation of the glands to determine their form, whether regular and smooth, or irregular and lobulated, and their consistency, is a very 22 338 DISEASES OF THE THYROID GLANDS important means of making the differentiation between the various forms of goiter. Prognosis. In parenchymatous goiter most cases recover. The glands grow smaller until of normal size or near it, and any general symptoms disappear. However, in cases where the glands are enormously enlarged and symptoms of cretin- ism and myxedema are present the prognosis is not favorable. A recurrence of this form of goiter, while rare, is always probable. Treatment. lodin medication both externally and inter- nally has proved to be of great value. Some remarkable results have been obtained in the rapidity and degree of reduction after its use. For internal administration it has been definitely proved that small doses give the best results. The dose should be regulated somewhat according to the age and size of the animal. One-fourth grain, 0.016 of potassium iodid for puppies, or 0.05-0.08 for older animals, given once daily, has given the best results. When given in large doses there is danger of too rapid depletion of the body and paralysis of the heart. These small doses should be continued daily for one to three weeks. For external application color- less tincture of iodin may be applied. Where staining the hair does not matter the regular tincture should be employed. An application can be made daily, or every second day. Thyroid extract (0.15 daily) has been used with excellent results. Surgical interference has not proved successful in relieving this form of goiter. Complete unilateral thyroidectomy might be tried in case one gland is enormously enlarged and the other nearly normal. The operation is performed under general anesthesia and strict antiseptic precautions. The gland is dissected out carefully and multiple ligation of the pedicle is necessary so that the tissue will not retract and allow the ligature to slip off. The gland is then removed about ^ inch from the ligature and the wound packed with antiseptic gauze for a few days. The ligature is then removed cautiously and the wound covered with an antiseptic dusting power. It is very important that the wound be kept free from infection during the first few days, and the ligature kept in position to avoid fatal hemor- rhage. GOI TERSTR UMABRONCHOCELE 339 Cystic Goiter. Definition. An enlargement of one or both thyroid glands, characterized by the formation of cysts which may be single or multiple. In cases of long standing, calcification of the cyst wall may take place. The cause of cystic goiter has never been clearly proved. When hemor- rhage occurs in the gland follicles they are distended, certain changes in the contents result, and there is left a more or less clear serous fluid. Further, through disturbance in the glandular activity, from injury, nervous influences, or hyper- emia, the circulation of the glands is abnormal leading to extravasation of serum into the follicles which may result in a permanent cystic condition. Cysts commonly compli- cate parenchymatous goiter. Symptoms. An enlargement of one or both of the thyroid glands is the most prominent symptom. Many cases develop rather suddenly while others require considerable time before the glands reach a sufficient size to become noticeable. As a rule, unless complicated with other forms of goiter, no general symptoms will be present. Should the cystic formation involve both glands it is quite possible that the normal function of the glands will be disturbed, then general symptoms will result. Pressure on the vagus, sym- pathetic, and recurrent nerves may lead to complications as in parenchymatous goiter. In the majority of cases the course of this goiter is chronic, and aside from the unsightly enlargement they produce, the animal will not suffer any inconvenience. Examination of the gland by careful palpa- tion will reveal the soft, fluctuating swelling, the absence of inflammation, and a consistency differing from other forms of goiter. Diagnosis. The diagnosis can be made positive by the examination, and if necessary by the use of an exploring trocar to obtain some of the yellowish or clear serous fluid. Prognosis. Favorable when proper and prompt treatment is used. Further, as this is in most cases a local condition confined to the gland, remedial measures can be applied more satisfactorily. Treatment. This is of two kinds, viz.: (a) Medical, and (b) surgical. 340 DISEASES OF THE THYROID GLANDS Medical. Medical treatment in the form of potassium iodid (0.03-0.06) is of value to assist in replacing the loss in the normal secretion of the gland, especially when both glands are extensively involved. Thyroid extract in 0.15 doses daily can also be used. Surgical. This consists in either aspirating the serous fluid from the cystic follicles and injecting a small amount of Lugol's solution to stop further filling up, or opening the cysts and packing the cavity temporarily with iodin gauze. After-treatment consists in the use of antiseptics. The wound will heal leaving but slight enlargement. Fibrous Goiter. Definition. An enlargement usually of one of the thyroid glands (rarely both) characterized by a hypertrophy of the stroma and an atrophy of the glandular tissue. It is most frequent in old animals. This form of goiter results in most cases from injuries, acute and chronic inflammation, and in a few cases no doubt from some of the other forms of goiter. The interstitial tissue is gradually increased exerting abnormal pressure on the gland substance, which leads to pressure atrophy. Symptoms. The presence of the enlargement confined in most cases to one gland. Occasionally both glands will be found affected. The size of the enlargement varies greatly from very slight to extreme thickening of the entire intersti- tial tissue. No general symptoms are observed in the major- ity of cases as it is confined to one gland and of long standing. When both glands are extensively involved, interfering with the function of the glands, emaciation, weakness and general cachexia may be prominent symptoms. Respiratory and other disturbances are only observed when the enlargement presses on the trachea or nerves. On palpation of the gland it will be found exceedingly firm, resistant, smooth in outline, non-inflammatory, and non-sensitive. The isthmus of the gland is easily determined. Diagnosis. This should not be difficult as the outline of the enlargement and the hard, firm consistency, with the other symptoms, are characteristic of fibrous goiter. Prognosis. Favorable. Many cases, when not exceed- ingly large, are not treated as they cause but little incon- GO I TERSTR UMABRO \CHOC ELK 341 venience to the animal. Reduction in the size of the gland is possible, or it can be extirpated. Treatment. Injections of iodin into the gland substance have given good results. Inject iodin tincture (2.0 to 5.0) into the gland being careful to avoid introducing the needle directly into a bloodvessel. The needle should be inserted unattached to determine this fact before the injection is made. The injections may be repeated after the acute symptoms subside. It is sometimes necessary to make several applications before reduction is complete. Extirpa- tion of the enlarged gland is recommended when of consid- erable size and the fellow gland normal. The operation is performed in the same manner as in parenchymatous goiter. When both glands are enlarged and general symptoms of athyrea are present, potassium iodid, or thyroid extract in small doses is recommended. Vascular Goiter. Definition. An enlargement of one or both thyroid glands, characterized by dilatation of the bloodvessels without the formation of new glandular tissue, and the absence of any marked general symptoms. This condition is not to be confused with exophthalmic goiter. It is the result of a local dilatation of the bloodvessels supply- ing the glands and may originate from the same causes as those producing congestion and inflammation of the glands. The exact etiology is not known, but has been observed as a sequel to distemper, prolonged estrual periods, and sexual diseases. Symptoms. One or both glands will be found enlarged and engorged with blood. Distinct pulsation of the arteries and even the glands can be seen at a distance. In some cases rupture of some of the vessels results, the blood accumulating in the adjacent tissues, producing an extensive enlargement along the course of the neck. The symptoms, as a rule, subside after a few weeks and may recur at more or less regular intervals. Many cases recover spontaneously. Very little general disturbance is present. Diagnosis. The dilatation of the arteries and engorgement of the gland will easily differentiate it from all forms of goiter, except exophthalmic. In exophthalmic goiter, tachycardia, 342 DISEASES OF THE THYROID GLANDS and nervous disturbances present should make the clinical picture complete and different from vascular goiter. Prognosis. Complete recovery is possible in most cases. In the milder forms it often disappears without any treat- ment. Treatment. An examination of the animal should be made carefully and if any general disturbance is observed it should be treated. Owing to the increased activity of the gland locally, iodin preparations are contraindicated. Small doses of tincture of opium (0.2 to 0.4 daily) can be tried. Should the glandular activity become too pronounced, as indicated by hyperthyrea, ligation of a portion of the blood supply to the gland would be indicated. However, in the majority of cases this is not necessary as the symptoms will subside in the course of a few weeks. Malignant Goiter. Definition. An enlargement of one or both thyroid glands due to a malignant neoplasm. The malignant growth is either a sarcoma or carcinoma. The growth tends to invade the adjacent tissues and lymph glands, or even to the extent of involving secondarily the lymph glands of the thoracic cavity, the lungs, and other organs and tissues. The condition may become generalized. It is found mostly in old animals. Symptoms. The malignant growth may be confined to one gland, but in many cases occurs in both. When the enlarge- ment once begins, its development is quite rapid, and is characterized by an uneven, irregular form of the gland, the presence of acute inflammatory symptoms, very sensitive, and in some cases areas of degeneration and abscess forma- tion are found. Within a short time general symptoms are prominent. Emaciation and general cachexia develop rapidly. The rapidity of its development and the fact that it is usually an old animal affected would assist in making the diagnosis. Diagnosis. This is made by careful examination. The characteristic enlargement and condition of the gland with secondary involvement of adjacent lymph glands, together with the general symptoms of emaciation and cachexia, and GOITER STRUM A BRONCHOCELE 343 the age of the animal, should make the differentiation from other forms of goiter comparatively easy. Prognosis. Unfavorable. Treatment. But little can be expected of treatment. In the early stages, before involvement of the adjacent tissues takes place, extirpation of the gland may relieve the condition for a time but no permanent results can be hoped for. Exophthalmic Goiter. Basedow's Disease. Graves' s Dis- ease. Definition. A disease characterized by exophthalmos, functional disturbances of the circulatory system, and more or less enlargement of the thyroid gland. This disease is not of frequent occurrence in animals, but is found occa- sionally in the dog. Etiology. The exact etiological factor has been in dispute, but is evidently a pure neurosis as indicated by some of the more recent investigations made. It has also been claimed that it is due to a central lesion in the medulla oblongata. A certain amount of evidence has been produced to partially substantiate this claim. The fact that the primary result of the disease is a hyperthyrea would indicate that it might be a special involvement of the glands. However, this has not been proved and the best evidence seems to prove the former etiological factor the most likely. Pathology. On examination the thyroid glands show en- largement, congestion, the production of newly formed tubular spaces and a collection of mucinous fluid. They show every evidence of hyperactivity. Pathogenesis. It is quite important from every standpoint to note that this form of goiter is a primary hyperthyrea while most forms are just the opposite (athyrea). The development of the disease is the result of the increased secretion of the thyroid glands leading to a general toxic condition. The iodothyroidin content of the secretion is greatly increased which no doubt accounts for the intoxica- tion. From an experimental standpoint much the same condition can be produced in animals by administering large and con- tinued doses of thyroid extract. Further, when thyroid extract or iodin is administered in exophthalmic goiter the condition becomes rapidly aggravated. 344 DISEASES OF THE THYROID GLANDS Symptoms. Both the acute and chronic forms have been observed. In the acute form the disease develops very rapidly. The following symptoms are most prominent: (a) Exophthalmos.A. prominence of the eyes which may be unilateral or bilateral. This symptom is readily recog- nized by the protrusion of the eyeballs, and the prominence of the sclera of the eye. The lids do not cover the eye completely. It is important to note that in some breeds of dogs the eyes are very prominent and this should not be mistaken for exophthalmos. The normal sight is retained in most cases. In severe cases it is possible to have a pan- ophthalmitis which w r ould destroy the sight temporarily or permanently. Ulceration of the cornea is common. (6) Enlargement of the Thyroid Glands. Some enlarge- ment of the glands is present in practically all cases. The common expression ".inward goiter" has been given to this condition when the glands are not much enlarged and the other symptoms are prominent. The enlargement may be general or only one lobe affected. (c) Tachycardia. The heart action is rapid and the pulse- rate is usually so much increased that it cannot be counted accurately. The action of the heart at first is regular, but during the later stages of the disease becomes very irregular. The throbbing of the heart is often so intense as to shake the animal's body. Acute dilatation of the heart with dyspnea, cough, etc., is a prominent symptom in the later stages. Distention of the arteries and pulsation of the entire gland is easily seen from a distance. On palpation a distinct throbbing can be felt. The gland may be more or less firm, or soft and flabby, depending on the degree of involvement. (d) Tremors. Tremors or trembling of the muscles is often observed. General symptoms of restlessness, whining and crying, and spasms are present in some cases. Emacia- tion comes on rapidly, and general exhaustion is very common. The chronic form is characterized by similar symptoms but milder in character and lasting for several weeks or months. GO I TE RSTR UMABRONCHOCELE 345 Diagnosis. The diagnosis is not difficult when all the symptoms are taken into consideration. A differential diagnosis should be made from the other forms of goiter, but aside from vascular goiter this should be easy. In vascular goiter the general symptoms are usually absent. Prognosis. Not considered favorable. Some cases recover rapidly under proper treatment. Treatment. Owing to the hyperthyrea present, iodin preparations and thyroid extract are contraindicated. The treatment indicated is the reduction of the hyperactivity of the thyroid glands, and regulating the heart action. The hyperactivity of the glands is best controlled by ligation of a portion of the blood supply to them which will immediately stop the function of that particular part and reduce the total volume of secretion. It is recommended that the anterior arteries be ligated. -This should be done under strict anti- septic precautions and morphin anesthesia. Immediate good results are obtained in many cases. Extirpation of a portion of the gland is often done in the human subject but is not so practicable in animals. The heart action should be controlled by small doses of digitalis fluidextract (0.1 to 0.2 twice daily), or aconite tincture (0.1 to 0.2 two or three times daily). The animal should be kept in a quiet place. Other conditions arising must be treated accordingly. PART VI. DISEASES OF METABOLISM. CHAPTER I. DISEASES OF METABOLISM. DIABETES. Definition. Diabetes is a disease ordinarily characterized by an excessive secretion of urine. It occurs in two forms: (a) Diabetes insipidus; (6) diabetes mellitus. Diabetes Insipidus. Definition. A chronic disease charac- terized by the passage of a large volume of urine of a low specific gravity and containing no albumin or sugar. There should be a distinction made between diabetes insipidus and polyuria. The latter is a symptom of some other disease. In polyuria, often confused with diabetes insipidus, the volume of urine passed is not constant. The disease is evidently a functional disturbance of the kidneys in which large quantities of water are voided and equal amounts taken into the system. The solid content of the urine is naturally reduced. Occurrence. Diabetes insipidus is not observed very often, but perhaps the larger number of cases is folmd in dogs. Polyuria is frequently seen in rabbits from improper feeding. Certain foods tend to produce it, which, if continued, may result in a chronic condition resembling diabetes insipidus. There is no doubt but that it is often not diagnosed. Etiology. Several things have been recorded as having to do with the cause of diabetes insipidus: (a) Observed dur- 348 DISEASES OF METABOLISM ing the convalescent stage of acute diseases (distemper). (&) Accompanying diseases of the nervous system, such as tumors of the brain, lesions of the medulla, cerebral hemor- rhage, inflammation of the membranes of the brain or spinal cord, (c) Subjection to cold; drinking large quantities of cold water have been thought to cause the disease, (d) Trauma of the liver; vertebral column, (e) The administra- tion of diuretics either when given in large doses or con- tinued over a long period of time in small doses will produce it. (/) There is a possibility that the disease is of infectious origin; however, this has never been proved. The production of diabetes insipidus is no doubt due to a vasomotor disturbance of the renal vessels resulting in a great increase in the secretion of urine. The above men- tioned conditions lead to this disturbance through direct irritation, or to functional irritation of the center in the medulla, which brings about a constant state of renal con- gestion. Pathology. The necropsy findings are unimportant in the majority of cases. Quite often very slight or no changes in the tissues are found. In some cases the kidneys are enlarged and hyperemic. Dilation of the ureters and pelvis of the kidneys is occasionally seen. Certain changes will also be found in the nervous system, liver and lungs. The musculature is pale and anemic in advanced cases. Symptoms. The disease may come on suddenly resulting from irritation to the nervous system or kidneys, or it may be gradual in its development. In rabbits it may develop suddenly after feeding mouldy food, etc. Many cases are not observed until the symptoms of anemia and general cachexia are present. Two very prominent symptoms are: (a) Copious secretion of urine; (6) intense thirst. (a) A large quantity of urine is passed each day; in dogs as much as two to four liters in twenty-four hours, and in rabbits one-fourth the quantity. The urine has a low specific gravity (1.001 to 1.003), is colorless, almost odorless, and voided without any difficulty except when the condition is accompanied by a catarrhal inflammation of the mucous membrane of the urethra or bladder. The urine contains DIABETES 349 neither albumin nor sugar. Normal solids are very much reduced in quantity. (6) The animal will show intense thirst; large quantities of water are consumed each day, in dogs as much as four to ten liters. Often animals will show a vitiated thirst and will drink contaminated water or even urine. The appetite is usually normal during the first stages, but gradually diminishes and becomes variable. During the later stages the appetite may be lost entirely, the animal becoming emaciated, and various complications develop. The tem- perature remains normal until the very latest stages when it may be subnormal. Course. When polyuria results from the food it may disappear in a short time following the change in food. This has been observed particularly in rabbits. In cases of real diabetes insipidus the course is chronic, the disease lasting one or two years. Diagnosis. A differential diagnosis must be made between diabetes insipidus, polyuria and diabetes mellitus. Polyuria is distinguished from diabetes insipidus by the symptoms disappearing when the food is changed. The symptoms of polyuria are also more variable. Diabetes mellitus is dis- tinguished by the increased specific gravity of the urine and the sugar content. Prognosis. ^Yhile in polyuria the prognosis is usually favorable, in real diabetes insipidus it is bad, the disease terminating fatally after a prolonged course. Treatment. An investigation of the food should be made, and if found of poor quality, containing moulds or other objectionable substances, it should be discontinued and other foods substituted. Regulation of the diet is an important factor during the early stages of the disease. Limiting the water supply does not have any appreciable effect on true diabetes insipidus, but if it is a simple polyuria it would be well to restrict the patient to a small amount of water. Medical treatment has not been satisfactory. Small doses of valerianate of zinc (0.2 to 0.4) daily, may be tried; or vasoconstrictors used, such as fluidextract of hydrastis, or fluidextract of ergot. Stomachics and general tonics may be 350 DISEASES OF METABOLISM of some value, tincture nux vomica (0.3 to 0.6), once or twice daily. Diabetes Mellitus. Definition. Diabetes mellitus is a chronic, nutritive disorder in which grape-sugar accumulates in the blood and is excreted in the urine. The condition may be permanent or occur periodically. It is generally con- sidered that in order for a case to be true diabetes mellitus, the sugar eliminated must be grape-sugar, and it must extend over a rather long period of time. Occurrence. The disease is not very common in animals. A few cases have been found in dogs. The cat and rabbit are very seldom affected. Etiology. The exact etiology of diabetes mellitus is not known. It is quite evident that several factors may have to do with the production of the disease. Nervous diseases, especially those of the central nervous system, and diseases of the liver and pancreas probably produce the larger number of cases. The pathogenesis of diabetes mellitus is not quite clear, but the condition may be brought about by a disturb- ance of the liver or pancreas, in which the grape-sugar taken into the body is not converted into glycogen but taken up as grape-sugar by the circulation and eliminated in this form. Pathology. Many cases present no anatomical changes. There may be hemorrhages in the nervous system, tumor formations, etc. Very often fatty degeneration of the liver is present. The pancreas may be enlarged by connective tissue proliferation and an atrophy of the glandular substance. The other structures show emaciation and evidences of cachexia due no doubt to the chronicity of the disease. Symptoms. Until the patient shows emaciation, notwith- standing good appetite, the disease is usually not recognized. The general symptoms are: The animal fatigues easily, becomes dull and listless and does not move about in a normal way, shows increased thirst and appetite. The mucous membrane of the mouth becomes dry, and gingivitis is often present. The most characteristic symptoms are found in connection with the urinary organs. The urine is increased in amount, sometimes double the normal quantities voided, is pale, colorless, of a sweetish odor (aceton) and acid in DIABETES 351 reaction. The specific gravity is increased (1040 to 1060). An examination of the urine should be made to determine the sugar content. From 3 to 5 per cent, of sugar has been found. The amount of sugar content will depend to quite an extent on the kind of food given the patient. The feeding of carbohydrates materially increases the per cent, while nitrogenous foodstuffs diminish it. (For testing for sugar in the urine, see Diseases of the Kidneys.) As the disease progresses certain other symptoms are uniformly present. Opacity of one or both cornea (keratitis) , or of the lens (cataract) is often found, gradually producing blindness. Other portions of the eye may also be affected, llceration of the cornea has been observed. Secondary involvement of the respiratory organs takes place in the form of a catarrhal inflammation of the larynx, trachea, bronchial tubes and lungs. Pneumonia and gangrene of the lungs may develop. Cardiac weakness is noted during the last stages. Other symptoms, such as vomiting, diarrhea and constipation, may be seen. Ulceration of the skin, falling out of the hair, found in some cases, indicate the general disturbance in metabolism. During the last stages the patient becomes very weak, emaciated, cachectic, and dies from exhaustion. Course. The disease is characterized by its chronicity and may last from several months to two years. Sugar is some- times present in the urine for a long time before the disease is recognized. Diagnosis. This disease should be differentiated from diabetes insipidus. In the former the presence of sugar in the urine, the gradual emaciation and the retention of the appetite would be sufficient to make a positive diagnosis. Prognosis. Is always unfavorable. The disease is a progressive one, in which complications follow each other making the condition hopeless. Treatment. Very little can be accomplished except by regulation of the diet and limiting the carbohydrates fed. Dogs should be fed on a diet rich in fats and proteids (eggs, fat meat, or oat meal with fat meat) . Large doses of sodium bicarbonate should be given (1.5 to 2.5) daily to reduce the acidosis which is apt to develop. The amount may be 352 DISEASES OF METABOLISM increased if necessary. Other alkaline agents, such as Carlsbad salts and ammonium carbonate, may also be administered. Tincture of opium in large doses (0.6 to 1.0) once or twice" -daily is highly recommended as it tends to reduce the amount of sugar. The treatment at best can only bring about temporary relief, and no permanent results can be hoped for. It is important that the patient be kept quiet and its general strength maintained. OBESITY. Definition. An excessive fat accumulation in the body which may be general throughout the entire organism, or confined to certain localized areas, such as under the skin. The condition is very commonly observed in small animals, particularly in dogs. Certain breeds, especially the smaller, are most subject. Castrated animals, especially if castrated after maturity, tend to become obese. Etiology. One of the chief factors in the production of obesity is the taking in of larger quantities of food elements than are utilized in the body. Pet animals which are fed highly nutritious foods (candies, cakes, etc.) and are not given sufficient exercise become over-fat. It often happens that an animal will accumulate fat rapidly when only the normal amount of food is allowed. This occurs in most cases from insufficient exercise, the elements taken in not being utilized. The feeding of large quantities of carbohydrates, or restricting the diet to substances containing a large proportion of such elements will bring it about. The tem- perament of animals no doubt has also some influence. Animals having a phlegmatic temperament tend to become obese through insufficient activity and exercise. Castration of animals changes their disposition, tends to make them phlegmatic and lazy, and therefore fit subjects for the development of this condition. Should animals be castrated before maturity this tendency for obesity is not so noticeable. Anemia by reducing muscular energy may cause obesity, providing no organic lesion is present and the proper amount OBESITY 353 of food is allowed. The majority of cases can be ascribed to hyperalimentation and lack of exercise, rather than any constitutional disturbance of metabolism. Through the disturbance of glandular secretions (thyroid) and its regula- tion by certain organs (adrenals, pancreas, etc.) oxidation is diminished and constitutional obesity may develop. Pathology. No anatomical changes are noted except a general accumulation of fat under the skin, in the muscles, liver, around the heart and other organs. The changes in appearance of the organs and tissue are due to the fatty deposits. Symptoms. The condition is characterized by the rapid increase in weight, the change in contour of the body, and in the disposition of the animal. The most common loca- tions of observable fatty deposits are in the panniculus adiposus, neck, shoulders and abdomen. Palpation of the parts will reveal the condition. The animal shows lassitude, fatigues easily, and often shows dyspnea on exercise. This is no doubt the result of impeded action of the organs from the fatty accumulations. Later, during the progress of the condition, disturbances of other organs and functions will develop. Digestive disturbances are often quite pro- nounced and the heart action may be interfered with. The mucous membranes are pale, showing anemia. Course. The course is chronic. Mild degrees of obesity do not interfere particularly with the animals' health or use- fulness. Prognosis. Depends a great deal upon the extent of the condition. If the diet can be regulated and restricted, the prognosis is quite favorable. In pet animals, however, it is very difficult to restrict the diet as the owner will invariably break the rules laid down in this regard. Treatment. Reduction in the amount of food, system- atic and forced exercise are important. At first the reduc- tion in food should be slight but continuous until only a sufficient amount is allowed to maintain the strength of the patient. The composition of the foodstuffs given is also important. Limit the amount of carbohydrates and fats and allow a greater proportion of nitrogenous foods. A 23 354 DISEASES OF METABOLISM reduction in the amount of drinking water should be attempted. The medical treatment consists in administering small doses of magnesium sulphate (5.0 to 12.0) daily, or Carlsbad salts (4.0 to 10.0) once or twice daily. Care should be taken to avoid a too severe laxative action over a long period of time. Thyroid extract is of value in increasing the oxidation of fats. Thyroidinum depuratum (0.2 to 0.75), or iodo- thyrin (0.1 to 0.2) administered once daily has given the best results. The proteid food elements should be increased slightly when these medicinal agents are adminis- tered. Complications, should they arise, are given appropri- ate treatment. GOUT. PODAGRA. ARTHRITIS URICA. Definition. A disturbance of nutrition with an excess of uric acid in the blood. It is characterized clinically by attacks of acute arthritis, a gradual accumulation of sodium biurate in and adjacent to the articulations, and with the development of irregular constitutional symptoms. The con- dition may involve the internal organs, or both the organs and the articulations. Occurrence. Old dogs are most commonly affected. Birds, especially chickens, pheasants and pigeons, are also common sufferers. Experience has shown that it is far more common in fowls than in any of the other small animals. Etiology. The real factors in the production of gout are not definitely known. The following, probably predisposing causes, are the most important: (a) The diet evidently plays an important role in the production of the disease. Foods rich in albumin, particularly nucleoproteids, seem to favor the development of the condition. Chickens and other birds w r hen fed on meat, and meat scraps, are often found with the disease. Feeding offal from slaughter houses has the same effect. (6) Certain chemical substances, such as lead, chromic acid, corrosive sublimate, carbolic acid, acetone, etc., seem to have some effect in bringing on the disease. (c) It may be due to the change in the metabolic processes. GOUT PODAGRA ARTHRITIS URICA 355 (d) Fungi on grains and grasses haye been found to be the cause in fowls, (e) Diseases of the kidneys and ureters, in which there is an interference in the elimination of the uric acid compounds, have proved to be important factors in its production. (/) Lack of exercise, confinement of the animals or birds, together with the feeding of highly nitrogenous foods are no doubt the cause of quite a number of cases of gout. Older dogs, and the larger breeds of chickens are most commonly affected. Pathogenesis. The development of gout is probably due to an increase in the production of uric acid, and an inhibition in the elimination of urates, which allows its accumulation in the blood, and in certain cases to be deposited in connec- tion with the tissues. Other theories have been advanced for the development of the disease and have supporters. It is possible also to have the disease develop in cases when there is no increase in the formation of uric acid, but other diseases being present to interfere with the -elimination of the uric acid compounds. Pathology. The characteristic lesions found in articular gout are enlargement of the joints of the toes, or wings, and a chalky-like deposit found in the joint proper or in the adjacent tissue. Examination of the bone-marrow, and the ligaments and tendons around the joint will often reveal the same condition. Several joints may be found affected. In visceral gout, the serous membranes of the cavities, the pericardium, air sacs, and the liver are covered with small nodules containing the same white chalky material. The kidneys contain small white foci, and the ureters are often found filled with a white, pasty mass. Examination of this material under the microscope will reveal the crystals of sodium biurate. Symptoms. The first indications of the condition are usually enlargement of one or more joints, difficulty in walking about, and lameness. The joints most commonly enlarged are the wing joints (birds), and the metatarsal and phalangeal joints in dogs and birds. The animal will stand quietly and refuse to move, but when forced to do so shows considerable pain and lameness. Fowls often assume a 356 DISEASES OF METABOLISM crouching position standing on one limb or shifting from one leg to the other. Birds will walk or flap their wings with a minimum use of muscles owing to the pain induced. Exami- nation of the wings will show enlargement of one or more joints. At first the swellings are soft and sensitive, but later become more defined, firmer and not so painful. The size of the nodules will vary in different birds but is usually from that of a pea to a hickory nut. Considerable deformity of the joints of the wings and limbs may be present. The toes are often spread apart from the enlargement. In some cases the joints become anchylosed, while in others degenera- tion takes place with necrosis and a discharge of a whitish- yellow soft mass. In the latter case there will be an ulcera- tive process left which often exposes the joint. Small nodules are found in other locations in the skin, muscles, and tendons. The general symptoms of rough plumage, pendent wings, paleness of the comb and wattles, and general emaciation develop gradually. The bird will frequently die from exhaustion. Dogs show enlargement of the joints of the toes, meta- tarsus ribs, etc. Lameness and stiffness are quite prominent symptoms. A careful examination should be made in all cases. Internal or visceral gout will not be recognized except when accompanied by enlargement of the joints. Course. The disease is practically always chronic. A few cases have been recorded of the acute form. The disease develops irregularly from one joint to another and therefore runs a protracted course. Diagnosis. The characteristic symptoms of enlargement of several joints, microscopic examination of the contents of the nodules, and chemical examination will make the diag- nosis positive. Treatment. Dietetic. Foods rich in nitrogenous sub- stances should be withheld. If necessary reduce the total feed ration for a few days to a week. Medical. Alkaline agents, such as sodium bicarbonate should be used freely in the drinking water of the fowls. Give dogs 1.5 to 2.0 two or three times daily. The alkaline preparations will assist in the elimination of the deposited FEATHER EATING FEATHER PULLING IN BIRDS 357 urates. Piperazin is highly recommended to prevent the development of the urates in the tissues (chickens, 0.2 to 1.0; pigeons, 0.1 to 0.4; dogs, 0.5 to 1.0). Small doses are to be given three times daily and continued for several days. Internal administration of sodium salicylate has been tried with fairly good results. Local applications of menthol, or salicylic acid should be used. I^ffect a solution and apply to affected joint on absorbent cotton. When the nodules become large they should be opened, curetted and an anti- septic pack applied. FEATHER EATING. FEATHER PULLING IN BIRDS. A condition observed very commonly in caged birds, canaries and parrots, but also in chickens, turkeys and pigeons. Etiology . (a) It may be the result of improper food. Feeding the same materials for a long period, or foods in which there is a deficiency of certain nutritive elements is a cause. Confinement of birds in close quarters predispose to it, partly through lack of exercise, and partly to a narrowing of the feed ration. (6) It is often considered a vice or habit. Fighting or picking at each other starts the vice, (c) Results from skin diseases, especially from parasitic conditions (lice, fleas, mange mites). The irritation from the parasite leads to picking at the skin and feathers. Feathers will drop out as a result of certain diseased conditions. Symptoms. Birds are observed to be pulling out their own feathers or of those confined with them. Bald spots will be noticed on different parts of the body. Often large areas are denuded. Careful observation of a flock reveals the situation. In skin diseases the feathers fall out which can easily be distinguished from feather pulling. The skin lesions will assist in making the differentiation. Treatment. Birds confined, especially chickens, turkeys and pigeons, should be given freer range. Complete change of food will have an important bearing on overcoming the condition. Feed plenty of oyster shell, bone meal, meat scrap, dried blood, etc., with green foods to supply the 358 DISEASES OF METABOLISM elements lacking. Parrots and canaries are difficult to relieve from the habit. Change in the food, with plenty of green materials will often help. Examine them carefully to be sure they are free from lice, or other parasites. Bitter solu- tions applied to the feathers may stop it. Feather eating is difficult to control, but change of food as described above, and the administration of small doses of apomorphin hydro- chlorid (0.0005-0.001) have proved to be of value in a number of cases. CHAPTER II. DISEASES OF METABOLISM AFFECTING PRIMARILY THE BONES. RACHITIS. RICKETS. Definition. A disease of young animals, characterized by impaired nutrition of the entire body and disturbances and changes in the growth of the bones leading to marked deformity. Occurrence. The disease is rather widespread, appearing in nearly all countries. Animals in some countries are very commonly affected, while in others the disease is not so prevalent. Young animals, as a rule, become affected during the first few weeks of life, or at about weaning time. The condition is observed more commonly in dogs than in any of the other small animals. Cats and rabbits are not very often affected. Fowls occasionally suffer from the disease, especially chickens and pigeons. It is commoner in the larger breeds of dogs and fowls, perhaps due to their more rapid growth during early life. Etiology. Various factors have been given as the cause of rachitis : (a) Due to a deficiency of lime salts in the organism. This is no doubt one of the most important causes of the condition, as it develops most frequently in the breeds that grow rapidly, and at a time in the animal's life when there is apt to be a deficiency in the amount of lime salts ingested. Clinical and experimental evidence tend to prove the accuracy of this statement. (6) Improper assimilation of lime salts due to a lack in the acid content of the gastric juice preventing the lime salts from being dissolved and consequently not absorbed. Foods rich in potassium salts reduce the hydro- chloric acid content in the stomach leading to an insufficient 360 DISEASES OF METABOLISM solution or absorption of the lime salts, (c) Digestive disturbances (gastric and intestinal catarrh) reduce the amount of lime salts absorbed by increasing the normal elimination of calcium compounds from the intestines. In young animals this condition often occurs at the time of weaning when the character of the food is suddenly changed. (d) Inflammatory conditions of the bones in which the blood- vessels are enlarged and the circulation increased preventing the depositing of the lime salts in the new bone tissue. This process keeps the lime salts in solution instead of being deposited in their normal manner, (e) The possibility of infection having to do with the production of rachitis has been considered, but not proved. Various toxic agents (poisons) w r ill bring about a disturbance in the function of the normal metabolic processes in the body and possibly bring on the condition or predispose to it. (/) Absence of sunlight, dark, damp and unsanitary cellars are no doubt predisposing causes. Heredity has been mentioned also as having some influence in the development of the disease. It is quite evident that the exact etiological factor in the production of rachitis has not yet been determined. Pathology. The deformity occurring in rachitis is found mainly in connection with the long bones. The diaphyses of the bones are. shortened, softened, become curved. The epiphyses are thickened, more or less spongy, and much enlarged. The bones are much softer than normal and have the consistency of decalcified bone. They can be cut easily with a knife. The periosteum is thickened, reddened and when removed from the bones may include some of the bone substance. In many cases the interior of the bones is soft and the canal abnormally large. The short bones are found spongy and easily separated. Marked deformity occurs in the skull bones which are often separated. The patient in general will show evidences of malnutrition. Symptoms. During the early stages of the disease, before deformity of the bones is present, there are gastric and intestinal disturbances (catarrh), and evidences of mal- nutrition. Weakness, loss of appetite, diarrhea and tendency RA CHI TI SRfCKE TX 36 1 for bloating are observed in the early stages. Very often the disease is not noted until the change in the form of the bones begins. Deformity appears in various places. The bones of the head and face show a bulging which gives the animal a peculiar appearance. The limb bones show curva- ture and enlargement at the joints. Palpation along the ribs at the attachment of the bones to the cartilage will reveal small, rounded enlargements. Twisting and curvature of the spine are quite commonly observed. The teeth become loose and displaced, the gums soft and spongy and bleed easily. Deformity of other bones may be present. General emaciation, weakness and irregular development of the bones, w r ith marked gastric and intestinal disturbances are prominent symptoms. Course. The course of rachitis is nearly always chronic, lasting for several months. Occasionally the condition runs an acute course when complications are present. Prognosis. When the disease is observed early and treated, the prognosis is rather favorable. After there is marked deformity and evidences of emaciation and malnutrition very little can be hoped for. Treatment. The first consideration in the treatment should be the diet. Dogs should be allowed plenty of meat with the addition of ground bone. In birds meat scraps and ground bone seem to produce the best results. Gastric and intestinal catarrh should be treated, if present, by alkalies and mild laxatives. The lime deficiency must be relieved by the administration of lime salts. Syrup of calcium lactophos- phate has been very satisfactory for this purpose (dogs, 8.0- 12.0; chickens, 1.0-2.0). This should be given twice daily and continued for a few weeks. Chalk (calcium carbonate), or calcium phosphate is also to be recommended in doses of 1.0 to 8.0 daily. In some cases there will also be a deficiency of phosphorus which can be replaced with calcium phosphate. Phosphorus in a bland oil (dogs, 0.001-0.002 in 10.0 oil; birds, 0.005-0.001 in 2.0 oil) is also recommended. Small doses of hydrochloric acid, well diluted, will assist in the solution and assimilation of lime. 362 DISEASES OF METABOLISM In dogs, when the limb bones become soft and deformed, splints and bandages are useful to act as a support which reduces the deformity to a minimum. OSTEOMALACIA. BRITTLENESS OF BONES. Osteomalacia occurs so rarely in small animals that the reader is referred to other works for the discussion of it. PART VII. DISEASES OF THE ORGANS OF LOCOMOTION. CHAPTER I. ARTICULAR RHEUMATISM. POLYARTHRITIS RHEUMATICA. Definition. Articular rheumatism is evidently an infectious febrile disease in which several joints are affected. It is a serous or serofibrinous inflammation of the joints. It may suddenly shift from one joint to another. Etiology. The actual cause of the disease has never been definitely proved, but all indications point to infection. Several factors no doubt have considerable influence in bringing on the attacks, such as (a) subjection to cold and chilling the surface of the body; (6) keeping animals in cold, damp cellars, or forcing them to sleep out in extreme cold weather; (c) infection following birth of the young. The close association of the disease with endocarditis and other diseases of serous membranes further suggest its infectious nature. Pathology. The joint capsule is more or less distended with a yellowish gelatinous-like fluid mixed with the synovia. The connective tissue is infiltrated with the same material. Examination of the synovial membrane itself reveals swelling, injection and hemorrhages. The cartilage of the joint is bluish or yellow in color and the surface roughened. Chronic cases show marked thickening of the periarticular tissue. Similar changes are often found in the tendon sheaths. The musculature shows atrophy. :^64 ARTICULAR RHEUMATISM POLYARTHRITIS Symptoms. The condition often begins suddenly involving one joint or several at the same time. The affected ones are very painful, the animal refusing to place any weight on the limb and holding it in a flexed position. The joints will be hot and swollen. Owing to the pain small animals usually remain in a recumbent position and refuse to arise. The acute symptoms often subside after a week, or ten days, and eventually develop into a chronic inflammation with deform- ity of the joints. Favorite locations of the inflammation are in the carpal, stifle, and phalangeal joints. In the early stages of the attack there is fever, which may reach 103-105 F. The respirations are increased, the pulse double the normal number. The animal refuses to eat in most cases. The urine is reduced in quantity and dark in color. In the chronic form the disease assumes the character of a serosynovitis; the joint capsule is very much thickened and adhesions take place between the joint surfaces in a number of cases. Ankylosis, however, is rare. There is usually but little fever in this form but general emaciation and cachexia will be prominent. In a few cases complica- tions develop. Inflammation of the serous membranes is the most common. This is indicated by a greater rise in temperature and by the specific symptoms of the complicat- ing condition. Course. In the acute form the disease usually runs for two or three weeks. Remissions often occur at different intervals for several months to one year. In many cases the attack disappears quite suddenly which may be for only a short time or permanently. Diagnosis. This may be difficult. A careful examination must always be made to differentiate it from other diseases affecting the joints. It should be borne in mind that articular rheumatism comes on primarily while that produced by other diseases shows the primary condition elsewhere before the joints become affected. Prognosis. Should not be considered too favorable. How- ever, in the dog they may recover completely. Very often the condition becomes chronic leading to permanent deform- MUSCULAR RHEUMATISM 365 ity of the joints. Complications may also follow, such as endocarditis or inflammation of other serous membranes. Treatment. Treatment in small animals is often satis- factory by the use of large doses of sodium salicylate (1.0 to 2.0 daily). After two to three days the temperature falls almost to normal and the general condition will improve. Other preparations have been recommended, as salicylic acid (intravenously), salol, or acetanilid. Local applications to the joints will assist in giving relief from the pain, and in the absorption of the deposits. lodin liniments, camphor oil, or mercuric iodid ointment, any one of which may be applied alternately with hot water applications. The animal should be placed in a moderately warm room, where it is quiet, and provided with a soft bed. In the chronic form, massage the joints thoroughly daily with Lugol's ointment. MUSCULAR RHEUMATISM. Definition. A primary affection of the muscles (myositis) probably of infectious origin. It occurs commonly in dogs. Owing to the fact that it is very difficult to make a distinction between muscular rheumatism and so-called "soreness" and "stiffness" of the muscles, they are usually classed as muscu- lar rheumatism. The number of cases of muscular rheu- matism would no doubt be decreased if a careful examination were made in all cases and a more accurate diagnosis estab- lished. There has been a tendency no doubt to use the term muscular rheumatism in a too inclusive sense. Etiology. The immediate cause of muscular rheumatism is probably an infection, the nature of which has not been determined up to the present time. Several factors have to do with the development of the disease: (a) Damp, cold kennels, and exposure to cold have proved decided factors in bringing on the attacks. Very commonly observed in hunting dogs following their exposure on hunting trips. This is especially true in those animals that have been pampered and kept in warm buildings and quarters, (b) Ptomain poisoning and intoxication from toxins absorbed from the intestinal tract will also produce it. (c) Certain infectious 366 ARTICULAR RHEUMATISM POLYARTHRITIS diseases of serous membranes will bring on attacks of muscu- lar rheumatism in a similar manner as articular rheumatism. (d) Injuries to the muscles, overexertion without previous exercise, will produce similar symptoms. This, however, should not be classed as muscular rheumatism. Pathology. On examination the muscles will show serous inflammation with infiltration of the intramuscular con- nective tissue. Disintegration and fatty degeneration are found in most cases. The muscular tissue shows evidence of hyperemia and swelling. In chronic cases the fibrous connective tissue elements are thickened. Symptoms. Pain is always a prominent symptom. This may be constant in severe attacks or in the milder forms periodic and recurrent. In dogs the condition very often comes on suddenly without any prodromal symptoms. The attack is usually transient lasting from a few hours to several weeks, and is very apt to recur. The symptoms of muscular rheumatism will depend somewhat upon the groups of muscles affected. Sometimes the muscles of the head and neck are involved ; in this case the head and neck will be more or less fixed, the animal holding the head in a rigid position. When manipulated or the animal made to move indications of severe pain are noted. In other cases the muscles over the scapula will show the primary seat of the disease. This is often unilateral, but may be present on both sides. The anterior limb will be relaxed or the animal show marked lameness when weight is placed on it. When bilateral the animal may be found in a recumbent position, with the limbs straightened out, and refuses to get up. The patient cries out and whines when the muscles are palpated. In involvement of the muscles of the back (lumbago rheumatica) the animal assumes a rigid attitude, very cautious in all its movements, frequently refusing to move and when forced to do so great pain is manifest. Occasionally the patient will be found lying down. Manipulation of the muscles over the region produces intense pain. When the muscles of the extremities are primarily affected the animal lies on its back with the feet upward, whining and crying. Feces and urine are often retained when the abdominal MUSCULAR RHEUMATISM 367 muscles are affected. The various functions of the body are interfered with owing to the pain from the disease. The sensibility of the skin is either normal or hypersensitive. As a rule no appreciable rise in temperature is noted. The respirations are increased and may be shallow when the respiratory muscles are affected. The pulse may be increased materially, due to the pain present. The general condition of the animal is good and the appetite retained. In severe cases animals become emaciated from the disturbance of the functions. Complications occur occasionally in the form of acute inflammation of serous membranes, and disturbances in the digestive tract. Course. The acute attack, as a rule, lasts only a few days to one week. The symptoms may disappear entirely. Recurrence of the condition is to be expected. Prognosis. Complete recovery without periodical recur- rences of the disease can hardly be hoped for. Unless complications develop the patient will apparently recover from the attack. Treatment. The early indications in the treatment are: Protection of the patient from exposure, relief from the pain and the administration of antirheumatic agents. The animal should be placed in a moderately warm, dry place with a soft bed. All further exposure to cold and dampness should be avoided. Local applications to the affected muscles are recommended. Massage the muscles with soap liniment, camphor liniment, or chloroform liniment. These should be applied once or twice daily. Hot towels applied to the affected area often give relief promptly. Internally administer sodium salicylate or salicylic acid in large doses (0.9 to 1.5) once daily. When the pain is intense it is advisable to control it by subcutaneous injections of morphin sulphate (0.1 to 0.2). This may be repeated in twelve to eighteen hours if necessary. Complications as they arise should be treated. In cases that tend to become chronic, potassium iodid is highly recommended (0.2 to 0.4). Ple- thoric animals should be depleted by administering saline laxatives (magnesium sulphate 8.0 to 12.0). 308 ARTICULAR RHEUMATISM POLYARTHRITIS FRACTURE OF BONES. As a result of injuries from various causes small animals are particularly prone to fractures of different kinds. The number of fractures and the bones affected are much greater than in the large animals. All kinds of fractures (partial, complete, compound, or comminuted) are observed. The larger number of fractures naturally take place in the extrem- ities, although fractures of the skull bones, inferior maxilla, ribs and vertebrte are not uncommon. The causes of frac- tures are varied, but the greater number of cases result from traumatism (being run over by vehicles, kicks, falls, jump- ing, gunshot wounds, bites from other animals). In a few cases extreme muscular contraction will fracture the bones. Various diseases of the bones, and senility predispose to fractures. The following are the more common fractures met with : Cranial Bones. This form of fracture occurs occasionally in dogs. The writer has observed six cases during the past ten years. Etiology. Practically always results from traumatism. Being struck by sharp or blunt objects, run over by automo- biles, kicks, etc., are the most frequent causes. Symptoms. Various kinds and degrees of fractures are recognized, from a simple fissuring of the bones to penetrat- ing, depressed or compound comminuted fractures. The symptoms vary with the degree and kind of fracture. Simple fissuring of the bones may not produce any marked symptoms unless the concussion has been sufficient to cause hemorrhage or injury to the membranes of the brain. The presence of the wound and on pressure slight movement between the bones may be observed. Penetrating wounds with fracture often produce complications of hemorrhage into the cranial cavity or direct injury to the structures within. Examination of the external wound and carefully probing will at once disclose the actual conditions. Fractures with depression of a frag- ment of bone cause more or less brain disturbance depending upon the location of the fracture. The psychical disturb- FRACTURE OF BONES 369 ances and the presence of the wound would assist in making the diagnosis. If there is doubt in regard to the exact con- ditions the external wound can be opened sufficiently to examine the parts direct. Compound and comminuted fractures show the presence of the wound and the opening through the cranial bones. Fragments of bone may be found projecting out through the opening or downward into the cranial cavity. Probing will reveal the conditions. The concussion from the injury may produce unconsciousness for a time even though but little damage has been done the bones themselves. Death occurs suddenly in many instances when the brain is severely injured or sudden severe hemor- rhage takes place. Careful examination should be made in all cases in order to establish a positive diagnosis. Prognosis. The prognosis should not be considered too favorable on account of the danger of brain complications. Treatment. The treatment will depend upon the kind of fracture. In simple fissuring of the bone no treatment is necessary, except for the contusion of the skin and muscular tissue covering the bone. Penetrating fractures are best treated by opening the external wound, examining the fractured portions and elevating them carefully with a scalpel or stiff probe. Clean the wound thoroughly and suture the skin covering it with iodoform collodion. Depression of the skull bones should have prompt treat- ment to relieve the pressure from the brain and membranes. This is best done by making external incision, and if necessary a small opening through the bones so that an instrument can be inserted to elevate them to their normal position. Strict aseptic precautions should be observed in the operation. Suture the outside wound. In compound comminuted frac- tures all fragments of bone should be removed, conserving as much as possible, and a protective dressing applied to the parts. Fracture of the Inferior Maxilla. Fracture of this bone occurs very often in dogs and cats. The points of fracture are usually at the symphysis, in front of the premolars, or posterior to the molars. Frequently the fracture is bilateral, but in most cases involves one side. 24 370 ARTICULAR RHEUMATISM POLYARTHRITIS Etiology. Traumatism is often the cause of the fracture. It can result from extraction of teeth. It may follow alveolar periostitis, or exfoliation of a portion of the bone weakening the jaw at this point. Extreme pressure from biting on hard objects (stones of large size) can be a cause. Diseases of the bones (fragilitas ossium) predisposing them to fracture. Symptoms. Difficulty in eating is the first symptom noticed. Other symptoms are displacement of the maxilla at the point of fracture, excessive salivation, and enlarge- ment on the side affected. On examination crepitus and movement between the portions of bone will be recognized at once, Prognosis. Owing to the complications of infection, and the difficulty in keeping the parts quiet, the prognosis is unfavorable. Treatment. Various methods of treatment have been tried. In fissuring without laceration of the mucous mem- brane it is advisable to try wiring them together with silver wire using the teeth as fixed points. In compound fractures when infection takes place treatment is usually unsatis- factory. Fixing the maxilla by the use of a leather pad or muzzle in contact with the superior maxilla, disinfecting the mouth twice daily, and giving liquid foods have proved the most satisfactory treatment. In comminuted fractures where fragments of bone must be removed but little can be expected of any treatment. Fracture of the Vertebrae. The points at which fractures most commonly occur are in the cervical, lumbar, and coccy- geal segments. Etiology. Most cases result from traumatism. Symptoms. The symptoms will depend upon the kind of fracture, whether it is confined to portions of the vertebra? outside of the canal or involves the canal with the spinal cord. Crepitus and pain on manipulation of the parts are prominent symptoms. Should the fracture be confined to the lateral processes no other symptoms will be observed. In complete fracture of the cervical vertebrae with involvement of the cord, death may result in a few minutes, or hours. Complete paralysis exists posterior to the point of the fracture. Fract- FRACTURE OF BONES 371 ure in the lurnbar region produces paraplegia and paralysis of the posterior portion of the body. Differentiation between hemorrhage in the canal, edema of the cord and fractures is often difficult and can be determined only by the progress of the case. Fractures of the coccygeal vertebrae are easily determined by crepitus and the increased mobility of the parts. Prognosis. Complete fracture of the vertebrae is unfavor- able. Fracture of the lateral processes or coccygeal vertebra? is favorable. Treatment. No treatment is possible in fracture of the cervical and lumbar vertebra 3 . The animal should be placed in a quiet, comfortable place. Give nourishing food. If necessary artificial feeding should be carried out. Laxatives are also necessary. Simple fracture of the coccygeal vertebrae is best treated by bandaging. If complications arise .or a compound fracture is present amputation may be necessary at the point of fracture, or slightly above. Fracture of the Ribs. This is found most commonly in dogs and is of very frequent occurrence. Etiology. Produced in many cases by being run over by vehicles, struck by objects, or kicked. Symptoms. One or two ribs may be fractured without producing marked symptoms. This is especially true in partial and in simple fractures. Some will show displace- ment and enlargement at the point of fracture. Crepitus is hard to distinguish in all patients. Compound fractures may cause injury to the pleura or lung tissue. Examination should be made carefully. Prognosis. Favorable unless complications involving the pleura and lungs develop. Treatment. Most cases do not require any treatment. Keep the animal quiet. A bandage applied around the thorax to assist in keeping the parts fixed might be used. Compli- cations involving the pleura and lungs should be treated according to the conditions. Fracture of the Scapula. This is not of frequent occur- rence. In dogs the points of fracture most common are through the neck and glenoid cavity. In young animals 372 ARTICULAR RHEUM AT ISM POYL ARTHRITIS separation takes place frequently between the epiphyses and diaphyses. Etiology. From injuries and diseases of the bones. Symptoms. Sudden development of lameness. The limb usually hangs inert and cannot be moved -upward and for- ward. Examination will reveal the fracture. Treatment. No satisfactory treatment can be applied owing to the location of the scapula. Dogs, when well cared for and protected, will recover without special treatment. Dogs protect the limbs better than any other animal. Stim- ulating liniments might be applied over the area (soap lini- ment, iodin liniment). Fracture of the Humerus. Owing to the exposed position of the humerus it is frequently fractured. In young animals separation of the epiphyseal and diaphyseal portions is not uncommon. It has been observed that the lower end of the bone is more often fractured than any other portion. Fract- ure of the condyles occurs with considerable regularity. Etiology. Traumata of various kinds produce the majority of cases. It occasionally happens that both the humerus and scapula are fractured at the same time., Symptoms. When unilateral fracture of either the epi- physeal or diaphyseal portions of the bone takes place the animal cannot support any weight on the limb. It will hang free and limp. Should both be fractured the animal rests its weight on its haunches, or assumes a recumbent position. Diagnosis. Examination of the limb will at once make the diagnosis positive. It is very rare to find a compound fracture. Prognosis. Favorable. Treatment. The application of bandages is very difficult. This is especially true when the fracture occurs in the upper portion of the bone. Experience has proved that good results follow without splints or bandages. Occasionally a false union of cartilage or fibrous connective tissue will result forming a pseudo-articulation. Fracture of the Radius and Ulna. This is the most fre- quent of all fractures in the anterior limb of the dog. All small animals are affected in a similar manner. Fracture FRACTURE OF BOXES 373 usually occurs in both bones simultaneously. When one bone is fractured it is usually the olecranon portion of the ulna. The lower third of the bones is the seat of the majority of fractures. Etiology. Practically always result from injuries. Some few cases are due to diseases of the bones. Symptoms. Inability to place weight on the limb and angularity at the point of fracture. There are swelling and distortion of the limb. When the olecranon is fractured the distortion will be marked at the point of the elbow. Crepitus and free movement between the fractured portions will be apparent on manipulation. Treatment. Wrapping the limb with ordinary linen band- age is recommended until the swelling subsides. Plaster bandages are unsatisfactory during the first few days owing to the change in the size of the parts from swelling. A pad of cotton should be applied to protect the skin from pressure necrosis and to allow for swelling to take place, then strips of cardboard softened by placing in w 7 arm water for a few minutes, and over this a linen bandage. The patient should be observed to determine whether the bandage has been drawn too tight or has become loose. Should the foot be found swollen it indicates that the bandage is too tight and free circulation of blood interfered with. It should be loosened. After a few days a plaster bandage can be applied if thought advisable. It should remain in position for a few weeks to ensure complete union. Uniting the bone at point of fracture with silver wire has been tried with varying degrees of success. Radial fractures usually make prompt and complete recoveries. Fracture of the Metacarpal and Phalangeal Bones. These bones are fractured from the same causes as mentioned under the others. Diagnosis. This is made by careful palpation. Treatment. Bandage as in fracture of the radins and ulna. In compound fractures it is sometimes necessary to amputate a portion of the limb or toes. Fracture of the Pelvis. Fracture of this bone is quite common in small animals, and presents a variety of condi- 374 ARTICULAR RHEUMATISMPOLYARTHRITIS tions. The most common points of fracture are through the symphysis, external angles of the ilium, or through the acetabulum. Both unilateral and bilateral fractures are observed. Complications are common following fracture of the pelvis, owing to the injury of adjacent structures. Injury to the nerves or bloodvessels is most common. Etiology. Pelvic fractures are produced very frequently by being run over, struck by objects, kicks, or falling. Symptoms. The symptoms will vary somewhat depending on the degree of fracture, its location, and the complications. Deformity of the pelvis is present in fracture of the external angle of the ilium. Crepitation and movement of the parts can be detected. Fracture through the symphysis is evi- denced by the unnatural gait of the animal, the abduction of the limbs, and the separation which can be detected on palpation between the fractured portions. It is sometimes difficult to make a positive diagnosis in fracture at other points on account of the smallness of the openings through which the examination must be made. Complicating symp- toms should be examined for in all cases. Prognosis. Unless complications of hemorrhage and destruction of some of the nerves occur, the prognosis is considered favorable. Different degrees of deformity will be met with which should be considered in the prognosis. The condition is serious in breeding animals on account of the deformity narrowing the pelvic canal. Such animals should be given a careful examination in this regard. Treatment. But little can be done in the way of treatment. Union usually takes place promptly by giving the animal protection for a few weeks. Various methods have been tried to approximate fractures of the pelvis but with little success. Fracture of the Femur. Fracture of the femur occurs often in dogs, cats and rabbits. The majority of cases are found involving the lower third of the bone. Some few cases are observed in the upper portion, even involving the head of the femur. Etiology. Injuries and accidents account for the larger number of cases. Diseases of the bone (fragilitas ossium and osteomalacia) predispose to fracture. FRACTURE OF BONES 375 Symptoms. In practically every case the limb is held off the ground, freely moved in all directions, and appears shorter than normal. Care should be made to differentiate between fracture and dislocation of the head of the femur. Examina- tion of the limb will reveal the point of fracture. Diagnosis. Fissuring of the bone may present some diffi- culty but in other cases the diagnosis is easy. Prognosis. Favorable. Union of the bones may result in some permanent distortion, such as shortening the limb, or a certain amount of angularity. Treatment. An attempt should be made to bandage the limb to keep the bones in apposition as nearly as possible. A temporary muslin and splint bandage should be used until the swelling subsides. Later a better and more permanent dressing may be applied. As a rule union takes place quite promptly and without much distortion. Fracture of the Patella. This bone is very rarely fractured in small animals. Careful palpation over the region would reveal the condition. No treatment other than bandaging can be applied. Fracture of the Tibia and Fibula. These bones are the seat of all types of fractures. Very common in dogs and rabbits. The symptoms, prognosis and treatment are similar to those given for the radius and ulna.- CHAPTER II. DISEASES OF THE ARTICULATIONS. THE various articulations in small animals are subjected to a variety of conditions. WOUNDS OF THE ARTICULATIONS. Punctured wounds and various kinds of incised wounds are frequently met with. In some cases the adjacent struct- ures may be severely injured complicating the condition. Further classification should be made into aseptic and septic wounds. From a practical standpoint it is important to examine the wounds carefully to make these distinctions. Etiology. It is selfevident that ' these wounds occur through various accidents and injuries to which the animals are subjected. Symptoms. The animal will favor the joint affected and refuse to walk on the limb. A thin, serous discharge (synovia) is noted coming from the wound. The amount of pain and swelling will not be marked in the early stages. However, if infection is introduced, these symptoms develop very rapidly. Pus soon makes its appearance, the joint becomes very hot and sensitive, and general symptoms of fever, loss of appetite, are observed. Diagnosis. This is made by carefully examining the dis- charge and by probing the wound with a sterile probe. Prognosis. Should not be made very favorable in any case, owing to the possibility of destruction of the joint, or anky- losis. Non-infected wounds usually heal without difficulty. Treatment. After learning the facts concerning the in- volvement of the joint, strict antiseptic precautions should be taken, and all means employed to prevent infection. SPRAINS AND INJURIES TO THE ARTICULATIONS 377 Shave the hair from the area and disinfect the surface with bichlorid of mercury and glycerin (1 to 500). Saturate gauze or cotton with this solution and apply under a bandage, if possible. When infection is already present it is advisable to open the wound so that adequate drainage will be brought about. Use the same solution as above and inject it into the articulation. Apply a protective dressing. Repeat this treatment at least twice daily. SPRAINS AND INJURIES TO THE ARTICULATIONS. In the larger number of injuries occurring in small animals it frequently happens that the structures around the joints are torn or otherwise injured without an external wound. This condition may occur in any of the articulations. As soon as the injury occurs the synovial secretion is increased in amount, and the adjacent tissues are often edematous. Symptoms. The condition develops suddenly following injury, or violent exercise. The articulation soon becomes enlarged, very hot and painful to the touch. The patient refuses to bear any weight on the limb. Careful examina- tion must be made to differentiate sprains from fracture or dislocation. Distortion, increased movement, and crepitus found in fractures are absent in this condition. The normal position of the bones would exclude dislocation. In severe cases the swelling may be so extensive as to interfere with making a positive and early diagnosis. Prognosis. Most cases of sprains recover. Course. The course depends upon the degree of injury. Treatment. The animal should be confined in a quiet place for several days. Cold applications in the form of cold water, or better, ice packs, should be applied during the first twenty-four to thirty-six hours. The packs are changed frequently to keep up the refrigeration. Follow this treat- ment with hot water, or liniment (iodin liniment, white liniment) applied once or twice daily. Massage the parts thoroughly. The latter treatment should be continued for two to three weeks, if necessary. 378 DISEASES OF THE ARTICULATIONS DISLOCATION OF THE ARTICULATIONS. LUXATION. Dislocation of the various articulations in dogs, cats and rabbits is a common occurrence. Birds often have luxation of the joints of the wings. The following are the most common dislocations found in small animals: Temporomaxillary. This occurs more frequently in dogs than in any other animal. Etiology. Resulting in most cases from extreme opening of the mouth, either from being forcibly pulled open, or from large objects being taken into the mouth. The condition may be either unilateral or bilateral. Symptoms. Fixation of the lower maxilla either laterally (in case of unilateral luxation), or downward and forward (bilateral luxation). Saliva flows from the mouth freely, the animal is unable to move the maxilla, or only slightly, and shows considerable anxiety and pain. Pawing at the mouth with the forefeet, rubbing the parts against objects, and carrying the head in abnormal positions, are prominent symptoms. Patients showing these symptoms should be handled carefully, as in some respects they are not unlike dumb rabies. Examination will easily reveal the differential features. Prognosis. Usually .favorable, except when the case is of too long standing and fracture of the bones is present. There is always the possibility of a recurrence. Treatment. Reduction of the dislocation should be made early. The animal should be anesthetized (morphin sulphate, 0.1 to 0.2), placed on a suitable table in the dorsal position, and by using a fulcrum inserted between the teeth, the jaws are forced apart by bringing the incisors together. By careful manipulation the bones are replaced in their normal position. Considerable patience is often necessary to accom- plish this. If fractures are present but little can be done. Use artificial feeding of liquid foods for a few days. It is advisable to tape the mouth shut for a few days until the articulations are normal again. DISLOCATION OF THE ARTICULATIONS LUXATION 379 Vertebral. Dislocation unattended by fracture is rare. The articulations are so arranged anatomically that luxation without fracture is not liable to occur. Partial luxation is met with occasionally and is diagnosed by the position of the head and curvature of the vertebrae. Straightening the head and neck should be attempted. Scapulohumeral. Owing to the position of the articulation and its anatomical structure complete luxation is not com- mon. The articulation is capable of rather extensive move- ment without dislocation. Etiology. It is brought about by excessive flexion of the joint from injuries and accidents. The luxation is usually forward and inward. Symptoms. The condition occurs suddenly and distortion of the joint is apparent at once. The joint is held in a flexed position and distention is practically impossible. The limb is much shorter than normal. Examination of the articula- tion reveals the head of the humerus forward producing an enlargement anteriorly and a depression posteriorly. Animals show pain on manipulation of the joint. Prognosis. In complete luxation the prognosis is favorable w T hen taken early but later when swelling takes place reduc- tion is difficult, and the joint capsule will rarely resume its normal condition. Partial luxations are favorable. Treatment. The animal should be anesthetized (morphin sulphate, 0.1 to 0.2), placed on the table in lateral recumbency with the affected articulation presented . Extend the humerus and push backward on the head of the humerus. Usually replacement will take place without much difficulty. Apply a bandage for a few days to protect the part. Massage and a stimulating liniment should be applied around the joint. Humero-radio-ulnar. Luxation of this articulation may be partial or complete. Various conditions can be found owing to the anatomical structure of the joint. The dislocation may be between the humerus and radius or between the radius and ulna. In some cases all of the structures are involved. The dislocation may take place to the inside or outside depending upon the cause of the condition. When dislocation occurs there is nearly always a tearing or stretch- 380 DISEASES OF THE ARTICULATIONS ing of the ligamentous attachments around the joints. A congenital dislocation is sometimes observed. Etiology. The condition is brought about by injuries, such as blows from the outside or inside, extreme flexion or exten- sion of the joint, falling, or jumping. Frequently the limb is given a sudden twist by the foot being caught when the animal is in motion, or pulling backward to free itself. Symptoms. Distortion of the articulation is noted, and the lower limb in an abnormal position, either abducted or adducted. There is an enlargement present on one side and a corresponding depression on the opposite. The limb appears short, and the animal refuses to place any weight on it when in motion or at rest. Examination reveals the joint to be hot and painful when manipulated. The dis- placed bone can easily be palpated, and the luxation deter- mined. Prognosis. Not very favorable owing to the injury to the annular ligaments, and the possibility of a return of the condition. Treatment. Reduction of the dislocation should be made under general anesthesia. The method of procedure will depend upon the dislocation. As a rule but little difficulty will be experienced in bringing the parts back to their normal position. After reduction of the luxation the parts should be bandaged to hold them in position. The bandage should be left in place for two or three weeks, or until the annular ligaments are united. Congenital luxation is unsatisfactory from the standpoint of treatment. Wiring of the bones might be tried in cases that cannot be kept in position by bandaging. Radio-ulnar-carpal. From violent injury luxation of this articulation may take place. The annular ligaments become torn allowing the articular surfaces to be displaced. Symptoms. Distortion of the articulation either forward or backward is most common. Diagnosis. The diagnosis is not difficult when a careful examination is made. Treatment. Reduction of the luxation is easy, but it requires several weeks before the animal will be able to use DISLOCATION OF ARTICULATIONS LUXATION 381 the limb. Protect the joint by placing a pad of cotton under a bandage. Keep the bandage on for two or three weeks. Phalangeal. Dislocation is very common and results from traumata. A careful examination should always be made to differentiate luxations from fractures, and to definitely determine the joint displaced. They should be reduced as early as possible and a bandage applied. Keep the bandage in position for two to three weeks. Coxofemoral. This is one of the most common disloca- tions in dogs, cats and rabbits. It may be partial or com- plete. When partial the damage is mainly in connection with the capsular ligament, while in complete luxation the entire joint structure and the adjacent tissues are involved. Etiology. Being struck by objects, run over by vehicles, and having the foot caught in traps, etc., are the most com- mon causes. Extreme extension of the limb from any cause may bring it about. Symptoms. The most frequent form of luxation is forward and upward. The animal is found with the limb fixed in a backward, adducted position, and refuses to place any weight on it. An enlargement will be noted just anterior to the normal position of the joint, and on palpation the head of the femur can be felt. Manipulation of the limb will at once reveal the condition. Luxation into the foramen ovale is not common but occurs in a small percentage of cases. The limb appears longer than normal, is slightly abducted, and the stifle joint is turned outward. Adduction of the limb is difficult and impossible to the normal degree. Palpation of the parts will easily diagnose the condition. A backward, upward luxation occurs occasionally and the position of the limb is forward and inward, with an enlarge- ment present on the posterior aspect of the joint. ( areful examination will determine the relationship of the parts. In partial luxation the animal is able to move the limb and shows lameness but very little deformity. Chronic conditions become accommodated to the movements of the anim through the formation of a pseudo-articulation. Prognosis.- Rather unfavorable for a complete recovery. Early cases are much more favorable than those of a few days or weeks standing. 382 DISEASES OF THE ARTICULATIONS Treatment. Treatment should be applied as early as pos- sible. -Anesthetize the animal and effect replacement by manipulation of the limb according to the character of the luxation. The principle involved is to extend the articulation in whatever direction is necessary so that the head of the femur can be returned to the acetabulum. Very little can be done in after-treatment except keeping the animal quiet for several days. Mechanical appliances to hold the bones in position have not proved satisfactory. Little can be expected in the treatment of chronic cases. Patellar. This occurs most frequently in the dog. The ligaments of the patella are not very well developed outside of the middle one. Therefore, displacement is more liable to occur laterally. Experience has shown that internal displace- ment is by far the most common. Etiology. The anatomical structure of the patellar liga- ments and the joint in particular make displacement easy from excessive exertion or injuries. In some breeds the internal femoral ridge of the patellar groove is very small; therefore internal displacement is of common occurrence. Symptoms. The limb is held in a flexed position, and the patient has difficulty in supporting weight. The flexion is most apparent at the stifle joint. The position of the limb is somewhat characteristic, the stifle joint adducted, the hock rotated outwardly, and the lower portion of the limb carried toward the median line. Examination of the stifle joint will reveal the misplaced patella. When the condition is bilateral the animal will show a crouching attitude, and will have considerable difficulty in maintaining the standing position. The animal moves with great difficulty in bilateral dislocation. Prognosis. The prognosis should not be considered favor- able owing to the difficulty in keeping the parts quiet and the possibility of a recurrence of the condition. Very often there is a tendency for the condition to become chronic. Treatment. Replacement of the patella presents very little difficulty; therefore the problem of keeping the patella in position until the ligaments assume 'their normal condition is to be the principal aim in treatment. Replacement is INFLAMMATION OF THE SYNOVIAL MEMBRANE 383 affected by extension of the joint which will allow the patella to be pulled back to its normal position. Apply linen bandage in order to retain the parts in their normal position. The animal should be kept quiet for several days. A plaster bandage might be used to advantage. Tibiotarsal. This is not very common in small animals. When it does occur it is accompanied by rupture of the liga- ments or fracture of some of the bones. A careful examination should be made to determine the conditions as accurately as possible. Linen bandage should be applied for the first few days, followed by a plaster bandage if necessary. Caudal Vertebrae. The larger breeds of dogs with long tails (Great Dane, greyhound, etc.) are the most frequent sufferers. Examination of the parts will reveal the condition. A bandage applied rather firmly and kept in position for several days will correct the dislocation. INFLAMMATION OF THE SYNOVIAL MEMBRANE AND ARTICULATIONS. SYNOVITIS. ARTHRITIS. Definition. An inflammation of the synovial membrane and articular surfaces. The conditions may be acute or chronic. Very often the entire joint will be inflamed (syno- vitis and arthritis). It is very difficult to make a distinction between these two conditions. Etiology. Most cases result from sprains and contusions of the joint. Few result from infection (pyogenic). The infection usually gains entrance through wounds of the syno- vial membrane. Symptoms. -Enlargement of the joint, extreme sensitive- ness, and increased local temperature are characteristic symptoms. The animal cannot use the limb to any extent. Examination should be made carefully to differentiate it from articular rheumatism. Prognosis. Favorable in cases resulting from sprains and bruises; unfavorable in infected joints. Treatment. During the early stages of the condition cold applications are applied either in the form of cold water or ice picks which should be carried out conscientiously if the 384 DISEASES OF THE ARTICULATIONS best results are to be expected. This treatment may be followed by hot applications and liniments (soap liniment, white liniment, iodin liniment). During treatment the animal must be confined to ensure rest to the affected joints. In case pus is present in the articulation, it should be opened and antiseptics directly injected. (See Wounds of Joints.) Chronic cases are not amenable to treatment. PART VIII. DISEASES OF THE URINARY SYSTEM. CHAPTER I. DISEASES OF THE KIDNEYS. Examination. Examination of the kidneys consists of ab- dominal palpation, direct inspection and exploration, and examination of the urine. (a) Abdominal palpation is best done with the animal in a standing position, using the fingers of both hands. By gentle digital pressure, abnormalities in the dimension and location of the kidneys will be noted. This method of examination will prove satisfactory only in cases where a marked enlarge- ment occurs, or in emaciated animals. (6) Direct inspection of the kidneys may be made, espe- cially in dogs, by performing laparotomy under anesthesia (see Laparotomy). This method can be done safely and will be found useful in determining accurately the size, consist- ency, and location of the kidneys. In cases of cysts or other enlargements an exploring needle may be used to obtain some of the contents for examination. (c) The examination of the urine should be made chemi- cally and physically. Chemically tests should be made for albumin and sugar. The tests for albumin are made as follows: Heller's ring test is a very valuable one as a very small percentage of albumin can be demonstrated with it. It is made in the following manner: A small amount of urine is filtered, poured into a test-tube containing concen- trated nitric acid. At the point of contact of the two liquids 25 386 DISEASES OF THE KIDNEYS a well defined white ring forms, the depth of which depends upon the amount of albumin present. The boiling point may also be used. Take a few cubic centimeters of urine in a test-tube and heat to boiling, acidu- late by adding 5 to 10 drops of concentrated nitric acid. A precipitate which has been formed by earthy phosphates or carbonates will then dissolve, but one due to coagulated albumin remains. The metaphosphoric acid test is made by adding an aque- ous solution of metaphosphoric acid to the urine. The urine becomes cloudy in case albumin is present. The acetic acid-ferrocyanid of potassium test is made by adding 2 per cent, of acetic acid to the urine and then a 5 per cent, solution of ferrocyanid of potassium, the latter drop by drop avoiding an excess. Jf albumin is present a decided turbidity or flocculent precipitate appears. The quantitative determination of albumin is made with Esbach's albuminometer. Acidulated urine is filled into the sign U, the reagent up to R (1 part of picric acid, 2 parts of citric acid, and 100 parts distilled water), the tube is closed with a rubber stopper and slowly turned over several times without shaking; let stand at room temperature for twenty- four hours, the precipitate has settled and may be read off. The figure indicates the proportion of albumin in grams pro mille. Urine containing a large percentage of albumin must be first diluted with water and the indicated figure must then be multiplied with the figure of the dilution to obtain the exact amount of albumin present. When it has been demonstrated that albumin is present in the urine, then it must be determined whether the albumin originates from the kidneys, from the urinary passages, or from the nearby genital organs. If the urinary sediment contains no organic form elements, or form elements derived from the kidneys, and if the presence of dissolved coloring matter of the blood may be excluded, then it is positive that it is renal albuminuria. If there is a large amount of organic sediment then it is not likely to be renal albuminuria. In some cases it is possible to have a mixture, coming from the kidneys and also from other parts of the urinary system. CONGESTION OF THE KIDNEYS HYPEREMI A 387 The chemical test for sugar in the urine is best made -by using Trommer's test, which is as follows: A few cubic centimeters of urine are put into a test-tube, after removing any albumin which might be present, dilute it with an equal volume of water, render it alkaline with a small quantity of sodium hydrate, then add drop by drop a 4 per cent, solution of copper sulphate until the liquid is clear and the sediment dissolved, then heat until it boils. If sugar is present, a reddish-yellow vapor appears at the sur- face of the fluid. The bismuth test is often used for the same determination. The albumin is removed from 10 parts of urine and added to this is 2 parts of subnitrate of bismuth, 4 parts Rochelle salts, and 100 parts of a 10 per cent, solution of sodium hydroxid. This mixture is boiled for five minutes. It becomes black if sugar is present. To determine the quantity of sugar present the saccharom- eter is used. The urine is fermented by adding a small quantity of yeast. Graduated glass tubes or other appa- ratus are necessary to determine the exact quantity of sugar present. Physically the urine varies in color and amount, depending a great deal upon the kind and amount of food, the condition of the kidneys, and the species of the animal. CONGESTION OF THE KIDNEYS. HYPEREMIA. This condition is- divided into two forms, viz.: (a) Acute hyperemia (arterial hyperemia), (6) passive hyperemia (venous hyperemia) . Acute Hyperemia. Etiology. The causes of this condi- tion are usually the same as those producing acute nephritis. Irritating foodstuffs, chemicals and various diuretic com- pounds, are the most common things producing acute hyper- emia. It may occur during the course of infectious diseases (distemper, rabies). Plethoric animals frequently have active hyperemia of the kidneys. Pathology. The kidneys are enlarged, swollen, softened and highly reddened. The arteries and capillaries are found 388 DISEASES OF THE KIDNEYS distended. Small hemorrhages appear under the capsule. The capsule is easily removed. Symptoms. This condition may not produce very marked symptoms. The most noticeable is the increased amount of urine, the specific gravity of which is much lower than normal. Sensitiveness over the region of the kidneys, and stiffness in walking are also common symptoms. Prognosis. Depends upon the cause. There is always danger of the condition resulting in an acute inflammation of the kidneys. Treatment. Acute purgation is indicated. Administration of magnesium sulphate, or calomel to remove the waste material through the bowels. Avoid irritating foodstuffs. Give milk for a few days. The cause should be removed if possible. Passive Hyperemia. Etiology. This condition is brought about as a secondary disease following valvular defects, dis- eases of the lungs, pleura, etc. In some cases it is produced by pressure on the renal vessels by tumors, etc. In all instances the circulatory disturbances lead to an engorgement or passive congestion of the kidneys. Pathology. In passive hyperemia the kidneys are of a dark bluish-red color, larger than normal. On cut section the venous blood oozes out. In old cases there will be found considerable connective tissue thickening. Symptoms. In this condition the quantity of urine is decreased, and albuminuria is present. Prognosis. Depends upon the primary condition. Treatment. Medical. Digitalis administered in small doses daily. Animals should be given gentle exercise. Give nourishing food which is non-irritating (milk and eggs). INFLAMMATION OF THE KIDNEYS. NEPHRITIS. Acute Nephritis Definition. An acute inflammatory condi- tion of the kidneys, which is characterized either by nutritional disturbances of the renal epithelium with only a slight change in the interstitial connective tissue (parenchymatous nephri- INFLAMMATION OF THE KIDNEYS NEPHRITIS 389 tis), or an involvement of both the renal epithelium and the interstitial tissue without the formation of a purulent exudate (nephritis acuta diffusa). Etiology. This disease is quite common in small animals and birds in which it frequently develops from infectious diseases and poisons. Acute nephritis occurs secondary to infectious diseases. The organisms circulate via the blood stream, become lodged in the glomeruli and in the intertubular bloodvessels, and at the point of lodgment injure the tissues. In this way the disease occurs during the course of distemper, chicken cholera, septicemia, etc. Bacterial toxins in passing through the cellular elements of the kidneys, produce in them and the bloodvessel walls certain degenerative processes, which eventually lead to an acute inflammation. The bacterial toxins probably produce the disease in the majority of cases, as the absorption of toxins takes place in a number of condi- tions, such as in diseases of the alimentary tract, diseases of the peritoneum, etc., and in this manner we may account for the development of acute nephritis during or following such diseases. In like manner acute nephritis may occur following any organic disease. In small animals it frequently follows the ingestion of decayed foods, the preformed toxins are absorbed and eliminated through the kidneys, producing a severe form of acute nephritis. The same condition may result from absorption of products from wounds, from mange, eczema, etc., especially when extensive. Acute nephritis also develops from vegetable and mineral poisons, especially when introduced in rather large quantities. Such substances, as cantharides, carbolic acid, arsenic, oil of turpentine, extract of male fern, mercury preparations, etc., are eliminated via the kidneys and excite an acute inflam- mation. Birds (turkeys) often eat various insects, such as grasshoppers, caterpillars, the acrid substances of which are absorbed from the intestinal tract and induce the inflamma- tion. This same condition has been observed in cats from eating large numbers of insects (grasshoppers). Injuries in small animals are very common, such as blows across the back in the region of the kidneys, being run over 390 DISEASES OF THE KIDNEYS by vehicles, falling, etc., which may result in direct injuries to the kidneys and eventually in acute inflammation. Sub- jection to extreme cold has been considered one of the etio- logical factors: It probably reduces the general resistance of the renal tissue so that infectious substances have a greater effect upon it. This has been observed, especially in puppies and kittens that have been kept in damp, cold kennels. The same thing is found in hunting dogs after being forced to wade or swim through cold water. Pathology. This is usually divided into three classes as follows : (a) Parenchymatous nephritis, in which the primary inflam- matory changes are most pronounced in the parenchyma of the kidney. This is characterized by only slight swelling, the capsule more easily removable, and on cut section a grayish or dull color is noted. Sometimes there will be observed grayish-red or yellowish-brown spots. The medul- lary substance is hyperemic, often dark red in color and the Malpighian bodies are quite prominent, while the balance of the organ is either normal or of a soft consistency. Microscopically the veins and capillaries are enlarged, congested, granular and fibrous deposits between the urinif- erous tubules, and epithelial casts, cells, fatty degeneration with swelling and opacity. (6) Hemorrhagic parenchymatous nephritis, which is char- acterized by a large number of red points giving the external appearance of the organ a dark red color, dull gray on section, blotches of red and in the medullary portion a deep red. Microscopically the veins and capillaries are found engorged with blood, hemorrhages appearing in the adjacent tissues. (c) Diffuse Acute Nephritis. Very noticeable is the in- crease in size and weight of the organ, sometimes two or. three times larger than normal. The tissues are soft and friable. The capsule is easily removed, and the external surface a bright red color with some yellowish or gray patches. Microscopically there will be found enlargement of all vessels with extensive extravasation of blood into the tissues, leukocyte casts in the dilated urinary ducts, and extensive INFLAMMATION OF THE KIDNEYS NEPHRITIS 391 cellular infiltration between them. The glomeruli are often filled with blood and covered with bloody extravasations. Symptoms. The general symptoms are loss or suppression of the appetite, slight elevation of the body temperature, pulse strong and hard at first, later weak and rapid; frequently vomiting in the dog and cat. Constipation during the early stages, followed later by diarrhea, is prominent in most cases. Most animals have difficulty in walking (stiff gait) as the movement of the body tends to compress or move the kidneys, hence pain is induced. During the early stages of the disease there are frequently noticed paroxysms of pain, especially when the animal is first moved, or palpated over the region of the kidneys. On standing they assume a stretched attitude in order to relieve the tension on the dis- eased organ. Frequently in walking the limb on the side affected will be dragged or the forward step shortened. It has been observed in male animals that one testicle will be drawn higher than the other. The changes in the urine form the most characteristic symptom. Usually at first there is suppression, with very scanty flow of urine, highly colored, containing some blood, albumin and tube casts. The total quantity passed in twenty- four hours is greatly reduced, specific gravity high, of a thicker consistency than normal, often slimy and turbid. Hematuria may develop. Microscopically the urine is found to contain urinary casts in large numbers, white and red blood corpuscles and numer- ous epithelial cells. The urine is voided a few drops at a time, especially in the dog, with pain (strangury) . Uremic symptoms are noted in some cases. The stoppage of the flow of urine from the swelling of the tissue of the kidneys, compression and filling of the ducts with exuded casts, causes a retention of waste products and a lack of secretion, hence an accumulation of urea and uric acid, and other decomposition products sufficient to produce marked symptoms. In the dog these symptoms develop rather rapidly in the form of weakness, staggering gait, convulsions, irregular temperature and coma. 392 DISEASES OF THE KIDNEYS Diagnosis. This condition is very frequently mistaken for inflammation of some other abdominal organ, especially peritonitis, enteritis, cystitis, or metritis. It is possible to make a differential diagnosis by a careful examination of the animal, by observing the character and amount of urine voided and a microscopic examination of the urine. Course. The course is usually acute; occasionally the dis- ease terminates in chronic nephritis. Prognosis. On the whole. the prognosis is unfavorable, the patient often dying in six to ten days. When the symptoms of uremia are present, the prognosis should be considered very unfavorable. Treatment. Dietetic. For the dog and cat a milk diet is of the greatest importance. Avoid the giving of irritating foods and drugs. Medical. Establish diaphoresis as early as possible. This can be done by the use of warm baths, steaming the animal, and rubbing the skin. Wrap the animal in warm blankets. Diaphoretics, such as pilocarpin, are not very satisfactory in small animals. Purgatives are to be recommended. Magnesium sulphate (10.0-16.0) every four hours until active catharsis takes place is useful. Small doses of arecalin (0.003-0.005) may be given to the dog to hasten early evacuation of the bowels. Calomel, owing to its prompt action, is excellent for dogs. In heart weakness, during the secondary stages of the dis- ease, digitalis fluidextract (0.1-0.15) should be used. Alka- line diuretics, as potassium acetate, are to be used in small doses. Diuretin has been found to be valuable as a diuretic. In convulsions following uremia, potassium bromid or morphin for dogs should be administered. Tannic acid (0.1) is highly recommended. Chronic Nephritis Definition. A chronic inflammation of kidney, which the may be divided clinically into two groups, viz.: (a) Chronic parenchymatous nephritis, characterized by marked dropsy and during the early stages of the disease, on postmortem, by the large white kidney. In the later stages CHRONIC NEPHRITIS 393 of the disease the kidney usually is small small white kidney. (6) Chronic interstitial nephritis, characterized by cardio- vascular changes which are pronounced, but only in a few instances will dropsical conditions appear. Etiology. It has been observed that chronic nephritis in some instances follows the acute form of the disease. This is true no doubt only in the subacute or milder acute cases. It may develop gradually as an insidious disease without any apparent cause. Injurious substances in the form of irritants, which may be either parasitic or chemical in nature, in being eliminated via the kidneys, may produce sufficient irritation to induce a chronic inflammation. Certain drugs when administered for some time (turpentine) or absorbed from the skin, as in the treatment of mange (coal-tar compounds), will produce irritation resulting in chronic nephritis. It may follow some of the infectious diseases, such as dis- temper in the dog and cat. The excess of w r aste products together with the various toxins formed are eliminated in such quantity that they irritate the renal tissue. Subjection to extremes in temperature (cold or heat) dis- turbs metabolism, which increases the action of the kidneys, and the amount of albuminous decomposition may be a cause. In other cases no apparent cause can be found. Pathology. (a) In chronic parenchymatous nephritis sev- eral varieties have been recognized. The large white kidney is characterized by enlargement, the capsule very thin. When cut longitudinally the cortex is swollen and yellowish-white in color, mottled on surface with a number of opaque spots. The pyramids of the kidney are deeply congested. The small white kidney in which the connective tissue is found thickened, and a gradual reduction in the enlargement of the parenchymatous tissue. On cut surface the resistance is much greater than the other type, the cortex is much smaller and contains a number of white or whitish-yellow spots. These whitish-yellow spots represent areas of fatty degeneration. The interstitial tissue is changed, enlarged, 394 DISEASES OF THE KIDNEYS many of the glomeruli destroyed, degeneration of the epi- thelium in the convoluted tubules, and the arteries are much thickened. Microscopically the epithelium is found granular and fatty; the tubules of the cortical substances are enlarged and filled with tube casts. Hyaline changes are found in the epithelial cells. The glomeruli are found enlarged, the cap- sules are thicker than normal, and the capillaries show some hyaline changes. The interstitial tissue is increased to some extent. (6) In chronic interstitial nephritis the kidneys are small, contracted, and may be reduced to nearly one-half their normal size. The capsule of the kidney is thickened, very much adherent, and when stripped off carries with it some of the cortical substance. Small cysts are often found on the surface. On cut section the kidney is found reddish or dark red in color. The cortex is very thin. The surface of the kidney is uneven with numerous small projections. Sometimes the kidneys are lobulated, the consistency is hard, and the general texture almost semicartilaginous. The inter- stitial connective tissue is far in excess of the parenchy- matous structure. Microscopically there is noted a great increase in the connective tissue, a degeneration and atrophy of the secreting structures, both glomerular and tubal.. The increase in the fibrous elements is widely distributed throughout the kidney, although in most cases found more extensively in the cor- tical portion. The glomerular changes are found marked, numbers of them being completely degenerated into hyaline substances. The tubules show changes in the epithelium, in some instances greatly atrophied, in others the epithelium has entirely disappeared. The bloodvessels (arteries) in the advanced cases show advanced sclerosis. The changes take place in the entire vessel wall. In chronic nephritis we find in a great many cases in dogs organic changes in the heart (hypertrophy). Symptoms. This condition does not present very definite symptoms until the disease is quite well advanced. The first symptoms noted are those of a general nature, such as par- tial or complete loss of appetite, weakness, fatigue, etc. CHRONIC NEPHRITIS 395 In parenchymatous nephritis the secondary symptoms are characterized by dropsical swellings appearing on the limbs, breast, and particularly ascites. The animal shows general emaciation, pale membranes, and all the signs of general cachexia. A careful examination must be made in such cases to distinguish from circulatory disturbances. The urine should always be carefully examined. We will find in these cases the amount of urine decreased and its specific gravity increased. The urine will also be found to contain numerous casts, epithelium, fat cells, and in some cases red blood corpuscles. The pulse will be found accelerated, tense and hard; the heart beat is strong, palpitating, and in smaller breeds may shake the entire body. Marked dulness over the region of the heart is noted indicating hypertrophy. The temperature is slightly elevated until in the later stages of the disease when it will be found to be subnormal. In the very late stages symptoms of uremia appear, with rapid emaciation and exhaustion, and the animal soon succumbs. In chronic interstitial nephritis the symptoms are some- what different. The most noticeable difference is in the character and composition of the urine. The amount of urine is increased, the specific gravity very low, and the albumin content is greatly diminished. There is compensa- tory hypertrophy of the heart, and if this compensating action is sufficient, the animal may live for some time. How- ever, sooner or later there will be insufficient heart action, the pulse will become weak, feeble, and ascites and edemas appear. The animal gradually becomes weaker and finally dies from exhaustion. Diagnosis. --This is only possible in cases where a careful examination is made of the urine, together with a pains- taking general examination. We must differentiate chronic nephritis from primary circulatory disturbances. Prognosis. In both forms of chronic nephritis, the prog- nosis should be considered unfavorable, because in the majority of cases the condition is quite well advanced before a diagnosis is made. Even in apparently mild cases marked pathological changes in the kidneys are often found. 396 DISEASES OF THE KIDNEYS Treatment. Dieted. Improve the general condition of the animal by giving plenty of milk and easily digested food. Avoid highly nitrogenous foods. Medical. The first thing to be considered from a medical standpoint is to sustain and strengthen the heart action by giving small doses of fluidextract digitalis (0.1 to 0.15) daily. As a diuretic, administer diuretin (0.2 to 0.4) twice daily. Calomel is useful in dogs to keep the bowels open and assist in the elimination of waste products. In dropsical conditions (ascites) small doses of pilocarpin (dog and cat 0.003-0.01) may be administered once daily. Small doses of potassium iodid (0.06-0.2) are to be admin- istered as a resorbent once daily to dogs. Surgical. When ascites threatens the life of the animal the fluid should be removed with a trocar. (See Abdominal Puncture.) Purulent Nephritis. Kidney Abscess. Definition. An in- flammation of the kidneys resulting from infection and characterized by the formation of either numerous small purulent foci, or larger abscesses. Etiology. A very common cause of this condition is the infection reaching the renal tissue from the blood stream (hematogenous) . This mode of infection in most cases follows diseases of other organs, or pyemia, such as endo- metritis puerperalis in the bitch and cat; mammitis, pneu- monia, phlegmonous pharyngitis in the cat; purulent bron- chial catarrh, distemper, and, in puppies, infection at birth. It has been found that purulent nephritis will be produced in animals without any particular focus of infection. In cases of general reduced resistance the organisms may find their way to the renal tissue, develop and form abscesses. Traumatic causes are quite common in small animals as injuries over the region of the kidneys are frequent. These may bring about the condition by reducing the local resist- ance and the accompanying inflammation makes a favorable place for the development of organisms which are present in the blood stream. Urogenic causes are perhaps the most frequent. The PURULENT NEPHRITIS 397 infection spreads to the organ via the bladder, ureters, and pelvis of the kidney. In small animals subjection to extremes in temperature has been mentioned as an indirect factor in bringing about the condition, Pathology. We recognize two forms of purulent nephritis on postmortem: Diffuse Purulent Nephritis (Nephritis purulenta punctata, diffusa).~\n this form the kidneys are enlarged; numerous small white spots or yellowish dots are present which are sur- rounded by a reddish zone. On close examination the puru- lent masses may be easily removed. These foci of infection may be found quite generally distributed in one or both kidneys. Microscopically there is found a large number of pus cells in the foci of infection, cellular infiltration with large numbers of bacteria present in the tissue surrounding them. The epithelial cells show fatty degeneration, the glomeruli surrounded by pus, and the tubules partially filled with leukocytes, red blood cells, and casts. Nephritis Apostematosa (Renal abscess). We find in this form abscesses of varying size, which may be a single abscess formed from an embolus, or the kidney tissue break down to form a very large abscess (pyonephrosis). The connective tissue increases around the abscess forming a thick wall. Symptoms. Clinically it is quite difficult to recognize this condition. In cases which originate by metastasis we will observe the symptoms of the primary condition, such as pyemia, endometritis, etc. Should the disorder develop rapidly, there will be found practically the same symptoms as in acute diffuse nephritis. (See Acute Nephritis.) In dogs the patient becomes very stiff, refuses to move, shows pain on palpation over the region of the kidneys; in some cases a distinct enlargement on one or both sides high in the lumbar region can be determined. In examining such cases the animal should be placed in a standing position, both hands used, one on either side of the animal, and the 398 DISEASES OF THE KIDNEYS palpation performed with gentle pressure. Micturition is painful, very often only small quantities of urine being voided. As the disease progresses more pronounced general symptoms of weakness, exhaustion, and uremia will be observed. Animals often die very early from general sepsis. Diagnosis. An accurate diagnosis is very difficult. In many cases the disease is not recognized until a postmortem examination is made. The symptoms, including careful palpation coupled with examination of the urine, usually suffice for the diagnosis. Prognosis. The prognosis is bad as the disease is usually in an advanced stage before being recognized. Treatment. In cases of advanced renal abscess there is little that can be done. The operation of removing one kidney does little good as both are usually diseased. Uremia commonly follows the removal of the kidney when both are involved. Symptomatic treatment is about all that can be done. Heart stimulants, laxatives, etc., may be tried. (See Acute Nephritis.) INFLAMMATION OF THE RENAL PELVIS. Pyelitis. Definition. Inflammation of the pelvis of the kidney. Etiology. Pyelitis may result from the spread of inflamma- tion from adjacent parts or organs, such as from the kidney (pyelonephritis) or from the bladder (pyelocystitis). The presence of urinary calculi in the pelvis of the kidney mechanically irritates the membrane and leads to an inflam- mation. In the course of infectious diseases (distemper in the dog and cat; cholera in birds) this condition develops on account of the infectious or poisonous matter excreted from the body via the kidneys irritating the mucous membrane. Excretion of toxic materials (poisons of different kinds) would act in a similar manner. On account of the frequency of poisoning in small animals this is a very common cause. Parasites often cause pyelitis, especially in dogs (Dioctophyme renale). The parasites cause an intense inflam- INFLAMMATION OF THE RENAL PELVIS 399 mation of the pelvis of the kidney which may involve the entire organ. Retention of urine from either disease of the ureters or the bladder. This leads to an inflammation of the pelvis of the kidney from decomposition of the urine. Pathology. Catarrhal inflammation of the pelvis of the kidney is characterized by swelling and redness, some hem- orrhage, and later, as the condition becomes chronic, the membrane becomes thickened, lighter in color and covered with thick mucus or pus. In severe cases numerous hemor- rhagic foci will be observed, with sometimes extensive hemor- rhage, or, if the irritation has been severe, ulcers will be found (pyeloulcerosa). In cases which have resulted from obstruction to the flow of urine, we may find dilatation of the pelvis of the kidneys, with the presence of urine (hydro- nephrosis). Symptoms. This disease does not present a clear clinical picture; it can easily be confused with inflammation of the kidneys or adjacent parts. The general symptoms are a disturbed general condition of the animal, frequent micturi- tion, which is more or less painful, stiff, painful gait, loss of appetite and slight elevation of temperature. The urine shows changes which should be considered. It will be found to contain much mucus, pus, organic sediment, long-tailed epithelial cells, having pointed projections on the ends, which come from the membrane of the renal pelvis. The urine should be examined for parasite eggs; this will often assist in locating the seat of the inflammation. Small granules are found when calculi are present. Careful palpation as in chronic nephritis may assist in locating the inflammation. Diagnosis. The microscopic examination of the urine is the best means of making an accurate diagnosis. The pres- ence of the peculiar, molar-shaped epithelial cells may be considered significant. Pyelitis must be differentiated from inflammation of the mucous membrane of the bladder or ureters. The presence of parasite eggs (Dfoctophyme renale) in the urine will be indicative of involvement of the renal pelvis. Prognosis. The prognosis depends to some extent upon the causative factor. In most cases it is not very favorable. 400 DISEASES, OF THE KIDNEYS Treatment. Dietetic. Milk should be the principal food. No irritating materials should be given. Medical. Diluents in the form of water or milk should be administered frequently (2 or 3 times daily) to assist in increasing the volume of fluids eliminated via kidneys to remove accumulated products. Disinfectants in the form of sodium salicylate (dog, 0.1- 2.0; cat, 0.05-0.1) should be given twice daily. Urotropin (0.5-1.0) three times daily with plenty of water or milk is useful. UREMIA. Definition. A toxemia developing during the course of certain diseases, such as nephritis or in conditions associated with retention of the urine. The nature of the poisons retained in the body is not definitely known. They may be normal urine compounds, or the result of abnormal metabolism. Etiology. Uremia is produced by the retention in the body of waste materials which should be eliminated by the kidneys. In the development of certain diseases, such as acute and chronic nephritis, or obstruction to some part of the urinary passages, the urine is not properly excreted but is retained in the blood. If due to stoppage of the outflow, the back pressure produced inhibits further secretion, hence the products of metabolism accumulate in the body. A cause is rupture of some of the urinary organs (kidneys, ureter or bladder) which is of frequent occurrence in the dog from injuries. The urine will flow out into the adjacent tissues, or peritoneal cavity, to be absorbed by the circula- tion, producing in the course of a few hours marked symptoms of acute poisoning. Symptoms. Clinically we recognize two forms: (a) Acute uremia, and (6) chronic uremia. Acute Uremia. In the dog the symptoms usually begin with chills, trembling of the muscles, staggering gait, followed in a short time by stupor, the animal finally lapsing into complete unconsciousness. Frequently there will be noted UREMIA 401 during the development of uremia certain nervous symptoms, such as contractions of groups of muscles (clonic spasms, epileptiform convulsions) followed by unconsciousness. Yelping or howling is often a prominent symptom during the nervous attacks. The respirations are slow, often difficult; edema of the lungs usually exists. The temperature is at first elevated, but later becomes subnormal, sometimes as low as 96 F. Vomiting in the dog and cat is a frequent symptom as is diarrhea. The discharges from the stomach and bowels usually have a uriniferous odor. Chronic Uremia. Chronic uremia develops from chronic diseases of the urinary organs, particularly chronic nephritis, and from long standing cases of partial urine retention due to some obstruction in the urinary tract. The most prominent symptoms of chronic uremia are: Digestive disturbances, such as gastro-intestinal catarrh, diarrhea, vomiting, etc., without any apparent cause; dis- turbances in the nervous system as dulness, and at times epi- leptiform convulsions, which are usually mild and recurrent. Diagnosis. This is made by careful examination of the patient, observation of the symptoms, and examination of the urinary organs. Prognosis. The prognosis depends upon the primary con- dition producing the uremia. In acute uremia it is unfavor- able, most cases terminating fatally. Chronic uremia is not so immediately fatal. The long course of the disease, which suffers exacerbations and remis- sions, eventually, however, terminates in death. Treatment. Medical. Medical treatment consists in the administration of laxatives to assist the elimination of urea compounds via the bowels. Diuretics are used except in those cases where there is some impediment to the outflow of urine. In chronic cases, after the uremic symptoms begin to dis- appear, tonics and alteratives are indicated. Surgical. Where an obstruction exists in some portion of the urinary tract, which interferes with the outflow of 26 402 DISEASES OF THE KIDNEYS urine an operation may be indicated. Rupture of the bladder or ureters should receive immediate attention and the torn or injured part sutured. CALCULI IN THE KIDNEY. Nephrolithiasis. Definition. The presence of urinary stones in the pelvis of the kidney. Etiology. Calculi in the renal pelvis are not frequent in small animals. They are far more common in the bladder. The principal condition for the formation of urolithic deposits is that the urine contains excess of salts, or that insoluble -or slightly soluble salts are formed in it. In the elimination of these salts they become gradually deposited around some foreign material. The center or nucleus of a calculus is usually an epithelial cell, bit of mucus, pus, a blood cell, cast, etc. In some cases the food which is rich in salts of various kinds will hasten the formation of calculi. In certain dis- tricts where the water is rich in mineral substances calculi are more common, no doubt due to the excess salts taken in and eliminated. Inflammatory diseases of the urinary passages, or in retention of urine from any cause, will often lead to the formation of urinary calculi by changing the character of the urine and the salts contained therein. Pathology. Stones in the pelvis of the kidney, if small, may not produce much change in the mucosa, except slight abrasion and irritation. When larger they may fill up the entire calices or the whole renal pelvis, and can lead to marked pathological changes such as extensive inflammation, hemor- rhage, and sometimes marked distention of the pelvis. In small animals the calculi usually consist of ammoniacal magnesium phosphate, small quantities of calcium phosphate or carbonate, some uric acid and its salts. Cystic calculi are also occasionally seen. They are small, soft, and have a shiny surface. Symptoms. The clinical picture of kidney stones is very similar to that of pyelitis, except the pain is usually more CALCULI IN THE KIDNEY 403 severe. The condition may be entirely overlooked during the life of the patient. The most pronounced symptoms are sudden attacks of colic, which come on after running, jump- ing, or falling, which dislodge the stone and occlude the ureter. The colicky symptoms are howling, whining and crying, which continue until the stone either passes into the bladder or back into the pelvis of the kidney. A prolonga- tion of the retention of urine may result in uremic symptoms. Periodic recurrence of the colicky pains is somewhat charac- teristic of this condition. The urine when examined micro- scopically will be found to contain pus cells, epithelial cells, and often very small fragments of stones. Blood cells are also common as small hemorrhages frequently take place. In the dog a direct examination can be made by performing a laparotomy which permits of the kidney being seen and felt. If calculi are present, they will be easily recognized by their hardness and shape. Diagnosis. The general symptoms are not sufficient for an accurate diagnosis. It should be differentiated from other diseases of the kidney. The urine should be carefully exam- ined. In doubtful cases a laparotomy may be performed. Prognosis. The prognosis depends on the size and number of stones present and whether or not the condition is uni- or bilateral. When the stones are small and the condition con- fined to one kidney, the prognosis is much more favorable. Owing to the difficulties encountered in removing the stones the prognosis is usually unfavorable. Treatment. Dietetic. Food should be given that contains but a small quantity of salts. Plenty of water should be allowed but the same precaution must be observed in regard to the salt content. Medical. The various compounds used to dissolve calculi have not proved very satisfactory. Large quantities of carbonated water may be tried; it has proved of value in some cases. Surgical. Surgical treatment has proved of practical importance in the dog, and has been successfully accom- plished in a number of cases. If, after an explorative lapa- rotomy of the kidney, it is found normal, showing no evidence 404 DISEASES OF THE KIDNEYS of hydronephrosis, nephrolithotomy should be performed. There are two methods used in this operation, as follows: (a) A longitudinal incision is made at the convex border of the kidney, at which point the vascularity is at a minimum, into the pelvis. In case hemorrhage is severe, clamping the renal artery will control it. By compressing the kidney longitudinally the incision will be held open and with a blunt curette the stones are removed. Care should be taken to be sure that the renal pelvis is freed of all the calculi, and a blunt probe of small caliber inserted into the ureter to be certain of a free passage into the bladder. Normal salt solution, which has been previously sterilized, is used to cleanse the cut surface. The wound is then stitched with sterile silk, using two or three interrupted sutures. Care must be taken not to use too much force in drawing the wound together as the resulting swelling will tear out the sutures. Return the organ to its proper position. Healing should take place per primam. (6) The other method is to open the pelvis of the kidney direct. Make an incision at one side of the pelvis, in about its middle portion, of sufficient size to remove the calculi. After all the stones have been removed and all the fluids absorbed by sterile gauze, the wound is stitched carefully, using plenty of sutures so that the edges of the wound will be thoroughly approximated. This must be done carefully to avoid fistula following the operation. If, however, the kidney is found diseased (hydronephrosis) nephrectomy should be performed, as follows: Laparotomy is performed. The kidney is then freed of its covering, gently pulled toward the wound, and doubly ligated at its pedicle, so as to prevent serious hemorrhage. Care should be taken to get the ligature securely in place to prevent its slipping off after the abdom- inal wound is closed. Double ligation is safest, ligating the vein and artery separately. After-treatment consists in the administration of general stimulants, and restricting the diet for four or five days to milk, or milk and eggs. DROPSY OF THE KIDNEY 405 DROPSY OF THE KIDNEY. Hydronephrosis. Cystic Kidney. Definition. A chronic condition in which urine collects in the pelvis of the kidney or the kidney proper, leading to functional disturbances of the organ. Etiology. (a) Mechanically by some impediment to the flow of urine from one or both kidneys. The urine is dammed up in the pelvis of the kidney with a gradually increasing pressure. As the pressure of the urine increases, the loss in the secreting power of the organ is more manifest, and event- ually if the pressure is constant or increased, the function of the organ may be entirely lost. The parts of the urinary passages affected by the impediment gradually dilate ' and the renal tissue atrophies, so that the condition anatomically stops as no more urine is secreted. (6) A number of conditions which cause partial stoppage of the flow of urine will cause cystic kidney. The most frequent are: Catarrhal inflammation of the ureters, bladder, or prostate glands; the presence of calculi in some portion of the tract which interferes with the passage of urine. (c) Sometimes the condition is congenital; there is either no opening through the ureter, or it is otherwise' anatomi- cally deficient. This allows the urine first formed to accu- mulate until the backward pressure is sufficient to stop renal secretion. (d) Compression of the urethra and neck of the bladder by adjacent new growths. The new growths interfere with the flow of urine and cause it to accumulate in the pelvis of the kidney. (e) Paralysis of the urinary bladder which allows the urine to collect and lead to back pressure. (/) In chronic inflammation of the kidneys some of the urinary tubules become constricted at certain points by the contraction of the interstitial tissue, which undergoes atrophy, causing the canals which are attached to the Malpighian bodies to become dilated. If the urine continues to be secreted it accumulates and forms small retention cysts. These cysts may be found singly or in large numbers in the 406 DISEASES OF THE KIDNEYS kidneys. This type of the condition is not found as often as the other form. Pathology. We find varying degrees of cystic kidney. In the earlier cases will be noted only a dilation of the calices and pelvis of the kidney with mild pathological changes in the lining membrane. In the more advanced cases will be noted distention of the pelvis of the kidney with compression of the renal tissue so that the atrophy is well marked. In some cases the renal tissue will be practically destroyed, and the kidney will be represented by a soft undulating mass. In dogs the kidneys may be so enlarged that distention of the abdominal wall appears. Symptoms. Frequently on autopsy cystic kidney involv- ing one of the kidneys, will be found which has not been noticed during the life of the animal, the other kidney having performed the function of both. When both kidneys are involved, howe\er, a change in the quantity of urine will be noticeable. On careful examination of the patient (dog) very frequently one of the kidneys, or in rare cases both of them, will be found much enlarged and can be easily palpated through the abdominal wall; cases appearing where the abdominal enlargement is noticeable by observing the stand- ing patient from the rear and carefully comparing both sides. General symptoms of weakness, stiffness, etc., are shown in the more advanced cases. Generally, however, cystic kidney does not produce characteristic symptoms during life. Diagnosis. This is made by careful examination of the patient, observing the flow of urine, and finally where neces- sary an explorative laparotomy. Prognosis. Favorable when unilateral as it may not affect the general health of the patient; unfavorable when bilateral. Treatment. The early indication in the treatment is to relieve the impediment to the flow of urine. The ureters, bladder, and urethra should be examined and if diseased proper treatment should be given. If the outflow of urine can be reestablished, the disorder will be relieved. If this is impossible, nephrectomy should be performed if the con- dition is unilateral. (For Nephrectomy, see Renal Calculi.) No other treatment has been found of value. ANIMAL PARASITES IN THE KIDNEY 407 AMYLOID KIDNEY. This condition is of no practical importance except to the student in pathology. It is not common in the small animals and the symptoms are very obscure. TUMORS IN THE KIDNEY. In small animals the kidneys are not commonly affected by primary tumor formations. There will be found: Sar- comata, carcinomata, and adenomata, occasionally resulting as secondary growths from some other organ or tissues. Tuberculosis of the kidney has been noted in a few cases in the dog. It may be either metastatic or urogenic in origin. It is not usually possible to recognize tumors during life. They sometimes produce disturbance in kidney function and may become metastatic. Treatment. Treatment must be symptomatic. ANIMAL PARASITES IN THE KIDNEY. Dioctophyme renale (Eustrongylus GV as a rule, is congenital, and is found in the dog and cat. It is diagnosed readily. A sufficient time should be allowed (ten to eighteen days) for the normal adhesions to disappear. Very often there will be found a small line or groove at the point where the opening should be. Treatment. A small opening is made through the lid at the outer canthus, a grooved director inserted and the incision carried clear across to the inner canthus. The after-treatment consists in washing the eyes with a boric acid solution (2 per cent), and applying vaseline to the lid margins to prevent further adhesions. In blepharophimosis there is a narrowing of the palpebral fissure which makes the eye appear much smaller than normal. It is often associated with trichiasis or entropion. To correct it the palpebral opening should be enlarged at the external canthus, and the skin sutured back both on the upper and lower lids to prevent adhesions. This operation will also correct trichiasis or entropion if either should be present. Keep the wound clean and apply a mild ointment to the recently incised margins. Symblepharon. This is an adhesion of the eyelids to the eyeball, and has been observed in dogs and cats. The majority of cases are congenital. Occasionally an acquired symblepharon is found due to adhesions following destruction of the conjunctiva! membrane during the course of distemper. An examination of the eye will at once reveal the condition. The lids cannot be everted and are found adherent to the eyeball. Treatment. Separation of the lid from the eyeball is pos- sible. The animal should be anesthetized. The lids are carefully separated so that the eyeball is left intact. The operation can be done satisfactorily with a fine pair of 506 DISEASES OF THE EYELIDS scissors or a very small scalpel. After the operation is com- pleted all hemorrhage must be controlled and an antiseptic ointment applied under the lids. Yellow oxid of mercury ointment has proved satisfactory for this purpose. It should be applied daily. LAGOPHTHALMUS. Definition. An incomplete closure of the eyelids in which a portion of the cornea is left exposed. When the cornea or conjunctiva is left continuously exposed to the air without the normal secretions covering them, they become irritated, inflamed and serious alterations take place. The membranes are thickened, the cornea opaque and dry, and may even become perforated. The tears follow the angle of the eyelids and flow down over the face. The condition is brought about in most cases by ectropion, exophthalmos, enlargement of the eyeball, and some few cases by paralysis of the orbicularis nerve. Wounds of the lids with extensive loss of substance may also produce it. Treatment. The first indication is to remove the cause, if possible. If this cannot be done the only thing left is- to protect the conjunctiva and cornea from dessication and eventual destruction. Oily solutions are best for this purpose. Instill them into the eye once or twice daily. TUMORS OF THE EYELIDS. Several varieties of tumors are found on the eyelids of small animals. Papillomata. Warts. These are not uncommon in dogs and birds. The wart-like excrescences found in birds, par- ticularly parrots, are usually tubercular, and are often asso- ciated with degenerations and abscess formation. In old dogs and cats, horn-like growths are found as outgrowths from the walls of Meibomian cysts. Small warts are also seen developing along the margin of the lid, or on the skin over the eyelid. During the course of epitheliosis of birds small horn-like growths appear on the lids. Treatment. Small warts appearing on the margin of the lids, or skin, are removed with the scissors. Cauterize the TUMORS OF THE EYELIDS 507 base of them with silver nitrate, and follow at once with salt solution to prevent undue caustic action and injury to the eye. Tubercular nodules and warts in parrots should be incised and removed as completely as possible. Conserve as much of the eyelid as possible. In epitheliosis the warts should be removed with the knife or curette and iodin applied. Warts projecting out from the Meibomian glands are opened and curetted with a small instrument. The base of the warts should be carefully cauterized. Chalazion. Meibomian Cyst. These are small cystic growths, appearing on the free margin of the lid, or on the skin, standing out prominently. They are sebaceous cysts having no inflammatory reaction and filled, as a rule, with a thick honey-like material. A true chalazion is a retention of the secretions of the Meibomian glands. They are fre- quently observed in dogs, more commonly in mature animals. They form a firm, circumscribed swelling, gradually enlarg- ing until they reach the size of a pea or walnut. A differentia- tion is difficult to make as they resemble sebaceous cysts. Their development often leads to a horny-like excrescence on the surface, and often take on the character of a malignant growth. They may involve the free margin of the lid, or extend to the entire structure of the upper eyelid. Treatment. Small sebaceous cysts are opened and the contents squeezed out. The opening is made large enough in order that the gland can be destroyed with iodin or silver nitrate. In true chalazion it is advisable to remove a small trian- gular portion of the lid, including the cyst, with the base of the triangle on the margin of the lid. This is best done, under morphin anesthesia, with the scissors. Approximate the wound thus made with fine silk or linen. Union is usually complete in ten days to two weeks. Curetting the enlarge- ment may be tried in cases where the operation is not possible. Pilosebaceous Cysts. These are found on the upper eye- lid in dogs, especially bulldogs and pugs with wrinkled skin. The contents of the cysts are hair, sebum, and pus, which is usually discharged through a fistulous opening. 508 DISEASES OF THE EYELIDS Treatment. The cyst should be opened, curetted, and the cyst wall destroyed with tincture of iodin. Lipoma and Sebaceous Tumors in Birds. These are fre- quently observed in the different species of birds. The tumors are well defined, of a firm consistency, and vary in size from a pea to a walnut. On opening the tumor fatty tissue may be seen, or which is more common, a yellowish, cheesy, tough material enclosed in a distinct capsule is present. They are situated immediately under the skin. From their nature they are either lipomas or sebaceous cysts. Various conditions are found. Sometimes the cysts will rupture, discharging the material, while in other cases horny growths will partially replace the cyst. Very often a number of birds in a flock will be affected. Treatment. Incise the tumor, remove all the contents and apply tincture of iodin to its base. Free hemorrhage may occur after incision, which can be controlled by cauterizing with silver nitrate. Enlargement of the Glands of Moll. These small glands are situated along the free margin of the eyelid, their ducts emptying into the glands of the hair follicles. They are enlarged commonly in older animals. The cysts are clear, transparent, and varying in size from a wheat grain and smaller. Treatment. The contents of the cysts are discharged. This is best done by crushing the small cyst with an artery forceps. Iodin is then applied to destroy the gland and cyst wall. Granulomas. Resulting from wounds, granulomatous tissue is often found developing on the free margin of the lids, or on the surface. This is easily determined by its general appearance. If there should be doubt a definite diagnosis may be made with the microscope. Treatment. Complete extirpation is indicated. Cauterize the base of the tumefaction with silver nitrate, or actual cautery. Malignant Neoplasms. Several varieties of malignant tumors have been found involving the eyelids of small animals. TUMORS OF THE EYELIDS 509 Epitheliomata, sarcomata, carcinomata, and tuberculomata are the ones most often observed. Diagnosis. A diagnosis is made partly on the character of the growth and finally by microscopic examination. Treatment. Complete excision of the tumor should be attempted as early as possible. When the entire eyelid is involved treatment is of very little value. A recurrence of the tumors is liable to occur after operation. In removing the tumor as much as possible of the eyelid should be saved. CHAPTER II. DISEASES OF THE CONJUNCTIVA. Examination. Examination is simple in the dog, cat and bird. The animal should be held either by an assistant or restrained so as to facilitate the examination. Ordinary daylight or artificial light may be used. The lower lid can be pulled downward by placing the thumb on or near the palpebral margin, and the upper lid pushed upward with the index finger of the same hand in a similar position. This manipulation will expose nearly all of the membrane. The examination is made for inflammations, foreign bodies, cysts, tumors, and wounds of various kinds. Vicious animals should be restrained by taping the mouth or by general anesthesia. CONJUNCTIVITIS. Definition. Inflammation of the conjunctiva. In small animals various types of inflammation are of frequent occur- rence. These animals are subjected to injuries which often involve the conjunctival membrane, and infectious diseases (distemper in dog and cat, epitheliosis in bird) which produce various . forms of inflammation. The xerosis bacillus, Staphylococcus albus and S. aureus, strepto- coccus, diphtheria bacillus and others are more or less present in the eye leading in many cases to local infection and inflammation. It is noted further that the conjunctival membrane is very vascular, rich in lymph cells, and sensitive to outside influences, all of which tend to favor the development of inflammatory conditions. The following forms of conjunctivitis are recognized: (a) Catarrhal, (b) purulent, (c) parenchymatous, (d) croupous, (e) follicular, and (/) exanthematous. CONJUNCTIVITIS 511 Catarrhal Conjunctivitis. A form of inflammation of very frequent occurrence in all small animals. It is characterized by congestion, swelling, and a discharge which may be serous, mucous, or mucopurulent. Etiology. Catarrhal conjunctivitis is often associated with or secondary to other diseases, such as eczema, distemper, epitheliosis, nasal catarrh, bronchitis and some constitutional diseases. Mechanical conjunctivitis often occurs in small animals from injuries of various kinds, foreign bodies, dirt or dust getting into contact with the membranes. Cold winds some- times produce it in hunting dogs. Irritating collyria instilled too often may produce it. Seri- ous disturbances are frequently observed from too strong solutions. Infection no doubt plays an important role in producing catarrhal conjunctivitis. The ordinary infection is con- stantly present and develops when the local resistance is reduced. Symptoms. There is a distinct change in the color of the membrane and a mucous or mucopurulent discharge. The congestion of the membrane produces a pink or reddish coloration which may be accompanied by a slight yellow tinge due to interstitial infiltration. The secretion, at first serous, soon, changes to mucous or mucopurulent and collects around the palpebral margin. The edges of the lids are found edematous. Some photophobia is present. The animal will show more or less constant movement of the lids, and holds the lids par- tially or completely closed. A careful examination reveals the true nature of the condition. Prognosis.- As a rule favorable except when secondary to infectious diseases. The inflammation usually subsides in a week or ten days. Treatment. A careful examination should be made to determine whether any foreign substances are present which must be carefully removed. Wash the membranes thoroughly with boric acid (2 per cent.). This can be repeated two or three times daily during 512 DISEASES OF THE CONJUNCTIVA the first few days. Follow each application of boric acid with an instillation of one of the following solutions: Zinc sulphate (1-1| per cent.) ; tannic acid (1-2 per cent.) ; chinosol (1-500); protargol (2-4 per cent.); or if the condition is persistent solution of silver nitrate (0.5 per cent.). The animal should be isolated and the premises disinfected to avoid spreading the disease. Purulent Conjunctivitis . Blennorrhea. Acute Form. Definition. A purulent secretion present in one or both eyes. In this condition the discharge is more copious and the inflammation more intense than in catarrhal conjunctivitis. Purulent conjunctivitis results very frequently from or accompanies distemper of dogs and cats, and epitheliosis in fowls. It often occurs as an epizootic or enzootic in kittens and puppies. Both the acute and chronic forms of the disease are frequently met with in practice. Etiology. The majority of cases can be determined quite definite!}- to be due to infection accompanying or following infectious diseases. It is very common in dog distemper, cat distemper, and epitheliosis in birds. Various kinds of organisms have been isolated from the discharge but none of them has been proved to be the specific cause. The fact that large numbers of puppies, kittens or fowls are affected, when closely associated, indicates the communicable character of the disease. It is possible to have this form of conjunctivitis follow the catarrhal, owing to the reduced resistance of the membrane which allows secondary infection to develop. It is, however, possible that many cases are produced in fowls and in some of the other animals by a parasite. Several species of parasites have been isolated from the conjunctival sac of birds. Newly born animals contract the disease from the vaginal infection of the mother at the time of parturition. Symptoms. The conjunctival membrane is of an intense red color and more or less uniform over its entire surface. The degree of redness depends upon the severity of the infection and the stage of development. In many cases the mucous membrane is prominent from the edematous swelling resulting from the irritation, thus giving it a "pouching out" CONJUNCTIVITIS 513 appearance. The amount of pus present is more or less characteristic. The eye is often entirely filled with a thick, whitish, glutinous pus, which becomes dried around the palpebral borders and forms crusts frequently agglutinating the eyelids. On account of the spread of the infection to the cornea, this organ becomes cloudy or even ulcerated. Owing to the irritant action of the pus the animal will show con- siderable pain, scratch and rub the eyes either with the paws or against objects. The membrana nictitans is red and protrudes over a portion of the eyeball. Most cases show considerable photophobia. General. General symptoms are noted in many cases in the form of dulness, loss of appetite and general weakness. There may be sufficient infection to produce general intoxica- tion and death in birds. In these cases, however, it is quite likely that the infection is found in other parts of the body. Prognosis. The prognosis is not always favorable. Due to complications, which may involve the eyeball, partial or total blindness can result. While many cases terminate in complete resolution, others produce ulcerations and perfora- tions of the cornea. When the latter occurs panophthalmitis is the result. In some animals, particularly birds, this would seriously interfere with the obtaining of food. When para- sites are the cause of the condition other complications follow, such as infestation of the nasal passages and sinuses, and in some cases invasion of the air sacs. Treatment. Thorough disinfection of the premises, houses, etc., should be practised in order to prevent the spread of the infection. This can be accomplished either by the use of liquor cresolis compositus (3 per cent.) with which all places and articles in contact with the animals are thoroughly saturated, or the animals are removed from the house or kennel which is then disinfected with formaldehyd fumes. The general condition of the patient must be considered and its strength maintained by good, nourishing food and such tonics as tincture of gentian, or tincture of mix vomica (0.2-0.4 twice daily). A solution of iron sulphate (2 per cent.) in the drinking water has proved of value as a tonic for birds. 33 514 DISEASES OF THE CONJUNCTIVA Local treatment is applied at least twice daily in order to remove the irritating material from the conjunctival sac, and also to destroy infection. Many preparations have been recommended and used for this purpose: Boric acid (2 per cent.); creolin (2 per cent.); chinosol (1-500); protargol (2-3 per cent.) ; or in severe cases silver nitrate (0.5 per cent.). This treatment must be continued for one to two weeks to obtain the best results. Chronic Form. This form of the disease has been observed very frequently in dogs and cats following infectious and contagious diseases. To recognize it as being separate from the acute form is necessary on account of its persistent and long course. It is very common in old animals and those kept under bad hygienic conditions. Many cases of eczema and mange are associated with chronic purulent conjuncti- vitis. It may follow the acute form. Symptoms. The condition of the conjunctiva and the presence of pus with agglutination of the palpebral margins present the appearance in general of the acute form. On examination the conjunctiva is found to be dull red in color, slightly edematous and the cornea frequently has numerous small bloodvessels over its surface. The general condition of the patient is usually bad. Prognosis. Owing to the chronic nature of the disease and its persistency the prognosis is not favorable. The disease may last for months or even the entire life of the animal. Treatment. One of the first essentials in the treatment of this disease is to secure good sanitary conditions, giv- ing plenty of nourishing food and do everything possible to increase the strength of the patient. The various anti- septic solutions recommended for the acute form may also be tried. Good results have followed in some chronic cases by pre- paring an autogenic vaccine and administering 1 to 2 c.c. subcutaneously every three to five days. This in con- junction with the above treatment has proved to be of considerable value. Parenchymatous Conjunctivitis. Erysipelatons Conjuncti- vitis. Definition. An inflammation of the deeper layers of CONJUNCTIVITIS 515 the conjunctiva and its submucous tissue. It occurs in all small animals, most frequently in birds. Etiology. There are many factors producing parenchy- matous conjunctivitis. Many of them are the same as those causing the catarrhal form. Injuries to the mucous mem- branes and underlying structures can produce it. Chronic agents in the form of irritants, such as irritating collyria, when used too often or in too large quantities; thermic agents in the form of hot water or hot antiseptic solutions. The disease is observed in hunting dogs from exposure, or to foreign bodies getting into the eyes while going through briers and brush. Infection plays an important role in the production of this form of conjunctivitis. The infection is often introduced directly into the conjunctiva! sac where it enters small wounds and produces intense inflammation of the parenchyma. Numerous organisms have been isolated in these cases. It is evident that no one specific organism produces it. The disease may also develop secondarily (hematogenously) to some of the infectious diseases. It is a common sequel to dog distemper or epitheliosis of fowls. Symptoms. -The early indications of the disease are swelling and puffiness of the mucous membrane. This is so marked in many cases that the swollen conjunctiva pouches outward over the palpebral borders or the cornea. During this stage the conjunctiva is intensely congested and reddened. There is considerable lacrimation and photo- phobia during the entire period of the disease. In the second stage there is a purulent discharge from the eye, which may be very copious. The general condition of the patient is usually not disturbed unless complications develop, or from the attending infectious diseases. Prognosis. The prognosis in most primary cases is favor- able. In the acute form it subsides in a week or ten days. When secondary to infectious diseases, the prognosis is not so favorable. In such instances it may develop into a chronic purulent conjunctivitis. Treatment. - -Prompt treatment is important in preventing the spread of the inflammation. Antiseptic and astringent solutions should be employed: Boric acid (2 per cent.); 516 DISEASES OF THE CONJUNCTIVA lead water (2 per cent.); potassium permanganate ( per cent.); tincture opium (1 per cent.). If the patient shows considerable pain and irritation with marked congestion of the membrane, codrenin solution (2 per cent.), or a few drops of stovain solution (2 per cent.) are recommended. When intense pain is present and the conjunctiva is a dull, red color indicating a subacute inflammation, silver nitrate (0.5 per cent.) is of value. Croupous Conjunctivitis. Definition. An inflammation of the conjunctiva characterized by the formation of a pseudo- membrane which covers its surface. Croupous conjunctivitis is observed more commonly in the dog and cat. In birds it accompanies epitheliosis, when the eyes are involved. Etiology. The majority of cases occurring in the dog and cat are produced either by chemical irritation or as a result of specific infection following or accompanying infectious diseases. In birds, owing to the prevalency of epitheliosis, large numbers in an individual flock may be affected at the same time. Symptoms. The conjunctiva is covered with a fibrinous exudate which frequently extends over the cornea. The corneal surface may be entirely covered. In birds a very heavy, thick, fibrinous membrane completely covers the entire anterior surface of the eye. Due to exudate and secretions collecting under the pseudomembrane, it is forced outwardly protruding between the lids. If the membrane is removed, the eye will be found normal in position and color. There are no general symptoms except as produced by some infectious diseases which the conjunctivitis attends. Prognosis. Favorable in primary cases. When secondary the prognosis depends upon the primary disease it accom- panies. Treatment. The animal's general condition should be observed and any necessary treatment applied. The eye may be flushed out with a warm boric acid solution and the croupous membrane removed with a pledget of cotton or a pincette. After the membrane is removed, apply antiseptic or astringent collyria. It will probably be necessary to re- move fragments of membrane as they later develop. CONJUNCTIVITIS 517 Follicular Conjunctivitis. Definition. An inflammation of the conjunctiva characterized by the formation of small, granular elevations over its surface. These granulations are due to swelling of the lymph follicles and to connective tissue proliferation, the result of inflammation. The granu- lations often attain the size of a grain of millet or larger. Follicular conjunctivitis occurs usually on the inner surfa' of the membrana nictitans. In a large number of dog^ examined, nearly one-half were found to be affected with , this disease. House dogs seem more susceptible than others. Etiology. The cause is unknown. Many etiological factors have been accused, such as dirt, dust and other irritants which enter the eye. Undoubtedly many cases result from distemper. Symptoms. As such a large number of dogs are affected with enlarged lymph follicles on the membrana nictitans one is led to conclude that their presence may not be abnormal. However, in many cases the granules appear also over the entire conjunctiva leading often to ectropion, an outward rolling of the eyelids. On examination the mucous mem- brane will be found to be of a dull red color and irregular on the surface. Small, white granules at their apices stand out quite prominently over the membrane. The membrana nictitans, when elevated with the forceps, will disclose small elevations on its under surface. In case of long standing the palpebral margins become red and the small glands prominent. There is some lacrimation and frequently a discharge of pus from the inner canthus. During the later stage small ulcers appear on the apices of the granulations, which, by confluence, form large, ulcerated surfaces. The eyes, kept partly closed and rubbed with the paw r s, show evidence of irritation and pain. Prognosis. The prognosis is not very favorable because the disease is usually well developed before the animal shows any marked symptoms. Owing to the chronic character of the disease the course is protracted requiring long continued treatment. Treatment. A thorough examination should be made of the entire conjunctiva in order to determine the extent of 518 DISEASES OF THE CONJUNCTIVA the disease. The ordinary collyria, such as zinc sulphate (1 per cent.) ; silver nitrate (0.5 per cent.), or chinosol (1-500), should be used for a few days to remove all of the surface infection and astringe the membrane. Following this treat- ment the affected parts of the conjunctiva are cauterized with silver nitrate. Apply immediately a solution of sodium cl^orid to prevent injury to the cornea. This operation c ' ly be repeated in a few days, if necessary. In the mean- \e the astringent and antiseptic solutions are to be con- aed. It is advisable to remove the membrana nictitans when it nows the pronounced follicular granulations. This is best ,ione in the following manner: The animal may be given a general anesthetic, or anesthetize the membrane locally by instilling 0.8-1.5 of codrenin solution in the affected eye. If the latter is used the operation should be delayed for ten or fifteen minutes for complete anesthesia. The animal is placed on the operating table, held by an assistant, the membrana nictitans grasped with a small forceps and pulled outwardly toward the inner canthus of the eye. It is then cut off carefully with a curved scissors. Care must be taken to prevent removal of any of the other conjunctival mem- brane, as this would lead to scar formation and result in entropion. Serious hemorrhage may occur in individual cases. If the hemorrhage is copious a gauze pack should be placed over the eye and held in place by a head bandage. This may be removed in twenty-four hours and the ordinary antiseptic solutions used. Recovery from the operation requires ten days to two weeks. Exanthematous Conjunctivitis. Definition. An exanthe- inatous eruption occurring during the course of certain diseases. In small animals this form of conjunctivitis is not very common, but has been observed accompanying or following distemper in the dog and cat. Parasitic skin diseases and eczemas often extend to the conjunctiva from the skin around the palpebral margins. This frequently results in suppurative inflammation of the glands along the margin of the lids, and in the membrana nictitans. Many cases of favus in fowls extend to the conjunctiva. TRAUMATIC LESIONS OF THE CONJUNCTIVA 519 Treatment. The treatment of exanthematous conjuncti- vitis is very similar to that of the catarrhal form and its varieties. The original disease must be treated, and anti- septic and astringent solutions applied to the affected con- junctiva. When there is severe lacrimation, calomel has proved to be of considerable value. PTERYGIUM. Definition. A triangular fold of the conjunctiva and sub- conjunctival tissue extending over a part of the cornea. It is derived from the bulbar conjunctiva and narrows to a point as it extends over the corneal membrane. Symptoms. Pterygium develops gradually and does not produce any marked irritation except a slight catarrhal inflammation. When it extends over on the cornea it may affect vision. Diagnosis. The diagnosis is not difficult. The triangular growth, attached more or less firmly to the cornea, rich in bloodvessels, which gives it a pink or reddish cast, charac- terizes it. Prognosis. Pterygium is not very serious and can usually be operated successfully. Treatment. It is advisable to treat the mucous membrane for a few days previous to the operation with antiseptic and astringent solutions. A local anesthetic should be adminis- tered, or if the animal is nervous, general anesthesia would be preferable. Dissect off the triangular fold of membrane from the cornea and remove it as near the base as possible with the scissors. It is further recommended that the base of the growth be dissected out completely and the wound sutured. The after-treatment consists in the use of antiseptic arid astringent solutions. Recovery is usually prompt, and, if the operation has been thorough, the growth does not return. TRAUMATIC LESIONS OF THE CONJUNCTIVA. Foreign Bodies in the Conjunctiva. Various kinds of sub- stances are found in the conjunctival sac of small animals. 520 DISEASES OF THE CONJUNCTIVA Dirt, straws, briars, wheat seeds, splinters of wood, etc., have been observed quite commonly. This is particularly true in hunting dogs, and animals that are kept in dusty and unsanitary kennels. In birds, parasites have been found in a number of cases (spiroptera) . These substances are fre- quently found underneath the membrana nictitans. Symptoms. All foreign bodies cause more or less intense reactive symptoms, such as lacrimation, photophobia, serous or mucopurulent discharge, swelling of the eyelids, opaque- ness of the cornea, etc. The severity of the symptoms will depend somewhat upon the character of the foreign body and the degree of irritation. The patient usually shows con- siderable pain, rubs the eyes against objects or with the paws, and thus intensifies the symptoms. A sudden development of the symptoms cited should lead one to suspect a- foreign body in the eye. Treatment. Flush out the conjunctival sac with warm water or boric acid solution (2 per cent.). Raise the mem- brana nictitans and evert the lids so that a close inspection of the entire conjunctival sac can be made. In the majority of cases the foreign body is visible. A reading glass will facilitate finding small foreign bodies. After the foreign body is located it is advisable to remove it either by flushing the surface with a boric acid solution (2 per cent.) or by grasping it with a small forceps, or wiping it out with a pledget of cotton. Considerable care should be exercised to see that all of the foreign material is removed. After removal flush the mucous membrane two or three times daily with boric acid solution (2 per cent.). Wounds on the Conjunctiva. Very often the conjunctiva is injured by sticks, pieces of straw, briers, etc. In the majority of cases the injury is slight and of little significance. In a few cases, where the lesion is extensive, there will be symptoms similar to those caused by foreign bodies in the conjunctival sac. A differentiation is made only by a careful examination. Treatment. The lids should be everted and the part thoroughly examined to determine the extent of the injury. ULCE RATION OF THE CONJUNCTIVA f>21 If any shreds of membrane are present, they should be removed with the scissors. Antiseptic and astringent collyria are used until the symptoms subside. CORROSIONS AND BURNS OF THE CONJUNCTIVA. These occur rather commonly in dogs and cats the result of accident or intent. They may also be due to the use of strong collyria. A common practice, when dogs are fighting, is to separate them by throwing ammonia, pepper, or other irritant substances into their eyes. This often results in a serious inflammation of the conjunctiva and cornea. Thermic agents, such as hot water, also produce extensive injury. Treatment. A careful history of the case should be obtained if possible in order to determine the cause of the injury. It would be best to first flush out the eyes with a warm boric acid solution (2 per cent.), and if the injury is produced by strong alkalies, follow with some soothing, lubricating agent, such as warm milk, or a dilute glycerin solution. Oleaginous preparations are also to be recom- mended. Ophthalmic ointments are useful. If the cauter- ization has produced an opacity of the cornea, of great value is a solution of succus cineraria maritima compositus (50 per cent.) used daily. ULCERATION OF THE CONJUNCTIVA. A more or less extensive ulceration of the conjunctiva! membrane occurs following diseases or injuries. It has been observed following burns and corrosions; in birds, tuberculosis produces it. Treatment.- When ulceration of the conjunctiva occurs, the part should be thoroughly cleaned, curetted, and the base of the ulcer cauterized with silver nitrate followed by salt solution. This treatment may be repeated in a few days, if necessary. The conjunctiva! sac should be washed daily with boric acid (2 per cent.) to prevent infection and injury to other parts of the eye. 522 DISEASES OF THE CONJUNCTIVA TUMORS AND GROWTHS ON THE CONJUNCTIVA. In small animals, tumors involving the conjunctiva and the membrana nictitans are of frequent occurrence. Several varieties of tumors have been observed. The principal ones are : Epitheliomas, sarcomas, tubercular nodules, dermoids, adenomas of the glands of Harder, papillomas, fibromas and lipomas. It is very essential that a differential diagnosis be made in order to distinguish the malignant from the non- malignant varieties. Malignant growths will not only invade the conjunctiva but spread rapidly to the adjacent tissue, and eventually cause the destruction of the entire eyeball. Treatment. All enlargements along the margin of the lids, on the conjunctiva or on the membrana nictitans should be removed completely as early as possible. This operation is best accomplished under general anesthesia. The after- treatment would consist in cauterizing the wound and the application of the ordinary antiseptics. INFLAMMATION OF THE MEMBRANA NICTITANS. Examination. An examination of the membrana nictitans is very easily accomplished in small animals by ordinary daylight. Proper restraint of the animal is necessary for a careful and thorough inspection. If the animal is of a nerv- ous temperament, or inclined to be vicious, a general anes- thetic should be administered, or the patient hoppled and a tape applied around the mouth. The lids are then everted or held open with the thumb and finger while with the other hand the membrana nictitans can be grasped w r ith a forceps and elevated so that all parts of it can be examined. Exami- nation should be made for inflammation, granular enlarge- ments, tumors, and injuries. As the mucous membrane of the membrana nictitans is exposed to the same causes of disease as the rest of the conjunctiva, it frequently shows lesions. Symptoms. Inflammation of the membrana nictitans is characterized by a red, more or less flat enlargement appear- ing at the inner palpebral fissure. In severe cases the TUMORS OF THE MEMBRANA NICTITANS 523 membrane stands out prominently and extends over a portion of the cornea. A protrusion of the membrana nictitans is observed in tetanus, which should not be mistaken for an inflammatory condition. This can easily be distinguished by other symptoms of tetanus appearing in other parts of the body. Prognosis. Favorable in most cases. It may terminate in a chronic inflammation in which case the membrana nictitans will remain permanently thickened. Treatment. The entire membrane should be inspected closely for foreign bodies. Flush out the membrane daily with boric acid solution (2 per cent.). If in the course of two or three weeks the swelling has not subsided, it would indicate a chronic inflammation. In this case the removal of the entire membrane is recommended. WOUNDS OF THE MEMBRANA NICTITANS. In small animals wounds of the membrana nictitans are produced by the same causes as those producing traumatic conjunctivitis elsewhere. As a rule they are of little impor- tance unless very extensive or followed by marked granula- tion . Antiseptic and astringent solutions usually suffice to heal them. If extensive granulation occur, it may be necessary to extirpate the entire membrane. TUMORS ON THE MEMBRANA NICTITANS. Various tumors have been found on the membrana nicti- tans. It is advisable in all cases to remove the membrane surgically. CHAPTER III. DISEASES OF THE LACRIMAL APPARATUS. Examination. This apparatus consists of the lacrimal gland and the lacrimal passages. In small animals it is somewhat difficult to make an examination of the entire apparatus. The lacrimal gland in the dog is flat, light pink in color, of a mixed type and is situated in the periorbit directly under the orbital ligament. In the cat the position is very similar. In birds the gland is a small, round, reddish body against the eyeball near the outer canthus and opens upon the wall of the eyelid through a small slit. The lacrimal openings (puncta lacrimalia) are elliptical fissures and are two in number in the dog and one in the bird. The lacrimal canal extends from the lacrimal gland to an opening in the lower border of the nasal canal. This is a whitish, membranous tube to conduct the excessive secretion into the nasal passages. The entire lacrimal apparatus is of lesser importance in small animals than in horses. LACRIMATION. Epiphora. Definition. A term applied to designate a flow of tears over the lid margins. It is not of common occurrence in small animals, except in certain breeds of dogs. Etiology. (a) Very often due to ectropion or entropion, which may produce a deviation of the puncta lacrimalia, allowing the secretion to flow out over the margin of the lids. (b) Obstruction of the lacrimal duct by foreign substances, mucus, etc. (c) Constriction and obliteration of the duct due to injuries, etc. (d) Lacrimation is often seen as a result of irritation or diseases affecting the conjunctiva! membranes. In this case the secretion forms so rapidly that the lacrimal duct cannot carry it away, the excess flowing over the lid margins, (e) Ordinary lacrimation may be produced by exposure to irritating gases, smoke, dust or cold air. DACRYOCYSTITIS 525 Symptoms. A copious tear flow over the lid margin. An examination of the surroundings of the patient should be made, and also a close inspection of the conjunctiva and lacrimal apparatus, to determine if possible the cause of the condition. In certain breeds of dogs (spaniels, poodles, Boston terriers) it should not be looked upon as anything serious. Prognosis. As soon as the causes are removed most cases recover promptly. In case the lacrimal passages are obstructed, the prognosis would be unfavorable. Treatment. If possible remove the cause of the condition. If in the lacrimal passages, the}- should be opened by injecting a warm solution of boric acid (2 per cent.) or sodium bicar- bonate (1 per cent.) with a fine nozzled syringe. As the duct is often very small the operation is not always successful. DACRYOCYSTITIS. Definition. An inflammation of the lacrimal sac. It is quite common in dogs and cats. Symptoms. The first symptom is a swelling or bulging in the neighborhood of the inner canthus of the eye. When pressed with the finger the contents are forced out through the puncta lacrimalia. The discharge may be serous, mucoid, or purulent, depending upon the age of the condition. The case often develops suddenly, the skin over the swelling becoming shiny and red. It often perforates and through the opening blood-tinged pus is discharged. Later the discharge becomes mucoid or serous. A lacrimal fistula frequently results from the continuous tear flow through the abscess opening. Dacryocystitis usually becomes chronic. Prognosis. On account of its chronicity and the develop- ment of fistula the prognosis is not very favorable. As a rule several weeks are required to bring about complete recovery. Treatment. In dacryocystitis, lacrimal catarrh and fistula thorough irrigation with warm antiseptic solutions is indicated. Apply with a syringe with a fine long nozzle. If the fistula persists, open the canaliculus and lacrimal sac by slitting and treat as an open wound. CHAPTER IV. DISEASES OF THE CORNEA. Examination. The cornea is normally transparent forming the anterior covering of the eyeball. It is shaped somewhat like a watch-crystal and in the dog, cat and bird spherical in form. The surface is smooth and shiny. In examining the cornea employ either daylight or artificial light. The animal may be restrained w r ith an anesthetic or hoppled and tape applied around the mouth. By everting the eyelids with the thumb and index finger the entire cornea is exposed. Its form should be noted, its curvature and its transparency. The curvature of the cornea of one eye should be compared with that of the other. Of assistance in this regard is a lighted candle. By noting the size of the flame as reflected by the cornea of each eye, comparisons may be made. If the curvature is weak, the flame appears larger; if strong, smaller. In dogs and cats physiological variations will be noted in the curvature of each cornea due to the difference in the shape and size of the eyes. The surface of the cornea should be smooth and even. To determine these observe it from the side, best using reflected light. The cornea should be tested for sensitiveness by gently touching it. It is normally very sensitive. In ulceration and when inflamed sensitiveness is increased; it is reduced in glaucoma. Further examination is made for cuts, scratches, foreign bodies, etc. ' KERATITIS. Definition. An inflammation of the cornea. Two types are recognized: 1. Non-suppurative, and 2, suppurative keratitis. Under the former are included the following forms: (a) Superficial, (b) vascular (pannus), (c) keratitis pigmentosa, (d) keratitis punctata superficial, (e) parenchy- KE RAT IT IS 527 matous, (/) keratitis punctata profunda. Under the latter are included: (a) Ulceration of the cornea, (6) abscess of the cornea, (c) keratitis neuroparalytica, and (d) keratitis from lagophthalmus. Non-suppurative Keratitis. Superficial Keratitis. Definition. An inflammation of the cornea which involves the epithelial layer and the superficial layers of the parenchyma. It is very commonly due to acci- dents, injuries, and infections. Etiology. Superficial keratitis may result from (a) a spread of infection from the palpebral or scleral conjunctiva. (6) Wounds on the cornea, (c) Foreign bodies, (d) Chemical irritants, such as too strong silver preparations, antisep- tics, etc. The common practice among the laity of using alum, ammonia, powdered glass in turbidity of the cornea obviously often injures it. (e) Spreading of inflammation from adjacent structures, such as the iris and ciliary bodies. (/) Superficial keratitis is often observed to accompany dog distempter and epitheliosis of fowls. Symptoms. Lacrimation and photophobia are early and prominent symptoms. Clouding of the cornea in the form of a bluish-white film is seen which may be localized or general. An epithelial desquamation is often produced on the surface of the corneal infiltration. This is so slight in many cases that it is not recognized. The symptoms usually disappear completely in a week or ten days. Course. The course is usually about two weeks. Prognosis. Favorable unless complications develop. Treatment. A careful examination should be made of all parts of the eyelids and cornea to determine the conditions accurately. Flush the cornea and conjunctiva with boric- acid solution (2 per cent.), or chinosol (1-2000 in distilled water). If considerable pain and photophobia are present a cocain and atropin solution (1-150) is recommended. A solution of succus cineraria maritima compositus (50 per cent.) has given most excellent results. Should the condition indicate chronicity, and no ulceration be present, a mild 528 DISEASES OF THE CORNEA solution of silver nitrate will be found useful to change the type of inflammation and to act as an antiseptic and astrin- gent. Daily examination and treatment must be carried out until the opacity disappears. Vascular Keratitis. Pannus. Definition. The formation of new vascular tissue extending over the cornea just under- neath the epithelial covering. Pannus is not frequent in small animals; it is seen occasionally in dogs. Etiology. Pannus occurs in most instances from irritation of a severe form extending over a long period of time. In dogs it commonly results from chemical irritation, when strong chemical agents, such as alum, mercury, etc., are used in treating opacities and chronic conjunctivitis. It may be due to trichiasis or districhiasis, and is also a sequel to chronic conjunctivitis, or may occur during the course of dog dis- temper. Symptoms. Pannus usually begins with photophobia and lacrimation. This is soon followed by a gray or white opacity, traversed by numerous bloodvessels which can be easily seen extending over the cornea in the form of reddish, radiating lines. Later, when the cause is removed, the new tissue becomes organized and appears as a white opacity of varying density. Prognosis. Complete recovery is difficult to attain in all cases. The prognosis should be guarded as complications may follow. Treatment. A careful history of the case should be obtained in order to determine the cause, which should be removed, if possible. If opacity is present a solution of succus cineraria maritima compositus (50 per cent.) is recom- mended, using a few drops once or twice daily. Some of the various ophthalmic ointments might also be tried . Operative procedure is recommended in case the ordinary treatment fails. The pannus may be removed by first giving the patient a general or local anesthetic, dilating the lids with an eye speculum, and carefully curetting the surface with a rather dull curette, ("are must be taken to prevent curetting too deep. After operating apply antiseptics, and in severe cases cover the eye with sterile gauze held in place by a head bandage. Daily dressing is recommended. KERATITIS 529 Keratitis Pigmentosa. Pigmentary Keratitis. Definition. -A chronic disease of the cornea, either inflammatory or degenerative, with which is associated pigment deposit. It has been observed quite often in certain breeds of dogs and cats. The poodle, small house spaniel, and other house dogs are the most common sufferers. Etiology. In most cases pigmentary keratitis is secondary to ulceration of the cornea, other forms of keratitis and cornea! opacities. It may occur as a primary condition in dogs having marked pigment deposits along the corneal limbus. In these cases it affects usually only a portion of the cornea, but may extend gradually to other portions. Occa- sionally the pigmentation may be deposited around the scleral corneal zone, extending toward the center of the cornea. The causes of the primary form are unknown. Symptoms. Pigmentary keratitis is characterized by deposits of melanin or pigment in the cornea. It usually begins as a fine, triangular network of small, dark lines radiating from the limbus, the base of the formation being at the limbus and the apex directed toward the center of the cornea. The triangular pigment formation is often so dense that the part of the cornea traversed by it is almost black. Sometimes the pigmentation disappears to reappear later. Continued recurrences eventually leave the cornea dull and uneven on its surface. Lacrimation and photophobia are little marked. Prognosis. The prognosis is unfavorable. As a rule following frequent recurrences permanent opacity of the cornea results. Treatment. Boric acid (2 per cent.), or ichthyol (2 per cent.) is recommended. Pain may be arrested by stovain (2 per cent.), or alypin (2 per cent.), combined with the antiseptics. Internally potassium iodid (0.012-0.12) once daily, or atoxyl in small doses has been used with apparent success. The patient should be fed liberally and given good Keratitis Punctata Superficialis. Facetted Keratitis. Definition. A chronic inflammation of the superficial layer of the cornea causing opacity and the appearance of small 34 530 DISEASES OF THE CORNEA facets occurring singly or multiple. This disease has been observed quite often in certain breeds of dogs but is very rare in cats and birds. Etiology. Nothing definite is known in regard to its etiology. Dogs with prominent eyes are often affected. It has been observed to accompany or follow rheumatic affections. It may be due to injuries, infections, specific or general, or exposure. Symptoms. Cloudiness of the cornea is the earliest symp- tom. This is followed soon by small, opaque, white, gray or yellow spots which penetrate into the parenchyma of the cornea. Ulceration of one or more turbid areas may take place causing small facets to appear. Injection of the conjunctiva and scleral membranes is a prominent symptom which may gradually disappear as the case becomes chronic. Lacrimation and photophobia are frequently seen. Owing to the disturbance of the cornea it will have a shagreened appearance. Prognosis and Course. The course of the disease is chronic. The symptoms may almost completely disappear only to recur. Some cases show a tendency to become periodic. The prognosis, therefore, should not be made too favorable. Treatment. Flush the cornea with boric acid (2 per cent.), chinosol (1-500), or silver nitrate solution (j per cent.). This should be followed immediately with a few drops of a solution of succus cineraria maritima compositus (50 per cent.). This treatment should be continued for several days or weeks to obtain the best results. Some of the ophthalmic ointments may be tried in obstinate cases. Parenchymatous Keratitis. Definition. An inflammation of the parenchyma of the cornea, characterized by a diffuse infiltration of the interstitial tissue with a vascularization of the sclera. It is accompanied in most cases by irido- cyclitis. Parenchymatous keratitis is a very common affection in dogs but rare in cats and birds. Etiology. Infection is an important factor. In dogs it follows or accompanies distemper. It may be due to a spread of inflammation from the iris (iritis), choroid (choroid- itis), etc. Chronic eczema, mange, etc., when they affect the KERATITIS 531 eyelids, ear, or adjacent parts, may be attended by it. Direct injury to the cornea may be a cause. Symptoms. The cornea becomes turbid, gray or yellow. The normal transparency is lost. The turbidity may not extend over the entire cornea. Very' often a dulness of the cornea is all that is noticed during the early stages of the disease. When the cornea is closely examined there will be found small elevations over the epithelial layer, and a network of fine bloodvessels radiating more or less evenly from the periphery to the center. The bloodvessels are often so small that a reading glass is necessary in order to see them. They run parallel to each other and usually do not anastomose but terminate in a small loop forming a zone entirely around the corneal limbus. These new formed vessels become quite extensive and involve the entire cornea- Lacrimation, photophobia, pain, and congestion of the sclera are present. When examined with an ophthalmoscope there will be evi- dence of iritis and choroiditis. Course. The course is usually several days to a few weeks. Abscess or ulceration of the cornea is a rare sequel. Prognosis. Owing to the changes that have taken place in the cornea, it requires quite a long time to bring about healing. The tendency to recur makes the prognosis rather unfavorable. Permanent turbidity of the cornea may result with partial or complete loss of sight. Treatment. During the early stages of the disease the patient should be protected from strong light and everything possible done to prevent irritation of the cornea. ( 'onstriction of the vessels and reduction of the irritation are best brought about by applying to the cornea three or four times daily codrenin solution (4 per cent.). This is continued for two or three days. When there is evidence of iritis or choroiditis atropin solution (^ per cent.) is of value to prevent adhesions (posterior synechia). If pus is present a mild, non-irritating antiseptic should be used. Recommended are boric acid (2 per cent.), biniodid of mercury (1-10,000). Codrenin solution may be added to the above to constrict the bloodvessels and control the pain. 532 DISEASES OF THE CORNEA When the condition becomes chronic silver preparations are useful. An autogenic vaccine has been used with good results and may be given every four or five days. Give the patient plenty of good, nourishing food, occasional laxatives, and small daily doses of potassium iodid (0.016- 0.032). Keratitis Punctata Profunda. Definition. An inflamma- tion of the deeper layer of the cornea appearing in the form of multiple, small spots. It is more common in the horse and dog than in other animals. Etiology. The cause has not been determined. It may be produced by specific infection and inflammation spreading from adjacent parts. Symptoms. Numerous small opacities or spots are noted in the depths of the cornea. They are visible to the naked eye, or are seen better with a reading glass, with oblique or direct illumination. The spots are mostly circular, well defined, evenly distributed, or more or less grouped. In color they are usually white, occasionally darker. The rest of the eye appears normal. Prognosis. Unfavorable. Treatment. No treatment is of avail. Suppurative Keratitis. Ulceration of the Cornea. Definition. A destruction of the substance of the cornea, the result of infection with pus. The ulcers vary in size, some are not larger than a pin point; others involve a large part of the cornea. Etiology. The causes of ulceration are varied. Wounds of the cornea, even though slight, form ports of entry for infection. In small animals the cornea is frequently injured by foreign Kodies which enter the lid sac, by being bitten or scratched by other animals, or from an inversion of the eyelashes. The undue exposure of the cornea which accompanies lagophthalmus, exophthalmus, and paralysis of the fifth nerve is a predisposing cause. Ulceration of the cornea accompanying or following infectious diseases, especially KERATITIS 533 distemper of the dog and oat, is not infrequent. Purulent infection of the conjunctiva (palpebral, scleral, corneal) may lead to ulceration. The microorganisms most frequently found are streptococci, staphylococci, pneumococci, and other pyogenic germs. The infection producing ulceration is no doubt in many cases carried by the blood to the cornea, and by the lymph into the cornea. Many diseases which reduce corneal resistance predispose to ulceration, such as chronic constitu- tional diseases, and some infectious diseases. In birds suppuration of the lacrimal passages and conjunctiva leads to ulceration as is frequently noted in epitheliosis. This form commonly leads to perforation of the cornea. Symptoms. Corneal ulcers vary considerably in size, form and depth. Any portion of the cornea may be the seat of one or more of them. Jn most cases, however, ulcers are found at or near the center of the cornea. In form they are mostly round with well defined, sharp borders as if cut out with a sharp instrument. In other cases their form is irregular. The base of the ulcer may be flat, concave, or convex; rough, vascular, or infiltrated. The cornea sur- rounding the ulcer is usually turbid, and secondary ulcers not uncommonly develop. Uleeration of the cornea accom- panying dog distemper often occurs suddenly, tends to spread rapidly and not infrequently leads to perforation in a few days. Photophobia, lamination, and congestion of the adjacent structures are nearly always present. Frequently a copious discharge of pus occurs from the affected eye. Pain may or may not be a prominent symptom, depending upon the cause of the ulcer and to what extent other struc- tures of the eye are involved. Course. The usual course is chronic. Some cases require several weeks for complete disappearance. The ulcer may disappear without trace, or it may lead to perforation, or cicatrization and permanent opacity. Prognosis. Ulceration of the cornea is always serious. Perforation, panophthalmitis, or opacity often follow it. Its chronicity and tendency to recurrence make the prognosis always guarded. 534 DISEASES OF THE CORNEA Treatment. Flush the corneal surface with a mild anti- septic solution (boric acid, 2 per cent.; ichthyol, 2 per cent.). If pain is present, drop into the eye a small amount of cocain, stovain or alypin solution, to reduce the irritation and prevent further injury by the patient rubbing or scratching the affected eye. This treatment will control the general infection preventing further spread of the ulcer. Where pus formation is copious (blennorrhea) an autogenic vaccine may be prepared and used in conjunction with the other treatment. Direct treatment of the ulcer requires judgment and care. Careful curetting followed by applying protargol solution (5 per cent.) is recommended. Good results have followed the use of succus cineraria maritima compositus (50 per cent.). When the ulcer shows a tendency to perforate an anti- septic pack should be applied to the eye (eyelids closed), and a head bandage to hold it in place. This will exert outside pressure and may prevent perforation, permitting in the meantime new formed granulation tissue to strengthen the defect. Lead and silver solutions should not be used too strong on account of the danger of permanent deposits resulting. Treatment should be applied daily. Abscess of the Cornea. Definition. A collection of pus in the cornea. Corneal abscesses are very common in dogs. Etiology. Infection with pus organisms usually through wounds or abrasions. Foreign bodies, bites and scratches pave the way for an infection which results in abscess. Corneal abscesses commonly result from distemper of the dog and cat, and epitheliosis in birds. Symptoms. The first symptoms noted are discharge of pus from the affected eye, photophobia, and a tendency to rub the eye with the paws. On examination a yellow, sharply defined abscess from the size of a pin-point to a wheat grain or larger is noted near the center of the cornea. The cornea surrounding the abscess may be transparent but is often turbid. As the abscess ages new formed bloodvessels are projected from the corneal bloodvessels across the cornea to the abscess. Surrounding the abscess a bloodvessel appears. If the abscess is large, or a number of small FOREIGN BODIES AND WOUNDS OF THE CORNEA 535 abscesses are present, the curvature of the cornea becomes stronger, sometimes cone-shaped. Conjunctivitis, conges- tion of the episcleral bloodvessels, and profuse lacrimation accompany the abscess. Course. Most cases require several weeks for complete recovery. As a rule the abscess ruptures outwardly; occa- sionally inwardly, discharging the pus into the anterior chamber causing hypopyon and in some cases suppurative panophthalmitis. Corneal ulcer may result from the abscess. Prognosis. On account of the danger of serious complica- tions, the prognosis should be guarded. It is possible for the corneal abscess to heal without trace. Treatment. To remove surface infection warm, antiseptic solutions (boric acid, 2 per cent.; ichthyol, 3 per cent.) may be used. Pain is controlled by cocain, stovain, alypin or codrenin. The abscess may be opened under strict antiseptic precautions and the cavity treated with protargol solution (5 per cent.). Treatment should be made daily. Keratitis Neuroparalytica. Definition. A rare affection in animals due to a paralysis of nerves (trigeminal, ciliary) lead- ing to undue exposure of the cornea. (See larger works.) Keratitis from Lagophthalmus. Definition. An inflam- mation of the cornea resulting from incomplete closing of the eyelids. The portions of the cornea not protected by the lid become dry, opaque, and ulcerated. Hypopyon, iritis and panophthalmitis frequently result. Treatment. Besides keeping the parts lubricated with glycerized antiseptics nothing can be done. FOREIGN BODIES AND WOUNDS OF THE CORNEA. Foreign bodies frequently enter the eyes of animals. Occa- sionally they become imbedded producing usually infected wounds of the cornea. Wounds also result from bites or scratches of other animals. Symptoms. The symptoms of lacrimation, photophobia and pain develop suddenly following the injury. The examination of the eye should be made thorough, everting the lids and nictating membrane, in order that foreign bodies will not be overlooked. 53G DISEASES OF THE CORNEA Prognosis. Providing too much injury has not been wrought by the offending foreign body, the prognosis is favorable. In making the prognosis one should bear in mind complications resulting from probable infection. Treatment. Flush the eye with mild antiseptic solutions (boric acid, 2 per cent. ; ichthyol, 2 per cent. ; chinosol, 1-2000). Foreign bodies must be removed. Further treatment will depend upon the progress of the case. The affected eye should be watched carefully and threatened complications promptly treated. Some wounds require careful handling in order to prevent perforation. OPACITIES OF THE CORNEA. Most opacities of the cornea result from inflammation. Those resulting from other causes are very rare in animals. The majority follow wounds, ulcers, irritant chemicals instilled into the eye, or burns. Depending upon their density, various terms have been applied to opacities: (a) Nebula, a slight turbidity. The cornea appears blue or slightly foggy. (6) Macula, a denser opacity easily seen in ordinary light. It may be milk white. (c) Albugo, a translucent opacity, (d) Leukoma, the entire cornea becoming turbid, milk white. It may be either con- genital or acquired. Prognosis. The prognosis depends upon the age of the patient, duration, location, extent and character of the opacity. The more recent the opacity, the more favorable the prognosis. Superficial opacities are more readily removed than deeper ones. However, the prognosis should be guarded. Treatment. As most opacities of the cornea are composed of cicatricial tissue complete removal of them is very difficult. However, some of them will entirely disappear and the cornea reassume its former transparency. The following agents are recommended: Dionin solution (o to 10 per cent.), or in the form of powder, has given excellent results. Begin with a few drops of a 5 per cent, solutjon instilled two or three times daily. The strength of the preparation may be ECTASIA OF THE CORNEA 537 increased later if necessary. A severe reaction usually follows the first treatments. This disappears later when the strength of the solution can be increased. Red or yellow oxid of mercury ointment has also been used with good results. A small quantity is applied once daily. Silver nitrate solution (4 per cent.), or protargol (10 per cent.) is used to stimulate greater cellular activity in the region of the opacity. Succus cineraria maritima compositus is also of value. To obtain results treatment must be continued for a long time. As a last resort, when medical treatment does not suffice, iridectomy may be tried. The operation consists in making an artificial pupil so situated that light may reach the retina. ECTASIA OF THE CORNEA. Two types of ectasia are recognized: (a) Inflammatory ectasia, and (b) non-inflammatory ectasia. Inflammatory Ectasia. Two forms occur in animals, viz.: Staphyloma, and keratectasia. Staphyloma. Definition. A protrusion of the cornea, the result of inflammation (ulceration, perforation, prolapsus of iris). Staphyloma may be partial or complete; in form spherical or conical. In animals it is usually complete the entire cornea protruding from the scleral margin. In color it is blue or black due to cellular infiltration and pigment deposit. The protrusion may interfere with the closing of the lids. Lacrimation, photophobia and pain are prominent symptoms. In the incomplete form (conical) only a portion of the cornea protrudes. 7 'reatment. Treatment is usually unsatisfactory. The cause should be removed if possible. Apply gentle pressure to the eye through antiseptic packs retained with a head bandage. When the intra-ocular pressure is too great, some of the fluid from the anterior chamber may be aspirated before applying the pack. Permanent satisfactory results can hardly be hoped for. When other treatment fails the afl'ected eye should be enucleated. Keratectasia. Definition. Keratectasia involves only the cornea which has become weakened at some point either from 538 DISEASE* OF THE CORNEA infiltration or from an ulcer which has not perforated its entire thickness. In keratectasia the iris is not involved as in staphyloma. Treatment Relieve the intra-ocular tension and apply a compress. Iridectomy may be useful in some cases. Non-inflammatory Ectasia. Two forms are recognized: Keratoconus, and keratoglobus. Keratoconus. A cone-shaped protrusion of the cornea which does not become opaque. It results from a weakening of the cornea at its center and an increase in intra-ocular tension. The condition is incurable. Keratoglobus. The entire cornea is enlarged as the result of a general increase in size of the entire eyeball. It is seen in hydrophthalmus. The cornea retains its transparency. The condition is usually congenital and most often observed in young dogs and young cats. Treatment. No treatment is of any value. TUMORS OF THE CORNEA. Tumors of the cornea are rare in animals. Dermoids are occasionally met with in dogs and cats. Sarcomas and carcinomas have been noted. They usually originate either in some other part of the eye or in adjacent tissues. Treatment. Surgical treatment should be attempted as early as possible. No treatment should be attempted in malignant tumors. CHAPTER V. DISEASES OF THE IRIS AND CILIARY BODY. General. In practice it is very difficult to separate the diseases of the iris and ciliary body of which the iris is practically an extension. The structure of the iris is much the same in all animals. The arrangement of its muscular fibers in different animals accounts for the variation in the shape of the pupil. In the cat the pupil is an elongated slit; in dogs it is spherical or oval. The color of the iris is due to the quantity of pigme nt present in the posterior layers and in the membrane proper. Frequently the pigment is entirely absent producing the albino or pink eye. This is common in rabbits and is occasionally observed in other animals. The other colors, such as blue, black or gray eyes, are determined by the amount and distribution of the pigment. A more com- plete examination of the iris can be made if a few drops of eserin are instilled into the eye to contract the pupil. The examination should be made for congenital defects, inflam- mations, tumors, etc. CONGENITAL DEFECTS OF THE IBIS. A number of defects in the formation and development of the iris has been observed: (a) Occlusion of the pupil, occurring in the dog, cat and rabbit, causing congenital blindness. (6) Ectopia pupillse, a displacement of the pupil often found accompanying luxation of the lens, (c) Toloboma, a portion of the iris failing causing a large, irregular-shaped opening, (d) Aniridia, absence of the iris, very unusual in animals. Treatment for these conditions is unsatisfactory. The size and form of the pupil are influenced by light, disease and medication. 540 DISEASES OF THE IRIS AND CILIARY BODY MYDRIASIS. Definition. A dilatation of the pupil. It may be due to: (a) Paralysis of the third nerve, (6) disease of the central nervous system, (c) constitutional diseases, (rf) poisons, (e) mydriatics. Mydriasis is produced artificially in order to examine the interior of the eye. MYOSIS. Definition. A contraction of the pupil. It is caused by paralysis of the cervical sympathetic nerves, tabes dorsalis, inflammation of the iris, foreign bodies in the cornea and by myotic drugs (morphin, codrenin, eserin). It is frequently noted in rabkr"animals. IRITIS AND CYCLITIS. IRIDOCYCLITIS. Definition. An inflammation of the iris and of the ciliary body. They usually co-exist and will be therefore con- sidered together (iridocyclitis). Etiology. Traumatism. A primary iridocyclitis is not common. Most cases are secondary to other diseases, such as distemper of the dog and cat. Symptoms. Iridocyclitis is characterized by congestion, discoloration, loss of the normal striations and inability of the iris to react to light or other stimulae. The pupil is usually found contracted. While it is possible for the iridian exudate to be very limited, the inflammation stopping in the congestive stage, as a rule, it is profuse, falls off the iris and accumulates in the anterior chamber (hypopyon if purulent). The exudate, which is usually fibrinous, may be seen through the cornea as a movable, yellow, sometimes blood-streaked accumulation floating in the anterior cham- ber. If an adhesion between the iris and the cornea results, anterior synechia is spoken of; if between the iris and lens, posterior synechia. Symptoms of lacrimation, photophobia and congestion of the conjunctiva are usually present. The cornea is nearly always involved, appearing as if lightly greased over its surface. When the ciliary bodies are CYSTS AND TUMORS OF THE IRIS 541 prominently involved a turbidity of the corneal margins is noted. Exudate, which has passed through the pupil, reaches the anterior chamber producing the same symptoms as iridian exudate. The iris may be only slightly involved as is determined by its color, striations and reaction to light. Course. The course in iridocyclitis is usually short. The inflammation rapidly subsides and the exudate is quickly resorbed. A few cases become chronic and lead to posterior synechia. Prognosis. In uncomplicated cases the prognosis is favor- able. When the choroid or retina is involved the prognosis is guarded. Treatment. When secondary to constitutional diseases, distemper, etc., these should receive attention. Local treatment consists in instilling atropin solution (0.5 to 1 per cent.) once or twice daily, which paralyzes the accom- modation, relieves pain and congestion and prevents adhe- sions. Dionin solution (4 per cent.) is also useful to stimulate the lymph circulation. Hot applications in the form of a hot-water compress are of great service. They should be applied for an hour at a time during the first twenty-four to thirty-six hours. Antiseptic and astringent solutions, such as succus cineraria maritima compositus (50 per cent.), or ichthyol (4 per cent.) may also be used. Complications should be treated as they arise. CYSTS AND TUMORS OF THE IRIS. Cysts involving the iris are quite rare. They most often result from injury and appear as enlargements on the iris. It is difficult to distinguish between cysts and tumors. They are treated by puncturing, under antiseptic precau- tions, with a knife needle inserted through the corneal margin. Both benign and malignant tumors may involve the iris. Melanoma is the most frequent primary tumor. Sarcomas and carcinomas also occur. They usually extend from adjacent structures which are their primary seats. Treat- ment consists in enucleating the eyeball. CHAPTER VI. DISEASES OF THE LENS. Examination. The lens is best examined after dilating the pupil with atropin. The patient should be placed in a good light or light may be reflected with an ophthalmo- scope against the lens. Normally the lens is transparent. It should be examined for turbidity, position and form. In old dogs the lens is usually less transparent than in younger animals. CATARACT. Definition. An opacity of the lens, its capsule or both. Cataract is common in the dog and cat, especially in old animals. The following kinds occur: (a) Symptomatic, (6) traumatic, (c) senile, (d) diabetic, (e) congenital. Symptomatic Cataract. This form results from an inflam- mation of some of the adjacent structures which interferes with the nutrition of the lens. In the dog and cat it often develops from distemper. Traumatic Cataract. Traumatic cataract is caused by injury to the lens by sharp objects which penetrate the cornea. Or it may be due to indirect injury, the animal receiving a blow which jars the lens from its fastenings. It may, therefore, result from fracture of the orbit or some of the other bones of the head. Senile Cataract. Common in old dogs. It is due to an atrophy of the lens and is usually bilateral. In the early stages senile cataract usually appears as radiating, gray lines which extend from the periphery to the center of the lens. In other cases it may occur as an opaque spot or spots in the lens. The opacity spreads until eventually the entire lens is involved. CATARACT 543 Diabetic Cataract. Very rare in animals. A few cases have been noted in dogs. Congenital Cataract. Quite common in young dogs. As a rule, the lens only is involved. It is often bilateral. It may be partial or complete. Symptoms. General. In animals cataract is usually over- looked until it becomes so well marked as to be visible to the ordinary observer. Partial cases are sometimes discovered during an examination of the eye for some other disease. In using the ophthalmoscope in cataract the light should not be too strong. Under subdued light the opacity appears as a dark spot, its color differentiating it from the tapetum lucidum or the red papilla. Cataract should be distinguished from foreign bodies on the cornea, corneal opacities and turbidity of the vitreous humor. In most cases a careful examination with an ophthalmoscope will suffice to differentiate between lens opacities and those in other parts of the eye. When the diagnosis cataract has been made, the form and cause should be determined whenever possible. The history of the case, the age and condition of the patient, and the appearance of the opacity are indicative. Course. The course in cataract is chronic, usually lead- ing to complete loss of vision. Occasionally a traumatic cataract develops rapidly and undergoes a spontaneous recovery within a short time. Such cases are rare. Prognosis. The prognosis is unfavorable. Treatment. The only treatment of value is an opera- tion to remove the lens. In veterinary practice the diffi- culty in keeping the parts aseptic, the dressings in place and the patient- quiet, is so great that cataract operations are seldom employed. There are two operations for cata- ract: (a) A discission of the lens, and (6) extraction of the lens. Discission. Discission is practised only in congenital cataract, or when cataract appears early in life, is soft and capable of absorption. The operation is performed under complete anesthesia and strict asepsis. The eye to be operated is flushed out with an antiseptic solution (boric acid, 2 per cent.; bichlorid of mercury, l-5000) s followed 544 DISEASES OF THE LENS by a solution of atropin (1 per cent.) to dilate the pupil. The lids are held open with an eye speculum. With a special instrument, a small knife-needle, which is passed through the cornea at its margin and pushed diagonally through the lens capsule into the lens proper, the lens is cut and separated. The instrument is then withdrawn carefully so as to avoid injury to the cornea. An absorp- tion of the lens should follow. If not, the operation may be repeated in a few weeks. Complications, such as swelling of the lens and increased intra-ocular tension with severe pain, may follow the opera- tion. Cold packs are recommended to reduce the swelling. If they afford no relief within a short time the cornea may be punctured at its margin which relieves the tension. Through the same opening the lens substance may be removed. If iritis result from particles of the lens coming in contact with the iris, instil atropin solution and apply hot packs. Extraction. The lens is extracted in all cases when the discission operation is contra-indicated. The technic of the operation is rather difficult and requires much practice. It consists briefly in incising the cornea in the sclerocorneal limbus, fixing the eyeball with a special fixation forceps, incising the capsule of the lens, and expressing the lens. The eye should be cleansed and a dressing applied. Many complications may follow the operation in animals: Panophthalmitis, prolapse of the iris; iritis and cyclitis in a small percentage of cases. Proper and careful dressing of the wound after the operation is especially important. LUXATION OF THE LENS. Luxation is not very frequent in small animals. In most instances it results from traumatism. It may be due to extreme intra-ocular tension in either chamber of the eye, or from rupture of the suspensory ligaments of the lens. The luxation may be partial or complete; into the anterior or posterior chamber. Treatment. Treatment is of no value. A removal of the lens is occasionally employed. CHAPTER VII. DISEASES OF THE RETINA AND CHOROID. THESE membranes can be seen only with the ophthalmo- scope. It is best to dilate the pupil in order to increase the size of the field of the eye's background. The following pathological changes may be noted on the retina: (a) Hyperemia, (6) edema, (c) inflammation (retin- itis), (d) detachment of the retina, (e) anemia, (/) atrophy. Hyperemia. A congestion of the retina. The blood- vessels will be found dilated and engorged with blood. Edema. Rare in animals. It may result from direct injury, or inflammatory exudate which collects in the retina. The retina appears cloudy. Inflammation (Retinitis).A.n inflammation of the retina. It usually develops during or as a sequel to infectious or chronic constitutional diseases. It is characterized by hyper- emia, edema, partial or complete obliteration of the papilla and hemorrhage. Detachment of the Retina.- Rare in animals. It may result from an accumulation of exudate or transudate between the retina and choroid, which causes the retina to become detached and float loose in the vitreous humor. It causes partial or complete blindness. Anemia. Retinal anemia usually results from general hemorrhage; obviously it accompanies general anemia. It may have a local origin, the bloodvessels supplying the retina becoming blocked and pressed upon by tumors or inflammatory growths. The retina appears pale and the bloodvessels reduced in size. Atrophy, Usually follows extensive and severe retinitis; or when the nutrition of the retina has become reduced. The bloodvessels appear unusually small; in some cases hardly visible. The diseases of the choroid are so intimately interwoven with those of the other membranes that a separate descrip- tion is unnecessary. 35 CHAPTER VIII. DISEASES OF THE OPTIC NERVE. USUALLY when the optic nerve is affected diseases of other structures, particularly of the retina, co-exist. The principal pathological changes affecting the optic nerve are: (a) Wounds, (6) hemorrhages, (c) inflammation, (d) tumors. The optic nerve is also affected by inflammation of adja- cent structures, and diseases of the central nervous system. The diseases of the optic nerve usually noted are: (a) Papillitis, (6) retrobulbar neuritis, (c) atrophy. Clinically amblyopia and amaurosis are recognized. PAPILLITIS. Definition. An inflammation of the papilla. It may be unilateral or bilateral. It is usually caused by poisons, traumatism and diseases of the central nervous system. Viewed with the ophthalmoscope the papilla appears either enlarged and engorged with blood or, on the other hand, too pale even white in color. Its outline is usually indistinct and striations are seen radiating from its center. When due to tumors and marked congestion is present, the papilla appears intensely red ("choked disk"). Prognosis. The prognosis is unfavorable. Partial or com- plete blindness will usually result. RETROBULBAR NEURITIS. Definition. An inflammation of the optic nerve just posterior to its entrance into the eyeball. It may result from injuries, infection through wounds involving the orbit; or attend nasal catarrh, or dog distemper which has AMAUROSIS 547 attacked the sinuses of the head. The patient is partially or totally blind. The papilla will appear congested. Many cases will recover when the cause is removed. ATROPHY OF THE OPTIC NERVE. Definition. It may result from inflammation or be a simple atrophy. Blindness is a prominent symptom. Prognosis. The prognosis is unfavorable. AMBLYOPIA. Definition. Partial blindness. No lesion can be deter- mined. In animals it usually results from poisoning. As a rule when the cause is removed sight is restored. AMAUROSIS. Definition. Blindness without visible lesion of the eye. Amaurosis is a symptom and not a disease. The term is falling into disuse as ophthahnoscopy becomes better developed. It may be congenital or acquired. Diseases of the optic nerve, retina, brain and certain poisons are its principal causes. The symptoms are blindness, abnormal dilatation of the pupil which does not react to light. In the early stages the eye appears normal but in time the globe becomes atrophic. Ophthalmoscopic examination may be negative, although usually changes can be noted on the retina or papilla. There is no treatment of value. Cases due to poisons may recover. CHAPTER IX. DISEASES OF THE GLOBE AND ORBIT. INJURIES to the eyeball are very common. They occur as wounds, lacerations and contusions. Sometimes the eyeball is ruptured. Diseases involving the globe and orbit are also frequent. The following are the most impor- tant: (a) Panophthalmitis, (b) glaucoma, (c) hydrophthal- mus, (d) exophthalmus, (e) luxation of the eyeball, (/) enophthalmus, (g) strabismus, (h) nystagmus, (i) parasites, 0) fracture of the orbit, (k) inflammation of the orbit, (I) tumors of the orbit. PANOPHTHALMITIS . Definition. An inflammation of the entire eyeball. It is usually due to injury with infection, or may develop during the course of infectious diseases, the infection being carried to the eye by the blood or lymph. Symptoms. The initial symptoms will vary, depending upon whether the infection enters through wounds (exo- genetic) or is carried by the blood or lymph (endogenic). When panophthalmitis begins in the posterior part of the eye it may escape attention until the anterior portion is involved. In cases of exogenetic origin usually a wound through the cornea or sclera is found out of which pus discharges. In endogenic infection a general congestion of the eyeball is an early symptom. As the disease progresses perforation usually through the cornea with prolapsus of the iris and sometimes the lens follows. As a rule, the eyeball is destroyed. Diagnosis.- Panophthalmitis should be differentiated from phleginonous conjunctivitis and inflammation of other GLAUCOMA 549 parts of the eye. These sometimes present symptoms con- fusingly like it. The eye should be carefully examined to avoid error in this regard. Should a perforating wound be found the diagnosis is simplified. Prognosis. Unfavorable. Almost every case leads to destruction of the eyeball. Treatment. An effort should be made to arrest the spread of the infection. Obviously as the deeper structures are involved this is difficult to accomplish. The eye should be flushed with warm antiseptic solutions (boric acid, 2 per cent.; ichthyol, 3 per cent). Subconjunctival injections of 1-2 c.c. of a solution of cyanide of mercury (0.5 per cent.) are recommended. Suppurating wounds should be drained and flushed out. Usually enucleation of the eyeball becomes necessary. GLAUCOMA. Definition. A term applied to a number of diseases of the eye marked by intense intra-ocular tension, atrophy of the papilla and blindness. It is rare in animals. It is supposed to be due to some disturbance in the lymph or blood circulation of the eyeball which may be congenital or acquired. Symptoms. Glaucoma develops gradually without signs of inflammation and with little evidence of pain. The early stages are often overlooked. As the disease progresses the pupil dilates and a marked hardness of the eyeball develops due to increased intra-ocular pressure. The cornea may be clear or cloudy. With the ophthalmoscope the optic nerve appears cupped. The vision is gradually destroyed. In some cases (inflammatory glaucoma) acute inflammatory symptoms suddenly develop. Prognosis. Bad. Treatment. Eserin or pilocarpin should be tried; if unsuccessful relieve the intra-ocular pressure by paracentesis of the anterior chamber of the eye. The results are usually unsatisfactorv. 550 DISEASES OF THE GLOBE AND ORBIT HYDROPHTH ALMUS . Definition. An enlargement of the eyeball in all its dimen- sions. It is common in pups and kittens. Hydrophthalmus develops slowly, the eyeball enlarging, the curvature of the cornea becoming weaker, the pupil dilated, intraocular pressure increased, and the papilla cupped. The condition is usually congenital. Treatment. Eserin and pilocarpin are recommended, but they do little good. Paracentesis of the anterior chamber will relieve intraocular pressure as in glaucoma. Iridectomy may be tried. EXOPHTH ALMUS. Definition. An abnormal protrusion of the eyeball. It should not be confused with normally prominent eyeballs of some breeds of dogs. Etiology. Fracture of the orbital arch, the displaced bones forcing the eyeball outward; edema, abscess or hematoma in the postbulbar tissue; retrobulbary cellulitis; intra-orbital tumors; tuberculous growths in the orbit. Exophthalmus is a prominent symptom of exophthalmic goiter in dogs. Symptoms. One or both eyes appear unduly prominent. As the eyelids do not entirely cover the eye the surface of the cornea becomes dry and ulcerated. Prognosis. The prognosis should be guarded. Treatment. Treatment is only successful when the cause can be removed. Tumors should be operated, enlarged thyroids removed and the affected eyeball protected. LUXATION OF THE EYEBALL. Common in the dog and cat. Dogs with prominent eyes are predisposed. It results from injury, fighting, becoming caught in doors, etc. Prognosis. The prognosis will depend upon how long the eye has been prolapsed, the degree of injury to the optic nerve and to the eyeball. Treatment. The patient should be anesthetized and the prolapsed eye flushed with a warm antiseptic solution ENOPHTHALMUS 551 (boric acid, 2 per cent.). Try replacement by picking up the eyelids, retracting them as much as possible, at the same time gently but firmly pressing the eyeball back into its socket. It may be necessary to enlarge the palpe- bral slit by cutting the outer canthus. After replacement two or three stitches will retain the eyeball in position. The after-treatment consists in fomenting the eye with warm water and keeping it lubricated with dilute glycerin or liquid vaselin. Should panophthalmitis or hydrophthal- mitis develop, or the luxation reappear, enucleation of the eyeball should be practised. The operation is as follows: The patient should be given a general anesthetic and the eyeball thoroughly washed with an antiseptic. The lids are held apart by a retractor, or with dressing forceps held by an assistant. Make an incision through the con- junctiva at the corneal margin, dissect back to the muscles, cutting them off close to their attachment to the eyeball. Keep as close to the eyeball as possible. When all of the muscles have been cut away pull the eyeball downward and excise the optic nerve. Control hemorrhage, pack the socket with sterile gauze, or iodoform gauze, put retaining sutures in the lids, and cover the whole with an antiseptic pack held in place with a head bandage. In twenty-four hours remove the pack and treat with antiseptic dusting powder. Healing is usually prompt. ENOPHTHALMUS. Definition. An abnormal sinking of the eyeball into the orbit. It is rare in animals. Etiology. It may be congenital. Most cases, however, are acquired and due to an atrophy of the retrobulbar fat cushion, general emaciation, spasms of the muscles of the eye. Symptoms. The eyeball appears retracted intp its socket. It should be distinguished from normal eyes which are unusually small. The general condition of the patient suffices for differentiation. 552 DISEASES OF THE GLOBE AND ORBIT Prognosis. Depends upon the cause. Treatment. Determine the cause and eliminate it by proper treatment. STRABISMUS. Definition. A deviation of one of the eyes from its normal direction so that the visual axes cannot be focussed simul- taneously on the same objective point. Etiology. It may be due to a mechanical interference with the movement and position of the eyeball, paralysis of the muscles of the eye, intracranial paralysis, spasms of the eye muscles, cerebral hemorrhage, and poisoning. Diagnosis. The diagnosis is not difficult. One eye will be turned inward or outward while the fellow one is directed straight ahead. Treatment. A palliative treatment consists in applying a counterirritant to the region of the orbit and administering internally small doses of iodid of potash. A radical treat- ment is to perform a tenotomy, severing one of the tendons of the eye muscle at its insertion into the sclera. The particular tendon to be divided is determined by the indi- vidual case. If the strabismus is convergent the internal rectus is cut; if divergent, the external. The operation is briefly as follows: Give a general anesthetic. Flush the eye with antiseptics and follow by a solution of codrenin to control the hemorrhage. Cut through the conjunctiva and carefully dissect down to the tendon which grasp with a blunt hook, pull forward and cut oft' with a scissors. Unless the tendon is entirely severed the results will not be satis- factory. The wound in the conjunctiva may be left open. Flush out daily with antiseptic solution. NYSTAGMUS. Definition. A continuous rolling movement of the eye- ball. It occurs occasionally in dogs. It very often accom- panies epilepsy, convulsions, parasitic invasion of the ear, catarrh of the ear and sometimes accompanies chloroform narcosis. TUMORS OF THE OK BIT 553 Treatment. No treatment beyond rectifying the primary condition of which it is a symptom is recommended. PARASITES OF THE EYE. Lice (pediculi) are often found on the margins of the lids and on the skin over the orbital region. Mange mites also invade the lids. The demodex mite may enter the Meibomian glands, conjunctiva and lacrimal apparatus. The Filaria oculi canini is occasionally found, and spiroptera have been noted in the eyes of birds. FRACTURE OF THE ORBIT. Common in animals. Careful palpation will reveal crepitation. Treatment. Treatment should follow the general principles of surgery. Possible injury to the eyeball demands first consideration. INFLAMMATION OF THE ORBIT. Usually results from traumatism. Due to the abundance of fat, inflammation of the orbit spreads rapidly and always endangers the optic nerve and eyeball. It is usually diffi- cult to obtain proper drainage or to apply antiseptics to stop the progress of the inflammation. An attempt should be made, however, to secure drainage and keep the parts clean. TUMORS OF THE ORBIT. Infrequent. Sarcomas, carcinomas, epitheliomas and oste- omas have been noted in this region. It is usually necessary to enucleate the eyeball in order to remove them. Malig- nant tumors are apt to recur. PART XIII. HERNIA. Definition. The term hernia is applied to a protrusion of a portion of the abdominal contents through a normal or an abnormal opening in the abdominal wall. The larger number of hernias is found under the skin, the smaller through the diaphragm. Occurrence. Hernia is very frequent in the dog but rather rare in other small animals. General Remarks. Hernia may consist of a portion of the bowel (enterocele), a section of the omentum (epiplocele), or a combination of both (entero-epiplocele) ; further, a portion of the uterus may be protruded (metrocele), or the uterus and its ligamentous attachments (metro-mesometrocele) . Some of the other organs are occasionally found in the hernial sac, such as the liver (hepatocele), etc. In the dog it is possible to find almost any one of the organs of the abdominal cavity present in the hernial sac. The number and forms of hernia are quite varied. The following parts are distinguished in a hernia: (a) Hernial sac, (b) hernial ring, (c) hernial contents. (a) The hernial sac consists of the skin, subcutaneous cellular tissues, and in most cases the peritoneum. Some- times the peritoneum is ruptured and when this occurs the skin and subcutaneous tissues constitute the hernial sac. (6) The hernial ring is the opening through which the contents pass from the abdominal cavity. In recent hernias the ring is made up of the margins of the muscular tissue, and its size is determined by the rent in the abdominal wall. In 556 HERNIA old cases connective tissue elements form around the margins which results in a distinct, firm ring. Palpation of a hernia will often reveal a well defined, firm enlargement which will serve to differentiate recent from long standing cases. (c) The contents of a hernia are quite varied and will depend somewhat on its location. In most cases they consist of a portion of bowel, or omentum, or both. In a smaller number a portion of one of the other abdominal organs is present, such as the liver, stomach, spleen, uterus or bladder. When the contents fluctuate on palpation it may be due to the fluid content in the loop of bowel, or to serum which accumu- lates from a venous stagnation of the imprisoned contents. From a practical standpoint it is important to classify hernias into: (a) Reducible, and (6) irreducible. (a) Reducible hernias are those in which the contents can be readily replaced in the abdominal cavity. This may be done by manipulation, or is often accomplished by changing the position of the patient. Such hernias present certain characteristic symptoms: They are enlargements, usually appearing on some portion of the abdominal wall, non-inflam- matory (usually), easily replaced in the cavity, and the ring readily distinguished. It is possible in many cases to determine the character of the hernial contents by palpation. Adhesions will take place in some cases between the hernial sac and its contents which will interfere with complete reduc- tion of the enlargement. In this case, as soon as pressure is removed from the outside, the hernial contents will again reappear in the sac. Practically all reducible hernias return unless outside pressure is maintained. (6) Irreducible hernias are those which cannot be returned by manipulation to the abdominal cavity. This condition may be brought about by adhesions between the different parts of the hernia, by swelling around the hernial ring, or by strangulation with subsequent swelling of the hernial con- tents. When a loop of bowel is present in the hernial sac- strangulation frequently occurs from fecal matter accumu- lating and distending the prolapsed bowel. It is very impor- tant to distinguish between strangulated and non-strangu- lated hernias. The differentiation is made very definitely UMBILICAL HERNIA 557 by the symptoms shown by the patient and the local examina- tion of the hernia. Marked symptoms of pain, vomiting, and local inflammation indicate strangulation. During the secondary stages of its development the hernial sac becomes cold, doughy, and non-sensitive to the touch. Fecal fistulse (intestinal fistulse) occur in some cases from a sloughing of a portion of the intestine. Forms. The following are the most common hernias found in small animals: (a) Umbilical, (6) ventral, (c) inguinal, (>/) femoral, (e) diaphragmatic, and (/) perineal. Umbilical Hernia. Etiology. This form occurs either congenitally (usual) or a short time after birth. The hernial ring is formed by an improper closure of the umbilicus, or the fibrous organization being of insufficient strength allowing the abdominal contents to pass through. Occasionally umbilical hernia occurs accidentally in which case the peri- toneum forms the inner portion of the hernial sac. The hernial contents may consist of omentum, small or large intestines, or both. In most cases in puppies the sac contains only omentum. Symptoms. The presence of an enlargement at the umbili- cus which may be soft or firm, depending on the contents and local conditions. In most cases the contents can be readily returned to the abdominal cavity. Occasionally adhesions are present which prevent this. Strangulation is very rare in this hernia. Treatment. In puppies many cases disappear sponta- neously. Several methods of procedure in treatment have been recommended: (a) Pressure bandage, or adhesive tape, applied over the part for a few days has proved satisfactory in many cases. This method keeps the contents in the cavity, allowing time for fibrous -tissue organization to close the ring. (6) Operation. When adhesions are present or the ring is of considerable size, it is advisable to perform herniotomy. The animal is anesthetized, placed in a dorsal position on the table, the hair removed from the area and painted with tincture of iodin. An incision is made through the skin of sufficient length, dissecting the hernial contents from the 558 HERNIA adjacent tissues, if necessary, carefully so as to avoid injuring the bowel. Return the contents to the abdominal cavity. Remove a small portion of the hernial ring on either side making a fresh wound surface to facilitate union of the parts. Suture the wound and apply after-treatment as in laparotomy (see Laparotomy). Ventral Hernia. Definition. Ventral hernia is a term applied to a subcutaneous rupture of the abdominal muscles which permits the abdominal contents to pass through. This may occur at any point in the abdominal walls. The hernial sac consists of the peritoneum, subcutaneous tissue and the skin in the majority of cases. Sometimes the peri- toneum is also ruptured allowing the contents to lie immedi- ately under the skin. Etiology. The cause of ventral hernia is usually traumatic, or intra-abdominal pressure. In some instances when incomplete union of the abdominal muscles takes place following surgical operations, a hernia will develop. Symptoms. The sudden development of an enlargement appearing at some point in the abdominal wall. The size of the hernia will depend upon the extent of the rent in the abdominal muscles. Palpation of the enlargement will reveal a soft, fluctuating or elastic mass which can be reduced in most cases except when strangulated. When reduction is brought about the opening through the abdominal muscles can be easily determined and the margins of the hernial ring felt. Changing the position of the patient will bring about reduction except when adhesions are present or the parts strangulated. Unless the hernia is very recent or strangu- lated, there will be no inflammation nor pain present on manipulation. It is necessary to differentiate recent hernia from abscess. This can be done by careful palpation or by explorative operation. Some difficulty will be experienced in distinguishing between incarcerated hernia and tumors. However, the consistency, location and an explorative opera- tion if necessary, will serve to make the distinction. A strangulated ventral hernia will be characterized by symp- toms of inflammation, doughy consistency, pain on palpation and the general reaction of the patient. VENTRAL HERNIA 559 Treatment. After the examination has been made carefully to determine the exact conditions, then it is possible to decide on the method of procedure. Treatment in ventral hernia should be operative. There is very little danger providing the usual precautions are observed in opening the abdominal cavity. In ventral hernia without strangulation or incarceration the operation is performed as follows: The animal is given a laxative and fasted for twenty-four hours. The field of operation is shaved and an antiseptic pack applied for the same period. The animal is then given an anesthetic, preferably morphin, placed on the operating table in an advantageous position, the pack removed and the surface painted with tincture of iodin. A longitudinal incision is made immediately over the hernia through the skin and parallel to the rent in the abdominal wall. The hernial contents are returned to the abdominal cavity. It is advisable to open the hernial sac in order to determine the condition of the hernial contents. When they are found normal and no evidence of injury to the structures the hernial sac can be trimmed off with the scissors and the rent in the abdominal wall sutured. If the hernial ring indicates fibrous tissue formation, it is advisable to trim off the margins with a scissors or knife to produce a fresh wound surface for approximation. The abdominal wound is then closed as in laparotomy (see Laparotomy). In strangulated ventral hernia treatment should be attempted as early as possible. The same precautions should be observed as above and the contents examined to deter- mine the cause of the strangulation and the condition of the contents of the hernial sac. If the strangulation is produced by a constricted ring it should be enlarged with a probe- pointed knife sufficiently to allow the contents to be returned to the abdominal cavity. The wound in the wall is closed in the usual manner. If the hernial contents have been strangulated and retained until gangrenous then proper treatment should be employed. A section of bowel or omen- turn may be removed without difficulty and successfully when properly done. Adhesions when present should be 560 HERNIA carefully broken down to allow the contents to be returned. Some of these cases may present special problems, and there- fore a careful examination of the contents should always be made. The after-treatment would consist of keeping an antiseptic pack in contact with the wound for a few days until union takes place. There is a possibility of a recurrence of the condition if union of the abdominal wall is incomplete. Reoperation is recommended when this occurs. Inguinal Hernia. It is necessary to divide this form of hernia into two classes on account of the anatomical differ- ences in the female and male animal: 1. Inguinal hernia in the female, and 2. inguinal and scrotal hernia in the male. 1. Inguinal Hernia in the "Female. Etiology. A. very common form of hernia. The inguinal canal in the female is very short and the diameter usually greater than in the male animal. During pregnancy considerable strain is thrown upon these structures resulting in a hernia. It may result also from increased intra-abdominal pressure, from ascites, distention of the organs, or hypertrophy. Congenital inguinal hernia in the female has been observed. The hernial contents consist of the round ligament with peritoneum, or one or both cornua of the uterus. In a smaller number of cases other abdominal organs may be present. Symptoms. An enlargement appearing just posterior to the inguinal mammae* It varies in size from a small, rounded mass to one of sufficient proportions to reach the ground. The consistency of the hernia will depend on its contents, sometimes fluctuating, at other times firm. When the animal is pregnant the fetuses may be palpated in the hernial sac. The contents, if no adhesions are present, may be easily pushed back into the abdominal cavity and the hernial ring distinctly felt. Placing the dog in a dorsal position with the hind limbs elevated often will effect replacement. Further, there is no symptom of inflammation and the parts are non-sensitive on palpation. All enlargements appearing in this location should be examined from the standpoint of hernia as it is not always possible to reduce them and palpate the ring. INGUINAL AND SCROTAL HERNIA IN THE MALE 56,1 Treatment. Operation is advised in all cases. Herniotomy is performed in the following manner: The animal should be properly prepared by fasting and administration of a laxative twenty-four hours in advance. The operative field should be shaved and disinfected. Make an incision longitudinally over the enlargement through the skin and hernial sac. If no adhesions are present and the contents capable of being replaced this should be done at once. If adhesions are present preventing reduction they must be carefully broken down when the contents will return easily. Sometimes the bladder is encountered considerably distended with urine. If this is the case, introduce a trocar and draw off the urine which facilitates replacement. When the gravid uterus is found in the sac it will be necessary to remove the fetuses in the usual manner and return the cornua to the abdominal cavity. After reduction has been brought about the hernial sac should be ligated as close to the cavity as possible and removed, pushing the stump into the cavity. Suture the ring by inserting the sutures close together, keeping away from the pudic veins. The extra skin which will be present should be properly trimmed off with the scissors and sutured. An antiseptic pack is applied, renewed daily, and kept in position until union is complete. The external sutures should be removed when the wound is healed. 2. Inguinal and Scrotal Hernia in the Male. Etiology. Inguinal hernia is not as common in the male animal although it is met with occasionally. Dilatation of the inguinal canal from any cause will allow the intestines or omentum to pass through carrying a portion of the peritoneum with it forming an inguinal hernia. Scrotal hernia is far more common in the male animal. The hernial sac is formed by the processus vaginalis, and the contents consist of omentum or a loop of bowel protruding out into the scrotum in contact with the testicle. The hernia may be unilateral or bilateral. Symptoms. Inguma.1 hernia is characterized by an en- largement appearing to one side of the penis. It is usually soft, fluctuating, and reducible. The ring can be palpated in most cases, Occasionally some difficulty in diagnosis 36 562 HERNIA might be met with when adhesions are present. Explorative operation would be recommended. Scrotal hernia is recog- nized as an elongated enlargement in the scrotum. Palpa- tion will usually reveal the dilated canal and the contents can be easily returned to the abdominal cavity. Holding the animal up by the hind limbs often effects replacement. Differentiation should be made from other scrotal enlarge- ments. As a rule no particular difficulty will be encountered. Treatment. In inguinal hernia the operation would be practically the same as in the female. The same care should be exercised to avoid complications. Scrotal hernia may be operated in two w r ay s : (a) Inguinal operation, and (6) scrotal operation. (a) Inguinal Operation. Prepare the dog the same as in the female. Make an incision through the skin over the inguinal canal down upon the internal ring. Open the processus vaginalis and pull the bowel or omentum back into the abdominal cavity. Suture the internal ring but allow sufficient room for the spermatic cord and vessels. A certain amount of swelling will take place after the operation which should be considered when applying the sutures. This operation is especially advised when the male is to be kept in the stud. (6) Scrotal Operation. This operation is performed by opening the scrotum, removing the testicle, returning the omentum or bowel to the abdominal cavity, and suturing the external ring. Retaining sutures should be placed in the scrotum for a few days to avoid prolapsus of the bowel in case the other sutures tear out. Femoral Hernia. This form of hernia is not common in small animals. It has been observed in a few instances. It consists in a portion of the viscera, in most cases intestine with peritoneum, which passes through the femoral canal in close proximity to the femoral vessels. Symptoms. A soft enlargement is found on the inner part of the thigh which interferes with bringing the limb forward producing lameness. Unless strangulated there are no inflammatory symptoms. Any enlargement in this location should be suspected of being a femoral hernia. PEIUNEAL HERNIA 503 Treatment. It is possible to reduce femoral hernia by the usual hernia operation but care should be taken to avoid the large vessels in the immediate vicinity. Diaphragmatic Hernia. Definition. A hernia taking place through the diaphragm. It may be either congenital or acquired. This hernia is characterized by the passage of a portion of the abdominal viscera into the thoracic cavity either with or without the peritoneum. Etiology. Most cases of acquired diaphragmatic hernia occur as a result of violence in which the diaphragm ruptures allowing abdominal viscera to pass through the rent. Stran- gulation is rare. Symptoms. No symptoms are observed in most cases of congenital diaphragmatic hernia. In the acquired form the symptoms come on suddenly and consist of severe dyspnea, restlessness, pain, etc. The patient as a rule does not live but a short time. A few cases have been observed where the patients lived for several months showing dyspnea and marked circulatory disturbance. A diagnosis is in most cases difficult. Treatment. Xo treatment can be given. Perineal Hernia. Definition. A hernia appearing in both males and females and characterized by an enlargement on one or both sides of the anus. Etiology. The perineal tissue is easily ruptured or torn allowing some of the abdominal organs or omentum to pro- trude at the sides of the rectum. Perineal hernia is often observed in trick dogs which are required to walk a great deal on their hind legs. The unnatural position and the pressure of the abdominal organs no doubt lead to rupture of the perineal tissue. It may also result from strain from coprostasis, prostatic enlargement, -etc. Strangulation is rare in this form of hernia. In some cases torsion of the bladder accompanies it. Symptoms. This hernia is recognized as an enlargement appearing at one or both sides of the rectum. The majority of cases are unilateral. The anus is pushed to one side and often there is difficulty in defecation. In the female the enlargement is usually slightly lower than in the male. 564 HERNIA The consistency of the hernia will depend upon the con- tents. Perineal hernias are usually soft, easily reduced and the hernial ring readily palpated. Holding the patient up by the hind limbs often effects reduction. Should the bladder be in the hernial sac the patient will show dysuria and the enlargement feel cystic. A positive diagnosis can be made by puncturing the swelling w r ith a trocar and obtaining some of the contents. A differential diagnosis is necessary between the hernia and enlargement of the anal pouches. A careful examination will reveal the difference between them. Treatment. A careful consideration of the symptoms should be taken into account in order to determine definitely the conditions so that proper treatment can be applied. If the bladder is in the hernial sac replacement should be brought about as soon as possible. This may be done by carefully manipulating the parts, or if this fails open the hernial sac, empty the bladder with a fine trocar and push it back into the abdominal cavity. Insert the sutures rather deep in the tissues in order to effect deep adhesions. In the female, if the uterus is in the hernial sac, ventro- fixation is recommended. Many cases, when of ordinary size and no particular disturbance present, should not be treated. Castration is recommended when enlarged pros- tates are present. In some cases it may be necessary to remove the glands. Other hernias have been observed but they are so rare that no attempt will be made to describe them. PART XIV. INFECTIOUS DISEASES. CHAPTER I. ACUTE GENERAL INFECTIOUS DISEASES. DISTEMPER OF DOGS. Definition. An acute, infectious, communicable disease which in most cases affects young dogs. Occurrence. This is one of the most common diseases affecting dogs, and is known in every country where dogs are found. It is particularly a disease of young animals, the majority of dogs contracting it at some time during the first year of their lives. Whole litters of puppies, or all the animals in a kennel may become affected at one time. It occurs in districts as an enzootic. In cities it is more prevalent than in the open country. The season of the year has some influence on its prevalency and distribu- tion, the fall and winter months being most productive of the disease. Highly bred animals are more commonly affected than those bred by natural selection. Etiology. There seems to be considerable difference of opinion in regard to the exact etiology of dog distemper. Some claim it to be produced by a specific microorganism (Bronchosepticus canis, Torrey, Ferry, McGowan), while others think it is due to a filtrable virus. In each case evi- dence has been produced which seems to substantiate the claim made. Two distinctive factors are recognized from a clinical standpoint: (a) A primary infectious agent which .")<)(> ACUTE GENERAL INFECTIOUS DISEASES produces the marked initial symptoms of the disease. (6) Secondary organisms which produce many varied and serious complicating conditions. A large number of organisms have been isolated from animals affected with distemper, but so far they have proved to be simply secondary invaders. Natural Infection. Natural infection takes place in several ways. It may be either direct or indirect, the animals coming into immediate contact with each other, or through intermediary agents, the virus being taken into the digestive tract with the food or drink. There are a number of factors which tend to favor the development of the virus, such as influence of any kind which reduces the general resistance of the animal, in the way of poor food, insufficient food, colds, etc., or various diseased conditions interfering with the assimilation of food. Puppies with weak constitutions are especially susceptible. The develop- ment of the disease is ordinarily in animals from three months to one year of age. Older animals are very seldom att'ected and if so take the disease in a mild form. This may be explained by the immunity the dog possesses or by its having had the disease in a mild form. House dogs which have been pampered and petted, or those of the finer breeds are more susceptible, and usually take distemper in a more severe form. It has been determined quite conclusively that the specific virus produces an acute or peracute condition with a high temperature followed in a few days by secondary changes due to other bacteria resulting in various complications, such as occur in the skin (pustules), respiratory passages, digestive tract, nervous system, etc. Necropsy. Owing to the variety of forms of distemper in dogs the lesions found on examination are of many kinds, varying with the complications due to secondary infection. In peracute and acute cases there will be effusions of fluid from the serous membranes particularly in the pericardial sac, the thoracic and abdominal cavities. Small hemor- rhages are observed in some of the organs (heart, liver and kidneys). In most cases of distemper the lungs will be affected, either as a capillary bronchitis, congestion or DISTEMPER OF DOGS 567 bronchopneumonia. The pleura is usually congested and sometimes covered with fibrinous deposits. The intestinal tract shows marked changes, in most cases a catarrhal inflammation, which may be primarily in the stomach, or involving the entire tract. The glands in the mucosa are swollen. Erosions and ulcerations are fre- quently noted in the subacute or chronic forms. The lymph glands of the mesentery are enlarged and edematous. The liver is usually congested, or inflamed, frequently show- ing degenerative changes. The kidneys are enlarged, the capsule easily removed and the cortex markedly changed. The central nervous system is often involved and there will be found congestion of the membranes and the cortex of the brain. Small hemorrhages will be observed in some cases. Other pathological changes of a minor character are noted, such as conjunctivitis, keratitis and more rarely panophthalmitis. Pustules in the skin are common. Symptoms. There is quite a variation in the symptoma- tology depending upon the form which the disease takes. The most prominent manifestations are those of an infectious catarrh, involving the membranes of the eye, the respiratory and digestive systems. The catarrhal symptoms are often complicated with those of severe disturbance of the brain and cord, pustular eruptions on the skin, and very frequently bronchopneumonia. For clearness in the description of the symptoms it is best to consider them under the following headings, depending upon the part affected: 1. Initial Symptoms. The period of incubation is usually from three to five days. This period will vary consider- ably, depending upon various factors. Some few cases have been known to develop the disease in two to three days, while in others it required two to three weeks. The peracute type of distemper is ushered in by marked constitutional disturbances, such as great depression, fatigue, total loss of appetite, a very high temperature (106-107 F.) which in the course of several hours drops to normal, and later to sub- normal. This form of the disease takes a very rapid course, the animal soon passing into a comatose state. 568 ACUTE GENERAL INFECTIOUS DISEASES The acute form usually begins with a rather high tem- perature (103-106 F.) and remains elevated for several days or weeks. Some cases show a marked variation in temperature, beginning with a high temperature which in a few days drops to normal or in some cases subnormal where it remains until either recovery or death takes place. In some cases due to complications the fever is remittent. The owner w r ill notice in the inception of the disease a change in the disposition of the animal. Instead of being lively it will be stupid, does not answer the call or obey commands given it. The hair coat becomes rough, quickly loses its gloss and the animal in general shows a dejected appearance. On examination of the nose, it will be found hot and dry; the mucosa becoming irritated induces rather violent sneezing. After one or two days more pronounced symptoms make their appearance. 2. Symptoms Shown by the Eyes. In a -large number of cases conjunctivitis is a prominent symptom. In the early stages it begins as a serous conjunctivitis, which soon becomes purulent from secondary infection. The discharge from the eyes consists of a thick mucus, or whitish or yellow- ish pus. This discharge is usually found collecting chiefly at the inner canthus of the eye, soiling the edges of the eyelids, or from the exudate drying, crusts form causing the eyelids to adhere. Usually in a few days lesions and ulcers appear on the cornea as a result of the irritant exudate, the patient rubbing its eyes or pawing them with the forefeet, or by the swelling which interferes with local nutrition. These ulcers are usually small, pin-point, funnel-shaped and extend downward in a straight direction; their base usually covered with a pus-like material. They heal by a prolifera- tion of vessels from the edges of the cornea. In some cases the ulceration leads to partial perforation of the cornea, with a protrusion of the Descemet's membrane, prolapsus of the iris (staphyloma). The resulting cicatrization causes permanent white spots on the cornea (leukoma). In other cases the entire cornea becomes opaque (parenchymatous keratitis) which gives the eyes the appearance of ground glass. Rarely does the entire eyeball become inflamed DISTEMPER OF DOGS 569 (panophthalmitis). Opacity of the cornea in a number of cases remains for weeks and even months. 3. Symptoms Shoicn by the Digestive Tract. Vomiting is an early symptom in a large number of cases. The vomitus often consists of particles of food, frothy mucus stained with bile in cases where the vomiting is persistent. The mucous membrane of the mouth is hot,, dry and congested. The animal drinks freely indicating the involvement of the mucosa of the stomach and bowels. Constipation is invariably the rule during the early stages of the disease, followed by diarrhea in the course of a day or so. The f eces in the latter case are very fetid, often shiny, frothy and even bloody indicating hemorrhagic intestinal catarrh. The intensity of the gastro-intestinal symptoms varies from mild catarrh to a severe hemorrhagic gastro-enteritis. Symptoms of icterus are present in some cases due to the catarrhal duodenitis (catarrhal icterus). 4. Symptoms in the Respiratory Tract. During the early stages of the disease the nose becomes dry and hot. There is nasal discharge which is at first serous but later thicker and mucopurulent in character. During the early stages there is much sneezing and sniffling due to the attending rhinitis. The dog shows much distress and makes frequent attempts to clear the nasal passages by sudden expiratory efforts, rubbing the nose against objects and clawing at the nasal openings with the forepaw r s. The discharge accu- mulates around the nasal openings in the form of crusts; when these are removed the skin and mucosa often show excoriations. In severe cases the discharge is often so copious that the nostrils will be found partially or completely occluded. Catarrh of the larynx is nearly always associated with this condition and is manifested by a cough, which usually occurs in paroxysms; it is at first dry and harsh, and later becomes moist and considerable mucus is coughed up, which is immediately swallowed by the animal. These paroxysms of coughing frequently end in gagging and vomiting. The catarrhal inflammation spreads quite rapidly to the trachea and bronchi. The resulting bronchitis causes a cough, which 570 ACUTE GENERAL INFECTIOUS DISEASES is deep and explosive. The respirations are accelerated. Auscultation reveals coarse, sharp vesicular murmurs, and rhonchi. As the inflammation proceeds it involves the bronchioli (capillary bronchitis) which produces increased, labored respirations. At this stage there is usually a feeble harassing cough, most noticeable when the dog is made to move, or if the thorax is manipulated. The auscultatory sounds become increased, and there will be noted dry or moist, crackling, or fine rales. In very weak, or young dogs, in which the exudation accumulates in the bronchioli, it is very sure to produce a bronchopneumonia on account of the secretions being drawn into the alveoli. The result- ing pneumonia will be recognized by: (a) The great increase in the temperature; (6) the excessive dyspnea (inflation of cheeks at each expiration) ; (c) the sitting posture of animals with elbows spread apart to facilitate respiration; (d) irregu- lar vesicular murmur; (e) irregular dulness and tympany on percussion; (/) the bronchial breathing which w r ill be audible. The cough at this stage becomes very dull and weak. The nasal discharge becomes very fetid, and often has a greenish cast. During the last stages as the heart becomes w r eak, symptoms of edema of the lungs appear in the form of severe dyspnea, and bubbling rhonchi. o. Symptoms Shown by the Nervous System. This disease in practically all cases is accompanied by some nervous phenomena. It often begins, especially in weak individuals, with marked dulness and depression. These symptoms may be all that the animal will show. However, in a great many cases, the nervous symptoms develop early in the course of the disease, and are manifested by excitement, restlessness, yelping, cries, even simulating some of the symptoms of furious rabies. In many instances tremors of muscles, tonic and clonic spasms, which mpy involve certain groups of muscles or the entire muscular system are observed. Local spasms and twitchings of the muscles are frequently observed involving the muscles of the face, over the region of the head and neck. The masseter muscles are frequently affected, resulting in chattering teeth and foaming at the mouth. Spasms of the muscles of the neck DISTEMPER OF DOGS 571 and limbs cause regular or irregular movement of the head or limbs. These movements may be present constantly or periodically. Convulsive contractions of certain groups of muscles are frequently observed, in which the animal at first becomes restless, excited, runs aimlessly about, is sud- denly seized by tonic and clonic spasms, the head and neck usually drawn backward, falls down as if from epilepsy, barks, cries and becomes unconscious with relaxation of the sphincter muscles. In some cases the animal will die during these convulsions; in others there is a gradual return to consciousness and in one or two minutes the animal is able to rise. Some cases pass into a long-continued state of coma. These convulsive seizures may become less fre- quent, and entirely disappear; or they may terminate in partial or complete paralysis. Paralysis is a very common sequel to this disease. It very rarely begins at the onset of the disease, but appears in most cases during the latter period. The paralysis may be confined to certain groups of muscles, in fact the posterior limbs are most often aft'ected. The paralysis of the sphincter muscles is a very frequent sequel. Some cases begin with a paralysis of the posterior limbs, and result subsequently in complete recovery, while others show a progressive ascending paralysis, resulting in death from general paralysis. Various paralytic compli- cations are often observed following the nervous form of distemper, such as deafness, amaurosis, hemiplegia laryngis, aphasia, loss of sense of smell, hydrocephalus, etc. o'. Symptoms Shown by the Skin. In a large number of cases there will be noted a characteristic pustular exanthema. Small, red spots appear along on the abdomen, on the inner surface of the thighs, occasionally on the skin of the face, around the eyes and on the internal surface of the external ear. In twenty-four to thirty-six hours these red spots are transformed into miliary nodules, each surrounded by a red ring. These nodules change very rapidly into vesicles which become infected to form pustules. The pustules vary but are usually the size of a pea. They dry up either into a yellow, brown crust, or rupture and leave reddened, moist places to become covered later by a scab. When the 572 ACUTE GENERAL INFECTIOUS DISEASES pustular eruption becomes extensive the body gives off a peculiar, offensive, sweetish odor. Healing of the pustules takes place usually in about six to eight days, leaving bright pigmented, reddish spots, which remain for several weeks. In some cases the pustular form of distemper may spread, the pustules become confluent, forming a scabby eczema, which may be localized around the eyes, over the abdomen, or thighs, or it may be general over the entire body. Com- plications, such as septicemia and septicopyemia develop occasionally from this form of the disease. When the pustular eruption forms around the margin of the lips, it often spreads rapidly to the mucosa producing a severe gangrenous stomatitis. Involvement of the external ear in the form of an otitis is observed in a large number of cases. This is characterized by a thin fluid secretion, which accumulates on the surface of the ear, dries and forms a yellowish-brown crust or scales. 7. General -Symptoms. The initial high temperature is usually followed by a remittent or subnormal temperature. Some cases do not show much abnormality in temperature. Normal temperature in this disease, when other marked symptoms are present, does not always indicate a favorable termination. As the disease progresses the animal becomes emaciated, weak, and the action of the heart is more or less disturbed, depending upon the severity of the case. The mucous membranes are pale, the patient becomes very weak, staggers or retains a recumbent position. Diagnosis. During the early stages of distemper it pre- sents some difficulty. It becomes necessary to decide whether we have distemper to deal with, or the beginning of some other condition, such as catarrhal inflammation of the eyes, nose, lungs, stomach or bowels. An accurate diagnosis cannot always be made during the early stages of the disease. Just as soon, however, as there appear symp- toms of general depression, high temperature, the implica- tion of several organs, especially in a young dog, distemper should be suspected. Should skin pustules be present they will assist materially in making the diagnosis. In catarrhal inflammation of the bowels there is usually DISTEMPER OF DOGS 573 very little rise in temperature, and catarrhal symptoms of the eyes, nose, etc., fail. The symptoms of cerebral irri- tation sometimes found in distemper make it necessary to differentiate it from rabies. The characteristic aggressive tendency of animals with rabies, the change in the 'voice, the facial expression, and the absence of catarrhal symptoms usually make the differentiation easy. The eruption on the skin might be confused with mange, but negative results on microscopic examination would at once show the difference. There should be but little difficulty experienced in differ- entiating it from eczema as the lesions and their location differ and the other symptoms of distemper usually present. The convulsions occurring in the nervous form of distemper are distinguished from those of epilepsy by the acute char- acter, occurring at frequent intervals, and the local muscular twitchings, which occur even between the convulsive attacks. Prognosis. The prognosis is not favorable, even in the milder forms of the disease. Owing to the variety of forms the disease assumes, and the frequent complications, the mortality is high, amounting to approximately 50 per cent. The prognosis depends to a certain extent upon the type of the disease, and whether or not the animal is strong and vigorous. The purely exanthematous form is most favor- able. If the disease confines itself to this form the majority of the cases will completely recover in two to three weeks. The catarrhal forms, involving the respiratory or digestive systems, are less favorable owing to serious complications which attend them. The highest mortality occurs when the nervous system is involved. When severe nervous phenomena are present the prognosis is bad, only 5 to 10 per cent, recovering. Where there is a continuous, high temperature the prog- nosis is not favorable as there is danger of heart compli- cations. A rapid fall in temperature to below normal is also a grave sign; in most cases it indicates the approach of death. Treatment. Dietetic. It is very essential in distemper to supply the patient with easily digested, nourishing food. Perhaps the best food is raw meat chopped fine, or scraped 574 ACUTE GENERAL INFECTIOUS DISEASES into a pulp. Patients will be tempted by this food when they will not eat anything else. In cases where the appe- tite is lost, and in order to maintain the animal's strength, beef broth is most excellent. This may be given with warm milk, or milk with an egg beaten up in it. Other foodstuffs may be given, depending upon the progress of the case, and the needs of the patient. In the digestive form of the disease only small amounts of liquid foods should be given via the mouth. Rectal feeding with warm milk and meat broth is recommended in these cases. Hygienic. The animal must be well protected from expos- ure to extremes in temperature, or cold draughts of air. They should be placed in a clean, moderately warm well- ventilated room. The bedding should be kept clean at all times. Supply plenty of fresh water. Medical. Owing to the various complications the medical treatment must be essentially symptomatic. During the early stages of the disease calomal (0.075-0.10) is recom- mended as a purgative and bowel disinfectant. This dose may be repeated in twenty-four hours if necessary. To overcome the general depression, which is an early symptom, nerve stimulants, alcohol, aromatic spirits ammonia, mix vomica tincture (0.4-0.7), anyone of which should be given well diluted, and repeated as the case demands. As an abortive treatment subcutaneous injections of^trichlorid of iodin (3 or 4 times daily, 2-4 c.c. of a solution of 1-1000) have been used with very good results. This treatment when given early in the course of the disease has a very beneficial effect in regulating the temperature. The patients seem brighter, and the catarrhal symptoms diminished. The injections should be made at different points owing to the danger of skin necrosis. Further medical treatment will vary depending upon the part affected. (a) When the disease involves the eyes, they should be washed with an antiseptic once or twice daily, boric acid (2 per cent.), creolin (1.5 per cent.), to prevent undue injury to the cornea and other structures from the infection. In obstinate cases with excessive pus formation and dis- charge, silver nitrate solution (0.5 to 1 per cent.) has been found very efficacious. When there is extensive parenchy- DISTEMPER OF DOGS 575 mat ous keratitis solution of stovain (1 to 2 per cent.) is useful to prevent irritation and subsequent injury to the eyes from rubbing them against objects, or with the paws. Opacities of the cornea when of some standing may be treated with a silver nitrate solution (2 per cent.), followed by a normal salt solution as a wash, or succus cineraria maratima compositus (0.4-0.7) dropped into the eye daily. This latter preparation has proved to be of great value in the eye complications of distemper. (6) The respiratory system should be treated by remov- ing the secretions from the nasal openings, spraying the nasal passages with creolin (2 per cent.), or silver nitrate solution (0.25 per cent.). Warm vapors, such as steam, or solutions containing alkalies (bicarbonate of sodium) given as inhalations are highly recommended. When there is a painful, dry, harsh cough the following formula is very beneficial : If Morphinii sulphatis 0.15 Aqua amygdalae amarte 12.00 Aqua dest 150.00 Misce et fiat solutio. Sig. Give teaspoonful once or twice daily. Iii the presence of profuse secretions, sedatives are contra- indicated. Instead ammonium chlorid (0.1-0.5) is given as an expectorant twice daily to dissolve the mucus and other secretions. If symptoms of pneumonia are present, counter- irritation to the thoracic walls with oil of mustard and glycerin (1-20). Heart stimulants are also advised. (See Treatment of Bronchopneumonia.) (c) The digestive complications are treated according to the conditions found. If the animal is constipated it should be relieved by the administration of a purgative; if severe diarrhea is present the irritating bowel contents are first removed by a laxative followed by astringents and sedatives. The following formula will be found beneficial in the latter condition: If Tinctune opii 10.0 Gummii acacia? 8.0 Aqua? fceniculi 250.0 Misce et fiat solutio. Sig. Give teaspoonful two or three times daily. 57<> ACUTE GENERAL INFECTIOUS DISEASES As a bowel disinfectant use small doses of salol (0.2-0.5) twice daily. If vomiting is persistent it must be controlled with cold \vater containing soda (2 per cent.), salicylate of bismuth (0.3), or in extreme cases by small doses of opium (0.05-0.15). (d) For the stimulation of the digestion small doses of hydrochloric acid (0.1-0.5) diluted in water and pepsin (0.075-0.5) is the best treatment. It is advisable to stimu- late the mucosa further with tincture of gentian (0.05-0.9), or tincture of nux vomica (0.4-0.7) given once daily. Fluid extract of echinacese (0.5-1.0) is also used. (e) When nervous symptoms are present, it is important that they be controlled by anodynes and sedatives (mor- phin 0.03-0.09, or sodium or potassium bromid 1-150 in water) given in teaspoonful doses four to six times daily. Some cases, when spasms and convulsions are severe, will require maximum doses to control them. When paralysis is present, electricity is highly recommended, also strychnin (0.001) once or twice daily. Subcutaneous injections of veratrin (0.01-0.05) are sometimes used. (/) The temperature in this disease is rarely treated, and only in exceptional cases where a very high temperature remains for several days and threatens to become dangerous to the heart, would it be advisable to use antipyretics. Phenacetin, acetanilid (0.25-0.50) may be used for this purpose. (g) In the skin form, when pustules are present, they should be opened, and washed with creolin (2 per cent.). For the exanthema the skin should be washed with an anti- septic soap (germicidal, or far soap), dried, and a drying powder or zinc oxid ointment applied. The latter is prefer- able. Sera and Vaccines. This disease has been treated quite extensively during the past two or three years with vaccines and sera. Good results have been obtained by their use by some, others have reported less favorably. The great advantage no doubt in the use of these preparations is to control the secondary infection which produces the com- plicating conditions. Varying degrees of immunity have been claimed by the use of vaccines. DISTEMPER OF CATS 577 Prevention. Animals with distemper should be isolated and kept from healthy young dogs. Thorough disinfection of all utensils, bedding, rooms, etc., should be attended to promptly. Preventive inoculation has proved of value in a large number of cases and is highly recommended. DISTEMPER OF CATS. Definition. An acute contagio-infectious disease found more commonly in young cats. Older animals are less often affected, probably due to either an acquired immunity (hav- ing had the disease in a mild form) or to a greater natural resistance against the infection. The disease in cats is not nearly so common as in dogs. Etiology. According to the best information obtainable it is produced by the same causes as canine distemper. Pathology. The pathological lesions are principally those found in canine distemper, except that the disease seems to be confined mainly to the respiratory and digestive tracts. -In the respiratory form there is an inflammation involving the nasal passages (rhinitis), larynx (laryngitis), the bronchi and bronchioli (capillary bronchitis), and the lungs (bronchopneumonia) . The digestive tract shows catarrhal inflammation. The mucosa is covered with a heavy mucous exudate which in some cases is mixed with blood (hernorrhagic catarrhal gastro-enteritis) . Some of the other organs (kidneys, liver and heart) show degenerative changes. Symptoms. The initial symptoms are those of inappe- tence, depression, vomiting in some cases and moderately high temperature (103-104 F.). When the respiratory passages are primarily affected the animal will sneeze fre- quently, there is a discharge from the nose which is at first thin, but later becomes thicker and glutinous. This will collect around the nasal openings and in some cases occlude them completely. Conjunctivitis is a very prominent symptom. At first the discharge is serous, but later it becomes mucopurulent. 37 578 ACUTE GENERAL INFECTIOUS DISEASES The cornea often presents the characteristic changes noted in dog distemper. The bowel form is observed frequently, and is characterized by vomiting, abdominal pain and later severe diarrhea. The animal becomes emaciated, there is marked weakness and' a fall i,n temperature, which often becomes subnormal. Convulsions and other nervous phe- nomena are not commonly observed. Diagnosis. The diagnosis depends upon the existence of catarrhal symptoms involving the eyes and nose, the tem- perature and the rapid emaciation and weakness. A differential diagnosis should be made from hemorrhagic septicemia. In this disease no catarrhal symptoms are present, as a rule, but there is marked gastro-enteritis, and the course is peracute. The mortality in hemorrhagic septicemia is much higher. Prognosis. The prognosis is bad. The mortality, how- ever, is lower in cats than in dogs. The catarrhal form involving the eyes, nasal passages and lungs is more favorable than the bowel form. Treatment. Hygienic. The animal should be kept in a moderately warm place, free from draughts of air. The room should be well ventilated, and every precaution taken to prevent unnecessary exposure. Dietetic. The appetite can be tempted by offering small amounts of fresh lean meat, or liver at frequent intervals. Milk should be allowed in small quantities.- In case the animal refuses food, it is advisable to give small quantities of beef broth, or warm milk to maintain strength. Medical. A laxative is given at the onset of the disease (castor oil 4.0-12.0, or sulphur in milk 1.0-2.0). The eyes should be cleansed daily with boric acid solution (2 per cent.) to control the blennorrhea. The nasal passages can be cleansed with a similar antiseptic solution. Small doses of opium (tincture of opium 0.10-0.15) are often beneficial in preventing the spread of the inflammation in the stomach and bowels and to control the diarrhea. Sulphocarbolate tablets are to be recommended as a bowel disinfectant (0.1-0.2). When pneumonia threatens inhalations of warm medicated solutions are valuable. Atropin sulphate (0.003) TYPHUS OF DOGS 579 is useful to sustain the heart action. Good care and nour- ishing food plays a very important role in the treatment of cat distemper. TYPHUS OF DOGS. Canine Typhus. Hemorrhagic Castro-enteritis. Dog Plague. Black Tongue. Definition. An acute, infectious disease occurring in an epizootic form, characterized by a severe gastro-enteritis, stomatitis, and in some cases severe nervous symptoms. Occurrence. During the past few years this disease has appeared as an epizootic in various sections of the United States, producing extensive losses, particularly in old dogs. In some districts it has made the breeding and handling of dogs prohibitive. The disease has been disseminated by dog shows, and follows in the wake of such exhibitions. Etiology. The nature of the disease indicates that it is produced by some specific infection. I p to the present time the infectious agent has not been isolated. Experi- mental inoculations with various organisms, which have been isolated, have not proved that any of them are con- stant in reproducing the disease in healthy animals. In a number of outbreaks in this country, old dogs were as com- monly affected as young. Further, dogs which have had distemper severely come down with this disease in a severe form. The breed, or sex of the animal seems to have noth- ing to do with its susceptibility. The infectious agent is probably taken in with the food or drink. The disease is spread by cohabitation, or by the infection being carried by intermediate agents. The period of incubation is from three to five days. Pathology. The autopsy in this disease presents a rather constant picture. The digestive tract is mainly involved. The mucosa of the mouth is often inflamed; ulcers are found in a number of cases, particularly noticeable along the margin of gums. In some cases extensive necrosis of the buccal mucosa is found. The tongue is frequently thick- 580 ACUTE GENERAL INFECTIOUS DISEASES ened, swollen and dark red or bluish in color. In the stomach the lesions are very prominent, and consist of an intense inflammatory condition. The mucosa is dark red, or almost black, corrugated and at the apex of the corru- gations the membrane is eroded. Hemorrhages take place in the membrane and give it a more or less mottled appearance. Some cases present extensive hemorrhages over the entire membrane. The surface of the mucosa is covered by a mucus of a dark brown, or chocolate color, which can be readily scraped off. The contents of the stomach have a peculiar offensive odor. The intestines show similar changes, but in most cases not_ so extensive. The cecum and small intestines show the most prominent lesions. The peritoneum covering the bowels is congested and the mesenteric lymph glands are enlarged. The spleen is often much enlarged and shows evidence of acute inflammation. The liver and some of the other organs are hyperemic. The lungs in most cases do not show much on examination. They are usually slightly congested, and edematous. The heart is pale in color and very friable. The brain and its membranes may be markedly hyperemic, or show but slight change. The lesions found on autopsy are indicative of a more or less intense gastro-enteritis. Symptoms. The initial symptom, which is quite constant, is a very persistent vomiting. The vomitus at first con- sists of food particles; later mostly mucus mixed with blood and bile. The attacks of vomiting often begin without any previous indication of illness, and suddenly become very severe, producing in a short time marked weakness and prostration. The appetite is lost; there is rapid exhaustion and staggering gait. The progress of the disease is quite rapid. Frequently in one to three days it has reached its characteristic form. Examination of the mouth reveals more or less extensive lesions of the mucous membrane. Along the margin of the gums will be noticed degenerative or necrotic changes, ulcers and at the margins of the lips there will be present the characteristic chocolate-colored discharge. The tongue will be affected; it is sometimes partially or TYPHUS OF DOGS 581 completely paraly/ed, swollen and of darkbluish color. A very unpleasant, peculiar odor is emitted from the mouth. As the disease progresses, the degenerative and necrotic processes continue until in many cases the ulcers become confluent, forming extensive ulcerative surfaces. The tongue usually in the later stages is dry, chapped, loses its sensitive- ness, and becomes necrotic or gangrenous. Necrosis of the lip is observed in some cases, usually most prominent at the commissures of the mouth. Palpation over the region of the stomach, which often induces vomiting, produces marked pain. Manipulation of the bowels is also painful in most cases. Constipation is present during the early period of the disease to be followed later by diarrhea. The dis- charges from the bowels are mixed or streaked with blood, and emit a very offensive odor. The mucous membrane of the rectum is inflamed and shows degenerative changes. The conjunctiva shows similar discoloration to that of the mouth (brownish-red), strongly injected, but the absence of a purulent discharge. The temperature does not rise, as a rule, at any stage of the disease. With the appearance of depression and coma the temperature falls rapidly to subnormal, the rule in this disease. There is no cough and in most cases no indication of lung involvement until the later stages of the disease, when in some cases acute edema, or a foreign body pneumonia producing dyspnea develops. The urinary secretion is nearly always dimin- ished or suppressed. Nervous symptoms of excitement and convulsions are occasionally observed, but in most cases somnolence, lassitude and coma are characteristic. Modi- fication of these symptoms may be found, depending upon the severity of the condition. Diagnosis. There are some very characteristic symp- toms which materially assist in establishing a diagnosis the sudden and persistent vomiting, the inappetence, the presence of ulcerations on the mucous membranes of the mouth, the great depression, the character of the vomitus, the characteristic injection of the conjunctiva, and the normal or subnormal temperature. A differential diagnosis must be made from canine distemper. In canine distemper 5X2 ACUTE GENERAL INFECTIOUS DISEASES there are invariably present the characteristic catarrhal symptoms involving the eyes and nasal passages. The period of incubation is usually longer in distemper, five to nine days. Further, distemper is more common in young animals, and the course of the disease is acute. This disease must also be differentiated from ptomain and other poison- ings. In some cases this is quite difficult, owing to the close similarity of the symptoms, gastro-enteritis appearing in both conditions. The necrosis of the membranes and ulcers are absent in ptomain poisoning, and in the majority of mineral poisonings. The development of the disease is different from ptomain, or other poisonings. Canine typhus usually appears as an epizootic which would assist in estab- lishing a diagnosis. Differentiation between this disease and ulcerative stomatitis should present no great difficulties. The absence of the general depression, vomiting and gastro- enteritis in ulcerative stomatitis is indicative. Scorbutus develops slowly, and is attended by neither vomiting nor general symptoms. Course. The average duration of the disease is four to six days; in milder cases often twelve to fourteen days. A few cases run a much more rapid course followed by death in one to three days. At the beginning of an outbreak it seems to run a more rapid course than later. Prognosis. The prognosis is unfavorable; the mortality from 50 to 75 per cent. Young animals suffer less severely than older ones. When the disease develops gradually, indicating low virulence of the infection, or high resistance on the part of the animal, the prognosis is more favorable; on the other hand when the development of the disease is rapid and the symptoms prominent, the outlook is grave. In some cases recovery takes place quite rapidly, and when this does occur there is usually no complication, and even the ulcerative processes disappear completely. Treatment. Dietetic. During the early stages of the dis- ease, no food should be given. After the acute symptoms have begun to subside and the animal reaches the con- valescent stage, nutritious food can be allowed. Meat broth would be most applicable as the sensitive mucous 1' I 'KITH A HEMORRHAGICA OF DOGS 583 membrane of the stomach would not retain solid food. Later small amounts of meat chopped fine could be given. Should it be impossible for the animal to retain food in the stomach, rectal feeding is advisable, using concentrated meat broth warmed to the body temperature. This should be injected high up in the rectum, small amounts given every three or four hours. Medical. At the onset of the disease, when vomiting is severe and persistent, it would be best to wash the stomach with sodium bicarbonate solution (2 per cent.). This may be repeated in ten to twelve hours. To allay vomiting, sedatives (morphin subcutaneously, 0.016-0.12), or small amounts of cold water at frequent intervals are useful. Hot packs applied to the epigastrium are beneficial. Rectal injections of warm water, or even washing the entire ali- mentary tract with sodium bicarbonate solution (2 per cent.) when diarrhea is present, will remove irritating material and infection. In obstipation, warm rectal infusions may be used in preference to laxatives or purgatives. Ichthargan has been highly recommended for typhus in the following formula: F$ lohthargan, Gummi arabicae aa 20.0 AqucD chloroformi 60.0 Misce et fiat mist. Sig. Give teaspoonful every three or four hours. Stimulants (atropin sulphate, 0.075-0.15 subcutaneously) to sustain the heart action and to overcome the general depression would be advised. The mucous membrane of the mouth should be washed at least twice daily with boric acid solution (2 per cent.); potassium permanganate (0.25 per cent.), or therapogen (2 per cent.). The animal should be well protected in a quiet place. In a great many cases the treatment has proved unsatisfactory owing to the per- acute course it often assumes. PURPURA HEMORRHAGICA OF DOGS. This disease has been observed in dogs, but as it is very rare it will not be described here. (See other works.) 584 ACUTE GENERAL INFECTIOUS DISEASES FOWL CHOLERA. Cholera Gallinarum. Pasteur ellosis Avium. Fowl Typhoid. Definition. This is an acute contagious disease of fowls, usually occurring in an epizootic form, and affecting par- ticularly chickens, geese, pigeons, ducks, quail, sparrows and pheasants. It is characterized by a general infection, and the prominent symptom of diarrhea. Occurrence. Fowl cholera is found in most sections of the United States, causing extensive losses to poultrymen. The finer breeds of fowls seem to be more susceptible to infection, probably because of exposure to the disease at poultry shows and other public exhibitions. It occurs as an epizootic, sometimes destroying entire flocks. The losses are serious from an economic standpoint. The monetary loss, which is great when a large number of birds die; the loss in egg production, and the interference with breeding operations make fowl cholera a formidable disease. The disease often spreads over a large area, producing enormous losses. Etiology. It is produced by the Bacillus avisepticus (bipo- laris). This bacillus is one of the smallest bipolar organisms. Pathogenesis. The transmission of the disease from one bird to another is very easy. Directly inoculating the blood from a sick fowl to a healthy one by scarifying the skin or membranes, produces the disease in practically every attempt. Subcutaneous and intramuscular inocu- lations bring similar results. Inoculations with the infected blood of any of the birds into other species will produce the disease. Instillation of the infection into the con- junctival sac of fowls produces the disease. Feeding infected meat to other fowls, or cultures of the organism will in the majority of cases result in the bird coming down with the disease. Other animals guinea pigs, mice and rats are susceptible to the disease by inoculation with FOWL 'CHOLERA 585 the infected blood or with cultures of the organism. Some of the domesticated animals are susceptible to intravenous injections of highly virulent cultures of the organism. The disease is not produced in dogs, cats or hogs from eating the infected meat of fowls. The virulence of the organism may be increased by repeatedly passing it through chickens, guinea pigs, pigeons or sparrows. The organism may be attenuated by subjecting it to sunlight, drying and exposure to the air. The attenuation may be sufficient to prevent further spread of the disease. Natural Infection. Natural infection may take place in numerous ways: (a) The droppings of fowls contaminate the feed and water given other fowls and the infection is thus introduced immediately into the digestive tract. (6) In most cases the flock is infected through newly acquired cholera-sick birds, or birds returned from shows or exhibitions where they have been in contact with the infection. (c) Pigeons and sparrows play an important part in the dissemination of cholera, by carrying the infection from flock to flock. This accounts for isolated outbreaks of the disease where no exchange of birds has taken place. (d) The infection is frequently carried on clothing, shoes and other objects. (e) It may be spread by carelessness in disinfecting cars in which cases have been transported. This has proved to be the source of infection in a number of instances. (/) Eggs have been the carriers of the infection in some few cases reported. The infection in most cases is taken directly in the digestive tract with the food or drink. The bacilli pene- trate the mucous membrane and enter the lymph spaces of the walls of the intestines. They are soon taken into the circulation where they multiply very rapidly. In some cases when the infection is introduced into wounds it is taken into the circulation more promptly, and consequently the course of the disease is more rapid. Death results in these cases no doubt from the large amount of toxins formed. .~>X() ACUTE GENERAL INFECTIOUS DISEASES Pathology. The most pronounced pathological changes are found in the intestines, heart and lungs. In the acute form the following lesions are found: (a) The intestines show marked pathological changes. The mucous membrane throughout the entire tract is highly congested and covered in numerous places with darker areas. The intestines contain a thin, watery, frothy, mucopurulent and yellow exudate often mixed with blood and bile giving them a dark greenish tinge. Defects in the mucosa are often present, the apex of the intestinal villi are often eroded, and in some cases croupous exudate is present, in others ulceration. All of these changes in the mucosa may be observed in the same case. The mucous membranes of the pharynx, crop, colon and rectum show the most pronounced lesions. The mesenteric lymph glands are nearly always enlarged, edematous and show numerous petechiae. (b) The heart shows, as a rule, distinctive changes. It is covered with small, dark red, pin-point dots, and the bloodvessels congested. The epicardium is often covered by a fine fibrinous membrane. The pericardial fluid is nearly always cloudy, containing some fibrinous flakes. In the peracute form of the disease these changes are not so prominent. (c) The lungs are found congested, thickened, dark red in color, very heavy (hepatized); the milder type will show congestion and edema. In the subacute form fibrinous pleuritis is frequently noted. The larynx, trachea and bronchi show congestion and reddening (catarrh). Some of the other organs (spleen, liver, kidneys) show parenchy- matous degeneration. In the subacute and chronic cases the lesions are caseous foci in the lungs, liver, on the mucosa of the intestine and occasionally on the epi- and endo- cardium. Fibrinous pleuritis is frequent in the chronic form. The joints of the limbs are often involved, showing exudation and more or less marked arthritis. The mus- culature in the chronic form will be grayish in color and flabby. FOWL CHOLERA 587 Symptoms. The period of incubation varies somewhat, no doubt due to the mode and virulency of the infection. It is usually one to four days; occasionally longer, four to seven days. Fowl cholera is characterized by its sudden onset and the rapidity of its course. When it first appears in a flock, birds will drop dead apoplectically without show- ing symptoms. They may be found dead beneath the roost, or on the nest. Some of them when attempting to walk or fly will drop suddenly and die after a brief struggle. After the disease has been in a flock for a few days, the less sus- ceptible will show some marked symptoms. The birds lose their appetite, become weak and greatly depressed. The wings are usually pendent, the neck curved and the head pulled downward. The entire plumage becomes ruffled and the birds walk with a weak, staggering gait. The temperature is elevated 2 to 4 F. above normal. Diarrhea, accompanied by intense thirst, becomes a prominent symp- tom. The droppings are at first of a yellowish-gray color, later becoming very thin, watery, fetid, of a greenish cast or dark green. The feathers around the cloaca become soiled and matted with the bowel discharge. Marked dyspnea sets in, the bird opening and closing its mouth during respirations; wheezing and rhonchi are frequently heard. The comb and wattles are dark bluish (cyanotic). The bird finally becomes very weak, staggers about, falls down, and dies in coma or convulsions. In the chronic form of the disease the course is much longer. The bird grows anemic, emaciated and cachectic. Frequently the joints are enlarged; the joint capsule may rupture and dis- charge a seropurulent material. Death results from exhaus- tion. The course in this form may extend over a period of several weeks. Diagnosis. There are a few conditions in birds that might be confused with cholera, as the symptoms are similar. An accurate diagnosis is only possible on finding the typical bacilli. However, the symptoms and pathological findings should assist in making a diagnosis. A differential diagnosis must be made from ptomain poisoning which is very com- mon in birds, and which frequently kills a large number in ">SS ACUTE GENERAL INFECTIOUS DISEASES a flock. The postmortem examination and the micro- scopic findings will be sufficient to make the distinction between them. Parasites in the bowels sometimes pro- duce similar symptoms, particularly Trichosoma collare, but an examination of one or more of the affected birds would make a clear differentiation. Chronic cases are some- times mistaken for tuberculosis and arthritis urica, but the autopsy and microscopic examination would at once make clear the difference. Inoculations with the blood into healthy birds may be made to assist in making the diagnosis. Prognosis. The mortality is 80 to 95 per cent. Fre- quently the entire flock will die. In some outbreaks the disease runs a milder course, the virulence of the infection not being high. Treatment. Medical. Treatment consists in the adminis- tration of bowel antiseptics and disinfectants. The course of the disease is usually too rapid for any medical treatment to be of value. It is advisable to administer to the entire flock a solution of iron sulphate (1 per cent.), which they should be allowed to drink of freely; or a solution of tannic acid (0.5 to 2 per cent.), which may be administered with a medicine dropper (1.0-2.0) to each bird twice daily. Some have claimed excellent results with sulphocarbolates (0.2-0.6) once daily. Various other medicines have been recommended but none has proved to be specific. Vaccines and Sera. The treatment of sick fowls with vaccines and sera has not been successful to date. An immune serum has been made which produces a passive immunity lasting for a period of one to two weeks. This is recommended as a preventive when the disease makes its appearance in a flock, or when a flock of birds is exposed to infection. Vaccines (autogenic and polyvalent) have been used. The results have been unsatisfactory where the birds were already infected. On the other hand, very good results have been reported from the use of autogenic and polyva- lent vaccines to prevent the disease in the healthy birds of an infected flock. Vaccines seem to establish immunity in healthy flocks, preventing the disease or reducing the FOWL PEST 589 mortality. More experimentation, however, is necessary before definite statements can be made regarding the value of vaccines and sera in the treatment of fowl cholera. Prevention. Preventive treatment is by far the most important. In applying it the following should be consid- ered : (a) All newly acquired birds should be isolated for at least ten days before being allowed to come in contact with the regular flock. (b) When the disease makes its appearance in the neigh- borhood, precautions should be taken in regard to the car- riers of the infection. Administer antiseptics. (See Medical Treatment.) (c) When the disease appears in the flock, radical meas- ures must be taken promptly. All healthy birds must be removed to new, uninfected quarters. The sick birds should be destroyed at once, and either burned or buried in lime. All litter and droppings should be treated in a similar manner. Disinfect the houses, coops, ground and yards with liquor cresolis compositus, using one gallon to thirty gallons of water. Use a spray pump so that the disinfectant will be forced to the ceiling, walls and all parts of the build- ing. The buildings and coops should then be allowed to stand open for a few days to allow the air to come in contact with all parts of it. It would be advisable to start with a new flock in the new quarters after a few weeks. A second disinfection would be recommended before allowing birds to be placed in the buildings. FOWL PEST. Fowl Plague. Pestus Aviurn. Definition. An acute, contagious, infectious disease of fowls. Very similar in many respects to chicken cholera. Occurrence. This disease has been reported from different sections of the United States, occurring in the form of an epizootic. It has been very prevalent during the past ten years in some of the European countries (Germany, 590 Belgium, Italy and France). There is no doubt but that it has frequently been mistaken for fowl cholera. Etiology. This disease is produced by an ultramicroscopic virus. The exact nature of this virus has never been deter- mined. It is contained in the blood, the droppings, the exudate found in the serous cavities, the bile and in the nasal discharges. The filtrate, when passed through porce- lain filters and injected into healthy chickens will produce the characteristic symptoms rather constantly. Pathogenicity. Practically all fowls are susceptible to the virus which is most commonly found in chickens, turkeys, sparrows and pheasants. Water fowls and pigeons are less susceptible to infection. Mammalia are not susceptible to the virus. Natural Infection.- Cohabitation of birds so that they come in contact with the nasal discharges and droppings from the sick is the most likely way in which infection is spread through a flock. Ingestion of food contaminated with the virus, or the eating of infected viscera, or blood, introduces the virus immediately into the digestive tract where it develops and produces the disease. Infection takes place no doubt in some cases from the infection entering the tissues through lesions in the skin or mucous membranes. The transmission of the disease may be brought about by the virus being carried through intermediate objects. Pathology. The lesions found on autopsy are similar in some respects to those found in fowl cholera. In the per- acute cases the lesions may be very slight. The principal lesions are those found in ordinary septicemia, especially hemorrhages in the serous membranes (pleura, peritoneum, epi- and endocardium), and in the mucous membranes of the digestive tract. The finding of a fibrinous exudate on the peritoneum and pleura has been frequently reported. Hyperemia of the spleen, liver and kidneys is usually present. The comb and wattles are dark bluish in color (cyanotic). Catarrhal inflammation of the conjunctiva and buccal mem- brane, with collections of frothy mucus, is often noted. In the digestive tract changes occur on the mucous membrane such as hemorrhages, collections of grayish-white, or yel- FOWL PEST 591 lowish-green fecal material. Catarrhal inflammation of the intestinal mucosa, in varying degrees of intensity, is found throughout its course. The lungs are but slightly involved in the majority of cases. Symptoms. These develop suddenly after a period of incubation of three to five days. They consist chiefly of depression, marked dulness, plumage becomes rough, comb and wattles bluish-red; drowsiness, coma, paralysis. The fowl will seek dark places, sit with head down in a crouching attitude, and refuse to move except when forced to do so. They will show a staggering gait, and as the disease pro- gresses will not be able to walk. There is nearly always a profuse discharge from the eyes, the conjunctiva inflamed and swollen. Collections of a similar secretion are found in the nasal passages, mouth and throat. On opening the mouth the membrane will show injection; in some cases hemorrhages and a thick glutinous collection over its surface. The bird often shakes its head and sneezes frequently to discharge the exudate which has collected. The bowel dis- charges may be normal in appearance, or thin, watery and have a greenish tinge. Sometimes hemorrhages occur in the bowels which give the feces a red or brown color. As the disease progresses the bird becomes much weaker, shows marked dyspnea and dies from paralysis. Some cases show spasms and convulsions shortly before death. The course of the disease is usually three to five days. Subacute cases last five to eight days. Diagnosis. There is always some difficulty in differen- tiating between fowl pest and fowl cholera. The symptoms and autopsy are so similar that it is necessary to make a microscopic examination to determine whether or not the bacilli of fowl cholera are present. In fowl pest no organisms are found on microscopic examination, nor on cultures. Differential Diagnosis. The differential diagnosis will depend upon: (a) Microscopic findings; (6) the infectio- contagious character of the disease (to distinguish from ptomain poisoning); (c) the well-known infectiousness of cholera virus to pigeons which are not susceptible to fowl pest. 592 ACUTE GENERAL INFECTIOUS DISEASES Prognosis. As most cases terminate fatally, the prognosis is bad. Treatment. No medical treatment is known that has any material effect in controlling this disease after the fowl is once infected. Preventive treatment is by far the most important, and should consist of radical measures of iso- lation and disinfection. (See Fowl Cholera.) CHAPTER II. ACUTE INFECTIOUS DISEASES WITH LOCALIZA- TION IN CERTAIN ORGANS. EPITHELIOSIS INFECTIOSA AVIUM. Contagious Epithelioma. Chicken-pox. Diphtheria. Ronp. Canker. Pre valency and Distribution of the Disease. The disease affects nearly all birds, especially chickens, turkeys, pea- fowls, pheasants, guineas, pigeons, sparrows, quail, etc., but is not so frequently observed in ducks, geese and swans. The malady is widely distributed, appearing in practically all countries where birds are found in any considerable numbers. In the United States infectious epitheliosis is quite prevalent, especially in the northern states during the colder months. In the fall when the cold, damp weather begins outbreaks occur quite commonly, and poultrymen often refer to the early inception of the disease as a "cold." The intensity of the disease usually increases until the warm weather makes its appearance, when it diminishes and lies dormant, to reappear at the first cool, damp weather in the fall when the birds are more closely confined. Etiology. -Evidence obtained by experiments indicates that a filtrable virus is the primary causative agent, and that the more or less severe complicating conditions are induced by secondary infection, of which a bacillus, probably the Bacillus diphtheria 1 columbarum of Loeffler, seems to be the most constant. Pathogenesis. Transmission of this disease is not very difficult. Usually about 70 per cent, of healthy birds will show symptoms of the disease after associating with an affected one for a short time. Actual contact is not neces- 38 594 ACUTE INFECTIOUS DISEASES sary, as is shown by the spread of the disease at poultry shows. A bird with mucous membrane lesions may trans- mit the disease to a susceptible bird in the cutaneous form, and vice versa. Emulsions of scrapings from either cutaneous or mucous membrane lesions injected subcutaneously, submucously or applied to scarified areas on the skin, would in some cases produce the generalized form of the disease. Similar results were produced by using an emulsion of a twenty-four-hour agar growth of cultures taken from , lesions and injected subcutaneously. It is possible at times by scarifying the mucous mem- brane of apparently healthy birds to produce at the point of injury local lesions not unlike those of this disease, but they disappear in a few days without manifestation of general symptoms. Incomplete experiments by using the blood of sick birds in an attempt to produce the disease gave negative results, which is contrary to that claimed by a few other investigators. Natural Infection. There are a variety of ways by which natural infection takes place. Cohabitation is one of the most common, an infected bird introducing the disease into an entire flock. The exfoliated membranes, or the exudate given off while sneezing or coughing, act as inter- mediary carriers to the healthy birds. The infection in this way will find lodgment on the skin where there are slight abrasions, or on the mucosa of the eyes or mouth, where it develops either to form the pox lesions or the various other forms found on the mucous membranes. It is quite possible to have the disease develop in the eyes by the infection gaining entrance, and the bird irri- tating the skin and conjunctiva by rubbing them against objects or by scratching them with their feet. The disease is frequently spread by food or drink which is contaminated with infective material. A very common source of the disease is the poultry show where infected birds are exhibited, and conditions exist favorable to reduce the bird's resistance. It very fre- quently happens that on the return of birds from the show EPITHELIOSIS INFECTIOSA AVJUM 595 the disease develops in the course of a week or ten days. Sparrows and pigeons are common carriers, often trans- porting the infection great distances. This is a very impor- tant method of transmission often overlooked. The disease has been observed in sparrows in a number of cases and exhibiting in them the same characteristics as in other birds. Sparrows and pigeons come in direct contact with poultry at feeding time and thus infect them. It is some- times spread by such intermediary agents as infected coops, clothing, etc. Young birds are more susceptible to the infection than older ones. Pigeons and chickens seem to be far more susceptible than other birds. It has been observed that one attack of the disease will produce immunity for a certain period. Either the skin form or involvement of the mucous membranes confers equal immunity against the opposite form. Pathology. The postmortem findings vary with the immediate cause of death. In rare cases when death is due to suffocation early in the disease only the acute con- ditions are noted. The body appears fairly well nourished, the mucous membranes are covered with a thick slimy mucus which may occlude the upper air passages. In the larynx, or somewhere along the trachea, possibly in the larger bronchi, will be found the mass of dense, tough, yellowish material obstructing the lumen. In some cases when both eyes are involved death results from starvation early in the disease. The body is emaciated. The mucous membranes of the eyes, and often of the mouth and respiratory passages show inflammation, and usually there is a mass of this same yellow material in the con- junctival sac distorting or obscuring the eyes. The skin around the eyelids may also be involved. The majority of the fatal cases die in two to five weeks. In these the body shows all the symptoms of a toxemia, emaciation is pronounced, and the serous membranes studded with petechise. In the cutaneous form the skin presents all the symptoms of a severe inflammation, each nodule being a distinct process. Some of them show a similarity to tumor formation, especially on the comb where 596 ACUTE INFECTIOUS DISEASES the skin is thickest, but on the wattles and feathered skin around the head this feature is less pronounced. Masses of tough yellow material often distend the suborbital fossae, accumulate in the external ear, in the lung substance and along the digestive tract. Symptoms. The disease assumes various forms, depend- ing upon whether it involves the mucous membranes of the mouth, the nasal passages, the eyes, the intestinal tract, or the skin. It is necessary from a clinical standpoint to consider these various types of the disease. It is this fact which has led to so much confusion among the poultrymen, as they have been inclined to consider these forms separate diseases. Na^al Passages. The early symptoms are similar to those of an acute nasal catarrh, but the bird shows more dulness and prostration and there is present a peculiar offensive odor. The odor is very characteristic. The discharge from the nasal passages is at first thin, serous and later becomes thicker and glutinous, causing the affected birds to sneeze and shake their heads in an effort to clear the nasal passages. The nasal secretions collect around the openings, forming dirty, yellowish crusts. The infra-orbital fossae become inflamed and distended with pus, forming an enlargement on one or both sides of the head below the eyes. Owing to the occlusion of the nasal passages the bird breathes with open mouth. Eycs.Kt first a thin serous secretion is observed flowing from one or both eyes; later it becomes turbid, thicker, adheres to the edges of the eyelids and dries to form crusts completely closing the eye. The retained yellow material becomes thicker and often accumulates to such an extent that it causes a pronounced bulging of the eyelids. Masses of this material as large as a walnut are often removed from beneath the lids. Sometimes infection develops posteriorly to the eyes in the form of abscesses which force the eyes partly out of position. The cornea is turbid and often ulcerated. Complete destruction of one or both eyes is often observed in severe cases. EPITHELIOSIS INFECTIOSA AVIUM 597 Mouth. Involvement of the mucous membrane of the mouth begins as a local disturbance. The disease is ushered in by a slight redness or congestion of isolated areas, or may involve the entire surface. In the center of the con- gested areas there will appear in a day or so small round or oval yellowish-white spots, which rapidly spread and eventually form extensive collections of glutinous pus, having somewhat the appearance of diphtheritic mem- brane. The nature of the collected material on these areas led to the name "diphtheria" for this form. As the disease progresses this process often extends over the entire mucosa of the mouth, tongue and throat. When the larynx is involved, or even the trachea, as is occasionally noted, there will be marked symptoms of dyspnea. Asphyxia is fre- quent when the lesions extend to the larynx and trachea. On removal of the deposits the mucosa presents a red, granulating surface, which bleeds easily, showing in some cases extensive submucous swelling and edema. The com- missures of the mouth are frequently involved as is the skin and contiguous tissues, a characteristic pox lesion developing in the skin. Other complications are frequently found spreading from the oral cavity, i. e., to the pharynx, esophagus and crop, producing severe diarrhea and other bowel disturbances. Skin. Lesions on the skin are found in quite a few cases, more commonly on the comb, wattles and other portions of the skin not covered with feathers. It is first noticed as a very fine gray vesicle, which soon develops into small elevations of a reddish-gray color, which later become more grayish. Microscopically the nodules are composed of degenerated epithelial cells. These nodules in some cases become quite large, warty in appearance, dry and hard. In severe cases large numbers of these nodules are found distributed over the skin on exposed surfaces. On removing the surface of the nodules a raw granulating area is noted. Some cases show distinct degeneration of contiguous tissues. A mixed variety of the disease is of frequent occurrence, the mucosa showing the characteristic deposits and the skin pox lesions. It is quite evident in these cases that 598 ACUTE INFECTIOUS DISEASES the disease spreads from one location to the other, and the difference in the lesions is due to the difference in the struct- ure of the tissue involved. General Symptoms. In the early stages before much secondary infection takes place, there are no marked general symptoms. Later marked general symptoms appear. The birds show dulness, assume a sitting posture, wings are held pendent, plumage becomes rough and the patients show much depression. The comb and wattles grow bluish-red in color, later pale and cold. In the colder climates the disease often assumes a subacute or chronic form, while in warmer climates the acute form is more often observed. Frequently, however, the disease assumes the character of a chronic catarrh. Diagnosis. The disease usually makes its first appearance in the fall and often occurs as the cutaneous form. It may be overlooked, especially if the birds are on the range. The mucous membrane form usually makes its appearance soon after housing for the winter. The sneezing, mouth- breathing, occluded nostrils and an occasionally inflamed eye are significant, especially when rapidly spreading through the flock. Soon after a few will refuse food and appear depressed. It must also be suspected when similar symptoms appear after adding new birds to a healthy flock or birds returned from shows. A peculiar characteristic and offensive odor is associated with this disease and poultrymen familiar with it often recognize the disease from the odor alone. The same odor is given off by cultures. Differential Diagnosis. Wounds on the skin around the head, usually pick-inflicted, appear suspicious, but these heal rapidly without extensive thickening. An injury to the eye, even though serious, will not cause the formation of the characteristic yellow deposit. Difficult respiration, rarely seen in more than one bird in a flock, may be due to several causes, and those observed persisted for some time without affecting the general health of the bird. ANTHRAX 599 Prognosis. The cutaneous form usually runs a more favorable course, apparently recovering in one to three weeks, when the nodules become dry and scale off. The mucous membrane form is less favorable, the mortality varying from 10 to 50 per cent., depending on the care and sanitary surroundings. Aside from the actual number that die we find there is considerable loss resulting from the chronic effects. After the disappearance of all visible lesions the birds do not seem to regain their former good condition for months. Egg production is far below normal, and young birds have their growth checked. Treatment. There have been a great many drugs recom- mended in the treatment of this disease, and so far none of them have proved very satisfactory. Daily treatment of individual birds is a tedious and laborious task, especially where large flocks are affected. The lesions, whether on the skin or in the mouth, should be washed with antiseptics, boric acid solution (2 per cent.), potassium permanganate (0.25-1 per cent.), or any other equally efficient antiseptic. The deposits should be removed with a curette or dull knife before applying the antiseptic. Vaccine. Vaccination has proved very satisfactory in this disease. One c.c. is administered subcutaneously, and in severe cases it should be repeated in four to six days. Prevention. All newly acquired birds should be examined and isolated for at least ten days before allowing them to come in contact with the regular flock. As soon as the disease is recognized, it is recommended that all birds be vaccinated immediately to check it. Healthy flocks and those intended for exhibition purposes may be vaccinated to establish immunity. This has proved very satisfactory. The immunity established will last for at least six months to one year. ANTHRAX. This disease is essentially found in large animals. (See other works.) 000 ACUTE INFECTIOUS DISEASES FOOT-AND-MOUTH DISEASE. Aphthce Epizooticce. Foot-and-mouth disease rarely occurs in carnivora, but has been observed in a few cases in dogs. Dogs kept on infected premises in contact with infected cattle, especially those that are used for herding animals are the ones most liable to be affected. Dogs are not very susceptible to the infection, and take it in a mild form. The principal symp- toms are vesicles on the mucous membranes of the lips, sometimes forming ulcers, which penetrate more or less deeply into the tissues. Sometimes the feet become involved, when there will appear a vesicular exanthema on the balls of the feet and between the toes. The feet will be swollen, hot and sensitive, and the patient very lame. General symptoms, such as elevation of temperature, diarrhea, loss of appetite and vomiting have been observed. The disease has made its appearance in fowls, but only in a few instances has it been recorded. HEMORRHAGIC SEPTICEMIA OF CATS. Infectious G astro-enteritis. History. This disease has been reported as occurring in various sections of the United States and Europe. So far but little is known about it as the disease is a comparatively new one. Occurrence. Cat septicemia occurs enzootically, espec- ially among cats congregated as in catteries and shows. Etiology. The disease seems to be produced by a specific organism (Bacterium felisepticus bipolaris of Huse and Coleman). It is described as a short, rod-shaped organism, taking the bipolar stain readily with the common stains, but is Gram-negative. Pathogenicity . The work up to the present time indicates the pathogenicity of this organism is confined to cats, rabbits and guinea pigs. Dogs and birds show no tendency toward natural infection. HEMOKRHAGIC SEPTICEMIA OF CATS (>01 Pathogenesis. The organisms are evidently taken into the digestive tract with the food and drink. The organisms multiply very rapidly and induce in a very short period of time a severe hemorrhagic gastro-enteritis. The severity of the disease depends upon the natural resistance of the animal and the virulency of the infection. Symptoms. The period of incubation is from two to five days. The development of the symptoms is very rapid. The disease is ushered in by a sudden suppression of the appetite, vomiting, retching, marked depression and general weakness. The animal shows a tendency to seek dark cool places and lies stretched out on its abdomen. The tem- perature rises rapidly after the onset reaching 103-106 F. in twelve to twenty-four hours. The temperature remains high during the early part of the disease, but later becomes normal or subnormal. Emaciation comes on rapidly, a profuse diarrhea is present, the feces having a characteristic- fetid odor. As the disease progresses the animal becomes weak, eyes retracted and staring. In three to four days coma develops, and death follows in the course of a few hours. The course is very rapid in acute cases, ^ome few cases assume a subacute form, and the symptoms are milder but progressive. Pathology. A more or less severe gastro-enteritis hemor- rhagica is typical of this disease. The entire mucosa of the digestive tract is highly congested and dotted over the surface with petechia> and numerous patches of ecchymoses. The membrane is covered with a catarrhal exudate which in the majority of cases contains some blood. The serous covering of the intestines shows marked congestion, but no petechirt'. The presence of gas in the stomach and bowels is quite constant. The stomach particularly is nearly always found distended. The heart muscle, liver and kidneys show- signs of rapid degeneration. The gall-bladder is greatly distended, and the bile is dark colored, thick and tenaceous. The lungs may show congestion, and in subacute attacks pneumonic areas. Other cases may not show changes in the lungs. 602 ACUTE INFECTIOUS DISEASES Diagnosis. The disease is recognized by its contagious character, its rapid, severe course and the profuse diarrhea. The absence of catarrhal symptoms of the air passages and eyes would assist in differentiating it from distemper. Ptomains or mineral poisons will produce similar symptoms, but the microscopic examination, the contagious character and the investigation of the food supply, history of poison- ing, etc., will serve to make clear the differentiation. It is very important to be able to make an accurate diagnosis for the protection of other animals. Prognosis. The prognosis is bad. Even in the early period of the disease, and in the apparently mild cases, it should be looked upon as a very serious condition. The mortality is very high, from 80 to 90 per cent, of the cases terminating fatally. Treatment. There is no treatment known that has much, if any, effect on the course of the disease. Sympto- matic treatment is the only thing that can be done. A vaccine is being used as a prophylactic treatment, but at present it is difficult to say what the results will prove to be. An antisera is also being used at present and gives considerable promise of success as a curative and preventive agent. The progress of the disease, after it once breaks out in a hospital or cattery can be curtailed only by removing all sick and exposed animals, and thoroughly disinfecting the rooms with formaldehyd gas. All utensils, litter, etc., should be rendered innoxious. Prevention is far more important than treatment. CHAPTER III. INFECTIOUS DISEASES WITH SPECIAL INVOLVE- MENT OF THE NERVOUS SYSTEM. RABIES. Hydrophobia . Lyssa . Definition.- An acute infectious disease, fatal in the majority of cases, and characterized clinically by disturb- ance of consciousness, marked irritability and later by .symptoms of paralysis. Occurrence. Rabies is one of the oldest known diseases and has been observed in all countries. It is most com- monly noted in dogs, cats, wolves and foxes. Other animals are less commonly affected. It is estimated that about 90 per cent, of the cases of rabies occur in dogs. The disease often occurs enzootically, which may be at any season of the year. The larger number of outbreaks in the I nited States has been in the colder months of the year. Outbreaks are naturally more frequent where dogs congre- gate, and in communities or cities where there are no pro- tective regulations. In some countries and districts rabies is decreasing, due to proper police regulations which restrict the number of dogs running at large. Etiology. Kabies is produced by an ultramicroscopic virus. This virus is found to be the most virulent when taken from the central nervous system (brain and cord), less so from the peripheral nerves, salivary and other glands and their secretions. The infection does not seem to be present in the blood of affected animals. The infectious agent is fixed, non-volatile and is an obligatory or fixed parasite. Pathogenicity. The disease is readily transmitted to dogs, rabbits, guinea pigs and other animals by inoculating 004 INFECTIOUS DISEASES them with the virulent saliva, or an emulsion of the cornu ammonis, medulla ohlongata, and some other portions of central nerve tissue. The most satisfactory results are obtained by injecting some of the virus under the dura mater of the brain or cord. The same inoculation may be made into the anterior chamber of the eye, or into the muscles, but the results are not so certain. Injection of the virus into or around the peripheral nerves has produced the disease quite constantly. Scarification of the skin and rubbing the virus on the area has produced positive results only in about 40 per cent, of the cases. Other methods of inoculation have been less successful. Birds may be infected by inoculation. Natural Infection. Rabies is produced in practically all cases by the victim being bitten by a rabid animal, intro- ducing the virulent saliva into the wound, to come in con- tact with the nerves, muscles, or subcutaneous tissues. Rarely are cases produced by the infectious agent being licked from wounds, or from contact with lesions on the skin. Pathogenesis. When the virus is introduced into some part of the body through a bite by another animal, or by inoculation artificially, it is supposed that it follows the course of peripheral nerve fibers along which it is carried to the central nervous system. The explanation of the development of the two types of the disease is explained by the path of travel to the central system, whether it reaches the brain, medulla oblongata, or the spinal cord. Alter the virus reaches the central nervous system to pro- duce irritation on certain groups of cells, it is then centrifu- gally distributed to different parts of the body. It reaches the salivary glands, which favors the development of the virus, increasing the secretion of the glands, and then is further disseminated through the saliva. The period of incubation of rabies is quite variable. The virus after being introduced into a wound may remain in a dormant state for some time before reaching the central nervous system. The variation in susceptibility of animals in the virulency of the infection, and the method of the dissemina- tion of the virus in the body naturally make the period of RABIES 605 incubation rather long. Three to seven weeks is the usual time for development in dogs. However, some cases develop only after several months. The period of incu- bation in cats and fowls is usually shorter than in dogs. The period of incubation is usually shorter in young animals. The toxicity of rabies virus and the pathogenic action on the tissues are no doubt due to some chemical product which up' to the present has not been determined. Pathology. The disease is really characterized by the absence of any marked gross pathological findings. The lesions vary somewhat in individual cases. The digestive tract shows congestion and hyperemia. The stomach may be contracted and empty, or is frequently partially filled with foreign material such as stones, straw, sticks, splinters of wood, hair, feathers, etc. The folds of the mucous mem- brane are markedly congested on their summits. Hemor- rhage sometimes occurs from the foreign material cutting or tearing the mucosa. The mucosa of the pharynx and larynx shows congestion and is covered with mucus. An acute catarrhal inflammation of the respiratory passages is frequently found. The brain and its coverings are often injected with small hemorrhages. No other lesions of any importance are observed. Symptoms. From a clinical standpoint it is necessary to divide rabies into two types, viz: (1) Furious rabies, and (2) dumb rabies. The different train of symptoms depends entirely upon whether the brain or spinal cord is primarily involved. However, cases are observed occa- sionally where an animal affected with dumb rabies suddenly develops the furious type. The dumb or mute rabies seems to be the most common form in the United States. 1. FURIOUS RABIES. In this form three stages of devel- opment are rather sharply defined : (a) Melancholic or pro- dromic stage; (b) maniacal or irritative stage; (c) paralytic stage. (a) Stage of Melancholy. In the stage of melancholy or in the beginning of the disease, the first thing usually noted by the owner is the altered behavior of the animal. It becomes sullen, afraid, seeks dark places, is easily irritated, restless and (JOG INFECTIOUS DISEASES obstinate (often does not obey its master). The patient is also inclined to hide itself, alternately gets up and lies down frequently, makes sudden, unusual movements, such as snapping or biting at imaginary objects, or barks sud- denly without any cause. During the early stage of the disease the appetite is not much changed, but later the manner of eating and the kind of food chosen are greatly modified. Dogs are inclined to eat indigestible objects, such as pieces of wood ; eat their own feces and lap up their own urine, etc. A very noticeable symptom is the tendency to grasp objects as if to eat them, then suddenly let them fall from the mouth. Constipation is usually present in this stage. During the latter part of this stage the patient is excitable. The patient shows a marked change in dis- position, snaps at objects, its master, other persons or other animals. This excitability is more noticeable toward strange persons or animals. Sometimes the patient mani- fests no change in disposition toward its master, familiar persons or animals. The excitability gradually, or very rapidly, increases. The nervous reflexes become sensitive and the patient is easily startled by sudden noises, touch- ing objects or by strong light. The pupil of the eye dilates and the facial expression is changed. Dyspnea is prominent at times. The patient will often scratch or bite the place of infection, sometimes doing extensive injury to the area. The appetite is entirely suppressed but the animal seeks water and attempts to drink, but, on account of the begin- ning paralysis of the larynx and pharynx, does not succeed. The salivary secretion is increased, and saliva hangs from the mouth in long strands. This stage usually lasts from one to three days. (b) Sbigr. of Irritation . In this stage the symptoms reach a higher degree of development. The excitement increases; hallucinations, which bring about violent fury or rage, are soon apparent. The voice of the animal changes decidedly from the normal. This is a very characteristic symptom of rabies, and no doubt results from the congestion and paralysis of the vocal cords. The owner's attention is always attracted by the unusual amount of barking and RABIES 607 the change in the voice. At this stage they become vicious, and if confined show a tendency to chew objects and tear them to pieces. Rugs, carpets, or other objects with which they come in contact are torn and destroyed. At this time if they are not confined they will usually wander away from home, biting other animals or persons that hap- pen to come in their path. Often during a short period of time they will travel long distances before returning, which they invariably do. Upon their return they show emacia- tion, exhaustion, often wounds from being bitten by other animals, and in general have a dejected appearance. The desire to bite aimlessly objects and animals is quite char- acteristic of this stage. A rabid dog in this stage may inoculate a large number of animals unless confined. ,When confined in a cage or room they show at times intense fury and viciousness. If irritated, by placing a stick between the bars of the cage, the dog will attack it viciously, but shows the peculiar symptom of simply biting instead of holding on to the stick as non-rabid dogs ordinarily do. As this stage progresses the periods of fury become shorter, and soon marked depression is noted. Paralysis of some of the special nerves develops, shown by the increase in the change of the voice, which becomes a peculiar wail or howl, and the difficulty in swallowing. The eyes are congested, and also the mucous membranes of the mouth. This stage of fury lasts usually two to four days. (c) Paralytic Stage. The symptoms of paralysis become more pronounced, and the patient is less vicious. Complete loss of voice and the inability to swallow, with paralysis of the tongue and masseter muscles, are early symptoms of this stage. The mouth is held open, the dry tongue is pro- truded and completely paralyzed. The eyes are retracted, lose their expression and luster; the pupils become dilated, in some cases unequally. The animal shows marked gen- eral emaciation, the hair coat rough and there is much exhaustion. The general paralysis asserts itself, beginning in most cases at the tail and posterior limbs. The animal has difficulty in walking or standing; later there is complete paralysis of the posterior part of the body. The paralysis rapidly ascends to the fore parts and central nervous sys- 008 INFECTIOUS DISEASES tern, causing death in most cases on the fifth to eighth day of the attack. The temperature in rabies has not been recorded in many cases. During the early stages it is elevated to 104-io6 F. ; later becomes subnormal. Varia- tions in the symptoms of furious rabies are observed, but most cases present a rather constant clinical picture. The symptoms of furious rabies in cats are very similar to those of dogs. They often become very vicious, and bite and scratch everything that they come in contact with. The change of voice is also quite noticeable. The course of the disease is usually shorter, lasting from three to six days. 2. DUMB RABIES. This form is characterized by a paralysis of the lower jaw, tongue, larynx and pharynx. This symptom develops early in the disease and is the most prominent one until general paralysis manifests itself. The owner is often led to suspect that the animal has a bone or some other object lodged between its teeth, or in its throat. All such cases should be looked upon with suspicion, and all precautions taken in making the exami- nation. In the majority of cases no nervous or excitable symptoms are shown; the paralytic symptoms gradually becoming more pronounced until the animal succumbs to general paralysis. Cases are observed occasionally where symptoms of excitement develop during the course of the disease. One such case was observed in which the early symptoms indicated dumb rabies but in twenty-four hours all the symptoms of the furious form had developed. Ani- mals with this form of the disease usually seek dark, cool places and lie almost constantly. There is the same peculiar expression from the eyes as in the other form. The patient often attempts drinking or eating which the paralysis prevents. There is usually no tendency to bite nor viciousness manifested. Rabies in rabbits nearly always assumes the paralytic form. Fowls show the characteristic symptoms of furious rabies in some cases, such as excitement, change of voice, ruffled plumage, attacking other fowls, people, etc. In other instances the paralytic form is observed. Diagnosis. In furious rabies the diagnosis does not RABIES 609 present any great difficulty where the symptoms are pro- nounced and the animal observed through the different stages. The positive proof of a bite inflicted previously by another animal is of considerable importance in mak- ing the diagnosis. An accurate diagnosis is of great impor- tance for two reasons, viz.: (a) In case human subjects are bitten, or in any way inoculated, it will give them an oppor- tunity to receive the antirabic treatment early; and (6) to protect other animals and persons from becoming inocu- lated by quarantining and confining the animal. Under no circumstances should an animal showing symptoms of rabies, or suspected of having the disease, be killed. It should be put in quarantine and observed. It has been demon- strated that animals destroyed early in the disease often do not show positive findings on microscopic examination. The characteristic symptoms of irritation, tendency for biting, change of voice, paralysis, etc., generally show evi- dence enough to the experienced clinician to establish the diagnosis. The detection of Negri bodies on microscopic examination will make the diagnosis positive. In dumb rabies the diagnosis is made on the characteristic symptoms of paralysis of the lower jaw, the somnolence in most cases, the expression and the paralysis of other parts of the body in the course of two to four days. All cases showing the symptoms of the lower jaw hanging down should be diag- nosed dumb rabies until ample proof is shown that it is some other condition. Microscopic examination of the brain should be made to establish the diagnosis as in furious rabies. Intracranial inoculations of rabbits have been used extensively in making a positive diagnosis. This method requires from fourteen to seventeen days, and is falling into disuse. Inoculations of the virus in guinea pigs have also been used extensively as a diagnostic measure. Prognosis and Course. The disease is fatal in practically all cases. The possibility of recovery in very mild cases cannot be denied. However, no authentic case of recovery has been recorded. It has been estimated that only about 17 to 20 per cent, of the animals bitten by known rabid animals develop rabies. This percentage is higher in dogs than in any other small animal. The course of the disease 39 filf) INFECTIOUS DISEASES is quite constant in the different animals, although variations occur occasionally. Five to seven days is the usual course; it may be in exceptional cases as short as two days or as long as ten or eleven daj's. There is but little difference in the course of the two forms; usually dumb rabies runs a longer course than the furious type. Differential Diagnosis. There are quite a number of diseases in small animals which might be confused with rabies: (a) Diseases of the brain, particularly inflammations involving the meninges and the cerebral substance itself. In these cases irritability and nervousness are present, but the tendency to bite, the aggressiveness, change in voice and development of the paralysis in the same way are absent. If there should be any doubt the animal must be confined and observed for a few days when the differentia- tion will not be difficult. (6) Canine distemper (nervous form) sometimes simulates rabies, but the history of the case, the other symptoms of distemper and the length of the course of the disease will reveal the difference, (c) Parasites in the intestinal tract often produce certain nervous phenomena, but of different development and type than rabies. Many of the characteristic symptoms of rabies are absent, (d) Other parasites (Linguatula rhinaria, Dioctophyme renale, Spiroptera sanguinolenta, Otodectes cynotis) may produce certain nervous symp- toms, but careful examination and observation of the animal will readily distinguish the difference, (e) Foreign bodies lodged between the teeth, around the tongue or in the pharynx all induce salivation, hoarseness from the accompanying edema and cause the mouth to remain open. These cases should be examined very carefully to differ- entiate them from rabies. In most of these cases it is impossible to close the mouth, which is not true in rabies, and there are no general symptoms. (/) Trigeminal or facial paralysis is observed occasionally in the course of distem])cr, or as an independent condition. In these cases there are no other symptoms of paralysis, nor any general symptoms. The course is longer and the animal remains otherwise normal, (g) Epilepsy might be confused with RABIES 611 rabies. But this condition comes on suddenly and lasts only a few minutes to disappear completely until the next attack, (h) Eclampsia is differentiated by its occurrence in bitches at or near the time of whelping, clonic spasms which affect the entire body and none of the other char- acteristic symptoms of rabies, (i) Infectious bulbar paral- ysis in which the symptoms are quite similar to rabies. It is distinguished from rabies by the absence of the furious attacks, viciousness and paralysis of the lower jaw. The blood and brain tissue are infectious and the saliva not. This disease develops suddenly and runs a more rapid course than rabies. Finally, there are a few conditions in which the animal will show more or less nervousness, but none of the other symptoms of rabies. Animal inoculation and the microscopic examination of the brain should be made in all cases of doubt. Treatment. After rabies has once developed in an animal no treatment will have any effect on the disease. Bitten wounds that have been caused by a rabid animal should be treated promptly. They should be opened freely, and if hemorrhage takes place it is all the better, as it will tend to remove the virus from the wound. The wound should be washed freely and thoroughly with potassium perman- ganate solution (1 per cent.), or bichlorid solution (1 to 1000). Cauterization of the wound with silver nitrate is also recommended. The success of this treatment in pre- venting the development of the disease will depend upon the length of time which has elapsed after the bite, and the thoroughness in which the antiseptic or caustic is applied. Disinfection of the wound alone should not be depended upon for the prevention of rabies. Preventive Inoculation. Preventive inoculation is being used with great success in animals, and is highly recommended in all cases where there is any doubt about the animal being infected. INFECTIOUS BULBAR PARALYSIS. Pseudorabies. Definition. An infectious disease affecting dogs, cats, rats, horses and cattle resembling rabies in many respects. 612 INFECTIOUS DISEASES Etiology. This disease is produced by a specific virus, the nature of which has not been determined. All animals except fowls are susceptible to inoculations with the virus which is found in the blood, central nervous system, and in some of the other tissues. The saliva, bile and urine are free from the virus. Pathogenicity. Most animals are very susceptible to infection by inoculating them with only minute quantities of the blood, or central nerve tissues, from those affected with the disease. At the point of inoculation, the tissues become red and inflamed; later, necrotic. The inoculated wound shows intense irritation, and the animal bites and scratches the part almost continuously. Dogs and cats contract the disease readily after being fed on organs or tissues containing the virus. Natural Infection. This has not been definitely established, but probably in most cases is due to eating infected meats, or being inoculated by infected mice or rats. Pathology. No marked lesions are found in this disease, except at the point of inoculation. The meninges of the brain, and the brain substance, usually show hyperemia, and blood extravasations. When infection takes place in cats and dogs from eating infected meat, the stomach and small intestines are congested, and in some cases markedly inflamed. Hemorrhages under the mucosa, and frequently petechise on the serous membranes of the stomach and intes- tines are noted. No other lesions are found. Symptoms. The period of incubation varies from two to nine days. The onset of the disease is characterized in the dog and cat by a sudden change in disposition, tendency to seek dark, cool places, where the patient lies quietly or maintains a crouching attitude. They often cry or mew as if in severe pain. Vomiting is more or less persistent, there is complete loss of appetite, and marked salivation. Severe itching is manifested in most cases by the animal scratching and biting itself, sometimes so severely that the skin is entirely removed over the involved area, usually around the lips or face. In some few cases this symptom may TETANUS. LOCKJAW 613 be absent. As the disease progresses the animal shows more pain by howling, crying, or groaning. The muscles around the head and face often show marked twitching, which may be periodical or constant. The nervous system is affected as is shown by increased reflex excitability, paralysis of the pharynx and larynx, and increased muscular sensitiveness. There is marked dyspnea. The temperature is usually normal or subnormal ; toward the end the subnormal temperature is very marked. The animal usually dies in about thirty-six to forty hours. Diagnosis. There might be some difficulty in establishing an accurate diagnosis. However, the symptoms, which are quite constant, and the rapid, fatal course, would assist. Differential Diagnosis. In the dog and cat it is necessary to distinguish this disease from rabies. The chief points of difference are the following: (a) Rabies (furious) is charac- terized by symptoms of rage or fury, aggressiveness; in dumb rabies by paralysis of the lower jaw. Both are absent in bulbar paralysis, (b) The saliva in rabies is highly infectious while in this disease it is non-infectious, (c) The period of incubation is usually from two to nine days, while in rabies, although variable, it is much longer. On account of its rapid course, it might easily be mistaken for some acute poisoning. Should the symptom of itching and irritation be absent a differentiation would be quite difficult. In such cases experi- mental inoculation with the blood of the affected animal into healthy ones will assist. Frequently, a number of animals in a neighborhood will become infected at the same time, the disease appearing in the form of an enzootic. Prognosis. Very unfavorable. The majority of cases die. Treatment. Treatment is unsatisfactory. Antiseptics for the digestive tract may be tried. Thorough disinfection is necessary in order to check the disease. All dead animals should be burned or buried in lime to destroy the virus. TETANUS. LOCKJAW. Definition. An acute, infectious disease, characterized by involvement of the nervous system, resulting in spasmodic 614 INFECTIOUS DISEASES contractions of certain groups of muscles, or the entire mus- culature of the animal's body, without that consciousness is disturbed. Occurrence. Tetanus is of rare occurrence in small animals. It is observed occasionally in dogs and birds. It is far more common in the large domesticated animals. Etiology. It is produced by a specific bacillus (Bacillus tetani of Nicolaier). Natural Infection. Infection takes place by the bacilli or spores gaining entrance to wounds in the skin or mucous membranes. The most common intermediate carrier of the infection is the soil or earth which comes in contact with the wounds. Rarely is the disease spread from one animal to another. Pathology. The postmortem is usually negative. The affected muscles are usually pale, or may show occasional hemorrhages. The condition of the blood indicates in most cases that death is due to suffocation. Other lesions are inconstant and of minor importance. Symptoms. General tetanus is of rare occurrence, although observed occasionally. It is characterized by a stiff, stilty gait, extended head, ears stiffly erected, protrusion of the membrana nictitans, skin wrinkled over the forehead, trismus. The muscles of the back and posterior limbs are stiff and hard; tail erected and stiff. The reflexes are greatly accelerated as shown when the animal is touched or hears sudden noises. There i,s frequently opisthotonus, or ortho- tonus. Very characteristic is the facial expression of dogs suffering from tetanus. Perhaps in the greater number of cases in dogs and birds tetanus is local and involves only certain groups of muscles, usually the masseters, the muscles of the ears, skin and muscles over the forehead, membrana nictitans, and the muscles of the neck, all of which are con- tracted and the head held fixed. In birds the symptoms of stiffness of the neck, wings held in a fixed position, ruffled feathers, stilty gait are the most prominent. Diagnosis.- This is made mainly on the characteristic symptom of tonic spasms of groups of muscles, with normal consciousness and temperature, and the subacute course. Differential Diagnosis. (a) Differentiation must be made TETANUS LOCKJAW 615 between tetanus and strychnin poisoning which show very similar symptoms. In strychnin poisoning the spasms develop more rapidly, and are of much greater severity and the mem- hrana nictitans is not usually affected. .The extremely in- creased reflex excitability in strychnin poisoning as compared to tetanus will also serve to differentiate them. (6) Tetanus may also be mistaken for cerebrospinal menin- gitis, but in the latter disease other symptoms, such as dulness and paralysis of certain cerebral nerves, are present which will assist in the diagnosis. (c) Muscular rheumatism is differentiated by the absence of reflex excitability; the muscles are painful and swollen rather than contracted as in tetanus. (d) There are quite a number of conditions (rabies, eclamp- sia, epilepsy, articular rheumatism, etc.) which show some symptoms of tetanus, but there are always other symptoms present which are sufficient for differentiation. Prognosis. The prognosis in dogs, providing the symp- toms are localized, is quite favorable. Should the disease, however, become general it is unfavorable. The course in the dog is usually subacute or chronic. Treatment. Dietetic. When trismus is present, prevent- ing the animal from taking food, rectal feeding is recom- mended. Concentrated beef broth at body temperature is perhaps best. Two to four ounces should be given 3 to 4 times daily. During the later stages milk can be allowed as they will lap it in small quantities. Medical. Small and repeated doses of morphin sulphate (0.05-0.2) once or twice daily to control spasms of the muscles; or chloral hydrate administered per rectum (1 to 4 with acacia and glycerin), using 6.0-12.0 of the mixture once or twice daily. Subcutaneous injections of a diluted carbolic acid solution have been recommended, but are of doubtful value. Serum. Tetanus antitoxin has proved to be of greater value as a prophylactic than a curative treatment. Large doses might be used, 1500 units daily for three to four days. Surgical. In case a wound is found indicating the focus of infection, it should be thoroughly curetted and strong antiseptic solutions applied (mercuric chlorid 1 to 1000; carbolic acid solution 5 per cent.). CHAPTER IV. CHRONIC INFECTIOUS DISEASES. TUBERCULOSIS OF BIRDS. Tuberculosis Avinm. Avian Tuberculosis. Definition. A chronic infectious disease of chickens, ducks, pigeons, parrots and .canaries. It is characterized by a slow, progressive emaciation, which ends in death from exhaustion. Occurrence. Avian tuberculosis is a very common disease of chickens and parrots. Occurring enzootically among the former, enormous losses to the poultrymen result. During the past few years it has made its appearance in practically all sections of the United States. In a number of instances entire flocks of birds have succumbed to the disease, or become so infected and emaciated that their destruction was necessary. The economic importance of the disease is not entirely confined to those that die from the disease directly, but it has an important bearing on the egg produc- tion. Etiology. Tins disease is produced by the Bacillus tuber- culosis avium. Its biological characteristics are similar in many respects to the Bacillus tuberculosis of other animals (mammalian tuberculosis) . Pathogenesis. The bacilli, picked up with the food, are passed directly to the intestinal tract, where they pass through the lymph follicles into the intestinal wall, either to become localized at this point, or to pass into the portal vein and liver. Or they may gain access to the general circu- lation and through it become distributed to various parts of the body. It is possible that the intestines may not become affected by the bacilli passing through the walls, but in a great many cases tubercular nodules are found in this TUBERCULOSIS OF BIRDS 617 location. When the bacilli are taken into the general circula- tion specific lesions will be found in the spleen, lungs, joints, etc. The large number of nodules found in the intestinal wall develop in most cases from the infection following along the course of the lymph nodes, or from the bacilli becoming lodged between the serous and muscular coats of the bowel, producing a reactive inflammation and the formation of tubercles. The toxic action of -the chemical products of the bacilli produces a gradual emaciation, cachexia, and ultimately death. Natural Infection. Most cases of tuberculosis in fowls no doubt result from eating foods contaminated with bowel discharges from affected birds. Bacilli are found in the feces of affected birds in large numbers, particularly in those cases where ulcerations are present on the intestinal mucosa. Another very common source of infection is when healthy birds eat the organs of those that have succumbed to the disease. Carelessness in disposing of dead birds makes this a very common source of infection. There is a possibility of birds contracting the disease from the fecal discharges of cattle affected with tuberculosis. This is a disputed point at the present time. There is considerable doubt also about their contracting the disease from the sputum of the human subject. Parrots seem to contract the disease from this source. Numerous cases have been recorded where fowls contracted tuberculosis, and at the same time the attendants had the disease. Whether transmission of the disease is brought about in this way is in dispute. Flocks are usually infected from newly acquired tubercular birds. Pigeons may carry the disease from flock to flock. Pathology. The chief anatomical changes are found in the liver, spleen, intestines, joints, and in parrots in the joints, and skin about the head and neck. The surface of the liver is covered with numerous small nodules and on cross-section they are found to extend into or through the entire structure. Sometimes the tubercles become confluent and form large masses, white, gray, or grayish-white in color, the centers of which are caseous. The liver is frequently much enlarged, very friable indicating fatty degeneration. The spleen is ()18 CHRONIC INFECTIOUS DISEASES similarly affected. The intestinal lesions are very common, and consist of a large number of small nodules found on the mucosa. By confluence large areas appear as do ulcers. On the serous coat of the intestines are found nodules varying in size from a millet seed to a hazel nut. The mesentery may show similar lesions. The abdominal lymph glands are usually enlarged and caseated. In some cases on opening the abdominal cavity a striking picture is presented as the entire visceral peritoneum is covered by hundreds of very small white or grayish nodules. The lesions in the lungs are similar, although not usually so marked as in the liver and intestines. The affected joints are enlarged, contain a cheesy, yellowish mass and the articular cartilages are eroded. The other organs and tissues are not often involved, although nodules are found occasionally in the kidneys, ovaries, tes- ticles, pericardium, heart and gizzard. In parrots the disease is usually localized around the head and in the mouth. Xodules varying in size and condition are found containing the same cheesy, yellowish material. Symptoms. In the early stages of avian tuberculosis the symptoms are very indefinite. The disease is chronic and characterized by a gradual emaciation without any specific clinical symptoms. The emaciation continues in spite of good appetite. The appetite persists as a rule until the beginning of a general toxemia, when it diminishes to disappear entirely during the latter stages of the disease. Symptoms of anemia develop as evidenced by paleness of the mucous membranes, comb and wattles, dulness, and rough plumage. During the latter stage the fowls are listless, much emaciated, and show all the symptoms of asthenia. Diarrhea sets in, and complete exhaustion is followed in a few days by death. There is con- siderable variation in the period of time required for the development of the general symptoms. When the bones and joints are affected, there is usually an involvement of the joints of the wings, and the tarsal joints. At first the joint shows swelling which develops gradually. The swelling is firm at first, but in nearly all cases becomes soft and fluctuat- ing, and when opened discharges a yellow, caseous material. The bird is lame and the wings are held pendent. TUBERCULOSIS OF BIRDS 619 In some cases small nodules are found beneath the skin on various parts of the body. Parrots are affected in the major- ity of cases locally around the eyes, face, or on the neck, or the articulations may be involved. The lesions are small, round, or oval nodules developing on some part of the skin or mucous membrane. Later they become caseous. Their characteristics vary somewhat, depending upon whether they are located in the skin, or in the mucous membrane of the mouth. The nodules when irritated often become quite large, rupture, and leave an extensive ulcerous surface. When the joints are involved the same symptoms are observed as in fowls. General symptoms occur occasionally in parrots. Diagnosis. The diagnosis from the symptoms presents considerable difficulty. However, when we consider that a number of fowls in a flock are affected with a disease causing emaciation, exhaustion and death, we should suspect tuber- culosis. Several methods of diagnosis have been recom- mended of which the following have given the best results: (a) An affected bird is killed and an autopsy made. The tubercular lesions are quite characteristic and the tubercle bacilli may be found under the microscope. (6) By use of avian tuberculin. This method has been employed quite extensively of late. It has been found quite reliable in most cases. The tuberculin is injected, using about 0.003 per bird, into the deeper layers of the skin of the comb or wattles, using a small dental syringe. Care should be observed that the needle is not inserted too deeply, or the tuberculin will enter the subcutaneous tissues. On the other hand, it must not be too superficial or the epithelial layer will rupture and allow the tuberculin to escape. The reaction consists in a rounded swelling which develops in twenty-four to seventy- two hours at the point of injection. The degree of reaction varies with individual cases. Differential Diagnosis. There are several conditions which might be confused with avian tuberculosis, viz: (a) Asthenia (" going light") which is characterized by gradual emaciation, and exhaustion, but negative findings on autopsy. Micro- scopic examination will aid in revealing the difference. (6) External parasites when affecting a number of birds in a 020 CHRONIC INFECTIOUS DISEASES Hock will produce emaciation and a general unthrifty condi- tion. Finding the parasites in large numbers, and negative autopsy will suffice for differentiation. (c) Rheumatic arthritis, or arthritis urica may resemble joint tuberculosis. In doubtful cases a microscopic examination (tubercle bacilli) may be resorted to. Prognosis. Unfavorable. Treatment. Xo treatment is of any value after the disease has once become established. Surgical. Localized abscesses as they occur in parrots should be incised freely, and the contents thoroughly removed with a curette. Tincture of iodin is applied to abscess cavities. Prevention. On account of the disease being difficult to diagnose until well established, separation of the sick from the healthy birds is not feasible. In valuable birds the tuberculin test with segregation should be tried. Removing the reactors will assist in controlling the disease. If this cannot be done, it is recommended that the entire flock be killed, all diseased fowls burned, and the healthy ones sold for food. The premises should be thoroughly disinfected, buildings, coops, etc., washed with bichlorid solution (1 to 2000). The soil in the runs should be saturated with liquor cresolis compositus (3 per cent.). A new flock of birds should not be obtained before at least six months have elapsed. Thoroughness in the cleaning and disinfection is very important if good results are to be expected. TUBERCULOSIS OF DOGS AND CATS. Occurrence and Form. Tuberculosis is not very often observed in dogs and cats. As the pulmonary form is most common, the infection is probably transmitted to the lungs on inhaled particles of dust. In some cases, primary involve- ment of the digestive tract is found, indicating that the germs were probably taken in with the food. Rarely do we find infection has taken place through any other channel. TUBERCULOSIS OF DOGS AND CATS 621 Pathogenesis. Most of the cases no doubt result from association with tubercular human beings, or contact with infected rooms, etc. It may also result from ingesting meat containing the bacilli. Pathology. Two distinct types are found on necropsy: (a) Pulmonary form, and (6) digestive form. (a) In the pulmonary form the lungs show caseous foci, or small miliary nodules. A chronic, indurative broncho- pneumonia or a chronic interstitial pneumonia is frequently found. Adhesions are common between the lungs and parietal pleura. Aside from these lesions there are very often present edema and emphysema of the lungs, bronchitis and bronchiectasis. The pleura often shows evidence of a serous or serofibrinous pleuritis with considerable fluid present in the thoracic cavity; or in other cases a dry, granular adhesive pleuritis in which the parietal and visceral pleura are adherent. Numerous small nodules are often found on the pleura. The bronchial lymph glands are more or less enlarged. (6) The intestinal lesions are mainly in the mesenteric lymph glands, which are enlarged; the walls of the intestines show miliary tuberculosis, particularly on the serous covering; the liver usually presents similar lesions. The spleen and kidneys often show miliary tuberculosis. The cadaver in general shows evidence of cachexia and emaciation. Symptoms. The disease usually runs a chronic course the symptoms developing gradually. General emaciation is apparent in spite of a fairly good appetite, the animals become easily exhausted, are dyspneic (lung form), and weak. After emaciation begins to be a prominent symptom, the form of the disease, whether pulmonary or intestinal, will assert itself. The pulmonary form is characterized by a short, dry cough, which later becomes moister and is accompanied by a dis- charge of a mucopurulent secretion which in most cases is swallowed. The respirations grow labored; dry or moist rales are heard on ausculation. Percussion reveals areas of flatness, and usually hydrothorax. An atypical fever is present during the course of the disease. In the intestinal form the symptoms of chronic intestinal catarrh are most 622 CHRONIC INFECTIOUS DISEASES prominent with diarrhea during the latter stages. Rapid emaciation is generally followed by death in a short time. Diagnosis. As tuberculosis is not very common in dogs and cats, and the symptoms not particularly characteristic, a diagnosis is not often made during life. The history of the case and its chronicity might lead one to suspect it. Tuber- culin (0.15 to 0.20) might be used subcutaneously. The reaction is more prompt but the test is not so reliable as in large animals. Prognosis. Unfavorable. Treatment. In advanced cases no treatment should be attempted. During the early stages good nutritious food, and tonics are best. Inhalations 'of creolin vapor are recom- mendablc. GLANDERS. In dogs and cats glanders is not very common. It is occa- sionally observed among carnivora fed meat or organs from horses affected with glanders. In zoological gardens glanders may be enzootic among meat eating animals, especially when horse meat is fed. Glanders usually assumes an acute form in these animals. The early symptoms are those of an intense inflammation of the mucous membrane of the nasal passages, larynx, trachea, and the conjunctiva. In a short time (two to five days) appears a greenish-gray or blood- stained secretion from the eyes and nose. The respirations are labored on account of the intense congestion and swell- ing of the respiratory mucous membrane. The symptoms rapidly become aggravated, the tissues about the head become swollen, nodules appear at different points in the skin, which open and form irregular shaped ulcers. Diarrhea is a prominent symptom. The animal becomes emaciated, and succumbs in the course of eight to fourteen days. When such symptoms occur, the animal should be isolated so that further spread of the disease is controlled. Thorough dis- infection of the premises, and proper disposition of the cadavers are very important. PSEUDO-ACTINOMYCOSIS OF DOGS 623 PSEUDO-ACTINOMYCOSIS OF DOGS. Streptotrichosu Canum. Actinomyces Canis. Definition. A specific disease, caused by the Actinomyces canis, cliaracterized by an inflammation of serous mem- branes, and abscess formation of the subcutaneous tissues. Occurrence. This disease is not of frequent occurrence in dogs. A few cases have also been noted in cats. Etiology. The specific virus, Actinomyces canis, produces long divided filaments, which are easily stained by the Gram- Weigert method. Sometimes they form club-shaped bodies. On artificial media the fungus grows at the body temperature. Pathogenicity. When pure cultures are injected intra- peritoneally into mice, they produce at the point of inoculation nodules of varying size (pea to bean) containing pus. Sub- cutaneous injections into rabbits cause at the point of injec- tion nodules which form abscesses. The same condition may be produced in dogs by subcutaneous injections. Pathology. The lesions usually found are in the pleura or peritoneum. They consist of an exudate of reddish color collected in the body cavity, containing numerous small, white, pin-point nodes. On the serous membrane will be a number of small nodules, and on the pleura fibrinous exudate. The lungs often contain a number of pea-sized nodes with caseous centers. Abscess formation occurs in different parts of the body, particularly in the subparotid region, the vagina, or in the subperitoneal connective tissue of the pelvis. The abscesses contain a grayish turbid mass in which are many of the characteristic granules. The abscesses usually heal after discharging their contents. The spleen, kidneys and heart muscles often show nodular lesions. Arthritis with pus formation is seen in some cases. Symptoms. The disease during the early stages does not present any characteristic symptoms. Later, however, there will be evidence of chronic inflammation of the serous membranes with collections of fluid in the thoracic and abdominal cavities. As the disease progresses, the animal shows general emaciation, weakness, and the presence of 024 CHRONIC INFECTIOUS DISEASES abscesses in various parts of the body. The inflammation of the lungs develops gradually and is not attended by any marked change in temperature. Dyspnea is a prominent symptom. The animal gradually grows weaker and dies from exhaustion. Diagnosis. -The diagnosis is established only after rinding the characteristic granules or filaments in the discharge from the abscesses. The symptoms alone would not be sufficient for an accurate diagnosis. Prognosis. When the disease shows evidence of general involvement of the body, the prognosis is unfavorable. More favorable are those cases of localized infection. Treatment. Abscesses should be opened, drained, and the cavity painted with tincture of iodin. Potassium iodid (dog 0.05 0.15; cat 0.00.5-0.05) given once daily is recommended. Xo further treatment would be of any value. CHAPTER V. INFECTIOUS DISEASES PRODUCED BY PROTOZOA. SPIROCKffiTOSIS OF FOWLS. Spirochcetosis Avium. Spirillosis of Chickens. Definition. A fatal septicemia of chickens, ducks, geese, and pigeons. Occurrence. This disease has made its appearance in several countries in enzootic form. A few outbreaks have been observed in the southern part of the United States. Up to the present time the disease has not attained economic importance in this country. It occurs most commonly in chickens where it seriously interferes with breeding. Etiology. The Spirochaete gallinarum (Spirillum anserum) is now recognized as the causative agent. This is a blood parasite, probably a flagellated protozoon. It appears as fine threads, 10 to 20 microns long, spirally formed, and provided with one or more cilia which show active move- ments. These parasites leave the blood rapidly after the fowl's death. Pathogenesis. The disease is easily produced by injections of virulent blood from one fowl to another of the same species. Older fowls are less susceptible than younger ones. The disease develops rapidly following inoculation. After the second day larger numbers of the spirilla are found in the blood. Natural Infection. The disease is transmitted by ticks; mainly by the Argas miniatus, in some cases by the Argas persicus and Argas reflexus, and in others by the Ornitho- dorus moubata. The ticks exist in waste places or in wooded districts. Fowls become infested by roosting where the ticks occur. The ticks attach themselves to the body, and suck 40 626 INFECTIOUS DISEASES PRODUCED BY PROTOZOA its blood, thus directly inoculating the fowl. The spirillee are soon found in the blood. Pathology. The most characteristic lesions on necropsy are enlarged spleen and liver, both organs showing numerous areas of degeneration and necrosis. The heart muscle shows evidence of inflammation. No other lesions of importance are found. Symptoms. The period of incubation is from eight to ten days. Some cases develop in four to six days after the ticks have been placed on the fowl. The early symptoms are those of suppression of appetite, high temperature (108-111 F.), somnolence, weakness. Later diarrhea sets in; the comb and wattles become bluish-red; marked weakness and paralysis. During the later stages of the disease the temperature becomes normal or subnormal. Death follows in a short time in most cases under symptoms of convulsions and para- lysis. The majority of cases are acute; a few have been observed to assume a chronic type. The course of the disease is usually from four to six days in the acute form and ten to eighteen days in the chronic. Diagnosis. This is made by noting the enzootic character of the disease; the characteristic lesions on autopsy, and the finding of the Spirochaetes in the blood of sick birds. Prognosis. The prognosis is unfavorable when the disease is well established. Some cases recover. Treatment. Atoxyl (0.1 peroremfortwo consecutive doses) has been recommended, and has proved to be highly efficient in producing immunity from infection in normal fowls. Atoxyl (0.05) as an intramuscular injection is recommended for infected birds. In two to three days the parasites dis- appear from the blood. Atoxylate of mercury has also been used in a similar manner. This treatment when properly administered will produce excellent results. Immunization of fowls with the blood of sick chickens, which has been allowed to stand for forty-eight hours, has proved of great value. After this period the blood is no longer infectious and may be injected subcutaneously into healthy fowls. This establishes an immunity against infec- tion. ENTEROHEPATITIS G27 A horse serum has been produced (by hyperimmunization of the horse with repeated injections of live spirillse). In doses of 3 to 5 c.c. per bird it has given good results. Immun- ization of the flock by this method would be recommended as early as possible. ENTEROHEPATITIS. Blackhead. Definition. A disease peculiar to turkeys. It is occa- sionally observed in other birds, particularly chickens. Occurrence. Blackhead is very prevalent in various sec- tions of the United States, occurring often in an enzootic form destroying whole flocks, and seriously interfering with the raising of turkeys in many districts. It is especially fatal in young birds. Etiology. It is produced by a protozoon, Amoeba melea- gridis. This parasite is microscopic in size and is found in large numbers in the liver, ceca and other portions of the intes- tinal tract. Some authorities claim that a coccidium is the cause of the disease. When coccidia are present, however, the above parasite also coexists which makes it probable that the amoeba rather than the coccidia cause the disease. Pathogenesis. Blackhead is spread by the bowel discharges of the affected birds which contain the parasites in large numbers. Food and water polluted with infested fecal matter are taken into the digestive tract of well birds. When the amoeba reach the intestinal tract they develop rapidly, producing irritation to the mucosa and ultimately lead to a marked inflammation. The liver as a rule is invaded during the progress of the disease showing intense hepatitis. The parasites may enter the liver via the lymphatic system or directly through the bile duct. Intermediate agents (other birds, sparrows, pigeons, etc.) are often responsible for the transmission of the disease to other flocks. Necropsy. The autopsy findings are confined mostly to the liver and intestines. The liver is found much enlarged (often three to four times normal), the surface studded with whitish or yellowish spots, which when opened show degener- 028 INFECTIOUS DISEASES PRODUCED BY PROTOZOA ated areas filled with a soft caseated material. On cross- section the liver will show darkened spots often surrounded by degenerated areas, giving it a peculiar spotted or marbled appearance. The organ is soft, friable, easily crushed between the fingers. The infection produces a more or less rapid necrosis of the entire liver substance. The ceca are much enlarged and the mucosa swollen; later cases show ulceration and degeneration of the membrane. Chronic cases exhibit extensive ulcerations on various portions of the mucosa. The fecal matter in the lower bowels is mixed with blood, giving it a dark tarry appearance. The serous membranes (pericardium, pleura, peritoneum, etc.) show evidence of inflammation and effusion of fluid. The cavities (thoracic and abdominal) may be partially filled with exudate. In chronic cases dropsical swellings are often found in the cavities and extremities. Symptoms. The disease is most often observed in young turkeys, although in some outbreaks older birds are affected. The early indications of the disease are purplish discoloration of the comb and wattles, dulness, rough plumage, drooping of the tail and wings, complete loss of appetite in most cases, and a tendency for the bird to remain in a sitting posture for long periods. During this period there is nearly always a severe diarrhea. The discharges, being greenish-yellow in color, have a very offensive odor. The birds gradually grow weaker and become exhausted in a few days. Death occurs in most cases in three to five days. In less severe, or chronic cases, the birds lose their appetite or it becomes irregular, and they gradually grow emaciated and weak. Some cases will partially recover, and the bird will droop around for several weeks. Other cases recover completely from the disease. Diagnosis. This is made by considering the enzootic character of the disease, its symptoms, and autopsy findings. There is no other disease common to turkeys producing such serious losses. Whenever the disease is suspected a micro- scopic examination should be made of the discharges and cecal contents. INFECTIOUS DIARRHEA OF CHICKS 629 Prognosis. Owing to the high mortality of the disease the prognosis is unfavorable. Its rapid spread from one bird to another, and to other flocks, makes the disease difficult to control. The mortality may reach from 50 to 90 per cent. Treatment. Intestinal antiseptics are indicated. Sodium sulphocarbolate (0.2-0.4) two or three times daily has given good results. Also salol in the same doses. Admin- ister sulphate of iron in the drinking water, using one ounce of the sulphate of iron to one gallon of water. This has proved to be of value as a bowel disinfectant. As soon as an outbreak appears, radical means should be adopted at once to prevent the spread of the disease. Disinfect the coops and houses thoroughly with lysol solution (3 per cent.), or lime solution. Clean up. all droppings two or three times daily and either burn them or bury in lime. Disinfect all drinking fountains and feed pans daily. Extreme care must be used by attendants to prevent carrying the infection to other birds or flocks. Good results often follow when these details are carried out conscientiously. INFECTIOUS DIARRHEA OF CHICKS. White Diarrhea. Definition. An infectious disease affecting young chicks, characterized by a severe diarrhea, prostration and high mortality. Owing to the fact that it affects chicks shortly after being hatched, and such large numbers die, it is one of the most important diseases with which the poultry- man has to contend. The losses to the poultry industry through its ravages are enormous. In some districts it is becoming very difficult to rear young chicks. Etiology. It is necessary to recognize two distinct etiolog- ical factors, viz: (a) A form produced by the Bacterium pullorum, and (6) a protozoal form caused by the Coccidium tenellum. Both of these forms are frequently met with in practice. The reason the conditions should be classified together is because they appear in the same aged birds, produce much the same symptoms, and it has been found 630 INFECTIOUS DISEASES PRODUCED BY PROTOZOA that the two diseases often coexist in the same chick. It is necessary to differentiate the two conditions by examination of the cecal contents for the coccidia, or the liver, spleen and kidneys for the bacterium. Necropsy. In the form produced by the Bacterium pul- lorum the principal lesions are found in the liver, kidneys, spleen and intestinal tract. The liver shows areas of conges- tion and fatty degeneration. The kidneys are usually normal in size but show some evidence of congestion and cloudy swelling. The involvement of the intestinal tract is as a rule of minor importance. Therefore, but slight changes are found in the majority of cases. The other tissues in the body are pale, anemic and show evidence of emaciation. In the form produced by the Coccidium tenellum, the most promi- nent lesions will be present in the intestinal tract. The mucosa is congested and distinct ulcerations are usually present in the ceca. The liver, kidneys and musculature show similar changes as found in the other form. The intestinal contents indicate partial or complete loss in function. Pathogenesis. In the bacillary form it is quite evident that the eggs are frequently contaminated in their formative stage. \Vhen hatched the infection is already present in the chick. This no doubt accounts for the large number of chicks that succumb to the disease so soon after they are hatched. This mode of infection is explained by the fact that the laying hens carry the infection in some of the organs, probably the ovaries, which permit the organisms to pass to the eggs during the early stage of their development. The bacilli have been found in the yolks of eggs. It is quite possible to have other modes of transmission of the infection, such as the infection being carried on the outside of the egg shell and when the bird is liberated it becomes infected. Many cases are infected from the water, feed, or discharges from the diseased chicks. The infection, when introduced into the delicate digestive tract of the chick, develops rapidly and interferes with the early digestion of the food. Natu- rally assimilation is practically stopped and the bird rapidly becomes weak and emaciated. It has been proved that during the first few days of the chick's life its principal INFECTIOUS DIARRHEA OF CHICKS 631 source of food supply is from the yolk of the egg from which it is hatched. The infection is carried to the other organs by the blood or lymph systems. The coccidial form develops in a similar manner. Numer- ous examinations have proved that laying hens are often chronic carriers of the coccidia which are passed out either with the eggs, or with the discharges. The food, water, litter, etc., are contaminated and therefore easily picked up by the chick during the first week or ten days of its life. The coccidia, when introduced into the digestive tract, develop in a few hours and penetrate into the mucosa which accounts for the digestive disturbances. Both forms of the disease result in intestinal irritation, congestion, and disturbed function. Symptoms. The early indication of the disease is the presence of a whitish, or whitish-brown, frothy discharge from the bowels. Examination of the chick reveals the soft, pasty mass adhering around the cloaca and on the feathers. They are dull, wings held pendent, head held down and more or less constantly emitting a peculiar "peeping" sound. The appetite is suppressed or entirely lost. The chicks rapidly become weak, often fall down when urged to move, and show every evidence of general cachexia. Death follows often in a few days following hatching. Other cases when infected later often are normal during the first few days or week only to take the disease in two to four weeks, showing practically the same symptoms. The mortality is 50 to 90 per cent, of the hatch. In order to determine the presence of the bacilli or coccidia, a microscopic examination should be made of the discharges, cecal contents, or cultures taken from the organs. Diagnosis. This is not considered difficult as the disease makes its appearance soon after the chicks are hatched, and the fact that a number of them are affected at the same time. The symptoms are also quite characteristic. There is no similar disease aft'ecting young chicks at this age, except possibly ptomain poisoning. A microscopic examination will assist in making the diagnosis. 632 INFECTIOUS DISEASES PRODUCED BY PROTOZOA Prognosis. Due to the character of the disease and the high mortality the prognosis is unfavorable. It will depend to some extent on the age of the chicks and the virulency of the infection. Treatment. Dietetic. Withhold all food from the chicks during the first two or three days. They have sufficient food from the yolk of the egg to sustain them for this period. Afterward feed small amounts of egg yolk, or bread and milk. Buttermilk or sour milk is highly recommended on account of the acid it contains producing antiseptic action on the bowel contents. A small amount of lactic acid added to sweet milk will have a similar action. Buttermilk tablets are recommended so that a uniform quantity of sour milk may be kept for their use daily. These when added to sweet milk bring about sufficient fermentation in twelve to twenty-four hours. It is quite important that they do not receive too much food during the first week to bring on digestive dis- turbances, thereby lowering the natural resistance of the chick. Medical. Zinc sulphocarbolate or sodium sulphocarbo- late has given excellent results. It is best given by dissolving the preparation in water and allowing the chicks to drink of the solution freely. Each chick should receive from three to five grains of the compound one or twice daily. When the diarrhea is severe iron sulphate in the drinking water (30.0 to 4000.0) is beneficial as an antiseptic and astringent. In the coccidial form the following formula is highly recommended : 3 Potassi dichromate 12.0 Water . 250.0 Misco et fiat solutio. N'K- Use one teaspoonful to 1 quart of water for chicks one week old. YounRcr chicks half the quantity. Allow them to drink of this solution freely. Prevention. Much can be done to prevent the disease developing in young chicks: (a) All incubators should be thoroughly disinfected by washing all parts of them with a liquor cresolis compositus solution (3 per cent.). Allow them to dry out thoroughly before using. Another very effective PIROPLASMOSIS OF THE DOG 633 method is to close them up tight and introduce formaldehyd gas. Incubators have proved to be common carriers of the infection, therefore attention to this matter is especially important. (6) All eggs selected for hatching should be cleaned and disinfected in the following manner: Saturate a cloth in 50 per cent, alcohol and wipe each egg carefully before placing it in the incubator. Do not use an excess of alcohol as it will penetrate the egg shell. This treatment will effectively remove all surface infection, (c) All coops, houses, nests, etc., should be disinfected at regular intervals. (d) When possible it would be advisable to select hens as layers that are free from the disease. This can be done quite efficiently by examining samples of eggs, discharges, aggluti- nation test, etc. (e) All litter from infected houses, coops, etc., should either be burned or treated with lime to pre- vent the perpetuation of the disease. PIROPLASMOSIS OF THE DOG. Infectious Jaundice. Biliary Fever. Malignant Jaundice. Definition. A malignant or infectious disease of the dog produced by the Piroplasma canis or Piroplasma commune. Etiology. Piroplasmosis of the dog has been reported in several different countries. It is produced by two species of piroplasma or Babesia: Piroplasma canis and Piroplasma commune. Morphologically these parasites are identical with Piroplasma bigeminum. The Piroplasma canis is 2-4 microns in diameter, the free organisms spherical, and those contained within the corpuscles are pear-shaped or contain many angles. Multiplication is by direct division. The Piroplasma commune is similar, round or pear-shaped. The round type is 1.0-1.5 microns, and the pear-shaped 1.5-2.5 microns in diameter. The former is not transmissible to any other animal while the latter has been transmitted to the guinea pig and cat. Dogs become infected from ticks and fleas (Ixodes ricinus, Rhipicephalus sanguineus, Dermacentor variabilis, Haema- physalis Leachi, Ctenocephalus canis), which have been found to be common carriers of the disease. Young animals 034 INFECTIOUS DISEASES PRODUCED BY PROTOZOA (puppies) are most susceptible and often an entire litter will develop the disease. Older animals are partially or com- pletely immune. The disease may be readily transmitted by injecting young animals with virulent blood. The initial symptoms develop in two to three days. Natural infection takes place from animals coming in contact with fleas or ticks infested with the piroplasm. The period of incubation from natural infection is from seven to ten days. Pathology. In the acute form the disease process is often so rapid that but little will be found on postmortem examina- tion. The liver is found congested, the bile of dark color and thick. The spleen is enlarged often two or three times its normal size; the color is dark, the borders rounded. The kidneys are congested, and small hemorrhages are noted on the surface. The heart muscle is pale, and small petechise and ecchymoses are observed on the endo- and epicardium. The lungs are usually edematous, and ecchymoses occur on the membranes. The bladder contains a reddish-brown colored urine, especially in the very acute form of the disease. The skin and mucous membranes are greenish in color, which in some cases may be absent, the membranes very pale and anemic. In the chronic form the postmortem lesions are those of an anemia, with a paleness of all the tissues and organs. The liver is found intensely congested, the bile of a syrupy consistency and very dark in color. The blood from the spleen will contain large numbers of the parasites. The kidneys, heart and lungs are congested and show num- erous small hemorrhages on their surfaces. The marrow of the bones is intensely congested, and of a dark reddish color. In the chronic form icteric symptoms are also observed. The blood has a thin, watery appearance, the serum practically colorless. Symptoms. The initial symptoms of the acute form are those of a severe infectious disease: Depression, loss of appetite, often severe vomiting. Paralysis of the posterior extremities often takes place early (in eighteen to twenty- four hours) and ascends rapidly producing a general paralysis in three to four days. In the more subacute form the symptoms are less pronounced, presenting all the evi- PIROPLASMOSIS OF THE DOG 635 deuces of an acute anemia, the mucous membranes becoming pale, colorless, or bluish. The most common change -in the mucous membranes, however, is icteric discoloration. A characteristic symptom is the blood coloring matter in the urine, which turns it pale red or reddish-brown. The hemo- globin found in the urine is rather high (5 per cent.). The temperature in the early stages is elevated (103-105 F.). It remains elevated usually for twenty-four to forty-eight hours, when it drops suddenly and becomes subnormal. In young dogs the temperature drops very rapidly, as low as 95-96 F. The pulse is increased, weak and wiry; the respirations 36 to 60 and often labored. The blood is thin and paler than normal. The number of the red corpuscles is greatly reduced (from 5-7 million to 2 million per c.), the white corpuscles greatly increased (from 6-7000 to 40,000 per c.). In the chronic form the symptoms are less pronounced. There are evidences of anemia, the animals become weak and indifferent to their surroundings. The mucous mem- branes are usually pale or yellowish, and sometimes of a bluish color. The urine contains blood-coloring matter, which seems to be a constant symptom. The blood when examined will be found to have a great reduction in the number of red corpuscles, but less than in the acute form, and the white corpuscles are about in the same ratio as in the acute form. Most of the white corpuscles are found to be polynuclear, and are often almost completely filled with the parasites. The course in this form may be long, lasting for days or weeks, the animals gradually recovering or dying of marasmus. Diagnosis. The diagnosis is made ^by carefully observing the symptoms, the fact that the disease occurs in several animals at the same time, and the microscopic examination of the blood to determine the ratio between the red and white corpuscles, and the presence of the specific parasite. Some- times it is difficult to find the parasite from a clinical case under the microscope. In such cases it is of advantage to confirm the diagnosis by inoculating a young puppy with some of the blood of the affected animal. The virulent f>3() INFECTIOUS DISEASES PRODUCED BY PROTOZOA blood should he injected into the circulation to obtain the most accurate and rapid results. Prognosis. In the acute form, the prognosis is very unfavor- able, the animals grow weak rapidly, and die from exhaustion in from three to six days. In the chronic form recovery often takes place after several weeks. Treatment. In the acute form, treatment has but little effect on the course of the disease. Symptomatic treatment must be used. When there is extreme weakness and sub- normal temperature stimulants, such as strychnin sulphate (0.001 subcutaneously) , or diffusible stimulants should be given as often as necessary to keep up the circulation and general condition of the animal. Quinin (0.3-1.0) two or three times daily has been highly recommended. The treatment in the chronic form is very similar. Plenty of good nutritious food should be given to conserve the strength of the patient. EQUIVALENT OF METRIC WEIGHTS 637 EQUIVALENTS OF APOTHECARIES IN METRIC MEASURES. Cubic Cubic Minims. Centimeters. Fluidrams. Centimeters. 1 0.061 1 . . . . . . 3.7 2 0.123 2 . . . . . . 7.39 3 0.185 3 . . . . . . 11.09 4 0.246 4 . . . . . . 15.00 5 0.308 5 . . . . . . 18.50 6 0.370 6 . . . . . . 22.50 7 0.431 7 . . . . . . 26.00 8 0.493 9 0.554 Cubic 10 0.616 Fluidounces Centimeters. 11 0.678 1 . . . . . . 29.57 12 0.739 2 . . . . . . 59.14 13 0.801 3 . . . . . . 89.00 14 0.863 4 . . . . . . 118.29 15 0.924 5 . . . . . . 148.00 16 1.00 6 . . . . . . 177.42 17 1.06 7 . . . . ." . 207.00 18 ...... 1.12 8 . . . . . . 236.59 20 1.23 9 . . . . . . 266.16 30 1.84 10 .. . . . . 295.73 40 2.46 12 . . . . . . 355.00 50 3.08 16 . . . . . . 473.17 20 . . . . . . 591.50 24 . . . . . . 710.00 32 . . . . . . 946.35 128 . . . . . . 3785.43 EQUIVALENTS OF APOTHECARIES IN METRIC WEIGHTS. Grain. Grams. Grain. Grams. 1-1000 . . . .000065 1-2 0324 1-500 . . . .000129 1 . . . . . . .0648 1-250 . . . .000258 2 . . 1296 1-200 . . . .000324 3 . . 1944 1-150 . . . .00043 4 . . 2592 1-120 . . .00054 5 . . 3240 1-100 . . .00064 6 . . 3888 1-75 . . .00086 7 . . . . . . .4536 1-60 . . .00108 8 . . . . . . .5184 1-50 . . . .00129 9 . . 5832 1-40 .... .00162 10 . . 6480 1-30 . . . .00216 11 . . 7128 1-25 . . . .00259 12 . . 7776 1-20 . . . .00324 13 . . 8424 1-12 . . .00540 14 . . 9072 1-10 .... .00649 15 . . . . . . .9720 1-8 . . .0081 20 . . . . . . 1.2960 1-6 ... .0108 25 . . . . . . 1.6200 1-5 ... .0129 30 . . . . . . 1.9440 1-4 . . .0162 35 . . . . . . 2.2680 1-3 . . .0216 40 . . . . . . 2.2920 638 EQUIVALENTS OF METRIC WEIGHTS Grain. Grams. Ounces. Grams. 45 . . . . 2.9160 3 . . . . . . 93.310 50 . . . . 3.2400 4 ... . . 124.414 55 .... 3.5640 5 . . . . . . 155.517 59 .... . . 3.8232 6 . . . . . . 186.631 7 . . . . . . 217.724 Drams. Grams. 8 . . . . 9 . . . . . . 248.828 . . 279.930 1 .... 2 .... . . 3 . 88 7.776 10 . . . . . . 311.035 3 .... 4 .... 5 .... 6 . 7 .... 11.664 . . 15.552 . . 19.440 . . 23.328 . . 27.216 11 . . 12 . . . . 14 . . . . 16 . . . . 20 . . . . 24 . . . . 342.138 . . 373.242 . . 435.449 . . 497.656 . . 622.070 . . 746.484 32 . . . . . . 995.312 Ounces. Grams. 48 . . . . . . 1492.968 1 . . . 31.103 64 . . . . . . 1990.624 2 . 62.207 100 . . . . 3110.350 INDEX. A ABSCESS of cornea, 534 of kidney, 396 of liver, 236 renal, 397 Acne, 468 definition, 468 etiology, 468, 469 pathology, 469 prognosis, 469 symptoms, 469 treatment, 469 Actinomyces canis, 623 Adhesions of eyelids, 504, 505 ankyloblepharon, 505 treatment, 505 symblepharon, 505 treatment, 505, 506 Alopecia, 465 definition, 465 diagnosis, 466 differential, 466 etiology, 465 pathology, 465 prognosis, 466 symptoms, 465, 466 treatment, 466 Alveolar periostitis, 108 Amaurosis, 547 Amblyppia, 547 Amyloid kidney, 407 liver, 242 definition, 242 etiology, 242 pathology, 242, 243 symptoms, 243 Anal glands, suppuration of, 224 Anemia, 319 of brain, 437 223 , Anemia of brain, definition, 437 etiology, 437 pathology, 438 prognosis, 438 symptoms, 438 treatment, 438 cerebral, 437 course, 321 definition, 319 diagnosis, 321 etiology, 319, 320 occurrence, 319 pathology, 320 prognosis, 321 symptoms, 320, 321 treatment, 321, 322 Animal parasites in blood, 330 in kidney, 407 in trachea and bronchial tubes, 42 Ankyloblepharon, 505 Ankylostoma canina, 207 Ankylostomum stenocephalum, 207 trigonacephalum, 207 Anthrax, 599 Aphtha, 100 Aphthae epizooticse, 600 Apoplexia hepatis, 246 Apoplexy, 440 definition, 440 diagnosis, 441 etiology, 440 pathology, 440 prognosis, 441 symptoms, 440, 441 treatment, 441 Arthritis, 383 urica, 354 Articular rheumatism, 363 Articulations, dislocation of, 378 caudal vertebra, 383 040 INDEX Articulations, dislocations of, cau- dal coxofemoral, 381 etiology, 381 prognosis, 381 symptoms, 381 treatment, 382 humero-radio-ulnar, 379, 380 etiology, 380 prognosis, 380 symptoms, 380 treatment, 380 patellar, 382 etiology, 382 prognosis, 382 symptoms, 382 treatment, 382, 383 phalangeal, 381 radio-ulnar-carpal, 380 diagnosis, 380 symptoms, 380 treatment, 380, 381 scapulohumeral, 379 etiology, 379 prognosis, 379 symptoms, 379 treatment, 379 temporomaxillary, 378 etiology, 378 prognosis, 378 symptoms, 378 treatment, 378 tibiotarsal, 383 vertebral, 379 inflammation of, 383 sprains and injuries to, 377 course, 377 prognosis, 377 symptoms, 377 treatment, 377 wounds of, 376 diagnosis, 376 etiology, 376 prognosis, 376 symptoms, 376 treatment, 376, 377 Ascaridir, 201 Ascites, 257 . definition, 257 diagnosis, 259, 260 etiology, 257, 258 pathology, 258 prognosis, 260 symptoms, 258, 259 Ascites, treatment, 260, 261 Aspergillosis, 40 Asthenia, infectious, of birds, 191 definition, 191 diagnosis, 191, 192 etiology, 191 pathology, 191 prevention, 192 prognosis, 192 symptoms, 191 . treatment, 192 Atrophy of liver, 240 definition, 240 diagnosis, 241 etiology, 240, 241 pathology, 241 prognosis, 241 symptoms, 241 treatment, 241 of optic nerve, 547 definition, 547 prognosis, 547 Auditory nerve, paralysis of, 453 Avian tuberculosis, 616 B BALANITIS, 265 Basedow's disease, 343 Belascaris marginata, 202 myxtax, 202 Benign neoplasms of mouth, 102 tumors of mammary glands, 317 fibromata, 317, 318 lipoma, 318 Biliary fever, 633 Black tongue, 579 Blackhead, 627 Bladder, calculi in, 420 catarrh of, 416 diseases of, 410 examination, 410, 411, 412 by laparotomy, 411 by palpation, 410, 411 of urine, 411, 412 incontinence of urine in, 416 , parasites in, 423, 424 retention of urine in, 414 rupture of, 412 torsion of, 420 tumors in, 423 INDEX 041 Bladder, wounds of, 412 Blennorrhea, 512 Blepharitis, 498 definition, 498 etiology, 498 prognosis, 498 symptoms, 498 treatment, 498, 499 Blepharoptosis, 501 Blepharospasm, 503 Bothriocephalus felis, 197 Brachial plexus, paralysis of, 455 Brain, anemia of, 437 congestion of, 435 diseases of, 431 examination, 432, 433, 434,435 psychic disturbances, 433 sensibility, 433, 434, 435 general considerations, 431,432 cerebellum, 432 cortex, 431, 432 midbrain, 432 hyperemia of, 435 tumors of, 441, 442 Bi ittleness of bones, 362 Bronchial catarrh of birds, 38 tubes and trachea, animal para- sites in, 42 Bronchitis, 38 and tracheitis, 34 acute, 34 chronic, 44 Bronchocele, 336 Bronchopneumonia, 53 definition, 53 diagnosis, 56 etiology, 53, 54 pathology, 54, 55 prognosis, 56 symptoms, 55, 56 treatment, 56 Bulbar paralysis, infectious, 611 CALCULI in bladder, 420 etiology, 420, 421 forms and varieties, 421 acid urine calculi, 421 alkaline urine calculi, 421 prognosis, 422 symptoms, 421, 422 41 Calculi in bladder, treatment, 422, 423 in kidney, 402 definition, 402 diagnosis, 403 etiology, 402 pathology, 402 prognosis, 403 symptoms, 402, 403 treatment, 403, 404 in urethra, 427 prognosis, 428 symptoms, 427, 428 treatment, 428, 429 Canine typhus, 579 Canker, 593 of mouth, 97 Caponizing, 276, 277, 278 Carcinomata of bladder, 423 of eyelids, 509 of mammary glands, 318 of penis and prepuce, 269 of scrotum and testes, 273 Caries of teeth, 109 definition, 109 etiology, 109 pathology, 109, 110 symptoms, 110 treatment, 110 Castration, 273 of birds, 276, 277, 278 of cat, 275, 276 of dog, 274, 275 cryptorchid, 275 monorchid, 275 Catalepsy, 460 course, 460 definition, 46Q diagnosis, 460 etiology, 460 pathology, 460 prognosis, 460 symptoms, 460 treatment, 460 Cataract, 542 course, 543 definition, 542 forms, 542 congenital, 543 diabetic, 543 senile, 542 symptomatic, 542 traumatic, 542 642 INDEX Cataract, prognosis, 543 symptoms, 543 treatment, 543, 544 discission, 543, 544 extraction, 544 Catarrh of bladder, 416 definition, 416 diagnosis, 419 etiology, 416, 417 pathology, 417, 418 prognosis, 419 symptoms, 418, 419 treatment, 419, 420 bronchial, of birds, 38 definition, 38 diagnosis, 39 etiology, 39 prognosis, 39 symptoms, 39 treatment, 39, 40 chronic, of stomach, 146 of crop in birds, 137 definition, 137 diagnosis, 138 etiology, 137, 138 prognosis, 138 symptoms, 138 treatment, 138, 139 nasal, acute, 19 definition, 19 diagnosis, 19 etiology, 19 prognosis, 19 symptoms, 19 treatment, 19, 20 chronic, 23. definition, 23 diagnosis, 24 etiology, 23 pathology, 23 prognosis, 24 symptoms, 23, 24 treatment, 24 of rabbits, 20 infectious, 20 definition, 20 diagnosis, 21 etiology, 20, 21 necropsy, 21 prognosis, 21 prophylaxis, 22 symptoms, 21 treatment, 21 Catarrh, nasal, of rabbits, para- sitic, 22 definition, 22 diagnosis, 23 etiology, 22 prevention. 23 prognosis, 23 symptoms, 22 treatment, 23 preputial, 265 definition, 265 etiology, 265, 266 prognosis, 266 symptoms, 266 treatment, 266 simple, of stomach, 142 Catarrhal conjunctivitis, 511 pneumonia, 53 stomatitis, 94 Caudal vertebrae, dislocation of,383 Cerebral anemia, 437 hemorrhage, 440 Cestoda, 193, 194, 195 species, 195 tseniae, 195 in intestine of birds, 198 of cats, 197 of dogs, 195, 196, 197 of rabbits, 197, 198 Chalazion of eyelids, 507 Chicken-pox, 593 Choanptsnia infundibuliformis,198 Cholelithiasis, 245 symptoms, 245 treatment, 245 Cholera, fowl, 584 gallinarum, 584 Chorea, 461 definition, 461 diagnosis, 461 etiology, 461 pathology, 461 prognosis, 461 symptoms, 461 treatment, 461 Chronic catarrh of stomach, 146 coryza, 23 dilatation of stomach, 154 dyspepsia, 146 enteritis, 173 gastritis, 146 interstitial hepatitis, 243 pneumonia, 57 INDEX 643 Chronic inetritis, 29G nasal catarrh, 23 peritonitis, 255 pharyngitis, 125 rhinitis, 23 tracheitis and bronchitis, 44 Cirrhosis of liver, 243 definition, 243 diagnosis, 244 etiology, 243 pathology, 243 prognosis, 244 symptoms, 243, 244 treatment, 244 of lungs, 57 definition, 57 diagnosis, 58 etiology, 57, 58 pathology, 58 prognosis, 58 symptoms, 58 treatment, 58 Cittotsenia denticulata, 197 Coccidia in kidney, 409 Coccidium tenellum in kidney, 409 Comb disease, 484 white, 484 Compression of peripheral nerves, 450 of spinal cord, 448 definition, 448 diagnosis, 449 etiology, 448, 449 pathogenesis, 449 prognosis, 449 symptoms, 449 treatment, 449 Concha, ulceration of, 488 Concussion of spinal cord, 445 course, 447 diagnosis, 447 etiology, 445 pathogenesis, 446 prognosis, 447 symptoms, 446, 447 treatment, 448 Congenital defects of iris, 539 malformations of penis and pre- puce, 265 of urethra, 425 of vagina and vulva, 309 Congestion of brain, 435 of kidney, 387 Congestion of liver, 231 active, 231 course, 232 definition, 231 diagnosis, 232 etiology, 231 pathology, 231 prognosis, 232 symptoms, 232 treatment, 232, 233 passive, 233 definition, 233 diagnosis, 234 etiology, 233 pathology, 233, 234 prognosis; 234 symptoms, 234 treatment, 235 of lungs, 49 active, 49 diagnosis, 50 etiology, 49 pathology, 49 prognosis, 50 symptoms, 49, 50 treatment, 50 passive, 50 diagnosis, 51 etiology, 50, 51 pathology, 51 prognosis, 51 symptoms, 51 treatment, 51, 52 of mammary glands, 316 of thyroid glands, 334, 335 Conjunctiva, corrosions and burns of, 521 diseases of, 510 examination, 510 foreign bodies in, 519, 520 growths on, 522 traumatic lesions of, 519 tumors on, 522 ulceration of, 521 wounds on, 520 Conjunctivitis, 510 definition, 510 forms, 510 catarrhal, 511 etiology, 511 prognosis, 511 symptoms, 511 treatment, 511, 512 644 INDEX Conjunctivitis, forms, crotipous, 516 definition, 516 etiology, 516 prognosis, 516 symptoms, 516 treatment, 516 erysij)elatous, 514 exanthematous, 518 definition, 518 treatment, 519 follicular, 517 definition, 517 etiology, 517 prognosis, 517 symptoms, 517 treatment, 517, 518 parenrhymatous, 514 definition, 514, 515 etiology, 515 prognosis, 515 symptoms, 515 treatment, 515, 516 purulent, 512 acute, 512 definition, 512 etiology, 512 prognosis, 513 symptoms, 512, 513 treatment, 513, 514 chronic, 514 prognosis, 514 symptoms, 514 treatment, 514 Constipation, 182 definition, 182 diagnosis, 183 etiology, 182 pathology, 182 prognosis, 183 symptoms, 182, 183 treatment, 183, 184, 185 Contagious epithelioma, 593 Cornea, abscess of, 534 diseases of, 526 examination, 526 ectasia of, 537 foreign bodies of-, 535 opacities of, 536 tumors of, 538 ulceration of, 532 wounds of, 535 Cornua uteri, torsion of, 302 Corrosions and burns of conjunc- tiva, 521 treatment, 521 Coryza, 19 chronic, 19 Coxofemoral dislocation, 381 Cranial bones, fracture of, 368 Crop, catarrh of, in birds, 137 hard, 139 obstruction of, in birds, 139 soft, 137 Croupous conjunctivitis, 516 enteritis of cats, 190 pharyngitis of birds, 127 Ctenocephalus canis of dog, 472, 633 felis of cat, 472 Cuterebra emasculator, 273 Cyclitis, 540 Cystic goiter, 339 kidney, 405 Cysticercus cellulosa; in kidney, 409 Cystitis, 416 Cysts of ear, 494 of eyelids, 507 Meibomian, 507 pilosebaceous, 507 of iris, 541 of ovaries, 284 retention, in mouth, 103 of uterine tubes, 291 DACRYOCYSTITIS, 525 definition, 525 prognosis, 525 symptoms, 525 treatment, 525 Dandruff, 464 definition, 464 diagnosis, 464 etiology, 464 prognosis, 464 symptoms, 464 treatment, 464, 465 Davainea cesticillus, 198 crassula, 198 echinobothrida, 198 proglottina, 198 tetragona, 198 u Deafness, 495 INDEX 645 Deafness, etiology, 495 prognosis, 495 symptoms, 495 treatment, 495 Defects, congenital, of iris, 539 aniridia, 539 coloboma, 539 ectopic pupillie, 539 occlusion of pupil, 539 Demodex folliculorum, 480 mite, 480 . Dermacentor variabilis, 633 Dermatitis, 466 definition, 466 diagnosis, 468 etiology, 466, 467 pathology, 467 prognosis, 468 symptoms, 467, 468 treatment, 468 Dermatomycosis, 482 definition, 482 examination, 482 Diabetes, 347 definition, 347 insipidus, 347 course, 349 definition, 347 diagnosis, 349 etiology, 347, 348 occurrence, 347 pathology, 348 prognosis, 349 symptoms, 348, 349 treatment, 349, 350 mellitus, 350 course, 351 definition, 350 diagnosis, 351 etiology, 350 occurrence, 350 pathology, 350 prognosis, 351 symptoms, 350, 351 treatment, 351, 352 Diaphragmatic hernia, 563 Diarrhea, 178 definition, 178 diagnosis, 181 etiology, 178, 179, 180 infectious, of chicks, 629 definition, 629 diagnosis, 631 Diarrhea, infectious, of chicks, etiology, 629, 630 necropsy, 630 pathogenesis, 630, 631 prevention, 632, 633 prognosis, 632 symptoms, 631 treatment, 632 prognosis, 181 symptoms, 180 . treatment, 181 white, 629 Dicranotaenia sphenoides, 198 Dilatation and diverticula of esoph- agus, 136 definition, 136 diagnosis, 137 etiology, 136, 137 prognosis, 137 symptoms, 137 treatment, 137 of stomach, 152 acute, 152 diagnosis, 154 etiology, 152, 153 pathology, 153 prognosis, 154 symptoms, 153, 154 treatment, 154 chronic, 154 diagnosis, 157 etiology, 154, 155 pathology, 155, 156 prognosis, 157 symptoms, 156 treatment, 157 Dioctophyme renale, in bladder,423 in kidney, 407 Diphtheria, 593 Dipylidium caninum, 195 Dirofilaria immitis in blood, 330 Dislocation of articulations, 378 Dispharagus nosutus in stomach of birds, 163 spiralis in stomach of birds, 163 Distemper of cats, 577 definition, 577 diagnosis, 578 etiology, 577 pathology, 577 prognosis, 578 symptoms, 577, 578 treatment, 578, 579 646 INDEX Distemper of dogs, 565 definition, 565 diagnosis, 572, 573 etiology, 565, 566 natural infection, 566 necropsy, 566, 567 occurrence, 565 prevention, 577 prognosis. 573 symptoms, 567, 568, 569, 570, 571, 572 treatment, 573, 574, 575, 576 rabbit, 20 Districhiasis, 504 Diverticula of esophagus, 136 Dochmius trigonacephulus, 207 Dog plague, 579 Dropsy of kidney, 405 definition, 405 diagnosis, 406 etiology, 405, 406 pathology, 406 prognosis, 406 symptoms, 406 treatment, 406 of pericardium, 76 Dyspepsia, acute, 142 chronic, 146 Dystocia, 305 definition, 305 diagnosis, 307 etiology, 305, 306 prognosis, 307 symptoms, 306, 307 treatment, 307, 308 EAR, diseases of, 487 examination, 487 fistula, 495 etiology, 495 prognosis, 496 symptoms, 4% treatment, 496 neoplasms of, 493 parasites in, 494 wounds of, 487, 488 Echinococcus granulosus, 197 Kchinorhynchus canis, 202 Eclampsia, 461 definition, 461 Eclampsia, diagnosis, 462 etiology, 462 prognosis, 462 symptoms, 462 treatment, 462 Ectasia of cornea, 537 inflammatory, 537 forms, 537 keratectasia, 537 definition, 537, 538 treatment, 538 staphyloma, 537 definition, 537 treatment, 537 non-inflammatory, 538 forms, 538 keratoconus, 538 keratoglobus, 538 treatment, 538 Ectropion, 500 Eczema, 469 definition, 469 diagnosis, 471 etiology, 470 pathology, 470 prognosis, 471 symptoms, 470 treatment, 471 Edema of lungs, 52 pulmonary, 52 Eimeria avium in kidney, 409 Empyema of infraorbital fossae of birds, 20 definition, 20 etiology, 20 prognosis, 20 symptoms, 20 treatment, 20 Endocarditis, acute, 85 definition, 85 diagnosis, 88 etiology, 85, 86 necropsy, 86, 87 prognosis, 88 symptoms, 87, 88 treatment, 88, 89 Enophthalmus, 551 definition, 551 etiology, 551 prognosis, 552 symptoms, 551 treatment, 552 Enteritis, 167 INDEX 647 Enteritis, acute, 167 definition, 1G7, 168 diagnosis, 171 etiology, 168, 169 pathology, 169 prognosis, 171 symptoms, 169, 170, 171 treatment, 171, 172, 173 chronic, 173 definition, 173 diagnosis, 174, 175 etiology, 173 pathology, 173, 174 prognosis, 175 symptoms, 174 treatment, 175 croupous, of cats, 190 definition, 190 diagnosis, 190 etiology, 190 pathology, 190 prognosis, 190 symptoms, 190 treatment, 191 membranous, 190 Enterohepatitis, 627 definition, 627 diagnosis, 628 etiology, 627 necropsy. 627, 628 occurrence, 627 pathogenesis, 627 prognosis, 629 symptoms, 628 treatment, 629 Enterorrhagia, 175 Entropion, 499 Epilepsy, 458 definition, 458 diagnosis, 459 etiology, 458 pathology, 458 prognosis, 459 reflex, 459, 460 treatment, 460 secondary, 459, 460 symptoms, 459 treatment, 459 Epiphora, 524 Epistaxis, 24 definition, 24 etiology, 24, 25 prognosis, 25 Epistaxis, symptoms, 25 treatment, 25 | Epithelioma, contagious, 593 Epitheliomata of eyelids, 509 of mouth, 104 of penis and prepuce, 269 of pharynx, 129 Epitheliosis infectiosa avium, 593 diagnosis, 598 etiology, 593 natural infection, 594, 595 pathogenesis, 593, 594 pathology, 595, 598 pre valency and distribution, 593 prevention, 599 prognosis, 599 symptoms, 593, 597, 598 treatment, 599 Esophagismus, 135 definition, 135 etiology, 135 prognosis, 135 symptoms, 135 treatment, 135 Esophagitis, 130 course, 131 definition, 130 etiology, 130 pathology, 130, 131 prognosis, 131 symptoms, 131 treatment, 131 Esophagus, dilatations of, 136 diseases of, 130 examination, 130 diverticula of, 136 foreign bodies in, 131 neoplasms of, 141 obstruction in, 131 stricture of, 135 Eustrongylus gigas, 407 Eversion of uterus, 300 diagnosis, 301 prognosis, 301 symptoms, 301 treatment, 301, 302 Exanthematpus conjunctivitis, 518 Exophthalmic goiter, 343 Exophthalmus, 550 definition, 550 etiology, 550 prognosis, 550 048 INDEX Exophthahnus, symptoms, 550 treat men I, 550 Eye, parasites of, 553 Eyeball, luxation of, 550 Eyelidd, adhesions of, 504, 50(5 diseases of, 497 examination, 497 inflammation of, 498 malposition of, 499 tumors of, 506 wounds of, 497, 498 F FACETTED keratitis, 529 Facial nerve, paralysis of, 450 Fatty liver, 241 definition, 241 etiology, 241, 242 pathology, 242 symptoms, 242 Favus, 484 diagnosis, 485 etiology, 484 pathology, 484 prognosis, 485 symptoms, 484, 485 treatment, 485 Feather eating in birds, 357 etiology, 357 symptoms, 357 treatment, 357, 358 pulling in birds, 357 Femoral hernia, 562 Femur, fracture of, 374 Fetid stomatitis, 96 Fibromata of bladder, 423 of mammary glands, 317, 318 of mouth, 102 of scrotum and testes, 272, 273 of "uterus, 303, 304 of vulva and vagina, 313 Fibrous goiter, 340 Filaria immitis in blood, 330 Filarida-, 330 Fistula, ear, 495 salivary, 118 definition, 1 18 diagnosis, 119 etiology, 118 pathology, 118 prognosis, 119 Fistula, salivary, symptoms, 118, 119 treatment, 119 Fleas, 472 description, 472 diagnosis, 473 occurrence, 472 Ctenocephalus canis of dog, 472 felis of cat, 472 Pulex avium of bird, 472 gonivcephalus of rab- bit, 472 irritans of man, 472 symptoms, 472, 473 treatment, 473 Follicular conjunctivitis, 517 Foot-and-mouth disease, -600 Foreign-body pneumonia,. 58 Foreign bodies and wounds of cornea, 535 prognosis, 536 symptoms, 535 treatment, 536 in conjunctiva, 519, 520 in esophagus, 131 diagnosis, 133 etiology, 131, 132 prognosis, 133 symptoms, 132, 133 treatment, 133, 134, 135 in mouth, 106 symptoms, 106 treatment, 106 in pharynx, 126 diagnosis, 126 prognosis, 126 symptoms, 126 treatment, 126, 127 in stomach, 148 diagnosis, 149, 150 etiology, 148, 149 prognosis, 150 symptoms, 149 treatment, 150, 151, 152 Fowl cholera ; 584 definition, 584 diagnosis, 587, 588 etiology, 584 natural infection, 585 occurrence, 584 pathogenesis, 584, 585 pathology, 586 INDEX 649 Fowl cholera, prevention, 589 prognosis, 588 symptoms, 587 treatment, 588, 589 pest, 589 definition, 589 diagnosis, 591 etiology, 590 natural infection, 590 occurrence, 589, 590 pathogenicity, 590 pathology, 590, 591 prognosis, 592 symptoms, 591 treatment, 592 plague, 589 typhoid, 584 Fracture of bones, 368 cranial, 368 etiology, 368 prognosis, 369 symptoms, 368, 369 treatment, 369 femur, 374 diagnosis, 375 etiology, 374 prognosis, 375 symptoms, 375 treatment, 375 humerus, 372 diagnosis, 372 etiology, 372 prognosis, 372 symptoms, 372 treatment, 372 inferior maxilla, 369 etiology, 370 prognosis, 370 symptoms, 370 treatment, 370 metacarpal and phalangoal, 373 diagnosis, 373 treatment, 373 patella, 375 I>elvis, 373, 374 etiology, 374 prognosis, 374 symptoms, 374 treatment, 374 radius and ulna, 372, 373 etiology, 373 symptoms, 373 Fracture of bones, radius and ulna, treatment, 373 ribs, 371 etiology, 371 prognosis, 371 symptoms, 371 treatment, 371 scapula, 371 etiology, 372 symptoms, 372 treatment, 372 tibia and fibula, 375 vertebra?, 370 etiology, 370 prognosis, 371 symptoms, 370, 371 treatment, 371 of orbit, 553 treatment, 553 of teeth, 108 treatment, 108 G GALL-STONES, 245 Gangrene of lungs, 58 of tongue, 112 definition, 112 diagnosis, 113 etiology, 113 pathology, 113 prognosis, 113 symptoms, 113 treatment, 113, 114 Gangrenous glossitis, 112 stomatitis, 97 Gapes in chickens, 42 Gastritis, 142 acute, 142 definition. 142 diagnosis, 144 etiology, 142, 143 pathology ; 143 prognosis, 144 symptoms, 143 treatment, 144, 145, 146 chronic, 146 definition, 146 diagnosis, 147 etiology, 146 pathology, 146 prognosis, 147 INDEX Gastritis, chronic, symptoms, 146 treatment, 147, 148 Gastro-enteritis, hemorrhagic, 579 infectious, 000 Gastrophilus intestinalis in stom- ach of dog, 163 Glanders, 622 Glands of Moll, enlargement of, 508 submaxillary and sublingual, dis- eases of, 118 symptoms, 118 treatment, 118 Glaucoma, 549 definition, 549 prognosis, 549 symptoms, 549 treatment, 549 Globe and orbit, diseases of, 548 Glossitis, 111 definition, 111 etiology, 111, 112 gangrenous, 112 pathology, 112 prognosis, 112 symptoms, 112 treatment, 112 Goiter, 336 cystic, 339 definition, 339 diagnosis, 339 prognosis, 339 symptoms, 339 treatment, 339, 340 definition, 336 exophthalmic, 343 definition, 343 diagnosis, 345 etiology, 343 pathogenesis, 343 pathology, 343 prognosis, 345 symptoms, 344 treatment, 345 fibrous, 340 definition, 340 diagnosis, 340 prognosis, 340, 341 symptoms, 340 treatment, 341 malignant, 342 definition, 342 diagnosis, 342, 343 prognosis, 343 Goiter, malignant, symptoms, 342 treatment, 343 occurrence, 336 parenchymatous, 336 definition, 336 diagnosis, 337, 338 occurrence, 336 prognosis, 338 symptoms, 336, 337 treatment, 338 vascular, 341 definition, 341 diagnosis, 341, 342 prognosis, 342 symptoms, 341 treatment, 342 Gout, 354 course, 356 definition, 354 diagnosis, 356 etiology, 354, 355 occurrence, 354 pathogenesis, 355 pathology, 355 symptoms, 355, 356 treatment, 356, 357 Granulomas of eyelids, 510 Graves's disease, 343 H^EMAPHYSALIS L.EACHI, 633 Hsemostrongylus vasorum in blood, 332 Hard crop, 139 Heart, diseases of, 78 hypertrophy and dilatation of, 89 rupture of, 92 Helminthiasis, 193 Hematemesis, 160 definition, 160 diagnosis, 161, 162 etiology, 160 pathology, 160, 161 prognosis, 162 symptoms, 161 treatment, 162 Hematoma, 489 diagnosis, 490 etiology, 489 prognosis, 490 symptoms, 489, 490 INDEX 651 Hematoma, treatment, 490 Hematozoon Lewis! in blood, 332 Hemopericardium, 77 definition, 77 etiology, 77 symptoms, 77 treatment, 77 Hemophilia, 328 Hemorrhage, cerebral, 440 intestinal, 175 definition, 175, 176 diagnosis, 177 etiology, 176 prognosis, 177 symptoms, 176, 177 treatment, 177 Hemorrhagic gastro-enteritis, 579 septicemia of cats, 600 diagnosis, 602 etiology, 600 occurrence, 600 pathogenesis, 601 pathogenicity, 600 pathology, 601 prognosis, 602 symptoms, 601 treatment, 602 Hemorrhoids, 216 definition, 216 diagnosis, 217 etiology, 216 pathology, 216 prognosis, 217 symptoms, 216 treatment, 217 Hemothorax, 67 definition, 67 diagnosis, 68 etiology, 67 pathology, 67 prognosis, 68 symptoms, 67 treatment, 68 Hepatitis, 235 chronic interstitial, 243 definition, 235 diagnosis, 236 etiology, 235 pathology, 235 prognosis, 236 suppurative, 236 definition, 236, 237 diagnosis, 239 Hepatitis, suppurative, etiology, 237 pathology, 237, 238 prognosis, 239 symptoms, 238, 239 treatment, 239, 240 symptoms, 235, 236 treatment, 236 Hernia, 555 definition, 555 diaphragmatic, 563 definition, 563 etiology, 563 symptoms, 563 treatment, 563 femoral, 562 symptoms, 562 treatment, 563 general remarks, 555, 556, 557 hernial contents, 556 ring, 555, 556 sac, 555 irreducible hernias, 556, 557 reducible hernias, 556 inguinal, 560 in female, 560 etiology, 560 symptoms, 560 treatment, 561 in male, 561 etiology, 561 symptoms, 561, 562 treatment, 562 occurrence, 555 perinea!, 563 definition, 563 etiology, 563 symptoms, 563, 564 treatment, 564 scrotal, 561 treatment, 562 umbilical, 557 etiology, 557 symptoms, 557 treatment, 557, 558 ventral, 558 definition, 558 etiology, 558 symptoms, 558 treatment, 559, 560 Herpes tonsurans, 482 diagnosis, 483 etiology, 482 652 INDEX Herpes tonsurans, pathology, 482 prognosis, 483 symptoms, 483 treatment, 483, 484 Heterakidir, 202 Heterakis compressa, 203 crassa, 203 * differens, 203 . . dispar, 203 inflexa, 203 lineata, 203 muculosa, 203 papillosa, 202. 203 jxjrspicillum, 203 vesicularis, 202, 203 Hodgkin's disease, 327 Honeycomb ringworm, 484 Hookworm, 206 Humero-radio-ulnar dislocation, 379, 380 Humerus, fracture of, 372 Hydrometra of uterus, 304 Hydronephrosis, 405 Hydropericardium, 76 definition. 76 etiology, 76 symptoms, 76 treatment, 76 Hydrophobia, 603 Hydrophthalmus, 550 definition, 550 treatment, 550 Hydrops abdominis, 257 ascites, 257 jxTitonei, 257 Hydrothorax, 65 definition, 65 diagnosis, 66 etiology, 65 pathology, 65 prognosis, 66 symptoms, 66 treatment, 66 Hy|M-remia. 3S7 acute, 387 etiology, 387 pathology, 387. 388 prognosis, 388 symptoms, 388 treatment. 388 of brain, 435 definition, 435 diagnosis, 436 Hyperemia of brain, etiology, 435 pathology, 435. 436 prognosis, 436 symptoms, 436 treatment, 436. 437 of lungs, 49 passive, 388 etiology, 388 pathology, 388 prognosis, 388 symptoms, 388 treatment, 388 Hypertrophy and dilatation of heart, 89 definition, 89 diagnosis, 91 etiology, 89, 90 necropsy, 90 prognosis, 91 symptoms, 90, 91 treatment, 91 of prostate gland, 280 ICTERUS, 225 definition, 225 diagnosis, 229 etiology, 225, 226 pathology, 226, 227 prognosis, 229 symptoms, 227, 228, 229 treatment, 229, 230 Incontinence of urine in bladder, 416 definition, 416 etiology, 416 prognosis, 416 symptoms, 416 treatment, 416 Incrustations of tartar, 108 Infectious asthenia of birds, 191 bulbar paralysis, 611 diarrhea of chicks, 629 gastro-enteritis, 600 jaundice, 633 leukemia of chickens, 325 nasal catarrh of rabbits, 20 Inferior maxilla, fracture of, 369 Inflammation of eyelids, 498 of kidneys, 388 of rnembrana nictitans, 522 INDEX 653 Inflammation of membrana nicti- tans, examination, 522 prognosis, 523 symptoms, 522, 523 treatment, 523 of orbit, 553 of ovaries, 283 definition, 283 diagnosis, 284 etiology, 284 prognosis, 284 symptoms, 284 treatment, 284 of renal pelvis, 398 of synovial membrane and artic- ulations, 383 definition, 383 etiology, 383 prognosis, 383 symptoms, 383 treatment, 383, 384 of urethra, 429 Inflammatory ectasia of cornea, 537 forms, 537 keratectasia, 537 staphyloma, 537 Influenza, rabbit, 20 Infraorbital fossae of birds, empy- ema of, '20 Inguinal hernia, 560 in female, 560 in male, 561 Injuries of peripheral nerves, 450 of spinal cord, 445 Insufficiency, valvular, 78 Interstitial hepatitis, 243 chronic, 243 pneumonia, 57 chronic, 57 Intestinal hemorrhage, 175 obstruction, 182 Intestines, diseases of, 167 examination, 167 parasites in, 193 round worms in, 202 of birds, 202, 203 of cat, 202 of dog, 202 of rabbit, 202 strongylidse in, 207 of cat, 207 of dog, 207 of rabbit, 207 Intestines, tacnia in, 195 of birds, 198 of cats., 197 of dogs, 195, 196, 197 of rabbits, 197, 198 trichinellidae in, 209, 210, 211 of birds, 210, 211 of dog, 210 of rabbit, 210 wounds of, 188 Intussusception, 186 definition, 186 diagnosis, 187 etiology, 186 pathology, 186, 187 prognosis, 187 symptoms, 187 treatment, 187, 188 Inversion of uterus, 300 Iridocyclitis, 540 course, 541 definition, 540 etiology, 540 prognosis, 541 symptoms, 540, 541 treatment, 541 Iris and ciliary body, diseases of, 539 congenital defects of, 539 cysts of, 541 tumors of, 541 Iritis, 540 Itch, 475 red, 482 Ixodes ricinus, 633 JAUNDICE, 225 infectious, 633 malignant, 633 KERATECTASIA, 537 Keratitis, 526 definition, 526, 527 non-suppurative, 527 keratitis pigmentosa, 529 definition, 529 etiology, 529 654 INDEX Keratitis, npn-suppurative, kera- titis pigmentosa, prog- nosis, 529 symptoms, 529 treatment, 529 punctata profunda, 532 definition, 532 etiology, 532 prognosis, 532 symptoms, 532 treatment, 532 superficialis, 529 course, 530 definition, 529, 530 etiology, 530 prognosis, 530 symptoms, 530 treatment, 530 parenchymatous, 530 course, 531 definition, 530 etiology, 530, 531 prognosis, 531 symptoms, 531 treatment, 531, 532 superficial, 527 course, 527 definition, 527 etiology, 527 prognosis, 527 symptoms, 527 treatment, 527, 528 vascular, 528 definition, 528 etiology, 528 prognosis, 528 symptoms, 528 treatment, 528 suppurative, 527 abscess of cornea, 534 course, 535 definition, 534 etiology, 534 prognosis, 535 symptoms, 534, 535 treatment, 535 keratitis from lagophthalmos, 535 definition, 535 treatment, 535 neuroparalytica, 535 definition, 535 ulceration of cornea, 532 Keratitis, suppurative, ulceration of cornea, course, 533 definition, 532 etiology, 532, 533 prognosis, 533 symptoms, 533 treatment, 534 Keratoconus, 538 Keratoglobus, 538 Kidney abscess, 396 amyloid, 407 animal parasites in, 407 coccidia, 409 Coccidium tenellum, 409 Cysticercus cellulosse, 409 Dioctophyme renale, 407 Eimeria avium, 409 Eustrongylus gigas, 407 calculi in, 402 congestion of, 387 cystic, 405 diseases of, 385 examination, 385, 386, 387 dropsy of, 405 inflammation of, 388 tumors in, 407 LACRIMAL apparatus, diseases of, 524 examination, 524 Lacrimation, 524 definition, 524 etiology, 524 prognosis, 525 symptoms, 525 treatment, 525 Lagophthalmos, 506 definition, 506 treatment, 506 Laryngitis, 30 acute, 30 definition, 30 diagnosis, 31 etiology, 30 pathology, 30, 31 prognosis, 31 symptoms, 31 treatment, 31 chronic, 31 INDEX 655 Laryngitis, chronic, definition, 31 diagnosis, 32 etiology, 31 pathology, 32 prognosis, 32 symptoms, 32 treatment, 32, 33 Larynx, diseases of, 30 examination, 30 Lens, diseases of, 542 examination, 542 luxation of, 544 Leukemia, 322 course, 325 definition, 322, 323 diagnosis, 325 etiology, 323 infectious, of chickens, 325 course, 326 definition, 325 diagnosis, 326, 327 etiology, 325, 326 occurrence, 325 pathogenesis, 326 pathology, 326 prognosis, 327 symptoms, 326 treatment, 327 lymphatic, 322 myelogenous, 322 occurrence, 323 pathology, 323 prognosis, 325 symptoms, 323, 324, 325 treatment, 325 Lice, 473 description, 473, 474 diagnosis, 475 kinds, 474 Linognathus piliferus, 474 Menopum biseriatum, 474 trigonocephalum, 474 Trichodectes latus, 474 subrostratus, 474 prognosis, 475 symptoms, 474, 475 treatment, 475 Linognathus piliferus, 474 Lipoma of eyelids, in birds, 508 of mammary glands, 318 Liver, abscess of, 236 amyloid, 242 atrophy of, 240 Liver, cirrhosis of, 243 congestion of, 231 diseases of, 225 . examination, 225 fatty, 241 neoplasms of, 244 rupture of, 246 Lockjaw, 613 Lungs, cirrhosis of, 57 congestion of, 49 active, 49 passive, 50 diseases of, 47 examination, 47, 48, 49 auscultation, 47, 48 percussion, 49 respiration, 47 thorax, 47 edema of, 52 gangrene of, 58 hyperemia of, 49 Luxation, 378 of eyeball, 550 prognosis, 550 treatment, 550, 551 of lens, 544 treatment, 544 Lymphadenitis, 120 Lyssa, 603 M MALFORMATIONS, congenital, of penis and prepuce, 265 of urethra, 425 symptoms, 426 treatment, 426 of vagina and vulva, 309 of teeth, 107 treatment, 107 Malignant goiter, 342 jaundice, 633 neoplasms of eyelids, 508, 509 of mouth, 104 tumors of mammary glands, 318 carcinoma ta, 318 sarcomata, 318 in nasal passages, 29 Malposition of eyelids, 499 blepharoptosis, 501 blepharospasm, 503 ectropion, 500 050 INDEX Malposition of eyelids, ectropion, definition, 500 etiology, 500 prognosis, 500 symptoms, 500 treatment, 500, 501 entropion, 499 definition, 499 etiology, 499 prognosis, 499 symptoms, 499 treatment, 499, 500 paralysis of orbicularis nerve, 502 definition, 502 etiology, 502 prognosis, 502, 503 symptoms, 502 treatment, 503 ptosis, 501 definition, 501 etiology, 501 symptoms, 502 treatment, 502 spasm of orbicularis nerve, 503 definition, 503 treatment, 503 Mammary glands, congestion of, 316 diseases of, 315 examination, 315 tumors of, 317 wounds and injuries of, 315 Mammitis, 316 definition, 310 etiology, 310 prognosis, 317 symptoms, 310, 317 treatment, 317 Mange, 475 definition, 475 demodectic, 480 diagnosis, 481 etiology, 480 pathology, 480 prognosis, 481 symptoms, 480, 481 treatment, 481, 482 etiology, 475, 476 mites, 476 demodex, 480 folliculorum, 480 sarcoptes, 476 Mange, mites, sarcoptes of cat, 477 Sareoptes minor, var. cati, 477 Notoedres cati, var. cat, 477 of dog, 476, 477 Sarcoptes scabiei, var. canis, 476, 477 of ferret, 477, 478 Sarcoptes scabiei, var. hydrochsri, 477, 478 of fowl, 478 Cnemidocoptes mutans, var. gallinae, 478 Sarcoptes mutans, 478 of rabbit, 477 Notaodres cati, var. cuni- culi, 477 Sarcoptes minor, var. cuniculi, 477 red, 475 sarcoptic, 475 diagnosis, 478 pathology, 476 prognosis, 478 treatment, 478, 479, 480 Mastitis, 316 Megrim, 457 Meibomian cyst of eyelids, 507 Membrana nictitans, inflammation of, 522 tumors on, 523 wounds of, 523 Membranous enteritis, 190 Meningo-encephalitis, 438 definition, 43P, 439 diagnosis, 440 etiology, 439 pathology, 439 prognosis, 440 symptoms, 439, 440 treatment, 440 Meningomyelitis, 443 definition, 443 diagnosis, 445 etiology, 444 pathology, 444 prognosis, 445 symptoms, 444, 445 treatment, 445 Menopum biseriatum, 476 trigonocephalum, 476 INDEX 657 Metacarpal and phalangeal bones, fracture of, 373 Metastrongulinse, 330 Metritis, 293 acute, 293 definition, 293 diagnosis, 295 etiology, 293, 294 pathology, 294, 295 prognosis, 295 symptoms, 295 treatment, 295, 296 chronic, 296 definition, 296 diagnosis, 298 etiology, 296,- 297 pathology, 297 prognosis, 298 symptoms, 297, 298 treatment, 298 definition, 293 Moniezia denticulata, 197 Mouth, benign neoplasms of, 102 canker of, 97 diseases of, 93 examination, 93, 94 abnormal conditions noted, 93, 94 foreign bodies, 94 mucous membranes, 94 neoplasms, 94 odor, 93 secretions, 93, 94 foreign bodies in, 106 malignant neoplasms of, 104 sore, 96 Multiceps multicer-s, 196 serialis, 196, 197 Mumps, 115 Muscular rheumatism, 365 Mycotic pneumonia, 40 Mydriasis, 539, 540 definition, 539 Myocarditis, 82 acute, 82 definition, 82 diagnosis, 84 etiology, 82, 83 necropsy, 83 prognosis, 84 symptoms, 83, 84 treatment, 84 chronic, 84 42 Myocarditis, chronic, definition, 84 etiology, 85 necropsy, 85 Myomata of uterus, 304 Myosis, 540 definition, 540 N NASAL catarrh, acute, 19 chronic, 23 of rabbits, 20, 21 infectious, 20, 21 parasitic,- 22 passages, diseases of, 17 examination, 17, 18 abnormal conditions noted. 18, 19 discharge, 19 foreign bodies, 18 hemorrhage, 18 infectious, 18 malformations, 18, 19 parasites, 18 tumors, 18 neoplasms of, 28 benign tumors, 28 papillomata, 28 treatment, 28 polypoid fibromata, 28 treatment, 28, 29 malignant tumors, 29 diagnosis, 29 prognosis, 29 symptoms, 29 treatment, 29 parasites of, 25 definition, 25 diagnosis, 27 etiology, 25 life cycle, 26 necropsy, 27 prognosis, 27 symptoms, 27 treatment, 27 Nematoda, 201 species, 201 ascaridae, 201 hookworm, 206 round worms, 201 in intestine of birds, 202, 203 058 INDEX Ncmatoda, species, round worms, in intestine of cat, 202 of dog, 202 of rabbit, 202 strongylidse, 206 in intestine of cat, 207 of dog, 207 of rabbit, 207 trichinellidse, 209, 210 in intestine of birds, 210 of dog, 210 of rabbit, 210 whipworm, 209, 210 Neoplasms of ear, 493 cysts, 494 papillomata, 493 prognosis, 493 symptoms, 493 treatment, 493 sebaceous tumors, 494 treatment, 494 of esophagus, 141 diagnosis, 141 prognosis, 141 symptoms, 141 treatment, 141 of eyelids, 508, 509 of liver, 244 symptoms, 244 treatment, 244 of mouth, 102 benign, 102 fibromata, 102 symptoms, 103 treatment, 103 osteoma, 103 symptoms, 103 treatment, 103 papillomata, 102 symptoms, 102 treatment, 102 retention cysts, 103 treatment, 104 malignant, 104 epitheliomata, 104 symptoms, 104, 105 -treatment, 105 sarcomata, 105 symptoms, 105 treatment, 105 of nasal passages, 28 of pharynx, 128 Neoplasms of pharynx, epithelio- mata, 129 symptoms, 129 treatment, 129 polypoid growths, 128 symptoms, 128 treatment, 128 in rectum, 222 diagnosis, 223 prognosis, 223 symptoms, 222, 223 treatment, 223 in stomach, 165 prognosis, 165 symptoms, 165 treatment, 165, 166 Nephritis, 388 acute, 388 course, 392 definition, 388, 389 diagnosis, 391, 392 etiology, 389, 390 pathology, 390 prognosis, 392 symptoms, 391 treatment, 392 chronic, 392 definition, 392, 393 diagnosis, 395 etiology, 393 pathology, 393, 394 prognosis, 395 symptoms, 394, 395 treatment, 396 purulent, 396 definition, 396 diagnosis, 398 etiology, 396, 397 pathology, 397 prognosis, 398 symptoms, 397, 398 treatment, 398 Nephrolithiasis, 402 Neuritis, retrobulbar, 546, 547 Non-inflammatory ectasia of cor- nea, 538 forms, 538 keratoconus, 538 keratoglobus, 538 Non-suppurative keratitis, 527 forms, 526, 527 keratitis pigmentosa, 529 punctata profunda, 532 INDEX 659 Non-suppurative keratitis, forms, keratitis pig mentosa, punctata superficialis, 529 parenchymatous, 530 superficial, 527 vascular, 528 Nystagmus, 552 definition, 552 treatment, 553 OBESITY, 352 course, 353 definition, 352 etiology, 352, 353 pathology, 353 prognosis, 353 symptoms, 353 treatment, 353, 354 Obstipation, 182 Obstruction of crop in birds, 139 definition, 139 etiology, 139 prognosis, 140 symptoms, 139, 140 treatment, 140, 141 in esophagus, 131 intestinal, 182 Occlusion of rectum and anus, 212, 213 artificial, 213 congenital, 212, 213 diagnosis, 213 prognosis, 213 symptoms, 213 treatment, 213 ; 214 of urethra, 425 Ollulanus tricuspis in stomach of cat, 163 Oophorectomy, 285, 286 in cat, 289 in dog, 286, 287, 288, 289 Oophoritis, 283 Opacities of cornea, 536 prognosis, 536 treatment, 536, 537 Optic nerve, atrophy of, 547 diseases of, 546 hemorrhages of, 546 inflammation of, 546 tumors of, 546 Optic nerve, wounds of, 546 Orbicularis nerve, paralysis of, 502 spasm of, 503 Orbit, fracture of, 553 inflammation of, 553 tumors of, 553 Orchectomy, 273 Orchitis, 271 definition, 271 etiology, 271, 272 prognosis, 272 symptoms, 272 treatment, 272 Osteoma of mouth, 103 Osteomalacia, 362 Otitis externa, 490, 491 diagnosis, 492 etiology, 491 prognosis, 492 symptoms, 491, 492 treatment, 492 interna, 493 media, 493 Otorrhea, 490, 491 Ovariectomy, 285, 286 Ovaries, diseases of, 283 examination, 283 inflammation of, 283 tumors of, 284 * Oxyuridae, 221 Oxyuris ambigua, 202, 222 compar, 221 vermicularis, 221 PANNUS, 528 Panophthalmitis, 548 definition, 548 diagnosis, 548, 549 prognosis, 549 symptoms, 548 treatment, 549 Papillitis, 546 definition, 546 prognosis, 546 Papillomata of ear, 493 of eyelids, 506 of mouth, 102 of nasal passages, 28 of penis and prepuce, 269 of vulva and vagina, 314 660 INDEX Paralysis, infectious bulbar, 611 definition, 611 diagnosis, 612 etiology, 612 natural infection, 612 pathogenicity, 612 pathology, 612 prognosis, 613 symptoms, 612, 613 treatment, 613 of orbicularis nerve, 502 of peripheral nerves, 450 auditory, 453 diagnosis, 454 etiology, 453, 454 prognosis, 454 symptoms, 454 treatment, 454 brachial plexus, 455 etiology, 455 prognosis, 456 symptoms, 456 treatment, 456 facial, 450 diagnosis, 451 etiology, 450, 451 prognosis, 451 symptoms, 451 treatment, 451, 452 radial, 454 diagnosis, 455 etiology, 454, 455 prognosis, 455 symptoms, 455 treatment, 455 sciatic, 456 etiology, 456 prognosis, 456 symptoms, 456 treatment, 456 trigeminal, 452 diagnosis, 453 etiology, 452 prognosis, 453 symptoms, 452, 453 treatment, 453 of pharynx, 127 Paraphimosis, 267 definition, 267 etiology, 267 prognosis, 268 symptoms, 268 treatment, 268 Parasites, animal, in blood, 330 Dirofilaria immitis, 330 diagnosis, 332 etiology, 330, 331 occurrence, 330 pathogenesis, 331 pathology, 331 symptoms, 331, 332 treatment, 332 Filaria immitis, 330 Haemostrongylus vasorum, 332 diagnosis, 333 symptoms, 332 treatment, 333 Hema'tozoon Lewisi, 332 Spiroptera sanguinolenta, 333 in kidney, 407 coccidia, 409 Coccidium tenellum, 409 Cysticercus cellulosae, 409 Dioctophyme renale, 407 diagnosis, 409 life cycle, 408 prognosis, 409 symptoms, 408, 409 treatment, 409 Eimeria avium, 409 Eustrongylus gigas, 407 in bladder, 423, 424 Dioctophyme renale, 423 treatment, 424 in ear, 494 diagnosis, 494 prognosis, 494 symptoms, 494 treatment, 494 of eye, 553 in intestines, 193 of nasal passages, 25 in rectum, 221 Oxyuridse, 221 Oxyuris ambigua, 222 compar, 221 vermicularis, 221 symptoms, 222 treatment, 222 in scrotum and testes, 273 in stomach, 163 of birds, 163 Dispharagus n a s u t u s, 163 INDEX 661 Parasites in stomach of birds, Dis- pharagus spiralis, 163 Trichosomum contortum,163 of cat, 163 Ollulanus tricuspis, 163 Taenia tseniaeformis, 163 diagnosis, 164 of dog, 163 Gastrophilus intestinalis, 163 Spiroptera sanguinolenta, 163 prognosis, 164 of rabbits, 163 Strongylus strigosus, 163 symptoms, 164 treatment, 165 in trachea and bronchial tubes, 42 Parasitic nasal catarrh of birds, 22 of rabbits, 22 stomatitis, 100 Parenchymatous conjunctivitis,514 goiter, 336 keratitis, 530 Parotitis, 115 definition, 115 diagnosis, 117 etiology, 115, 116 pathology, 116 prognosis, 117 symptoms, 116, 117 treatment, 117 Passolurus ambigus, 202 Pasteurellosis avium, 584 Patella, fracture of, 375 Patellar dislocation, 382 Pelvis, fracture of, 373, 374 Penis and prepuce, congenital mal- formations of, 265 diseases of, 263 examination, 263 tumors of, 268 wounds of, 263, 264 Pericarditis, 73 definition, 73 diagnosis, 75 etiology, 73, 74 necropsy, 74 prognosis, 75 symptoms, 75 treatment, 75, 76 Pericardium, diseases of, 69 examination, 69, 70, 71, 72, 73 Pericardium, diseases of, exami- nation, heart, 71 auscultation, 71, 72, 73 endocardial bruits, 72, 73 pericardial bruits, 73 palpation, 71 percussion, 71 pulse, 69, 70 frequency, 69, 70 quality, 70 rhythm, 70 dropsy of, 76 Pericementitis, 108 Perineal hernia, 563 Periodontitis, 108 Periostitis, alveolar, 108 definition, 108 etiology, 108, 109 pathology, 109 symptoms, 109 treatment, 109 Peripheral nerves, compression of, 450 injuries of, 450 paralysis of, 450 pressure on, 450 Peritoneum, diseases of, 248 general remarks, 248, 249 Peritonitis, 250 acute, 250 course, 253, 254 definition, 250 diagnosis, 254 etiology, 250, 251 pathogenesis, 251 pathology, 251, 252 prognosis, 254 . symptoms, 252, 253 treatment, 254, 255 chronic, 255 definition, 255 diagnosis, 257 etiology, 255, 256 pathology, 256 prognosis, 257 symptoms, 256 treatment, 257 Pestus avium, 489 Phalangeal dislocation, 381 Pharyngitis, 123 acute, 123 definition, 123 662 INDEX Pharyngitis, acute, diagnosis, 124 etiology, 123 pathology, 124 prognosis, 124 symptoms, 124 treatment, 125 chronic, 125 definition, 125 etiology, 125 pathology, 125 prognosis, 125 symptoms, 125 treatment, 125, 126 croupous, of birds, 127 definition, 127 etiology, 127 pathology, 127 prognosis, 128 symptoms, 128 treatment, 128 Pharynx, diseases of, 123 examination, 123 foreign bodies in, 126 neoplasms of, 128 paralysis of, 127' Phimosis, 266 definition, 266 etiology, 266 symptoms, 266, 267 treatment, 267 Phlegmonous stomatitis, 99 Phthiriasis, 474 Pigmentary keratitis, 529 Piles, 216 Pilosebaceous cysts, 507 Piropla-sma bigeminum, 633 canis, 633 commune, 633 Piroplasmosis of dog, 633 definition, 633 diagnosis, 635, 636 etiology, 633, 634 pathology, 634 prognosis, 636 symptoms, 634, 635 treatment, 636 Plague, dog, 579 fowl, 589 rabbit, 20 Pleura, diseases of, 60 Pleurisy, 60 Pleuritis, 60 definition, 60 Pleuritis, diagnosis, 64 etiology, 60, 61 pathology, 61, 62 prognosis, 64 symptoms, 62, 63 treatment, 64, 65 Pneumonia, catarrhal, 53 chronic interstitial, 57 foreign body, 58 definition, 58 diagnosis, 59 etiology, 58, 59 pathology, 59 prognosis, 59 symptoms, 59 treatment, 59 mycotic, 40 definition, 40 diagnosis, 41 etiology, 40 pathology, 40, 41 prevention, 41 prognosis, 41 symptoms, 41 treatment, 41 Pneumothorax, 66 definition, 66 diagnosis, 67 etiology, 66 pathology, 66 prognosis, 67 symptoms, 67 treatment, 67 Podagra, 354 Polyarthritis rheumatica, 363 Polypoid fibromata of nasal pas- sages, 28 growths of pharynx, 128 Poulardizing the female chicken, 289, 290 Preputial catarrh, 265 Pressure on peripheral nerves, 450 Proctitis, 214 definition, 214 diagnosis, 215 etiology, 214 pathology, 214, 215 prognosis, 215 symptoms, 215 treatment, 215 Prolapse of rectum, 217 definition, 217 diagnosis, 218 INDEX 663 Prolapse of rectum, etiology, 217, 218 prognosis, 218, 219 symptoms, 218 treatment, 219, 220, 221 of uterus, 300 of vagina, 311 diagnosis, 312 etiology, 311 prognosis, 312 symptoms, 312 treatment, 312, 313 Prostate gland, diseases of, 279 examination, 279 hypertrophy of, 280 tumors of, 280 Prostatitis, 279 definition, 279 etiology, 279 prognosis, 280 symptoms, 279, 280 treatment, 280 Pseudo-actinomycosis of dogs, 623 definition, 623 diagnosis, 624 etiology, 623 occurrence, 623 pathogenicity, 623 pathology, 623 prognosis, 624 symptoms, 623, 624 treatment, 624 Pseudoleukemia, 327 definition, 327 diagnosis, 327 etiology, 327 occurrence, 327 pathology, 327 prognosis, 327 symptoms, 327 treatment, 327 Pseudorabies, 611 Pterygium, 519 definition, 519 diagnosis, 519 prognosis, 519 symptoms, 519 treatment, 519 Ptosis, 501 Puerperal septicemia, 298 definition, 298, 299 diagnosis, 299, 300 etiology, 299 Puerperal septicemia, pathology, 299 prognosis, 300 symptoms, 299 treatment, 300 Pulex avium of birds, 472 gonivcephalus of rabbits, 472 irritans of man, 472 Pulmonary edema, 52 definition, 52 diagnosis, 53 etiology, 52 pathology, 52 prognosis, 53 symptoms, 52 treatment, 53 Purpura hemprrhagica of dogs, 583 Purulent conjunctivitis, 512 Pyelitis, 398 definition, 398 diagnosis, 399 etiology, 398, 399 pathology, 399 prognosis, 399 symptoms, 399 treatment, 400 Pyometra, 296 Pyosalpinx, 291 R RABBIT distemper, 20 influenza, 20 plague, 20 Rabies, 603 course, 609, 610 definition, 603 diagnosis, 608 differential, 610, 611 confused with canine dis- temper (nervous form), 610 diseases of brain, 610 eclampsia, 611 epilepsy, 611 foreign bodies, 610 infectiousbulbar paralysis, 611 parasites in intestinal tract, 610 trigeminal or facial par- alysis, 610, 611 664 INDEX Rabies, etiology, 603 natural infection, 604 occurrence, 603 pathogenesis, 604, 605 pathogenicity, 603, 604 pathology, 605 preventive inoculation, 611 prognosis, 609, 610 symptoms, 605, 606, 607 treatment, 611 Rachitis, 359 course, 361 definition, 359 etiology, 359, 360 occurrence, 359 pathology, 360 prognosis, 361 svmptoms, 360, 361 treatment, 361, 362 Radial nerve, paralysis of, 454 Radio-ulnar-carpal dislocation, 380 Radius and ulna, fracture of, 372, 373 Ranula, 103 Rectum and anus, diseases of, 212 examination, 212 neoplasms in, 222 occlusion of, 212, 213 parasites in, 221 prolapse of, 217 Red itch, 482 mange, 475 Reflex epilepsy, 459 Renal abscess, 397 pelvis, inflammation of, 398 Reproductive organs, diseases of, 263 Retentio urinae vesicalis, 414 Retention cysts in mouth, 103 of scrotum and testes, 273 of urine in bladder, 414 definition, 414 diagnosis, 415 etiology, 414 prognosis, 415 symptoms, 414, 415 treatment, 415 Retina and choroid, diseases of, 545 pathological changes, 545 anemia, 545 atrophy, 545 detachment of retina, 545 edema, 545 Retina and choroid, pathological changes, hyperemia, 545 inflammation (retinitis), 545 Retrobulbar neuritis, 546, 547 Rheumatism, 363 articular, 363 course, 364 definition, 363 diagnosis, 364 etiology, 363 pathology, 363 prognosis, 364, 365 symptoms, 364 treatment, 365 muscular, 365 course, 367 definition, 365 etiology, 365, 366 pathology, 366 prognosis, 367 symptoms, 366, 367 treatment, 367 Rhinitis, 19 chronic, 23 coccidiosa, 22 Rhipicephalus sanguineus, 633 Ribs, fracture of, 371 Rickets, 359 Ringworm, 482 honeycomb, 484 Roundworms, 201 diagnosis, 204 in intestine of birds, 202, 203 Heterakis compressa, 203 crassa, 203 differens, 203 P dispar, 203 inflexa, 203 lineata, 203 muculosa, 203 papillosa, 202, 203 perspicillum, 203 vesicularis, 202, 203 of cat, 202 Belascaris mystax, 202 of dog, 202 Belascaris marginata, 202 Echinorhynchus canis, 202 Toxascaris limbata, 202 marginata, 202 of rabbit, 202 INDEX 665 Roundworms in intestine of rabbit, Oxyuris anibigua, 202 Passolurus ambigus, 202 pathology, 293, 204 prevention, 205, 206 prognosis, 205 symptoms, 204 treatment, 205 Roup, 593 Ruptura hepatis, 246 Rupture of bladder, 412 prognosis, 413 symptoms, 412, 413 treatment, 413 of heart, 92 etiology, 92 symptoms, 92 treatment, 92 of liver, 246 diagnosis, 246 etiology, 246 pathology, 246 prognosis, 246, 247 symptoms, 246 treatment, 247 of uterus, 303 prognosis, 303 symptoms, 303 treatment, 303 of vagina, 313 SALIVARY fistula, 118 glands, diseases of, 115 examination, 115 Salpingitis, 291 definition, 291 etiology, 291 symptoms, 291 treatment, 291 Sarcomata of bladder, 423 of eyelids, 509 of mammary glands, 318 of mouth, 105 of penis and prepuce, 269 of scrotum and testes, 273 of vulva and vagina, 314 Sarcoptes mite, 476 of cat, 477 Notcedres cati, var. cati, 477 Sarcoptes minor, var. cati, 477 Sarcoptes mite of dog, 476, 477 Sarcoptes scabiei, var. canis, 478, 479 of ferret, 479, 480 Sarcoptes scabiei, var. hy- drochaeri, 477, 478 of fowl, 478 Cnemidocoptes mutans, var. gallinse, 478 Sarcoptes mutans, 478 of rabbit, 477 Notoedres cati, var. cuniculi, 477 Sarcoptes minor, var. cuni- culi, 477 Scabies, 475 Scapula, fracture of, 371 Scapulohumeral dislocation, 379 Sciatic nerve, paralysis of, 456 Scorbutus, 328 Scrotal hernia, 561 Scrotum, diseases of, 271 parasites in, 273 tumors of, 272 wounds and injuries of, 271 Scurvy, 328 definition, 328 diagnosis, 329 etiology, 328 occurrence, 328 pathology, 328, 329 prognosis, 329, 330 symptoms, 329 treatment, 330 Sebaceous tumors in birds, 508 of ear, 494 Secondary epilepsy, 457 Septicemia, hemorrhagic, of cats, 600 puerperal, 298 Simple catarrh of stomach, 142 Skin diseases, non-parasitic, 463 examination, 463, 464 microscopic, 463, 464 parasitic, 472 vegetable 482 Soft crop, 137 Soor, 100 Sore mouth, 96 Spasm of orbicularis nerve, 503 Spinal cord, compression of, 448 concussion of, 445 diseases of, 443 666 INDEX Spinal cord, diseases of, examina- tion, 443 general considerations, 443 functions of cord, 443 injuries of, 445 Spirillosis of chickens, 625 Spirochsetosis avium, 625 of fowls, 625 definition, 625 diagnosis, 626 etiology, 625 natural infection, 625, 626 occurrence, 625 pathogenesis, 625 pathology, 626 prognosis, 626 symptoms, 626 treatment, 626, 627 Spiroptera sanguinolenta, 333 in stomach of dog, 163 Sprains and injuries to articula- tions, 377 Staphyloma, 537 Stenosis, 78 Stomacace, 96 Stomach, chronic catarrh of, 146 dilatation of, 152 acute, 152 chronic, 154 diseases of, 142 examination, 142 foreign bodies in, 148 neoplasms in, 165 parasites in, 163 simple catarrh of, 142 ulceration of, 157 Stomatitis, 94 catarrhal, 94 definition, 94 diagnosis, 95 etiology, 94, 95 pathology, 95 prognosis, 96 symptoms, 95 treatment, 96 fetid, 96 gangrenous, 97 definition, 97 diagnosis, 98 etiology, 97, 98 pathology, 98 prevention, 99 prognosis, 98, 99 Stomatitis, gangrenous, symptoms, 98 treatment, 99 parasitic, 100 definition, 100 diagnosis, 101 etiology, 100, 101 pathology, 101 prognosis, 101 symptoms, 101 treatment, 102 phlegmonous, 99 definition, 99 diagnosis, 100 etiology, 99 pathology, 99 prognosis, 100 symptoms, 100 treatment, 100 ulcerative, 96 definition, 96 diagnosis, 97 etiology, 96 pathology, 96 prognosis, 97 symptoms, 96, 97 treatment. 97 Strabismus, 552 definition, 552 diagnosis, 552 etiology, 552 treatment, 552 Streptotrichosis canum, 623 Stricture of esophagus, 135 definition, 135 etiology, 136 prognosis, 136 symptoms, 136 treatment, 136 of urethra, 426 definition, 426 diagnosis, 427 etiology, 427 prognosis, 427 symptoms, 427 treatment, 427 Strongylidse, 206 diagnosis, 208 in intestine of cat, 207 Ankylostomum trigono- cephalum, 207 of dog, 207 Ankylostomum canina, 207 INDEX 667 Strongylidae in intestine of dog, Ankylostomum stenoce- phalum, 207 Dochmius trigonocephalus, 207 Uncinaria stenocephala, 207 trigonocephala, 207 of rabbit, 207 Strongyloides longus, 207 Strongylus strigosus, 207 pathology, 208 prognosis, 209 symptoms, 208 treatment, 209 Strongyloides longus, 207 Strongylus strigosus, 207 in stomach of rabbits, 163 Struma, 336 Submaxillary andsublingual glands, 118 Superficial keratitis, 529 Suppuration of anal glands,223, 224 diagnosis, 224 treatment, 224 Suppuratiye hepatitis, 236 keratitis, 532 forms, 532 abscess of cornea, 534 keratitis from lagophthal- mos, 535 neuroparalytica, 535 ulceration of cornea, 532 Symblepharon, 505 Syngamosis, 42 Synovial membrane, inflammation of, 383 Synovitis, 383 TABLE of equivalents in weights and measures, 637 Taenia, camirus. 196 crassicollis, 197 cucumerina, 195 echinococcus, 197 elliptica, 197 hydatigena, 196 marginata, 196 pisiformis, 195 pseudo-elliptica, 197 serialis, 190 Tamia serrata, 195, 196 taeniaeformis in stomach of cat, 193 Taeniae, 193 in intestine of birds, 198 Choanotaenia infundibulifor- mis, 198 Davainea cesticillus, 198 craswula, 198 echinobothrida, 198 proglottina, 198 tetragona, 198 Dicranotaenia sphenoides, 198 Taenia cantaniani, 198 of cats, 197 Bothriocephalus felis, 197 Taenia crassicollis, 197 elliptica, 197 pseudo-elliptica, 197 taeniaeformis, 197 of dogs, 195 Dipylidium caninum, 195 Echinococcus granulosus, 197 Multiceps multiceps, 196 serialis, 196, 197 Taenia ccenurus, 196 cucumerina, 195 echinococcus, 197 hydatigena, 196 marginata, 196 pisiformis, 195, 196 serialis, 196, 197 serrata, 195, 196 of rabbits, 197, 198 Cittotaenia denticulata, 197 Moniezia denticulata, 197 life history, 194, 195 Taeniasis, 193, 194, 195 in birds, 198 in cats, 197 diagnosis, 200 in dogs, 195 pathology, 198, 199 prognosis, 200 in rabbits, 197, 198 symptoms, 199, 200 treatment, 200, 201 Tartar, incrustations of, 108 Teeth, caries of, 109 diseases of, 107 examination, 107 668 INDEX Teeth, fractures of, 108 malformations of, 107 Teini>oroinaxillary dislocation, 378 Testes, diseases of, 271 parasites in, 273 tumors of, 272 wounds and injuries of, 271 Tetanus, 613 definition, 613, 614 diagnosis, 614 etiology, 614 natural infection, 614 occurrence, 614 pathology, 614 prognosis, 615 symptoms, 614, 615 treatment, 615, Thrush, 100 Thyroid glands, congestion of, 334, 335 diseases of, 334 examination, 334 general considerations, 334 Thyroiditis, acute, 335 definition, 335 etiology, 335 prognosis, 335 symptoms, 335 treatment, 335, 336 Tibia and fibula, fracture of, 375 Tibiotarsal dislocation, 383 Tongue, diseases of, 111 examination, 111 gangrene of, 1 12 Tonsillitis and lymphadenitis, 120 definition, 120 etiology, 120, 121 pathology, 121 prognosis, 121 symptoms, 121 treatment, 121, 122 Tonsils, diseases of, 120 examination, 120 Torsion of bladder, 420 of cornua uteri, 302 symptoms, 302 treatment, 302 Toxascaris limbata, 202 marginata, 202 Trachea and bronchial tubes, ani- mal parasites in, 42 definition, 42 diagnosis, 43 Trachea and bronchial tubes, ani- mal parasites in, etiology, 42 prevention, 43 prognosis, 43 symptoms, 42, 43 treatment, 43 diseases of, 34 examination, 34 Tracheitis and bronchitis, 34 acute, 34 definition, 34 diagnosis, 37 etiology, 34, 35, 36 pathology, 36 prognosis, 37 symptoms, 36, 37 treatment, 37, 38 chronic, 44 definition, 44 diagnosis, 45 etiology, 44 pathology, 44 prognosis, 45 symptoms, 44, 45 treatment, 45, 46 Traumatic lesions of conjunctiva, 519 foreign bodies, 519, 520 symptoms, 520 treatment, 520 wounds, 520 treatment, 520, 521 Trichiasis, 503 definition, 503, 504 prognosis, 504 symptoms, 504 treatment, 504 Trichinellidse, 209, 210 diagnosis, 211 in intestine of birds, 210, 211 Trichosomum annulatum, 210 brevicolle, 211 collare, 210 retusum, 210 tennissimum, 211 of dog, 210 Trichuris depressiusculus, 210 of rabbit, 210 Trichurus unguiculatus, 210 pathology, 211 INDEX 669 Trichinellidse, prognosis, 211 symptoms, 211 treatment, 211 Trichodectes latus, 474 subrostratus, 474 Trichosomum annulatum, 210 brevicolle, 211 collare, 210 contortum, 163 in stomach of birds, 163 retusum, 210 tennissimum, 211 Trichurus depressiusculus, 210 unguiculatus, 210 Trigeminal nerve, paralysis of, 451 Tuberculomata of eyelids, 511 Tuberculosis, avian, 616 avium, 616 of birds, 616 definition, 616 diagnosis, 619 etiology, 616 natural infection, 617 occurrence, 616 pathogenesis, 616, 617 pathology, 617, 618 prevention, 620 prognosis, 620 symptoms, 618, 619 treatment, 620 of dogs and cats, 620 diagnosis, 622 form, 620 occurrence, 620 pathogenesis, 621 pathology, 621 prognosis, 622 symptoms, 621, 622 treatment, 622 Tumors of bladder, 423 prognosis, 423 treatment, 423 varieties, 423 carcinomata, 423 fibromata, 423 sarcomata, 423 of brain, 441, 442 symptoms, 442 on conjunctiva, 522 treatment, 522 of cornea, 538 treatment, 538 of ear, 493 Tumors of eyelids, 506 varieties, 506 chalazion, 507 treatment, 507 cysts, meibomian, 507 pilosebaceous, 507 enlargement of glands of Moll, 508 treatment, 508 granulomas, 508 treatment, 508 lipoma in birds, 508 treatment, 508 malignant neoplasms, 508, 509 diagnosis, 509 treatment, 509 varieties, 509 carcinomata, 509 epitheliomata, 509 sarcomata, 509 tuberculomata, 509 Meibomian cysts, 507 papillomata, 506 treatment, 506, 507 pilosebaceous cysts, 507 treatment, 508 sebaceous, in birds, 508 warts, 506 of iris, 541 in kidney, 407 treatment, 407 in nasal passages, 29 benign, 28 malignant, 29 of mammary glands, 317 benign, 317 fibromata, 317 prognosis, 318 symptoms, 318 treatment, 318 lipoma, 318 prognosis, 318 symptoms, 318 treatment, 318 malignant, 318 carcinomata, 318 prognosis, 318 symptoms, 318 treatment, 318 sarcomata, 318 diagnosis, 318 symptoms, 318 070 INDEX Tumors of mammary glands, ma- lignant, sarcomata, treatment, 318 on membrana nictitans, 523 of orbit, 553 of ovaries, 284 varieties, 284 cysts, 284 diagnosis, 285 prognosis, 285 treatment, 285 other tumor formations, 285 of penis and prepuce, 268 varieties, 269, 270 carcinomata, 269 epitheliomata, 269 papillomata, 269 symptoms, 269 treatment, 269 sarcomata, 269 diagnosis, 269 symptoms, 269 treatment, 269 venereal granulomata, 269 diagnosis, 270 prognosis, 270 symptoms, 269, 270 treatment, 270 of prostate gland, 280 diagnosis, 281 prognosis, 281 symptoms, 281 treatment, 281, 282 of scrotum and testes, 272 carcinomata, 273 fibromata, 272, 273 retention cysts, 273 sarcomata, 273 treatment, 273 of uterine tubes, 291 of uterus, 303 fibromata, 303, 304 diagnosis, 304 prognosis, 304 symptoms, 304 treatment, 304 hydrometra, 304 definition, 304 diagnosis, 305 etiology, 304, 305 prognosis, 305 symptoms, 305 treatment, 305 Tumors of uterus, myomata, 304 of vulva and vagina, 313 fibromata, 313 diagnosis, 313 prognosis, 313 treatment, 314 papillomata, 314 treatment, 314 sarcomata, 314 treatment, 314 venereal granulomata, 314 treatment, 314 Typhoid, fowl, 584 Typhus, canine, 579 of dogs, 579 course, 582 definition, 579 diagnosis, 581, 582 etiology, 579 occurrence, 579 pathology, 579, 580 prognosis, 582 symptoms, 580, 581 treatment, 582, 583 ULCERATION of concha, 488 etiology, 488 prognosis, 489 symptoms, 489 treatment, 489 of conjunctiva, 521 treatment, 521 of cornea, 532 of stomach, 157 definition, 157, 158 diagnosis, 159 etiology, 158 pathology, 158 prognosis, 159 symptoms, 158, 159 treatment, 159 Ulcerative stomatitis, 96 Ulcus yentriculi, 157 Umbilical hernia, 557 Uncinaria stenocephala, 207 trigonocephala, 207 Uremia, 400 definition, 400 diagnosis, 401 etiology, 400 INDEX 671 Uremia, prognosis, 401 symptoms, 400 treatment, 401, 402 Urethra, calculi in, 427 congenital malformations of, 425 diseases of, 425 examination, 425 inflammation of, 429 occlusion of, 425 stricture of, 426 wounds of, .426 Urethritis, 429 symptoms, 429 treatment, 429 Urine, incontinence of, in bladder, 416 retention of, in bladder, 414 Urocystitis, 416 Uterine tubes, cysts of, 291 diseases of, 291 examination, 291 tumors of, 291 Uterus, diseases of, 292 examination, 292, 293 eversion of, 300 inversion of, 300 prolapse of, 300 rupture of, 303 tumors of, 303 VAGINA, diseases of, 309 examination, 309 malformations, congenital, 309 prolapse of, 311 rupture of, 313 tumors of, 313 and vulva, 309 congenital malformations of, 309 Vaginitis and vulvitis, 309 definition, 309 diagnosis, 311 etiology, 310 prognosis, 311 symptoms, 310 treatment, 311 Valvular insufficiency and stenosis, 78 definition, 78, 79 insufficiency, 78, 79 Valvular insufficiency and stenosis, definition, insufficiency, imperfect closing of valves, 78, 79 stenosis or contraction of openings, 79 diagnosis, 81 etiology, 79 necropsy, 80 prognosis, 81 symptoms, 80, 81 treatment, 81, 82 Vascular goiter, 341 keratitis, 528 Vegetable parasitic disease of skin, 482 Venereal granulomata of penis and prepuce, 269 of vulva and vagina, 314 Ventral hernia, 558 Vertebrae, fracture of, 370 Vertebral dislocation, 379 Vertigo, 455 definition, 455 diagnosis, 456 etiology, 455 prognosis, 456 symptoms, 455, 456 treatment, 456 Volvulus, 185 . definition, 185 diagnosis, 185, 186 etiology, 185 pathology, 185 prognosis, 186 symptoms, 185 treatment, 186 Vulva, diseases of, 309 examination, 309 tumors of, 313 Vulvitis, 309 W WARTS on eyelids, 506 Whipworm, 209, 210 White comb, 484 diarrhea, 629 Wounds of articulations, 376 of bladder, 412 on conjunctiva, 520 of cornea, 535 072 INDEX Wounds of ear, 487, 488 ; Wounds of intestines, 188 prognosis, 488 definition, 188 symptoms, 488 etiology, 188 treatment, 488 symptoms, 188, 189 of eyelids, 497, 498 treatment, 189 and injuries of mammary gland of membrana m'ctitans, 523 315 of penis and prepuce, 263, 264 treatment, 315 prognosis, 264 of testes and scrotum, 271 symptoms, 264 prognosis, 271 treatment, 264, 265 symptoms, 271 of urethra, 426 treatment, 271 treatmert, 426 UNIVERSITY OF CALIFORNIA LIBRARY Los Angeles This book is DUE on the last date stamped below. 1 3 1334 PSD 2343 9/77 J Vl58 00401 220 "A 001 107 745