I . CJm D THISfSTHEPROPERTVor 1001101 OF ilGRICULTit >^ i'-llbi!^ , CORNE LL UNIV ERSITY THE FOUNDED BY ROSWELL P. FLOWER for the use of the N. Y. STATE VETERINARY COLLEGE 1897 Digitized by Microsoft® Cornell University Library SF 769.C12S 1908 Studies in clinical veterinary medicine 3 1924 001 115 355 Date Due j« iQM ^^--vW Litirary Burca J Cat. No. 1137 Digitized by Microsoft© This book was digitized by Microsoft Corporation in cooperation witli Cornell University Libraries, 2007. You may use and print this copy in limited quantity for your personal purposes, but may not distribute or provide access to it (or modified or partial versions of it) for revenue-generating or other commercial purposes. Digitized by Microsoft® Digitized by Microsoft® Cornell University Library The original of tiiis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924001115355 ' Diqitizeaby Microsoft® STUDIES IN CLINICAL VETERINARY MEDICINE AND SURGERY By P. J. CADIOT Professor of Surgery at the Veterinary School of Alfort; late President of the Central Society of Veterinary Medicine of Paris THANSI.A.TBD, EDITED, AND SUPPLEMENTED WITH 49 NEW ARTICLES AND 34 ILLUSTHATIONS By JNO. A. W. DOLLAR, M.R.C.V.S. Corresponding Member of the Central Society of Veterinary Medicine of Paris; Life Member of the Royal Italian Society of Hygiene; Corresponding Associate of the Royal Spanish Society of Hygiene; Corresponding Member of the Society of Veterinary Medicine of Brabant {Belgium^; Honorary Associate of the Spanish Society of Arts; etc. New York WILLIAM R. JENKINS CO. PUBLISHERS 851 & 853 Sixth Avenue 1908 Digitized by Microsoft® 7 ^ f / c I/' D Digitized by Microsoft® THiSISTHEPROPERTVOF OEPARTierOFAGeiGijaiE, TO VICTOR HORSLEY XCbie worft 10, witb permiseion, &eMcate& AS A TOKEN OF RESPECT AND GRATITUDE BY THE TRANSLATOR AND CO-AUTHOR. Digitized by Microsoft® BY THE SAME AUTHOR. Royal Svo, 438 pages, 406 illustrations, A HANDBOOK OF HORSE-SHOEING, With Introductory Chapters on the Anatomy and Physiology of the Horse's Foot, and 54 full-page plates with descriptive notes by Albert Wheatley, F.R.C.V.S. 60 large pages (14! x 10 inches), 315 illustrations. AN ATLAS OF VETERINARY SURGICAL OPERATIONS. Demy 8vo, 42 pages, 16 full-page plates. A SURGICAL OPERATING TABLE FOR THE HORSE. Royal Svo, 732 pages, 142 illustrations. MOLLER'S VETERINARY SURGERY, Translated from the last German edition and Edited by JNO. A. W. DOLLAR, M.R.C.V.S. Digitized by Microsoft® PREFACE. Notwithstanding the general consensus of opinion in favour of clinical teaching, this method of instruction has until recently been somewhat neglected in British veterinary schools. In Germany, on the other hand, ambulatory cliniques occupied an important position from a very early date, and in the two great French schools of Lyons and Alfort clinical demonstrations have received an extension and been brought to a pitch of perfection probably unsurpassed elsewhere. Convinced from my student's days of the value of this system I was greatly attracted by the impromptu lectures at Alfort, and early began the collection of extensive notes, and in some cases of drawings, designing on my return home to publish a small clinical volume. Pressure of literary and other work unfortunately — or perhaps fortu- nately — rendered this impossible. Meanwhile Professor Cadiot, one of the foremost clinical teachers in France, whose instruction I consider myself fortunate in having received, gave a renewed impulse to my purpose by the publication last year of his ' Etudes de Pathologic et de Clinique.' A glance at this admirable work convinced me that in great part at least my work had been anticipated, and that instead of pursuing my original intention I should better serve the interests of English-speaking colleagues by assuming the humble but (from their standpoint) no less useful part of translator, utilising my own material and that to be derived from English literature by way of supplement -to the experiences of my former teacher. On this conviction I have acted. The first part of the original Digitized by Microsoft® PREFACE. work, together with certain chapters considered of minor interest^ have been omitted ; forty-nine new articles have been added, and the number of illustrations has been nearly doubled. To Professor Cadiot, who has extended to me every assistance in his power, I hereb}' express my liveliest gratitude ; while for the un- failing patience and friendly sympath}' with which Professor McQueen, of the Royal Veterinary College, London, has carried through the task of reading the proof-sheets of the present work I desire to tender him my sincerest thanks. JNO. A. W. DOLLAR. 56, New Bond Street, London, W. ; September zgth, 1900. Digitized by Microsoft® CONTENTS. PART I. SURGICAL PATHOLOGY AND PRACTICE. I. Dentigerous cysts in the temporal region . . . i II. Purulent collections in the facial sinuses and dental caries . . 8 III. Affections of tht turbinated bones in the horse , . . .15 IV. Tumours in the facial sinuses and cancer of the superior maxilla . 22 V. The surgical treatment of chronic roaring , . . . sa VI. Acute inguinal hernia ....... 35 VII. Deep-seated inguinal abscess after castration . . . .40 VIII. Diaphragmatic hernia ..... 44 IX. Blenhorrhoea in the dog ...... 52 X. Amputation of the penis in the horse . . . . .56 XI. Radial paralysis in the horse ...... 64 XII. The treatment of spavin ....... 72 XIII. The treatment of picked-up nail .... .78 XIV. Plantar neurectomy .,.,.., 86 XV. Neurectomy of the median and of the ulnar nerves , . .92 XVI. Lymphangitis and multiple abscesses in the horse, due to the presence of staphylococci ....... 97 XVII. External tuberculosis in the dog and cat ..... loa XVIII. A case of sarcomatous disease ..... 106 PART II. MEDICAL PATHOLOGY AND PRACTICE. XIX. Acute endocarditis in the horse XX. Aortic insufficiency in the horse XXI. Mitral insufficiency in the horse XXII. Myocarditis XXIII. Ossification of the cardiac auricles XXIV. Cardiac intermittency in the horse XXV. Pericarditis in the dog XXVI. Pneumonia in the horse XXVII. Pneumonia in the horse (conclusion) 116 132 142 IS3 157 162 170 185 Digitized by Microsoft® CONTENTS. XXVIII. Chronic pleurisy in thie horse XXIX. The abdominal form of influenza in the horse XXX. A case of pharyngitis due to strangles XXXI. Tuberculosis in the horse XXXII. Tuberculosis in the dog XXXIII. Tuberculosis in the cat XXXIV. H^emoglobini^ria (azoturia) in the horse , XXXV. Haemoglobinuria (azoturia) in the horse (conclusion) XXXVI. Diabetes mellitus in the dog XXXVII. Exophthalmic goitre XXXVIII. Eczema in the dog XXXIX. Eczema in the dog (conclusion) XL. Eczema in the horse P.\GE 202 210 219 225 234 244 249 257 264 272 279 286 291 PART III. CLINICAL CASES. I. — Head and Spinal Cord. A. Cranium, brain, and spinal cord. Supernumerary tooth in the temporal region — operation —suppurating median otitis . . . ... 298 Tumour of the right hemisphere of the brain . . 300 Tumour of the cerebellum ... .... 303 Tumour of the brain in the horse . . . . ' . 304 Brain disease — tumour in neighbourhood of cerebellum and medulla . 304 Cerebral injury and Cheyne-Stokes respiration in a horse . . . 307 Tumour of the vertebral column .... 308 B. Eye and ear. Cancer of the lower eyelid and globe of the eye . . 309 Malignant carcinomatous intra-orbital growth with destruction of the eye in a cow ........ 310 Traumatic cataract . • . . . . . 311 Cataract — operation ... . .312 Symbiotic acariasis and eczema of the ear .312 C. Nose and nasal cavities. Necrosis of the nasal septum . .314 Necrosis of the cartilage of the left nostril 315 Sebaceous cysts in the false nostril . .316 Chronic inflammation and necrosis of the posterior (maxillary) turbinated bone . 317 Tumours in the nasal cavities . . 319 Purulent inflammation of the sinuses ; meningo-encephalitis 323 D. Lips. — Cheek. — Jaws. — Motith. — Pharynx. Pseudo-cancroid of the lip . 324 Papillary sarcoma of the cheek 326 Fracture of the lower jaw . 326 Ostitis of the inferior maxilla — necrosis — sequestrum . 327 Cancer of the inferior maxilla . 328 Dental caries 330 Dental fistula . 331 Digitized by Microsoft® CONTENTS. 333 ■Section of the tongue ....... F'oreign body in the mouth ... . . . -134 Chronic pharyngitis — double hyovertebrotomy . . . 335 Cold abscess in the retro-pharyngeal glands . . . 336 338 339 340 II. — Neck. Wound of the neck . Poll-evil . Sinus of the neck ..... Moist gangrene in the neck . . . . . . 340 Phlebitis of the jugular vein . . ..... 341 Extensive lacerated wound in neck of horse ; rupture of the trachea ; recovery . 344 Foreign body in the oesophagus .... . . 345 Foetid abscess in the neck of a cat caused by a needle .... 347 Surgical treatment of chronic roaring ...... 347 III. — Thorax. Fistulous withers ......... 354 Abscess in the left costal region — necrosis of the last rib . . . 357 Fracture of the first rib in the horse . . . 357 Myoma of the oesophagus . ... 358 Chronic endocarditis . ... 359 Myocarditis — cardiac intermittency .... . 361 Hydatid cyst of heart ..... 364 Intra-mural cardiac abscess in a cow . . . 365 Foreign body in the pericardium — intra-pericardial haemorrhage 365 Rupture of the right ventricle in the horse . . 366 Rupture of the pulmonary artery ....... 2^6 IV. — Abdomen and Tail. Necrosis of aponeurotic tissues in the flank . . . 368 Hernise ... . 369 Cancer of the stomach . 374 Abscess of the liver in the horse . . 376 Intestinal obstruction . . . 377 Perforation of the intestine . . . . . 378 Subcapsular haemorrhage in the liver of the hojrse ; partial recovery ; relapse and death ..... 379 Chylous ascites in the cat; meningitis as an accompaniment 380 Constipation . ... 384 Foreign body in the rectum . 385 Rupture of the posterior aorta . . 386 Thrombosis of the iliac arteries in the horse . 387 Acute nephritis . . 388 Cancer of the kidney . . 389 Diseased prostate in the dog 39' Cryptorchid operations . 397 ■Cryptorchidism in the cat . 4^4 Digitized by Microsoft® CONTENTS. Cancer of the scrotum . . • • • Cancer of the testicle— unsuccessful attempt to inoculate . Spermatic aneurysmal varix in the ox . • • Scirrhous cord with urethral obstruction in the horse ; operation Necrosis of the penis . . • • • Cancer of the penis ...••■ Paralysis of the penis . . • • Atrophy of the penis . . . ■ • Calculus in the urethra . . • • • Urethrotomy for removal of calculus in a horse Nymphomania — ovariotomy . • • • Hysteria in a mare ...•■• Prolapsus vaginae in a young mare . . . • Cystic degeneration of the ovary and Fallopian tube Prolapse of the uterus . . . • • Myxoma of the uterus . . . • • Imperforate vagina . . . . • Amenorrhoea due to imperforate hymen Epithelioma of the vulva . . . • • Rupture of the perinaeum — operation Cancer of the tail— generalisation after ablation PAGE 40s 40s 408 recovery 408 409 410 4" 414 414 415 . 416 417 418 421 422 423 423 424 424 426 • 427 v.— The Limes. Ossifying periosteal sarcoma of the shoulder — generalisation Total necrosis of the scapula ....-• Disease of the scapulo-humeral articulation— necrosis of the articular cartilages Injury of the flexor brachii muscle . Fracture of the humerus in a horse . Penetrating wound of the elbow Foreign body in the knee .... Suppurating synovitis of the carpal sheath . " Luxation " of the patella .... Ossification of the tendon of the semi-tendinosus muscle Fracture of the tibia in a horse Suppurating lymphangitis— abscess formation in the popliteal lymphatic glands- treatment with hydroxyl Spavin and knuckling over at the fetlock . Distension of tendon sheaths in front of the hock . Median and ulnar neurectomy — after complication Quittor — partial necrosis of the anterior lateral ligament of the pedal joint Operation for picked-up nail Complicated cases of corn . Granuloma on foot of stallion Rupture of the sesamoid ligaments in both fore-limbs 429. 430 432 433 434 435 436 437 438 442, 443 444 445 446. 447 449. 451 455 457 461 VL — Infectious Diseases. Tuberculosis in the horse ..... . . 463 Tuberculosis in a cow — inflammation of the omasum and ulceration of the abomasum ......... 469. Digitized by Microsoft® CONTENTS. XI Tuberculosis of the cerebrum External lesions of tuberculosis in the dog . Tuberculosis in the cat .... Transmission of pulmonary tuberculosis from man to the cat Transmission of tuberculosis from man to the paroquet Bothryomycosis ■ . . . . Pneumonia ...... Purpura hasmorrhagica .... Tetanus ...... PAGE 470 47" 473 475 475 477" 481 498. VII. — Various Diseases. Parasitic ansemia (Ixodes) ..... Echinococcosis of the brain, lungs, and liver in the horse . Paresis of the hind limbs (chorea) .... Rheumatism ....... Rheumatism or pachymeningitis .... Sarcomatous disease of the lung . Round-celled sarcoma of the right testicle with enormous tumour in the horse ..... Carcinoma of the kidney in the horse Mammary adenoma in the bitch with pulmonary metastasis Infective granuloma in a mare .... S04 504 510 511 512 515 intra-abdomir al Si6 517 517 S19 PART IV. EXPERIMENTAL AND COMPARATIVE PATHOLOGY I. A contribution to the study of avian tuberculosis II. Tuberculosis of parrots^its relation to human tuberculosis III. Experimental tuberculosis in the goat .... IV. Malignant tumours in animals ..... 522- 558 575 579' PART V. EXPERIMENTAL THERAPEUTICS. I. The treatment of tuberculosis . . ... 595 II. The serum treatment of glanders . . . . 600 . III. The action of vanadine . . 604 IV. Intra-venous injections of iodine ...... 607 Appendi^c — A comparative table showing the approximate equivalent in Fahrenheit scale of a given Centigrade reading ...... 614 Index ........... 615. Digitized by Microsoft® Digitized by Microsoft® LIST OF ILLUSTRATIONS. Fig. 1. Pre-auricular fistula due to presence of a dentigerous cyst . . . , 2. Method of closing the communicating orifice between the mouth and maxillary sinus left after punching out a molar tooth 3. The same as Fig. 2. Lower (palatine) surface 4. Necrosis of the turbinated bones 5. Pavement-celled epithelioma of the maxilla. Transverse front of the fifth molar .... 6. Diaphragmatic hernia .... 7. Amputation of the penis 8. Neurotomy of the anterior tibial nerve 9- 10. Moist gangrene of the foot after plantar neurectomy Neurectomy of the ulnar nerve 12. 13- 14- IS- 16. 17- section 19. 20. 24. 25- 26. 27. Tuberculous ulcer in the throat ,, ,, in the neck „ ,, of the nose Chronic endocarditis of the aortic valves Chest bandage Tuberculosis of the liver I) 1, ,) (atypical form) ,, „ epiploon 21. Tuberculous pneumonia. Section through right lung showing cavernous 22. Tuberculosis of the tracheo-bronchial and mediastinal glands 23. Brain disease. Position at rest Brain seen from left side Vertical section through brain Sarcoma of the vertebral column Necrosis of the nasal cartilage 28. Sarcoma of the nose . 29. Cancer of the inferior maxilla 30. Internal surface of the right branch of maxilla 31. Loop of thread removed from dog's tongue . 32. Wound of the neck . of the face spaces PAGET 4 II 20 27 46 61 76 76 88 95 95 lOI lOI 104 126 168 238 239 239 245 24s 305 306 307 309 315 32a 328 329 334 338 Digitized by Microsoft® LIST OF ILLUSTRATIONS. Fig. ,33. Lacerated wound of the neck, etc. 34. Fistulous withers (left side) 35- .. .. ("ght side) 36. Fractured first rib . 37. Chylous ascites 38. Chylous fluid . 39. Microscopic appearance of fresh milk .40. Diseased prostate, etc., naked-eye appearance 41. Prostate of dog. General structure (microscopic appearance) 42. ,, ,, Section of tumour 43. „ „ ,, of calcified portion of tumour 44. Right kidney of dog ..... 45. Epithelioma of the testicle (section) 46. Amputation of penis, showing stump and urethral orifice 47. Prolapsus vaginae in a mare ..... 48. Malignant epithelioma of anus and vulva in a cow 49. Suture for rupture of perinjeum .50. Total necrosis of the scapula 51. Disease of the scapulo-humeral articulation 52. Injury of the flexor brachii muscle . 53. Fracture of the humerus 54. Foreign body in the knee of a dog . 55. Luxation of the patella (position at rest) 56. ,, ,, ,, (position during movement) .57. Fracture of the tibia in a horse 58. Rupture of the flexor tendons, etc., after neurectomy 59. Granuloma on coronet of stallion (off-side view) 60. ,, ,, ,, (near-side view) 61. The above case three months after operation 62. Paroquet with cutaneous tuberculous growths 63. Bothryomycotic swelling of the shoulder 64. Bothryomycosis of the hock . 65. Echinococcosis. Region of insensibility 66. Liver with cysts 67. Liver, showing cysts, laid open 68 Right lung, showing cysts 69. Debris in cyst fluid 70. Echinococcus scolex .... 71. Brain, showing cysts . 72. Rheumatism or pachymeningitis ? 73- 74. Malignant granuloma from stomach ■75. „ ,, from lung 76. Tuberculosis of the liver (fowl ) 76A. ,, ,, „ 77. Horny growth developed on a tuberculous patch on cheek 78. Tuberculous lesion in neighbourhood of eye 7Q. Tubercle from liver of parrot 80. Tuberculosis of crest (parrot) 81. Tuberculous vegetations on head (parrot) 82. attitude when quiescent attitude during an attack PAGE 344 3S5 356 358 381 382 383 392 393 394 395 39f' 406 413 420 42s 426 431 432 434 435 437 439 441 443 448 458 459 460 476 477 479 505 506 507 507 508 508 509 513 514 519 520 528 .S46 563 564 566 568 569 570 Digitized by Microsoft® LIST OF ILLUSTRATIONS. Flu 83- 84. 85. 86. 87. 90. 91. 92. 93- 94. Tuberculous growth in left ventricle of goat Epithelioma of the mammary gland . Fusiform-celled sarcoma from mammary gland Chondroid sarcoma of the mammary gland Osteoid sarcoma of the mammary gland Epithelioma of the testicle . ,, of the parotid Pavement epithelioma of stomach Epithelioma of the perianal gland Sebaceous epithelioma Fusiform-celled sarcoma of the vertebral column 577 584 584 58s 586 587 587 588 588 589 589 590 TEMPERATURE CHARTS. Charts I and II . jj III and IV Chart n V VI. VII VIII IX . 482 483 484 485 486 491 494 COLOURED PLATES. Heart of a horse dead of contagious pneumonia. Acute myocarditis . Tuberculous infiltration of the lung. Section of right lobe -Sarcomatous form of pulmonary tuberculosis. Section of left lung . Tuberculous endocarditis in the horse. Left ventricle . TO KACE P.1GE 142 226 . 228 232 Digitized by Microsoft® Digitized by Microsoft® CLINICAL VETERINARY MEDICINE AND SURGERY. PART I. SURGICAL PATHOLOGY AND PRACTICE. I.— DENTIGEROUS CYSTS IN THE TEMPORAL REGION. A FEW days ago our advice was sought concerning a horse which showed on the temporal region, a little in front of and above the eye, a soft, fluctuating, indolent swelHng, which several of you thought to be a simple cyst, and others took for a " cold abscess." The owner of the horse having been offered several contradictory opinions as to the nature of this swelling, and the proper method of treatment, had finally decided to send the animal here. On account of the position and character of the swelling, I at once came to regard it as a dental or dentigerous cyst developed in the temporal region, an abnormality of which you will probably not see another example during the course of the present year. I was therefore anxious to utilise the chance offered of drawing your attention to this singular condition, the nature of which has long been known, but which often escapes notice, although a number of cases have been described. Dentigerous cysts have been found in many species of animals and in various organs, particularly in the genital region, in the ovary and testicle. They are, however, specially common in the temporal region, at the base of the ear^ on the forehead, and in the sinuses. These cysts have been divided into dental and radiculo-dental : in the latter, which are rare, the root of the tooth projects towards the centre of the cyst ; whilst in the former, which are more frequent, the crown A Digitized by Microsoft® 2 CLINICAL VETERINARY MEDICINE AND SURGERY. occupies that position. It is of little importance whether the tooth be temporary or permanent. The mere inclusion of a tooth will not produce a dental cyst. In point of fact, one sometimes finds unde- veloped teeth buried in foreign tissues, and cysts have been observed in which the included tooth does not project into the interior of the cyst at all, but is enclosed in its wall. Various theories have been advanced to explain the pathology of these cysts. The most probable is that of Monsieur Malassez, enunciated during his study of the paradental epithelial debris. This author explains their origin by the persistence of some epithelial debris around the included tooth, and considers them due to the irritation produced during the growth of the tooth. Those containing several teeth result from the formation of a cyst at some spot where several tooth germs have been buried close together ; the teeth deve- lop and break into the cyst cavity. I leave on one side the general history and pathology of these curious growths ; I wish to speak particularly from the clinical standpoint, and to restrict myself to dentigerous cysts of the temporo-auricular region, which are by far the commonest and most interesting to the practitioner. Their degree of frequence is established by statistics long ago published by Lanzilotti and Generali. Of seventy-five cases mentioned in the veterinary journals sixty-eight were of this character. I believe ?iIage-Grouille published the first authentic case in De Fromage de Feugre's Correspondancc. He punctured a collection of fluid developed between the left zygomatic process and ear of a three-year-old colt. At the base of the cavity he found implanted in the cranial wall a sort of " bony peg," which he removed. It was a large, irregular molar, measuring two and three eighths inches in length, and three and a half in circumference. Under the title of ' Eburnated Degeneration of the bony part of the Temporal,' Rodet related in 1827 a second case of supernumerary teeth. The foUowing year Benard recorded a third case in the Recitcil, and corrected Rodet's diagnosis. You will find in one of Goubaux's Reports, communicated to the Central Society of Veterinary Medi- cine in 1853, an outline of the principal cases published at that date. Among the more recent works relative to this question I may cite an article of Macorps, inserted in the Annals of Veterinary Medicine of i860, and the memoir of Lanzilotti and Generali, published in 1873 in the Gazzetta Vetcrinaria. Our last case may be described in a few words. The animal is a four-year-old horse, bought at Beauce a fortnight ago by a dealer, who Digitized by Microsoft® DENTIGEROUS CYSTS IN THE TEMPORAL REGION. 3 did not notice the existence of the swelHng. One morning, however, he remarked on the left side of the animal's head a swelling the size of a small egg. Being unable to obtain any exact information as to its nature and gravity he sent the horse here. At the first examina- tion it was easy to see that we had not to deal with an abscess. The swelling was uniformly soft, fluctuating, cold, and painless. Its posi- tion in front of the ear and above the zygomatic process, its sharp delimitation, the absence of inflammatory symptoms, and the dis- covery of a prominence of bony consistence in the depths, sufficiently suggested its nature. It was, in fact, a dentigerous cyst. The owner did not wish to run the risks of treatment, and removed the horse. In October last I operated on a two-year-old colt, which showed an open sinus about three eighths of an inch in front of the base of the ear. This sinus, which ran obliquely forwards and was about four inches long, ended over a kind of rough bony swelling, which was regarded by some of you as an exostosis, by others as a necrotic patch of bone. The animal having been cast, and the front of the fistula laid open, we discovered a rounded prominence of bony con- sistence, with an irregular summit and smooth sides. It was, in fact, a supernumerary tooth. I seized it with dental forceps and attempted to loosen it. It readily became detached, and when extracted had the appearance of a small molar. A little behind was another, which I removed without much difficulty. The cavities left by these teeth were rounded, regular, and partly lined with fibrous membrane. Haemorrhage was trifling. The cavities were curetted and plugged with gauze. The dressing was renewed in forty-eight hours and several times later. In a month the wound had healed. In 1888 I saw another case of this kind, in which intervention was equally simple and cure rapid. Towards the middle of September a six-year-old horse was sent to the external Clinique, with an old sinus in front of the ear. The margins were denuded of hair, hardened, and from them escaped a little greyish, laudable pus, with- out offensive odour. A probe introduced into this sinus was finally stopped by a raw, bony surface, and by manipulating it a little I was able to satisfy myself of the presence of some hard moveable body, like a sequestrum. Having opened up the fistula, I removed this body with a pair of bent-necked forceps. It proved to be a small molar, completely detached, and held in its alveolus by a root little larger than the crown. The walls of the cavity were scraped, and the parts washed out with strong carbohc solution. Suppuration proceeded for several weeks, doubtless because of some change in the bone, but the wound eventually healed. Digitized by Microsoft® 4 CLINICAL VETERINARY MEDICINE AND SURGERY. Dentigerous cysts in the temporal region usually appear during the first few years of life— in fact, during the period of dentition. At first the dentigerous cyst consists of a soft swelling, flattened or hemi- spherical, painless, or shghtly sensitive, varying in size between that of a nut and an egg. Sometimes it persists for long in this condition ; in other cases — and this is the more common — the skin ulcerates towards the centre, or at some point of its surface, the contents of the cyst escape, and a sinus forms. As a rule, the opening of the sinus is at the side of the cranium, a little in front of and an inch or so from the base of the ear,— occasion- ally, however, on a level with the scutiform cartilage ; sometimes it is a Fig. I. — Pre-auricular fistula due to presence of a dentigerous cyst. little further forward, sometimes nearer the middle line or the zygo- matic process ; occasionally it is situated at the base of, or more or less high upon, the free portion of the ear. In Rodet's and several other cases the sinus, though opening some distance up on the conchal cartilage, had originated from near the zygomatic process. The wound is sometimes encircled with a ring of granulation, some- times appears as a simple aperture in the skin, but more frequently is situated at the base of a narrow infundibulum, produced by the retrac- tion of the walls of the fistula. In most cases the parts are swollen, or indurated to a greater or less extent, but when the condition is old- standing, the swelling or induration which at first existed may almost have disappeared. Digitized by Microsoft® DENTIGEROUS CYSTS IN THE TEMPORAL REGION. 5 The sinuses vary in extent, some being only three quarters to an inch and a half, others three or four inches deep. A probe, when introduced, comes in contact with a rough, irregular, bony surface, which gives a sensation similar to that produced by a fragment of necrosed bone still adherent to the surrounding parts. Sometimes one can distinguish an irregular protuberance, surrounded by a trifling circular depression. In other cases, like that to which I have just drawn your attention, the body encountered is moveable. What- ever its position and characters, the sinus always discharges a thin greyish pus, more or less abundant, inodorous or fcetid, which glues together the neighbouring hair, and sometimes forms on the cheek or parotid region a long streak, in which greyish particles may be detected. A sinus of this nature being formed, the condition may persist for years without much change ; the amount of suppuration varying froni time to time. In some animals the discharge almost ceases at certain periods, and the sinus, becoming reduced to very trifling dimensions, seems to heal. Later the parts become inflamed, suppuration in- creases, and the fistula reopens, or another appears in the neighbour- hood. In old-standing cases several cicatrices, due to closed sinuses, may often be detected around the wound. Besides the recorded cases of multiple supernumerary teeth, others exist where several dental cysts have developed in succession, each giving rise to a fistula. In Rodet's case, after the extraction of the first tooth a second cyst appeared. The fourteenth case treated by Macorps was operated on twice at an interval of three months. Each time a tooth was removed. A little later a new fluctuating swelling appeared, due to the eruption of a third tooth. Such relapses, however, have only been recorded in a few instances. As a rule these cysts neither produce functional disturbance nor general symptoms, though exceptions to this rule exist. Two patients treated by Macorps and Gamgee showed difficulty in mastication and general wasting, troubles which only disappeared after removal of the tooth. Much graver complications may occur when the tooth develops within the cranial cavity, thrusts back the dura mater, and compresses the brain. Bay has related an interesting case of this character. A horse which had long suffered from a non-fistulous swelling of the temporal region, but without accompanying disturb- ance, died in twenty-four hours with symptoms of meningitis and encephalitis. Autopsy revealed the presence within the cranium of a new growth of apparently osseous nature, which, on more careful Digitized by Microsoft® 6 CLINICAL VETERINARY MEDICINE AND SURGERY. examination, was found to consist of four molar teeth ; the two lower had developed from the region of the sella turcica, and compressed portions of the brain, which in this situation, as is known, is very intolerant of injury. Monsieur Barreau published the history of a horse which, after long suffering from a temporal sinus, showed difficulty in mastication, general wasting, and unmistakable signs of some brain lesion. It was slaughtered. In the cranium was found a kind of bony new formation, hemispherical in shape, developed from the squamous temporal bone and the corresponding wing of the sphenoid. The anatomico-pathological characters presented by even the more benign of these lesions vary greatly. They may resemble dermoid cysts, abscesses, or recent or old-standing fistuliE. The cyst generally contains only one tooth. Sometimes, however, there may be two, three, or more, either distinct or fused together. They usually present the appearance and characters of molars ; in other cases they more closely resemble incisors. Their shape is either prismatic, pyramidal, or rounded ; the majority, however, are very irregular. In composition they do not essentially differ from normal teeth, dentine, enamel, and cement being associated in varying proportions, the dentine usually predominating. The firmness with which these teeth are fixed in position varies greatly. In certain cases, as in that seen by you, extraction is easy. In others it is difficult, and not without danger. In a two-3'ear colt Degive, after removing one tooth, discovered a more deeply placed eburnated swelling, formed by several teeth incompletely fused together. The removal of this growth opened the cranial cavity, its lower portion being in direct contact with the dura mater. Provided the nature of these cysts and sinuses in the temporo- auricular region is recognised, the operator is less likely to commit indiscretions. Without doubt, in this as in other regions, ordinary cystic swellings develop sinuses, and are kept discharging by the presence of bony or cartilaginous necrosis ; but such accidents are infinitely rarer than those consequent on dental irregularities. Several cases described as necrosis of the scutiform cartilage — Martin's among others — and some referred by the writers to in- flammatory changes of the temporal bone, can now safely be assigned to the presence of supernumerary teeth. If, before intervention, one hesitates between diagnosing a dental cyst or necrosis of bone, it should be borne in mind that the former hypothesis is by far the more probable. When the swelling embraces the base, and extends more Digitized by Microsoft® DENTIGEROUS CVSTS IN THE TEMPORAL REGION. 7 or less high on the free portion of the ear, it awakens suspicion of necrosis of the conchal cartilage, and may be mistaken for that at the first glance, but palpation of the parts and exploration of the sinus generally settle the question. What is the prognosis in these lesions ? I have already said they persist for long periods, even for years. I will add that they are very rebellious to ordinary treatment. The lesion, whether only a swell- ing or a sinus, depreciates the value of the animal. When there is discharge of pus this fouls the region of the wound, and the parts often emit a foetid odour, noticeable on first entering the stable. You have seen that complications sometimes result. Finally, if interven- tion is usually followed by success, it may also involve accidents of the most serious character. The treatment formerly recommended included puncture of the cyst or slitting up the fistula, and caustic injections or cauterisation of the walls of the cyst. These methods are insufficient. Cure can only be effected by removing the tooth and destroying the wall of the cyst. As a rule the operation is simple and without danger. The horse being cast, the bridle is removed and the head extended. The parts having been prepared, the fistula is laid open or the swelling incised in the form of a cross, and the tooth exposed by reflecting the flaps. The attachment is often slight, or the tooth may be loose. It is easily removed with strong forceps or with special tooth forceps, the cyst being afterwards curetted. When it is deeply seated, and the operator is unable to grasp the crown, it may be loosened by means of a chisel and mallet, but cases occur where, in order to free it, a groove must be formed around the tooth by means of a narrow-bladed gouge. It is always necessary to proceed cautiously, avoiding vio- lence, on account of the risk of fracturing the skull and injuring the meninges and brain. All possible antiseptic precautions should be observed. Even when properly carried out the operation may be followed by various complications, by necrosis of a portion of the alveolar wall, bruised during extraction, by fracture of the tympanum (if the tooth abuts on the middle ear), or, if the deep portion is in contact with the dura mater, by meningo-encephalitis. When intervention is considered dangerous, it is better to refrain altogether from interfering with the tooth, rather than risk a fatal accident. The only case in which a cranial tooth should be touched is when it produces grave symptoms in consequence of its pressing on the brain. Digitized by Microsoft® II.— PURULENT COLLECTIONS IN THE FACIAL SINUSES AND DENTAL CARIES. During the years 1896 and 1897 eighteen horses affected with collections of pus in the sinuses were trephined in the hospital. According to the nature or cause of the disease, these eighteen cases may be divided as follows : — Simple inflammation of the sinuses, four ; inflammation of the sinuses produced by tumours, five ; inflam- mation of the sinuses of dental origin, nine. The small number of cases of simple inflammation is truly striking. This may possibly be due in part to the fact that the animals sent to us are those regarded by ordinary practitioners as unpromising, but I believe the number of cases of secondary inflammation of the sinuses is in reality greater than is generally supposed. In addition to dental caries and to true tumours one sees diffuse myxomatous degeneration of the mucous membrane of the sinuses. In all the cases of inflammation of the sinuses due to new growths the tumours were malignant or beyond operation. I therefore confined myself to trephining and verifying diagnosis. In the cases of dental origin, treatment consisted in trephining the maxillary and frontal sinuses, afterwards enlarging the lower ori- fice and removing the diseased molars by punching. After cleansing the parts I plugged the alveolar cavity with gauze and cotton wool ; this dressing was renewed every twenty -four or forty-eight hours ; the sinuses were cleansed and irrigated as in cases of simple collections of pus. The results have been good. Of nine horses thus treated six were cured in a month to six weeks. The alveolar cavity does not heal with equal readiness in all cases. In some it fills up slowly, in others with fair rapidity, and these differences are seen in animals of the same age or thereabouts. In the following case closure of the cavity was particularly rapid. In November, 1896, I had to punch out the third and fourth upper molars of a seven-year-old mare. The large communicating space between the mouth and sinus was plugged with gauze and wadding, Digitized by Microsoft® PURULENT COLLECTIONS IN THE FACIAL SINUSES AND DENTAL CARIES. 9 the dressing being renewed daily for the first week, and every second day for the next three weeks. At the end of this time the alveolar cavity of the third molar was almost filled up. That of the fourth still admitted a man's little finger. Ten days later only a narrow canal -■^ Q ''/.,■ ^ -,/ vr- Fig. 2. — Shows the method of closing the communicating orifice between the mouth and maxillary sinus left after punching out a molar tooth. existed, food no longer passed into the sinus, and the mare was able to leave the hospital. Towards the end of January we were informed that cure was perfect. At the commencement of June of the same year, one of my colleagues in the Seine and Marne district sent me a horse affected with double-sided collections of pus of dental origin. On the right side the condition was due to caries of the third molar, and on the left to caries of the fourth. We first trephined the right side and punched out the diseased molar. In five weeks, with the precautions just mentioned, the alveolar cavity had tilled up. We then performed the same operation on the left side. The parts healed as steadily as before, although the alveolus closed rather more slowly, and healing Digitized by Microsoft® lO CLINICAL VKTERINARY MEDICINE ANIi SURGERY. was not complete until the eighth week. The pain and disturbance of mastication caused by the caries and by the two operations had produced very marked bodily wasting, but the diseased animal gradually improved. A fortnight later, after the second operation, its weight was 642 kilogrammes, a fortnight later it weighed 649 kilos., and in a month 660 kilos.* Another horse, in which I punched out the fourth left molar, quitted the infirmary when the opening between the mouth and sinus was still of considerable size. It was neglected, food accumulated in the sinus, and the discharge again became abundant and horribly foetid. At the end of two months it was returned here in an extremely thin condition. The sinuses were full of stinking food material and pus. The walls of the alveolar cavity were lined with a whitish, fibrous, pseudo-mucous membrane, which gave no hope of satisfactory granulation. I decided to fill the parts with gutta percha. The animal was cast on Daviau's table, the mouth kept open with a gag, and the tongue moderately drawn to the right side, so as to freely expose the left molars. The sinus and alveolar cavity were carefully cleansed and dried with tam_pons of cotton wool. Two pieces of gutta percha, softened in water at about 112'- F., were pushed from the sinus into the alveolus, and fixed with the aid of the left index finger introduced into the sinus, the right being introduced by the mouth between the third and fifth molars. I was careful to slightly flatten out the upper part of the inserted piece on the wall of the sinus around the alveolar orifice, and the lower part around the two neighbouring molars. In order to more rapidly harden the gutta percha it was irrigated for some minutes with cold water both by the mouth and by the sinus. The latter was after- wards plugged with gauze. The dressing was renewed each following day. A discharge occurred around the upper part of the mass of gutta percha, but was trifling in quantity and no longer foetid. The trephined orifice was left open and contracted little by little. The animal's condition gradually improved. When it left the school a week later it only showed a trifling discharge, and the trephine wound scarcely suppurated. This animal was brought back again in six months. It fed well, and its condition had become excellent. A trifling quantity of muco- purulent discharge escaped from the left nostril, but there was no offensive odour. The trephine wound had become replaced by a narrow fistula, which discharged a little whitish pus without odour. Examined through the mouth, the piece of gutta percha was not in any way displaced, and continued to perform its function perfectly. * A kilogramme = 2-2 lbs. English. Digitized by Microsoft® PURULENT COLLECTIONS IN THE FACIAL SINUSES AND DENTAL CARIES. II Altogether the operation has given very good results, for before the alveolus was closed the sinus was continually full of decomposing food material, etc., and the smell was repulsive. In the three cases of simple inflammation of the sinus cure was readily effected ; in two in less than a month, in the other during the fifth week. In one of these cases pus had existed in the sinus for four months. The animal, an eight-year-old entire horse, had a running from the left nostril. The discharge was little when at rest, but became abundant during exercise, was whitish, grumous, and offensive. There was no trace of any mechanical injury, and no deformity or tenderness about Fig. 3. — The same case as Fig. 2. Lower (palatine) surface. the region of the sinus. The contents of the mouth had no unpleasant odour, and there was no dental disease. The submaxillary gland was as large as a nut, superficial, soft, moveable, and indolent. The horse being cast, I trephined the left inferior maxillary sinus, giving exit to a large quantity of yellowish-white, very foetid pus. The cavity having been cleansed, I freely broke down the septum between the two maxillary sinuses, and then, by means of a centre-bit, formed a counter-opening into the nostril from the lowest point in the inferior maxillary sinus. Night and morning the patient was dressed according to our usual method, by washing out the sinuses with a warm Digitized by Microsoft® 12 CLIXICAL VETERINARY MEDICIXE AND SURGERY. antiseptic solution and plugging the trephine opening. At the end of a week the discharge by the trephine wound and left nostril had already diminished, and afterwards continued gradually to lessen. During the fourth week we ceased plugging the wound. Some days later the animal returned home. As a rule, the troublesome cases are those where the mucous mem- brane is thickened, shows exuberant granulations, or is affected with polypoid degeneration. Sometimes persistence of the discharge is due to the anatomical formation of the inferior maxillary sinus, to the fact of its being prolonged an inch or so below the extremity of the zygomatic ridge, — that is, beyond the point where this sinus is usually trephined ; a quantity of pus remains in the lower part of the cavity, and keeps up inflammation of the mucous membrane. It also hap- pens at times that this sinus is very large and deep, allowing the puru- lent fluid to accumulate and keep up exudation from the mucous membrane. In cases of this nature it is advantageous to make an opening through the internal wall of the sinus, level with the inferior meatus of the nasal cavity as above indicated. With a small surgical stock and bit the operation is easy. Care is required, however^ to make the opening level with the meatus, and not with the internal portion of the large submaxillary sinus ; if placed too low the instru- ment penetrates into the palatine plate of the superior maxilla. The need for plugging the trephine openings, to prevent their closing up before suppuration ceases, is unfavourable to cure, because during the interval between the times of changing the dressing pus is retained in the sinus. This may be prevented b}' fixing in the openings closely fitting tubes of wood, provided with a little handle on the external surface. With the same object, metal or gutta-percha cannula may be employed. Before concluding, I must refer to one of our patients which died. An entire cart-horse, twelve years old, was brought here towards the middle of March, i8g6. He had long had a discharge from the right nostril, which finally became so offensive that the driver refused to take him out. The animal was in a bad state, thin and exhausted ; he lay down as soon as he entered his box. A purulent ofl'ensive discharge escaped from the right nostril. There was no deformity of the sinus, and the submaxillary glands were little enlarged. On examining the mouth it was seen that the horse "pouched" his food on both sides, especially on the right. The fourth right lower molar projected beyond the others nearly half an inch. Having inserted a gag, we discovered that the corresponding Digitized by Microsoft® PURULENT COLLECTIONS IN THE FACIAL SINUSES AND DENTAL CARIES. 1 3 upper molar was carious. The purulent inflammation of the sinus was, therefore, of dental origin. Treatment was as follows : — The animal having been suitably secured, I first cut away the portion of the fourth lower molar which projected above the others. I then made three closely placed trephine openings in the inferior maxillary sinus, and removed the intervening portions of bony tissue. On introducing the finger into the sinus after free irrigation the root of the carious tooth was discovered. This was punched out. The crown was almost entirely destroyed, but the root was little damaged. The sinus and alveolar wound were then washed out with warm creolin solution and plugged with gauze. Next day and the following days the dressing was renewed. The horse only ate a part of his food, but as the temperature did not rise more than a few tenths of a degree, T was not alarmed. As, however, the fasces were scanty and coated, I prescribed daily about four ounces of sulphate of soda. On the third day the bowels became relaxed, but the appetite always remained poor. The day after, the condition was greatly aggravated. The animal was exceedingly depressed and did not touch its food ; there was twitching about the stifle and elbow ; the respiration was accelerated, the pulse frequent, small and hardly per- ceptible ; the conjunctiva was slightly injected ; percussion and auscul- tation of the chest revealed nothing abnormal ; there was fever to the extent of about 2j° F. On rectal exploration the bladder was found empty. In the depths of the abdomen towards the right side could be felt a large, hard, slightly doughy mass, which yielded under pressure of the fingers. Palpation of the right flank appeared to indicate that this hard mass was formed by the csecum crammed with food. We attempted to overcome the obstruction by repeated enemas, and by subcutaneous injection of a mixture of pilocarpin and eserin. A little dung was passed. During the day the animal took a small quantity of milk, but steadily became worse, and death occurred on the following day, preceded by symptoms of acute abdominal pain. At the post- mortem examination food material was found distributed in the peri- toneal cavity, and the posterior part of the base of the caecum was seen to be ruptured. The viscus itself was distended by an enormous mass of hard material. The tear was surrounded by a large hyperjemic zone, and the ecchymosis present clearly showed that the lesion was ante- mortem. This animal had long suffered from dental caries and difficulty in mastication. The food material had ended by becoming impacted within the caecum. I have recalled the history of this horse because it points a moral. Digitized by Microsoft® 14 CLINICAL VETERINARY MEDICINE AND SURGERY, When during the treatment of inflammation of the sinuses, consequent on dental mischief, the appetite falls off, and grave general disturbance occurs, one should beware of referring all this to the operative wound, and remember that dental affections in the horse and all large animals, especially when prolonged, favour obstruction of the large intestine, and may bring about impaction of the caicum. Digitized by Microsoft® III.— AFFECTIONS OF THE TURBINATED BONES IN THE HORSE. A FEW days ago, in making an examination of a horse which had died in hospital, we discovered it had suffered from necrosis of the turbinated bones. In drawing your attention to this condition I am completing what I have already referred to during my surgical patho- logical lectures on diseases of the nasal cavities. In the horse the turbinated bones are subject to various diseased conditions, primary or secondary in character, of which, up to the present time, only incomplete and confused descriptions have been given. The few clinical observations published concerning these con- ditions refer (i) to hypertrophy and eburnation of the turbinated bones ; (2) to tumour formation within them ; (3) to mucous degenera- tion ; and (4) to empyema of their cavities and to necrosis. In certain horses chronic nasal catarrh is followed by considerable thickening of the pituitary membrane, and hypertrophy of both tur- binated bones, or only of the anterior. This hypertrophy is some- times general, but more frequently partial. The mucous membrane becomes hyperplastic, irritated, fibrillated, is usually pale and firm, but sometimes reddish and less consistent. The anterior turbinated bone, hypertrophied and firm, forms a conical or cylindrical poly- pous mass, which compresses neighbouring parts, causes atrophy of the posterior turbinated bone, and more or less completely fills the nasal cavity on the affected side. Sometimes, as in the case men- tioned by Stockfleth, it becomes as hard as bone or ivory. It may attain such dimensions as inwardly to displace the nasal septum, above the nasal bone, and externally the wall of the sinuses, into which it penetrates. There is always more or less abundant, sometimes foetid, muco-purulent discharge. The diminution in size of the nasal cavity impedes respiration, and gives rise to an abnormal whistling or roaring sound. Later the upper portion of the face becomes de- formed, the diseased side projecting, in consequence of the upper wall of the nasal cavity and of the sinuses being pushed up from below. Digitized by Microsoft® l6 CLINICAL VETERINARY MEIUCINE AND SURGERY. Only in exceptional cases does the turbinated bone become hyper- trophied in its anterior part, so as to become visible on opening the wings of the nostril, but the swelling can often be felt with the finger ; when, however, it is limited to the upper part of the turbinated bone it can be detected only by a catheter, or by examination with the rhino-laryngoscope, and in order to determine the character of the new growth a portion of morbid tissue must be examined micro- scopicall}^ Although most cases of hypertroph}- of the turbinated bones result from chronic inflammation of the nasal mucous membrane, the only surgical treatment which can be recommended and which proves successful consists in ablation of the diseased bone. The operation may be performed in two ways. In the first, the bone is removed through the nose with long powerful forceps or a pointed hook. Hoyer, who used a hook, was obliged to make several attempts in order to remove all the diseased bone. Bleeding was trifling, and the animal recovered. The other operative method, recommended by Jessen, consists in freely trephining the roof of the nasal cavity, making a large opening through which the turbinated bone is removed. Ablation can then be performed more methodically and completely, while if bleeding is abundant it is more easily checked by cauterisation and plugging. Jessen cured four animals by this method, which has succeeded equally well in the hands of other practitioners. Whatever the technique employed, removal of the hypertrophied bone does not always cure. In some cases, especially when of old standing, fungous growths develop at the seat of operation, and in a short time again obstruct the nasal cavity. New growths of varying character may develop on the turbinated bones. In the horse the commonest are mucous or fibrous polypi, myxomata, or fibromata, the evolution of which is usually slow. At first the symptoms are those of chronic catarrh, with unilateral muco- purulent discharge, sometimes streaked with blood. Later, respiration is impeded (as in the preceding condition), inspiration especially being more or less noisy. The animal frequently snorts, and as the tumour increases the symptoms become more marked. One meets with polypi originating from the base of one of the turbinated bones, or from the ethmoid bone extending into the nasal cavity, generally along the floor, or along the middle meatus, and pushing back the turbi- nated bones, finally reaching almost to the nostrils. In other cases they extend towards the pharynx and interfere with deglutition ; others, Digitized by Microsoft® AFFECTIONS OF THE TURBINATED BONES IN THE HORSE. 17 again, resemble the naso-pharyngeal polypi of man, and extend in all directions, invading the bone, and filling up the sinuses. This last variety, common in the dog, is exceptional in the horse ; but a benign polypus, when of large volume, may push aside the nasal septum and the turbinals and raise the nasal bone, completely blocking the nasal cavity and deforming the face. Sarcomata, which are much rarer than polypi, extend to the bones forming the nose, and usually acquire large dimensions in a very short time. Epitheliomata (pave- ment, or cylindric celled) are equally rare. They rapidly seize on the lymphatics, and produce metastatic inflammation of the submaxillary gland. Treatment is limited to benign tumours, i.e. to polypi. Several cases of spontaneous cure have been related. The tumour has finally been expelled during snorting or coughing. Such a termination, however, is rare, and must not often be looked for. Ablation should be performed by the method I shall describe in speaking of disease of the upper turbinated bone. Under the name of mucous degeneration of the turbinated bones, Sand has described in the colt an affection of these parts, and of the bones of the nose and face, the symptoms of which recall those of inflammatory hypertrophy of the turbinated bones, and of tumours in the nasal cavities. It is marked by unilateral muco-purulent discharge, by diffuse swelling about the nose and sinuses on one side of the face, and by abnormal breathing sounds, due to partial obstruction of the nasal cavity. The swollen parts of the facial bones are thinned, parchment- like, or softened, and appear to fluctuate. As a general rule these symptoms are first noted in the region of the maxillary sinuses, then in that of the frontal sinus. If a puncture be made over the centre of the swelling, and a probe introduced into the sinus, the instrument passes in all directions through a non-resisting tissue. When the condition is bilateral, respiratory disturbance may be so severe as to threaten suffocation and necessitate tracheotomy. Sand lays stress on the special anatomical changes in this affec- tion, which he states are different from those of inflammatory hyper- trophy of the turbinated bones and empyema of the sinuses. The most striking points are the dilatation of the sinuses, and of those portions of the turbinated bones contributing to their formation ; the destruction of the bony walls of the sinuses and of the parchment- like leaf of the turbinated bones, or, more frequently, the replacement of a bony by a mucous tissue engorged with liquid ; finally, the B Digitized by Microsoft® 1 8 CLINICAL VETERINARY MEDICINE AND SURGERY. accumulation of a serous exudate in the sinuses, whose orifice of communication with the nasal cavity has disappeared. The cause of the disease is obscure. It seems always to appear in young animals. In some cases it makes rapid progress ; in others, on the contrary, it is chronic, develops very slowly, and only produces functional disturbance after the lapse of years. Treatment is similar to that of catarrhal inflammation of the mucous membrane of the sinuses : trephining, drainage, and anti- septic injections. Sand states that these methods usually suffice to arrest or cure recent cases. Collections of pus in, and necrosis of the turbinated bones, have sometimes been regarded as due to glanders. A certain number of cases, most of them recent, have shown that such complications may, however, be purely local in character, sometimes consequent on acute inflammation of the pituitary membrane, caries of the last molars, indirect injury of the turbinated bones through the bones of the face, or direct injury through the nostrils. On post-inorteiii examination I have never found necrosis of the turbinated bones as a primary affection, and had often debated with myself whether published cases were not complications of hyper- trophic rhinitis, or of Sand's disease, until last week I saw the case to which I referred at the commencement of this lecture. The facts are as follows : On the afternoon of the 4th May one of my coUeagues * sent me a twelve-year-old mare, which had been ill for a fortnight. The condition was indicated by discharge from the nostrils, and had at first been regarded as due to a trifling sore throat. The discharge from the right nostril, however, persisted, and later increased and grew fcetid. On the 3rd May the animal's condition suddenly became aggra- vated. The patient was greatly depressed, had difficulty in standing, and refused food. It was sent to the College. On arrival it could only be kept on its legs for a short time by partially lifting it with wooden bars, and soon had to be let down on the straw. Its coma- tose condition, the paralytic symptoms, diminution of general sensi- bility, and contraction of the pupil, indicated some affection of the meninges and brain. On the other hand, the foetid discharge running from the right nostril, and trifling swelhng of the submaxillary glands, * An outside practitioner. It is usual in France for a professor thus to refer to a prac- titioner, or for one practitioner to refer to another. Unfortunately we do not use the term quite in this sense, and I cannot translate it more exactly. — Jxo. A. W D Digitized by Microsoft® AFFECTIONS OF THE TURBINATED BONES IN THE HORSE. 19 aroused suspicion of pus formation in the sinuses, or turbinated bones- The temperature was ioi-i°F., the pulse 5o, and the respirations 36 per minute. I first explored the naso-pharyngeal cavity with a catheter, and afterwards trephined the nasal bone. The right nasal cavity was clear, not diminished in size, and the sinuses of that side contained no pus. I considered it probable that the ethmoid cells were necrotic, a condition complicated by meningo-encephalitis. I prescribed warm boric irrigations of the nasal cavity, and put off until next day examination with the rhino-laryngoscope, by which I hoped to confirm the diagnosis. During the night the temperature fell i'8°F., the mucous mem- branes became reddish-violet, and the coma was interrupted by an attack of convulsions with spasmodic contraction of the limbs. The patient died next morning. At the post-mortem examination we found secondary lesions of purulent inflammation, marked especially by the presence of large numbers of metastatic pulmonary abscesses. The primary changes were very extensive, affecting the turbinated bones, ethmoid, and the antero-inferior parts of the cranium. In the posterior portion of the right nasal cavity the pituitary membrane was extremely hyper- asmic and infiltrated. Near its base the maxillary turbinated bone was destroyed over an oval space, about an inch to an inch and a quarter in its longer diameter, which corresponded with the long axis of the nose. Around this point the mucous membrane was thickened and blackish, except towards the back, where it was covered with necrotic suppurating points. In front, the turbinated bone was full of caseous putrid pus. Opposite the lesion of the maxillary turbinated bone, the ethmoidal turbinated bone showed a necrotic area where the mucous membrane was thinned, greyish-yellow, and covered with blood-stained pus. The ethmoid cells of the right side were deep red in colour, and in places ecchymosed ; towards their base, the mucous membrane appeared partially necrotic. The ethmoid cells and sphe- noidal sinus contained foetid pus. In the region between the posterior border of the sphenoid, and the superior border of the cribriform plate of the ethmoid, the dura mater was thickened, yellowish or greenish- grey, and everywhere soaked in pus ; the arachnoid cavity contained a fibrinous exudate, especially thick near the sella turcica. Immersed in pus, the pituitary gland had become softened and partly destroyed. Bacteriologically examined, pus collected from the necrotic portions of the turbinated bones was found to contain various micro-organisms, but especially streptococci, in longer or shorter chains— the greater number in short chains— staphylococci, and a small bacillus strongly Digitized by Microsoft® 20 CLINICAL VETERINARY MEDICINE AND SURGERY. resembling the bacillus of necrosis mentioned by Bang. Pus from the pulmonary abscesses also contained several varieties of organisms, streptococci predominating. In the intra-cranial exudate I only found streptococci in short chains, usually of three to six. In this patient the phases of the process were probably as follows : At first, acute inflammation of the mucous membrane of the turbinated bones, and ethmoid cells ; afterwards, partial necrosis of these organs, and suppurative inflammation of the ethmoidal and sphenoidal sinuses. From the ethmoid cells, suppuration extended through the holes in the cribriform plate of the ethmoid to the meninges of the brain. While these processes were gradually developing in the direction of the meninges, pyogenic organisms must have entered the venous circulation, and brought about purulent infection. In volume ix of the J-ournal of Military Veterinary Medicine, Delamotte recorded a case which in regard to the nature of its Fig. 4. — Necrosis of the turbinated bone lesions shows certain analogies to the preceding. It refers to a mule, which one morning, without any preliminary symptoms, was suddenly attacked with abundant epistaxis, and discharged from the mouth torrents of black, thick blood, of repulsive odour. An hour and a half after the onset of bleeding the animal died from loss of blood and asphyxia. At the post-mortcin examination, in addition to obstruction of the bronchi by blood and lesions of asphyxia, the examiner found the mucous membrane of the ethmoid cells gangrenous, greenish- yellow, softened, and of offensive odour. Necrosis of the turbinated bones usually long remains localised, and reveals itself by an offensive, one-sided discharge, interference with respiration due to diminution in the nasal cavity, trifling en- Digitized by Microsoft® AFFECTIONS OF THE TURBINATED BONES IN THE HORSE. 21 largement of the submaxillary glands, and swelling at the base of the forehead. The cases reported by Sand, Moller, and Frohner, all agree in this respect. The three cases referred to by the latter are inter- esting from a therapeutic stand-point. The essential facts are as follows : the first case was that of a six-year-old mare, which showed abundant, yellowish, offensive discharge from the right nostril, swelling of the submaxillary gland, to which the skin was adherent, injection of the pituitary membrane, and, towards the base of the nasal bone, a painful circumscribed swelling, over which percussion gave a dull sound. The changes affected the deep part of the nasal cavity. Examination by means of the nasal mirror failed to explain the nature of the condition. On trephining the nasal bone, the anterior turbinated bone was seen to be partially necrotic. The dead part having been removed, the cavity was washed out with creolin solution and plugged with iodoform gauze. Recovery occurred in three weeks. The second case was that of a twelve-year-old mare, showing practically the same symptoms as the former. Discharge, however, was bilateral, and the swelling at the base of the forehead was on the left side near the wider portion of the nasal bone. This bone was trephined, the diseased portion of the upper turbinated bone removed, and the parts dressed as in the preceding case. Cure followed in a fortnight. The third animal was a nine-year-old horse, with necrosis of the left upper turbinated bone. The same operation was performed as in the two previous cases. In six weeks the animal was returned home. Three weeks later it had completely recovered. I ought to add that in other cases the result has not been so happy. Sometimes the discharge has persisted much longer. In one of Holler's cases necrosis recurred, and recovery appeared hopeless. You yourselves have seen that rapidly fatal complications may occur. The facts just given and the case I have published sufficiently demonstrate the occurrence in the horse of a special disease, consisting in partial necrosis of one or both turbinated bones ; a disease producing clinical signs permitting of diagnosis, which sometimes remains localised for a long period, sometimes is rapidly followed by compli- cations, and which is best treated by trephining the nasal cavity, removing necrotic portions of the turbinated bone, and applying anti- septic dressings. Digitized by Microsoft® IV._TUMOURS IN THE FACIAL SINUSES AND CANCER OF THE SUPERIOR MAXILLA. You recently saw in the external clinique a patient with a tumour of the sinuses and of the bones of the face, on which I refused to operate. I wish to explain to you this morning the reasons for my abstention, and for that purpose shall take as my subject "New Growths in the Sinuses." Although much less frequent than catarrhal inflammations of the mucous membrane, or simple inflammation of the sinuses, new growths in the sinus are, nevertheless, not very rare. I have collected a fair number of cases, differing considerably from one another in regard to the nature of the lesions and to their gravity. In the sinuses of the horse one meets with cysts, myxomata, fibromata, sarcomata, and epitheliomata. I will shortly relate some clinical cases, which will give you an idea of the symptoms, course, and prognosis of these various tumours, and will show you within what limits intervention is permissible. Let us first of all consider the cysts. In 1893 a Percheron horse, seven years old, was sent to the clinique on account of a discharge from the left nostril of two months' standing. The discharge was thick, grumous, and offensive. On the left side the submaxillary gland was slightly enlarged, and felt like a little bunch of grapes, the constituent portions, however, being moveable one over the other. The external wall of the sinuses was slightly raised, and sensitive on percussion ; the sound given was distinctly dull. I concluded that suppuration was occurring in the sinuses. An explo- ratory puncture confirmed the diagnosis, and the patient was left in hospital for treatment. Having trephined the parts, we found in the inferior maxillary sinus, along with a considerable quantity of pus, several small, soft tumours developed from the mucous membrane. In the frontal and superior maxillary sinuses the mucous membrane was simply thickened by inflammation. The teeth were normal, the maxilla was not Digitized by Microsoft® TUMOURS IN THE FACIAL SINUSES AND CANCER OF THE SUPERIOR MAXILLA. 23 invaded, and the septum dividing the two maxillary sinuses was not destroyed. I incised one of these tumours with the point of a bistoury, and a little viscous fluid escaped. The case was clearly one of cyst formation in the mucous membrane, without doubt at the expense of the small glands therein contained. I sufficiently enlarged the opening in the inferior maxillary sinus, and scraped the mucous membrane. The head of a thermo-cautery was passed over the membrane, after which the animal was treated Hke a patient suffering from ordinary inflammation of the sinuses, drainage being provided for, and the parts washed out twice daily with a slightly antiseptic solution, followed by astringent injections. At the end of a month the drainage-tube was removed. The lower wound having been plugged to prevent it closing too rapidly, allowed of our continuing the injections some time longer. The animal was returned to work a few weeks afterwards. Recovery was complete. These mucous cysts of the sinuses are not common, at least very few cases have been recorded. Not less rare are the dental cysts, of one of which M. Liautard gives the following interesting account. A seventeen-year-old mare, after influenza, discharged freely from the nose, showed slight swelling of the submaxillary gland, and a little swelling of the right side of the fore- head. An American veterinary surgeon diagnosed the case as glanders. M. Liautard, after carefully examining the animal, declared the sym- ptoms due to a simple collection of pus in the sinuses. The teeth appeared sound, and there was nothing unusual in the mouth. On opening the inferior maxillary sinus, three dental cysts were found, each containing a hard moveable body of the consistence of enamel, — in fact, a rudimentary tooth similar to those found in cysts of the temporal region. Extraction of these teeth and destruction of the cysts offered no difficulty. In some weeks recovery was complete. The first division of my subject comprises lesions which remain confined to the sinus, and usually only reveal themselves by symptoms of suppurative inflammation in these cavities, a condition which often complicates tumour formation after the lapse of a certain time. Myxomata and fibrous polypi form two other varieties of tumours of the sinus, commoner and graver than the preceding, save when they are recent and limited to one of these cavities. Fibrous polypi, as a rule, are more dangerous than myxomata. Both usually affect the ethmoid or the floor of the sinuses. They grow somewhat rapidly, thrusting aside the bony walls, especially the external, invade neigh- bouring parts of the nasal cavity, and may there develop to a consider- Digitized by Microsoft® 24 CLINICAL VETERINARY MEDICINE AND SURGERY. able extent, impeding respiration and producing a loud roaring sound, or even death by asphyxia. M. Trasbot has published a curious case of this nature. He had to treat a mare which for six months had suffered from intermittent muco-purulent discharge from the left nostril, sometimes streaked with blood. Tumour of the sinuses was suspected. The discharge grew more and more abundant, the sub- maxillary glands became swollen, and the animal roared loudly during work. Further examination revealed nothing, either in the forward portion of the cavities or in the mouth. The roaring sound became more intense ; finally it was produced when at rest in the stable. Swallowing was interfered with, and the saliva escaped by the mouth. One morning this animal was found dead in its box. Post-mortem examination explained these peculiar symptoms. The tumour, which arose from the ethmoid, was formed of two perfectly distinct parts : one partially filled the frontal sinus without becoming in any way adherent to its walls ; the other, extending along the anterior turbi- nated bone within the nasal cavity, had developed very extensively, passing beyond the guttural opening of the nasal meati, traversing the pharynx, and latterly arriving at the larynx, its extremity had at last accidentally entered the latter and had doubtless excited spasm, followed by death. On histological examination this tumour proved to be a myxoma. Considering the narrow base from which it originated on the ethmoid, excision would have been easy had the growth been early discovered. M. Labat described a case of polypus of the sinuses, successfully treated by ablation, in an eight-year-old horse. The superior maxillary and frontal sinuses of the left side were the seat of a polypoid tumour, which had deformed the surrounding hard tissues. From the bone covering the superior maxillary sinus, a triangular piece, two and three quarters by three and a half by four inches in size, was removed. The tumour, which was attached to the roof of this cavity, was entirely removed. At the end of two months the opening in the bone was reduced to two thirds of its former size, but did not entirely fill up. Many practitioners have also operated with success on fibromata and myxomata of the sinuses. The cases I have collected lead me to regard sarcomata of the sinuses as rather rare, nevertheless cases are seen from time to time. A number of you, without doubt, remember a horse whose case formed the subject of a clinical lecture last year, and the slaughter of which I recommended on account of sarcoma of the superior maxillary bone and of the sinuses. When brought here this horse showed, on the left Digitized by Microsoft® TUMOURS IN THE FACIAL SINUSES AND CANCER OF THE SUPERIOR MAXILLA. 25 side of the face, a hard, diffuse, shghtly painful tumour, without enlargement of the corresponding submaxillary space. A purulent discharge escaped from the left nostril. On examining the cavity of the mouth we only noted a trifling swelling of the mucous membrane on each side of the line of molars. The horse being old and used was slaughtered. Post-mortem examination showed that the sinuses of the left side were to a great extent filled by this tumour. I confine myself to merely mentioning melanotic and mycotic tumours, which in exceptional cases may be met with in the sinuses. I now arrive at an extremely grave form of secondary tumour occurring in these cavities : I mean epithelioma. The history of a few patients will doubtless fix in your minds the symptoms and malignity of these tumours. Towards the end of last year, a ten-year-old horse was brought here by a man who had bought it a few days before. He had noted that the cheek was swollen, that the animal had a discharge from the left nostril, and that it ate with difficulty, symptoms which he thought would be cured by a few applications of the tooth rasp. The animal's general condition was good, though it showed some depression, and the face indicated suffering. Attention was specially arrested by a curdled stinking discharge from the nose, and by strings of saliva running from the mouth. On examining the cavity of the mouth, the nature of the condition was easily recognised. Unfor- tunately, it was not at all what the owner had thought. The buccal cavity contained a large tumour, involving the hard palate, and extending the entire length of the left upper row of molars. It projected slightly above the level of the mucous membrane, so that its anterior boundary opposite the second molar was clearly distinguish- able. Other points were made out by inserting a gag, and artificially lighting the mouth. The last left molars, partially buried in exuberant granulations arising from the new growth, were already loose. The prominence formed by the tumour was only pronounced in the neigh- bourhood of the molars ; over the greater part of the hard palate it was scarcely noticeable. The mucous membrane appeared simply to be covered by a kind of granular membrane. The lower nasal cavity was deformed, its floor bulged upwards owing to pressure exercised by the tumour. The latter extended to the interior of the maxilla, but had principally developed in the mouth and sinuses. Another impor- tant symptom consisted in swelling of both submaxillary glands, a condition strongly indicating the nature of the new growth. The sub- maxillary gland on the left side formed a bosselated very hard mass, Digitized by Microsoft® 26 CLINICAL VETERINARY MEDICINE AND SURGERY. as large as an egg, and adherent to the deeper-seated tissues. The right was the size of a pigeon's egg, showed the same irregularity, and was very hard. The diagnosis of epithelioma of the maxilla was therefore fairly clear. The animal was incurable. Being asked to leave it for a time, the owner preferred to remove and re-sell it, so that I did not again see this patient. The following is a similar case dating from iSgr. A twelve-year- old horse was brought to the clinique with this history : About three months before, its forehead was seen to be swollen ; the swelling increased gradually, mastication became painful, and an offensive discharge occurred from the right nostril. The right side of the face showed a diffuse, firm, slightly painful swelling, not extending beyond the anterior extremity of the zygo- matic ridge of the superior maxillary bone. The submaxillary gland of the same side formed a hard bosselated mass, moveable in relation to the skin, but very adherent to the deep parts. From the right nostril a greyish ill-smelling discharge occurred. By separating the wings of the nostril, a greyish tumour could be seen filling the nasal cavity and extending forwards between the turbinated bones. On examining the cavity of the mouth, the portion of the hard palate extending along the line of upper molars was seen to be occupied by a reddish, exuberant, granulating swelling, which towards the middle of the mouth almost covered half the space between the rows of teeth. The cheek was partially filled by vegetations, and by food material in a putrefying condition. Several of the molars were very loose, and their alveoli had certainlj^ been destroyed. Though swelling of the forehead was relatively little pronounced, you saw that the changes were extensive. The diagnosis, incurable tumour of the maxilla, was patent to all. Microscopic examination of a fragment of new tissue removed from the hard palate opposite the second molar confirmed this diagnosis. The growth was a lobulated epithelioma of the pavement-epithelium type. Soon afterwards the animal was slaughtered. I was able to obtain the head, and trace the extent of the lesions. The tumour had destroyed almost the whole of the upper maxilla, the anterior portion of the palatine bone, and part of the turbinated bones. It filled the middle third, and part of the upper third of the right nasal cavity, as well as both maxillary sinuses. The third and fourth molars were completely detached, the second, fifth, and sixth hardly retained their positions. The affection was well marked in the submaxillary lymphatic, glands, which pre- sented the same characters as the tumour. Digitized by Microsoft® TUMOURS IN THE FACIAL SINUSES AND CANCER OF THE SUPERIOR MAXILLA. 27 The case we have just seen is that of a gelding about fifteen years old. Six months ago it showed gradual swelling of the upper left maxilla. A veterinary surgeon who was consulted considered this due to injury, and prescribed treatment, but without success. The swelling slowly increased, mastication became difficult, and the breath from the left nostril stank. These symptoms had existed about two months before the animal was brought to our clinique. The most striking feature at first glance was the asymmetry of the face. The cheek muscles were atrophied. The prominence of the masseter, usually so well marked, had disappeared, and was replaced Fig. 5. — Pavement-celled epithelioma of the maxilla. Transverse section of the face in front of the fifth molar. by a distinct depression. In the region of the superior maxilla, between the zygomatic process and the orbital cavity, was a tumour as large as a man's fist, uniformly hard except at its centre, where the skin had ulcerated, and allowed of fungous vegetations protruding. Examination of the parts was painful, and caused the animal to struggle. From the left nostril ran a grumous offensive discharge, the amount of which increased with exercise. The lymphatic glands in the . submaxillary space were enlarged, a little indurated and Digitized by Microsoft® 28 CI.lNICAl, VETERINARY MEDICINE AND SURGERY. painful, but moveable under the skin. The mouth was offensive. On examining the buccal cavity, considerable destruction of mucous membrane w^as noted on the left, and the gum on either side of the row of molars was covered with vegetations. By using the mouth-gag, the second, third, and fifth molars were found to be loose and implanted in a soft tissue. They were surrounded with decomposing food. The fourth molar had fallen out, its place being occupied by fungating new tissue. In order to make a more complete examination the animal was cast and chloroformed. The face was trephined at three points around the centre of the tumour. The large opening thus made showed the greater part of the maxilla to be destroyed, and exposed the roots of the molars, whose bony alveoli had disappeared. The second and fourth molars were removed. Diagnosis was easy. The symptoms were due to a tumour, which had invaded the greater part of the superior maxillary bone, had filled the sinuses, and had perforated the bony palate. Microscopic examination showed it to be another case of epithelioma of the pavement epithelium type. The animal was slaughtered. No secondary growths could be detected in the viscera. The superior maxilla was almost completely destroyed. The first molar was still fairly firm, but the fifth and sixth yielded to gentle traction. The new growth hardly projected above the level of the palate, which, however, was invaded throughout the entire left side, from its posterior border to a point level with the first molar. You see that these three cases are almost similar, the only differences being the position and extent of the lesions. In all three the tumours are similar in nature and origin — are, in fact, epithe- liomata affecting deep-seated portions of the maxilla. Epithelial tumours originating in the mucous membrane of the mouth, nose, or sinuses, certainly occur, but are rare in the horse. Those most commonly seen in this region usually start from the maxilla. They undoubtedly develop from, and at the expense of, paradental epi- thelial debris, according to M. Malassez's theory in the case of similar tumours in man. Under the influence of hitherto unrecognised stimuh, the cells forming these small tracts of tissue may at any moment commence to prohferate, and may form in the depths of the bone a tumour which afterwards extends towards the mouth or sinuses, most frequently towards both simultaneously. Little by little the cancer destroys the walls of these cavities and the alveoli of the teeth. Sometimes it excavates in the bone a large cavity, lined Digitized by Microsoft® TUMOURS IN THE FACIAL SINUSES AND CANCER OF THE SUPERIOR MAXILLA. 29. with epithelial fungations. This form has been termed rodent cancer of the maxilla. Even when the affection is discovered early, for example at the moment when the buccal mucous membrane becomes ulcerated, or when the face begins to show deformity, the body of the maxilla or the alveoli of the teeth have already undergone extensive injury. You must guard against founding your prognosis of tumours in the region of the sinuses on the volume of the swelling, or distortion of the facial bones. Whilst epitheliomata of the maxilla, even though hardly visible, are of the greatest gravity, innocent tumours developed from the mucous membrane of the sinuses may press against the external wall of the cavity containing them, thinning, lifting, and perforating it, and finally breaking through the skin. Such benign tumours can be operated on with success. The animal is chloro- formed, the invaded cavities freely opened — most frequently the two maxillary sinuses are those affected — and the new growth totally removed, either in one or several portions. Hsemorrhage is checked by plugging, or the use of the cautery. But in the case of truly malignant tumours such operations are unjustifiable, and the practi- tioner who wishes to avoid compromising his reputation will not attempt them. In speaking of these tumours it is well, in animals as in man, to reserve the epithet of malignant for those which grow rapidly, invade neighbouring tissues— bone and soft parts — and which extend to the lymphatics ; to those, in a word, whose course simulates the progress of an infectious disease. I may summarise the practical deductions to be drawn from the cases described in a few words : — Tumours developed on the mucous membrane of the sinus, which have only affected the' bone by mechani- cally lifting it, or by exercising on it permanent prolonged pressure, are curable. If the value of the animal justifies intervention they should be removed. When, however, the new growth invades tissues indiscriminately and has partially destroyed the walls of the sinus, or affected the alveoli of the teeth, without, however, seizing on the lymphatic glands, it is almost always of the nature of an osteo-sarcoma, and interference is not advisable. Finally, when the tumour shows metastatic characters, and affects neighbouring lymphatic glands, it is usually a malignant epithehal tumour, beyond operation, and always liable to return if ablation is attempted. Digitized by Microsoft® v.— THE SURGICAL TREATMENT OF CHRONIC ROARING. One day last week M. L — , of No. 12, Place Vendome, Paris, sent us for examination a horse suffering from chronic roaring, asking whether we would carry out on this animal the operation performed last year on a mare belonging to his neighbour, M. D — . He stated that M. D — 's mare, which had suffered from intense roaring, render- ing her useless before operation, was at that moment doing good service, and that M. D — was very well pleased with the result. I was not at the clinique on that day, but several of you will remember the mare in question. The operation indicated was arytasnoidectomy. I may shortly sketch the history of the animal thus cured. She was an Anglo-Norman mare, which excited much attention at the horse show of 1893, where she recei\'ed the first prize for harness horses. Bought towards the end of the show by M. D — , she worked well until 1895. During the winter of 1895-6 she contracted pneu- monia, and on return to work was found to have become a roarer. She was unsuccessfully treated with iodide of potassium. The roaring grew so marked that the animal, even at moderate paces, several times fell in the shafts. M. D — took the advice of several veterinary surgeons. A consultant told him that the disease was incurable, and that he would have to dispose of the mare. M. D — replied that he valued her greatly, and that he had heard speak of an operation which without the use of a tracheotomy tube had several times rendered roaring horses useful. He was informed that the operation did not succeed once in a hundred times. Having been thus advised, M. D — came to me one morning at the school, and asked whether I would consent to operate on his mare. After having exactly informed him of the value of surgical treatment for roaring, I proposed to first perform the small operation, and in case of failure to perform the other — terms which he accepted. On the i8th January I performed partial cricoidectomy. Return- ing to work on the 8th February the mare roared to the same extent as before operation. Being sent back here on the 5th March I Digitized by Microsoft® THE SURGICAL TREATMENT OF CHRONIC ROARING. 3 1 removed the left arytsenoid. She once more went to work at the commencement of May, since when she has continued without inter- ruption. At the present time she occasionally gives a few dry coughs, but no longer roars at a trot. At a very fast pace she produces a slightly abnormal noise, otherwise without importance, for it is not accompanied by any distress or interference with respiration. This is not an exceptional case. Since the first results, which I published in i8go, a number of my patients have proved to be cured and others to be improved. During the last few months several animals have returned here, in v/hich after intervals of a year, eighteen months, or two years, the good effects are found to have been maintained. These results are interesting, if only from the point of view of the surgery of the larynx. They show that deep, extensive wounds of the larynx readily heal without pulmonary complications, and that intra- laryngeal wounds with loss of substance may cicatrise without pro- ducing contraction of the air-tube. Considering that the condition for which operation is performed was formerly regarded as absolutely incurable they are encouraging, for if failures are still frequent, we now know how to avoid various accidents to which the operation gave rise at the time when I commenced to study it. This is not one of those operations which only became possible after the discovery of antisepsis. The progress effected is simply due to more perfect technique. On previous occasions I have spoken of the experiments made more than half a century ago by Gunther with the object of curing roaring. I have also mentioned Moller's researches, of which I gave a resume in my work in 1891. Among the various methods of opera- tion proposed by these veterinary surgeons is one whose efficacy is undoubted, and which deserves preference before all others. This method is arytsenoidectomy. In the great majority of cases I have treated I performed arytsenoi- dectomy pure and simple, following the method described in my work* and in my text-book on surgical treatment. I have since somewhat modified the instruments and technique. To ensure not injuring the mucous membrane of the trachea by undue compression, I replace the rubber balloon surrounding the Trendelenburg cannula with plaited gauze, fixed to the tracheotomy tube by ligatures. I only cut through the cricoid cartilage and first ring of the trachea. I * See ' Roaring in Horses,' by P. J. Cadiot, translated by T. J. W. Dollar. Digitized by Microsoft® 32 CLINICAL VETERINARY MEDICINE AND SURGERY. incise the laryngeal mucous membrane along the superior and posterior margins of the arytaenoid a little within their borders. As a dressing I place in the larynx two rectangular, flattened tampons of gauze on edge, which I fix by passing through them the silk threads of the suture used to unite the muscle. I remove the dressing and tracheo- tomy tube at the end of twenty-four hours. For the first few days I keep the trachea open and the wound exposed, by passing through the centre of the skin and muscle forming the lips of the wound two threads, which are tied together above the neck. Whilst sparing the mucous membrane covering the superior and posterior margins of the arytssnoid as much as possible, I slightly changed, though I ought to say without much benefit, the method of removing the cartilage. In certain cases I preserved a narrow band of the mucous membrane covering the anterior margin of the cartilage. In others, where the larynx was particularly narrow, I made the incision opposite the inferior margin of the arytsenoid a little larger, extending it to the mucous membrane and the uppfer part of the vocal cord. In others, again, I removed the greater part of the articular angle of the arytsenoid with cutting forceps. Except for this latter modifica- tion, I consider it very important to limit as far as possible the area of incisions in the laryngeal mucous membrane ; not to extend towards the region of the oesophagus when detaching the upper surface of the arytaenoid ; and not to wound either the portion of the arytsenoid left or the vocal cord. ^^"ith a little practice the manipulations in arytasnoidectomy are easily performed, even without antesthesia ; but these manipulations cannot be carried out correctly, or with the necessary certainty, by an unpractised or clumsy hand. When the wound resulting from ablation of the arytsenoid heals regularly, when granulation is not excessive or new cicatricial tissue exuberant, the entrance to the larynx remains enlarged ; the result is then good. In favourable cases the course of events is as follows : — The mucous membrane at the four margins of the wound left by removal of the arytenoid is far from being equally moveable ; the superior and inferior margins of this wound cannot be united by suture, but it is easy to bring the anterior and posterior in contact without dissection and without tearing ; the reason being that the anterior edge is very moveable and can easil}- be drawn towards the posterior, thus covering the whole wound. If left to itself the wound granulates over its entire surface, and the cicatricial tissue in contracting draws the anterior margin much nearer the centre than it does the others. It is the Digitized by Microsoft® THE SURGICAL TREATMENT OF CHRONIC ROARING. 33 anterior margin, therefore, which principally restores the covering of the parts; and when repair occurs regularly, without excessive new tissue formation, the upper portion of the larynx is and remains distinctly concave at its left side, i. e. at the site of operation. Under these conditions the vocal cord can neither be pushed nor drawn towards the median line. It is fixed in the position it occupies or drawn slightly outwards. Unfortunately, our subjects do not voluntarily allow anything to be done. It is impossible to follow the progress of the wound, to super- intend the healing, or to repress the excessive granulations which may form, and thus to obtain a flat cicatrix — an essential condition for the disappearance or diminution of roaring. Attempts have been made to still further enlarge the passage by excising, along with the arytsenoid, either the vocal cord, or the vocal cord and internal wall of the laryngeal ventricle. These are old methods. Ablation of the arytsenoid and of the vocal cord is not nearly so valuable as simple arytsenoidectomy. After a large experience I regard the benefit sought by removing the vocal cord as illusor\'. The mucous wound is greatly enlarged, and its inferior part, whence the cord is removed, is precisely that which most readily vegetates and gives rise to excessive granulations. There remains, then, arytasnoidectomy, completed by removal of the internal wall of the laryngeal ventricle. The advantage of enlarging the air inlet throughout its extent, without sensibly in- creasing the surface of the excision wound, was claimed for this opera- tion. It has been given up because most horses upon which it was performed died from mechanical pneumonia, due to passage of particles of food into the lungs. I avoided this by feeding my patients in the same way as human beings who have undergone arytasnoidectomy, and by exercising the same care after operation. The procedure was as follows : — I commenced by performing ary- taenoidectomy, following the ordinary method and suturing the borders of the wound. I afterwards passed the index finger into the ventricle of the larynx ; with one limb of a pair of straight scissors, introduced into the ventricle, I vertically divided the inner wall of the latter throughout its depth. Grasping the anterior flap with forceps, I partially excised it with curved scissors, avoiding injury to the epiglottis. I next grasped the posterior flap, covered by the vocal cord, in the same way, and removed it from below upwards with a button-pointed bistoury. The dressing and the subsequent precau- tions adopted were similar to those after arytsenoidectomy. Digitized by Microsoft® 34 CLINICAL VETERINARY MEDICINE AND SURGERY. This operation always gave bad results. Of the various methods suggested, arytaenoidectomy not only causes the fewest possible complications, but also gives the greatest number of lasting successes. Like all bold operations, like all surgical innovations directed against diseases previously considered incurable, arytsenoidectomy has its drawbacks and dangers ; but the fact remains, and cannot be gain- said, that it renders useful for various kinds of work a number of roarers otherwise condemned to tracheotomy. Like other methods of treatment, it must not be expected to effect too much, and those persons are certainly over-exacting who, after having all their lives proclaimed the absolute incurability of chronic laryngeal roaring, reproach it for its uncertainty and for its infrequent success, as if, instead of advancing a little even by the process of grop- ing one's way, it were preferable to stand still. It is, I feel sure, superfluous to labour the point, and I conclude by repeating with Lanzilotti : " E indubitato die inolti cavalli sono guariti ! " [Undoubtedly many horses are cured.] Digitized by Microsoft® VI.— ACUTE INGUINAL HERNIA. Last month an entire horse left here for treatment underwent two grave operations on the same day, one of which was rendered necessary by a quite unexpected accident. We had cast the animal in the morning to operate for necrosis of some of the horn-secreting tissues resulting from a prick in shoeing. The same evening we had to cast it again : it had a strangulated inguinal hernia — a hernia certainly due to the violent struggles it had made during the first operation. The history of this horse is interesting for a double reason, of which you will judge later. It was brought for examination on the i6th April because it went lame on the off fore-leg, and, to assist us in diagnosis, the driver stated that the animal had fallen the night before on the right side, — that before this fall it had not shown the slightest defect, but that it had gone lame immediately afterwards. I may add that it was brought here by its regular driver, who mentioned that he had found the shoulder painful, that he regarded it as the seat of lameness, and that the farrier who had been referred to said the same thing. We thus had to guide us the opinion of two experts. I examined the horse before you. I showed you that the different portions of the limb exhibited no recent lesion to explain the lameness, and that the shoulder especially was neither swollen nor painful. Rather more restlessness was certainly shown on this side when the two shoulders were comparatively examined, but that was due to a slight stimulant application which had been made, and possibly also to the manipulation, pressure, and traction carried out by the two colleagues. Percussion on the foot, however, produced very evident flinching. On lightly tapping around the hoof near the shoe the animal responded by lifting the foot. A similar test applied to the other foot produced no result. On removing the shoe — especially when I lifted the inner branch with the pincers — the animal again showed signs of pain. Similarly, when I "tried the foot round " by compressing the circum- ference, the animal was uneasy. The quarters and the inner heel were especially sensitive. I then proceeded to cut a groove along the white Digitized by Microsoft® 36 CLINICAL VETERINARY MEDICINE AND SURGERY. line and expose the nail-holes, the animal meanwhile showing pain and drawing away the foot, and in a moment it became clear that the last nail was badly placed. On cutting down, the horn soon appeared yellowish and infiltrated. Finally a little greyish pus exuded. The horse had been pricked. I thoroughly thinned the inner heel, sole, bars, and posterior portion of the quarter; in order to diminish compression of the injured parts I slightly enlarged the opening in the sole, washed out the purulent cavity with an antiseptic solution, and, as is our custom in cases of this kind, enveloped the foot in a thick layer of tow, moistened with five per cent, solution of sulphate of copper. The horse at once appeared to be relieved, and lameness had diminished. During the evening, and following days, the tow dressing was again moistened with sulphate of copper solution. For some time the condition remained practically unchanged, but on the morning of the 20th lameness was excessive, and the animal showed evidence of shooting pains in the foot. Some complication existed, and it became necessary to interfere more actively. The quarter having been thinned, the animal was cast on the right side, the affected foot released from the hobbles, and fastened above the hock of the same side. Opposite the point where the nail had pene- trated I removed the entire horny wall for a distance of two to two and a half inches in breadth, corresponding to the area over which I concluded the sensitive tissues had become necrotic. In the lower third the sensitive laminae, though thickened, infiltrated, and bright red in colour, were only inflamed, but between this part and the coronet was a black gangrenous patch as large as a two-shilling piece, dotted over with greyish points. I removed this dead piece of tissue, exposing at its upper part the lateral cartilage and below a narrow strip of the pedal bone. I excised a thin layer of the cartilage, which already appeared of a light green colour, and curetted the bone, the superficial layers of which were infiltrated with pus. Finally I irrigated the wound with a i in 1000 solution of sublimate, powdered it with iodo- form, and covered the parts with a surgical wool dressing. The operation and dressing had lasted about half an hour. On rising the horse walked much more comfortably than before operation. The foot was not lifted in the same restless way ; the lancinating pains had ceased. It was returned to its box, and at once began to eat. This was about 10.30 a.m. At I o'clock in the afternoon my assistant came to say that the animal was showing signs of acute colic. Some of you had noted a distinct difference in the two spermatic cords, but did not suspect the Digitized by Microsoft® ACUTE INGUINAL HERNIA. 37 existence of acute inguinal hernia. You will remember that on the first examination I was able to enlighten you on this point. Whilst the left cord was relaxed and free, and its different parts could readily be distinguished with the fingers, the right was retracted, enlarged, and felt as though inflated ; the two principal parts, the vascular cord and the vas deferens, could no longer be distinguished. At the first touch one could feel that the distended vaginal sheath contained, in addition to the spermatic cord, a loop of intestine swollen by strangu- lation. The chnical characters were such as to leave no doubt regard- ing the condition. The horse was cast on the left side, chloroformed, the off hind leg abducted and fixed with lengths of webbing by the usual method. Some attempts at taxis having failed, I was obliged, after preparing the parts, to perform the operation for strangulated inguinal hernia — kelotomy. You will recall the stages — free incision of the scrotum and dartos in the long axis of the hernial swelling ; isolation of the mass formed of deeper seated tissues, the vaginal sheath and its contents, by breaking down the subdartoid connective tissue, this isolation being prolonged upwards as far as possible ; puncture of the vaginal sheath at its posterior part, where its parietal layer is in contact with the testicle ; laying open the base of the vaginal sheath parallel to the long axis of the testicle for a distance corresponding to the entire length of the latter ; seizing the edges of the sheath by means of broad- jawed forceps ; incision of the outer edge of the hernial ring with a button-pointed bistoury ; washing of the extravasated intestine with boiled water ; reduction commencing with the upper parts of the loop; re-application of the vaginal sheath over the cord ; torsion of these parts; application of curved clams; finally, removal of the testicle by dividing the cord half an inch below the clams. In this horse the loop of herniated intestine, situated as usual in front of and inside the cord, measured about ten inches in length ; it was severely congested and distended ; its walls were infiltrated with fluid, but were firm, resistent, and not abraded, and there was there- fore no fear of their tearing through under cautious manipulation. The first incision not having given sufficient space, I reintroduced the left index finger into the vaginal sheath as high as the hernial ring, and increased it. Although the opening was sufficientl)' enlarged, the intestine returned with difficulty. I therefore had the horse placed on its back, and whilst one of you exercised traction on the upper part of the herniated loop through the rectum, I recommenced taxis. Re- duction was complete in a few minutes. Digitized by Microsoft® 38 CLINICAL VETERINARY MEDICINE AND SURGERY. When the herniated loop of intestine is situated outside the cord it is sometimes difficult to incise the hernial ring, and great caution is then necessary to avoid injuring the cord itself. Last year we ope- rated on a bubonocele of this character which had existed for twelve hours. Limited to the upper half of the inguinal canal, the loop was situated in front of and external to the cord. On account of the danger of injuring the intestine, which was greatly distended by gas, I was obliged to make several attempts before I succeeded in dividing the ring. Reduction was easy, and the animal recovered, practically without showing fever. I return to our last patient. When taken back to his box he was still dull and stupid ; but the symptoms due to chloroform gradually disappeared. In the evening he ate his food, and showed no abnormal symptoms. At 8 o'clock the temperature was ioo'4° F. During the following days his general condition remained perfectly satisfactory ; the fever was moderate, the temperature not rising beyond i03'i° F. The horse placed weight on the foot, and lanci- nating pain was absent. Treated with sublimate irrigations the in- guinal wound suppurated very little, and the swelling did not exceed that usual after castration. The clams were removed on the sixth day. Healing of both operative wounds occurred without complication or accident of any sort. On the 17th May the patient left the hospital. Some days afterwards he returned to work. This case shows that injuries of the fibro-cartilage of the foot may heal rapidly and without complications. It was long taught that necrosis of the central or anterior parts of this cartilage, or even their extensive exposure by removal of necrosed sensitive laminae, neces- sitated removal of the cartilage in toto. This rule, as you see, admits of exceptions. In our patient the cartilage was freely exposed in front ; its superficial layers exhibited the greenish colour peculiar to necrosis, and yet partial excision sufficed. The cartilage healed like the podophyllous membrane which normally covers it. Several years ago I published a number of cases showing that wounds of the feet involving the fibro-cartilages could be perfectly cured, without subsequent necrosis and without complication, by simply removing the infected or mortified parts of the cartilage, and that success can be obtained whatever the point at which the fibro- cartilage is wounded or necrotic. Operations on the horse's foot especially show the great value of modern surgical methods — antisepsis and the use of surgical dressings. Digitized by Microsoft® ACUTE INGUINAL HERNIA. 39 But this is not the principal point to which I wish to draw your attention. The most important thing to bear in mind is the possible occurrence of such grave accidents as that which overtook our horse whilst I was operating on the foot, the occurrence of hernia from casting. Luckily such things are rare. Still it is necessary to know that they may occur in order to recognise and remedy them in time. This accident is the second I have noted among injured animals in my clinique. I saw the first case in January, i88g, in a horse operated on for picked-up nail of the near fore-limb. The animal was cast on the right side. In his case hernia occurred on the left side. Its presence was indicated as usual by colic, and the condition was diagnosed three hours after occurrence. Performed rapidly and under good conditions the operation succeeded. It is not always so. When sick animals are not watched with sufficient closeness hernia may fail to be recognised until too late, or pain resulting from strangulation of the intestine may be referred to the operation which has been performed, the real cause not being revealed until post-mortem examination. Even here I saw a case of this character some seven or eight years ago in a horse operated on at the school, and at once removed by its owner, who lived in the neigh- bourhood. The owner noted that the animal was suffering from colic, but as it had great difficulty in walking it was treated at home with some nostrum. No one suspected for a single instant the existence of hernia. I conclude by formulating the warning to be drawn from the above facts : — Should an entire horse soon after having been cast for opera- tion show signs of colic, bear in mind the possible existence of hernia ; compare the two inguinal regions, and in proportion as pain persists direct more and more attention to the state of these parts. Digitized by Microsoft® VII.— DEEP-SEATED INGUINAL ABSCESS AFTER CASTRATION. During the holidays we operated on an English-bred five-year- old horse whose case was so instructive from the clinical point of view, and offered such peculiarities, as to merit some remark. The horse was castrated during the early part of May, i. e. more than fi\'e months ago. The operation was performed by the covered method, with clams. The wounds healed slowly, that on the left side not closing entirely, and a fistulous wound persisted, due, as it was thought, to " scirrhous cord." A veterinary surgeon, being consulted regarding this sinus, first of all prescribed antiseptic injections. In a month's time, seeing that they had no result, he cast the animal, explored the inguinal region, and not finding any induration of the left cord, suggested, as a temporary measure, to continue the injections for a further time. New symptoms appeared; the animal's movements became impeded ; the near hind leg, which was slightly swollen, was advanced with difficulty, and with a circular swinging movement (abduction). The appetite remained fair, but the animal lost flesh, and its coat appeared dull. M. Weber was asked to examine it. He was struck by the interference with movement of the near hind limb, and although swelling of the perinseum was little marked, and the purulent discharge trifling, he advised that fresh surgical treatment was necessary. The horse entered our clinique on the 27th August. I had only been told part of this history when, two days later, I had the animal cast, thinking we had to deal with a simple scirrhous condition, situated more or less high in the cord. The inguinal region was, as I have just said, little swollen, but showed diffuse induration, extending forwards over the abdominal region beyond the opening of the sheath. Having passed a director and laid open the fistula in front and behind, I only found a purulent cavity the size of an egg, situated at the lower part of the fistula. I incised the fibrous layer covering the inguinal canal, the entrance of which I explored without discovering anything abnormal. The sinus and abscess could not explain the swelling of, nor the difficulty in moving the near hind leg. Digitized by Microsoft® DEEP-SEATED INGUINAL ABSCESS AFTER CASTRATION. 41 The diffuse induration about the wound gave one the impression of a new growth, so that for a moment 1 fancied we might be deahng with an epithehal tumour developed in the perinseal region, and extending far forwards in the abdominal wall. Having enlarged the fistulous track, I asked M. Weber to examine the parts, and explore the fistula and abscess cavity. He found nothing to explain the symptoms previously noted. Nevertheless we decided not to make a deeper exploration at the time. I curetted the walls of the abscess, excised a fragment of dead tissue for micro- scopical examination, washed out the wound with an antiseptic solution, and allowed the animal to rise. During the evening the operative wound was washed out several times with sublimate solution. Histological examination of the tissue removed showed that the lesion was of an inflammatory character, at least at the point from which the fragment had been removed. Next day the patient's general condition was little changed. The neighbourhood of the wound was somewhat cedematous. Wishing to examine the state of the upper inguinal region and intra-abdominal portion of the cord, I had the animal fixed, without, however, casting it. The hind limbs hobbled, I proceeded to rectal exploration. In the pre-pubic zone, opposite the left inguinal ring, I found a kind of diffuse, rounded, smooth-surfaced swelling, larger than a man's two fists, and about four inches thick. This swelling was indolent or nearly so, and uniformly hard. No fluctuating point could be dis- covered with the fingers. The cord which emerged from it was scarcely enlarged. These are not the characters of an abdominal scirrhus ; in that affection the neighbourhood of the inguinal ring is seldom much swollen, whilst the cord itself is large and hard. Funiculitis, therefore, having been eliminated, with what condition had we to deal .'' It could only be a tumour or an abscess. The absence of pain on pressure, uniform hardness, and slightly bosselated surface of the swelling rather indicated a new growth than an abscess. On the other hand, the swelling of the corresponding hind limb, and the interference noted in regard to movement, might be explained by either theory, on the basis of the disease having extended. On being informed of the discoveries I had made, and of the gravity of the condition, the owner granted me full permission to operate further if I thought it advisable. The following days the swelling of the inguinal region remained stationary, but that of the limb gradually increased. The temperature oscillated between ioi"3° and i02'8" F., in addition to which there was depression and loss of appetite. The 5th September, after examining the swelling per rectum, and Digitized by Microsoft® 42 CLINICAL VETERINARY MEDICINE AND SURGERY. discovering that it showed the same characteristics as before, I cast the horse on the right side, and drew the left hind limb as far out- wards as the swelling allowed. The inguinal region and surrounding parts were washed with warm water and soap, and afterwards irri- gated with sublimate solution. With a bistoury I enlarged the wound in the direction of the long axis of the inguinal ring, cutting through the layer of hardened tissue surrounding the edges of the ring. A few vessels which bled rather freely were picked up with arter}' forceps. Having thus opened the inguinal canal, I enlarged the space by breaking down the connective and fibrous tissue which fills its lower part. Arrived at its middle portion without finding any traces of the spermatic cord, I was arrested by a strong partition running obliquely from above downwards and backwards, a partition which projected at its centre point, and through which I distinctly made out fluctuation. W'ith a sudden thrust of the left index finger perpendicular to the general surface of the centre of this partition, I perforated it. A flood of whitish, creamy pus immediately escaped through the lower inguinal ring. To enlarge the aperture I cut through the lower part of the partition with a bistoury. The abscess cavity was enormous, extend- ing particularly in the direction of the inguinal space. It did not contain four quarts of pus, as the prosector entrusted with the dressing has stated, but certainly at least two quarts. The pocket was washed out with warm 2 per cent, creolin solution. Bleeding, which at first had been rather severe, soon ceased. A large drainage-tube was placed in the inguinal canal, its upper end entering the cavity of the abscess. The lips of the incision were brought together with four sutures, one of which was passed through the drainage-tube itself, about two inches from its lower extremity. On rising the animal appeared to be greatly relieved, as one may very \\ell imagine, and when returned to its box at once began to eat. During the evening the pus cavity was again twice washed out through the drainage-tube. Next day the general condition was greatly improved. The animal had eaten all its food ; weight was firmly placed on the limb, which, however, was still swollen, and the temperature was only a few tenths of a degree above normal. During the following days improvement steadily continued. The swollen limb gradually diminished in size. As in most cases of infected wounds in the inguinal region, a fairly large cedematous swelling developed around the surgical incision, without, however, showing any disquieting character. Treatment was confined to washing out the abscess cavity with disinfectants. Digitized by Microsoft® DEEP-SEATED INGUINAL ABSCESS AFTER CASTRATION. 43 Up to the 13th September suppuration remained abundant, and the swelhng around the wound considerable, but the other symptoms — especially the serous infiltration of the hmb and difficulty in movement — steadily diminished. On the i8th the intra-abdominal swelling was limited to the cord, which ^^•as, however, hard, conical in shape, and smooth on the surface. From that date up to the 30th September the wound gradually contracted, its surroundings diminished in size by re-absorption of the interstitial exudate, and the purulent discharge diminished daily. On the 8th October, when our patient left hospital, the wound was only two and a half to two and three quarters inches in length — the margins a little swollen, the suppuration almost entirely ceased. By compara- tive examination of the upper inguinal regions one simply detected the persistence opposite the inguinal ring of a narrow indurated zone, and a rather firm condition of the cord for a distance of an inch or two. After castration by ordinary methods abscesses sometimes develop under the dartos. Their nature is well known. They result either from too early union of one of the operation wounds — union occurring while suppurative inflammation is still going on in subjacent tissues ; or from retention of a foreign body — one of the strings used for fastening together the branches of the clams, for example. But deep- seated abscesses in the inguinal space, where the pus remains enclosed for several months, as in the case just mentioned, are exceedingly rare. Apart from its inherent interest, however, this case teaches a lesson you should never forget. I have repeatedly shown you that in wounds of the horse's foot, when the intensity of the general symptoms suggests grave local mischief, and when after removing the horn the subjacent sensitive tissues appear simply to be inflamed round about the wound, it is necessary to incise these tissues, and to seek below them the principal diseased centre. The same line of conduct applies to diseases of other regions, more particularly to those of complex anatomical structure. When the local lesions met with in superficial parts do not sufficiently explain the functional and general disturbance which have led to surgical interference, you must seek beyond, and explore the depths. With exact anatomical knowledge, prudent technique, and antiseptic precautions, exploration of these regions is unattended with danger. Digitized by Microsoft® VIII.— DIAPHRAGMATIC HERNIA. On Thursday last a horse, which had suffered from cohc for nearly a week, and whose state had rapidly become aggravated during the last night passed in its own stable, was sent here for advice. At the time of examination it was in a very grave condition, profoundly depressed, and staggering on its legs. The face was drawn, the pulse almost lost, the respiration very rapid and oppressed. Percussion of the thorax revealed dulness in the lower third and tympanitic reso- nance in the upper parts. On auscultation an exaggerated respiratory murmur was heard in the upper third of both sides of the chest ; between the upper and middle thirds a slight deep-seated tubal blowing sound ; in the lower parts a sound indicating the presence of liquid, and borborj-gmus. The heart-beats were very feeble, and both jugulars showed a venous pulse. The extreme depression, marked pain, irregularity and exaggeration of the flank and chest movements, and especially the signs furnished by auscultation, led me to diagnose diaphragmatic hernia. In order to confirm this diagnosis I washed and shaved the lower half of the left costal region, and was preparing to puncture the chest with Dieulafoy's aspirator, when the animal suddenly fell, and died after a slight struggle. The post-iuortem examination confirmed the diagnosis just made. We found an old-standing diaphragmatic hernia with a very large rupture and extensive injury. Many of you were absent on that date, and neither saw the horse nor the state revealed on opening the body. As this is a very rare condition, of which we shall probably not see another case during the course of this year, M. Darras will read to you the notes which he made : A twelve-}'ear old gelding used for rapid work. On the morning of the nth October this horse, previously in good health, showed symptoms of colic. He appeared anxious and restless, pawed and turned his head towards the right flank, indicating that as the seat of pain. These symptoms disappeared in a few hours, to Digitized by Microsoft® DIAPHRAGMATIC HERNIA. 45 return, however, during the night between the i6th and 17th October. The animal rolled and struggled in violent pain. On the morning of the 17th, ha\ing refused his food, he was sent to the college. He arrived there covered with sweat, greatly depressed, and looking con- tinually towards his right flank. The face was drawn, the nostrils dilated, the extremities and ears cold, the mucous membrane cyanotic J the respiration was 32, irregular ; the pulse very feeble, and could not be counted ; the jugulars showed a well-marked venous pulse. Rectal exploration disclosed nothing abnormal. On the catheter being passed, only a small quantity of urine was dra\\'n off. On percussion of the chest dulness was noted in the inferior half of both sides. On auscultation the vesicular murmur in the upper portions of both pulmonary lobes was exaggerated. Towards the middle region, especially on the left side, a slight tubular wheezing sound was heard, and in the lower third a liquid sound, especially marked on the left side. We at first regarded the case as one of pericarditis, but, after carefully examining the patient, M. Cadiot noted the splashing sound and borborygmus, and delivered the diagnosis of diaphragmatic hernia. To confirm the diagnosis he resolved to tap the chest. The animal died at the moment we were about to perform the operation. A iitopsy. — In the abdominal cavity traces of peritonitis were visible on the large colon, jejunum, and ileum. At its upper part, towards the left, the diaphragm showed a large opening, through which had passed a considerable mass of abdominal viscera, comprising among other parts the stomach and some loops of intestine. These viscera were soiled with food material. The chest cavity contained a considerable quantity of yellowish acid- smelling fluid, holding in suspension fragments of food. The left lung, congested in its antero-inferior part, and emphysematous throughout almost its entire extent, was thrust upwards towards the spinal column. The spleen was situated externally and posteriorly, and was almost entirely in the thorax. It appeared normal. Its base was turned towards the abdomen ; its point was advanced and slightly depressed. Between the lung, pericardium, diaphragm, spleen, and chest walls, was a voluminous greenish mass formed by the gastro-colic omentum (epip- loon) filled with food. Towards the back, between the epiploic sac, spleen, and diaphragm, were two distinct masses of intestine. The first, situated above, was formed by a part of the small colon, about twelve inches in length, covered by the epiploon ; the other, below, lodged in the angle formed by the diaphragm and the left thoracic wall, consisted of several empty loops of the jejunum, of a total length of about fifteen feet. Digitized by Microsoft® 46 CLINICAL VETERINARY MEDICINE AND SURGERY. More deeply situated under the spleen and small colon we found the stomach, flaccid and empty, pushed close up to the vertebral column, the right half in advance, the smaller curvature turned towards the vertebral column, that portion of the left sac (fundus) nearest the oesophagus riding on the right margin of the rent in the diaphragm, a position which prevented food material returning into the oesophagus. The cardiac end (fundus) had also undergone rotation, which prevented vomiting. In the greater curvature of the right cul-dc-sac was a large rent measuring about eleven and a half inches in length. The margins Fig. 6. — Diaphragmatic hernia. E, epiploon. I G, loop of small intestine. C F, floating colon. R, spleen. P, lung. Pe, pericardium. were thin and blood-stained. The rent extended through the mucous membrane for a length of ten inches, and through the muscular and serous coats a further four inches. The two latter coats were retracted, forming a deep red margin around the opening in the mucous membrane. From this opening had escaped a large amount of food, which had dis- tended the large epiploon. The rupture through which the abdominal viscera had entered the chest was chiefl}- situated in the left upper portion of the diaphragm. It was elliptical in shape, and measured fourteen and a half by six inches. Its margins were smooth and fibrous throughout the greater part of their length. The right margin was straight, thick, and rigid, and ran obliquel\- from above downwards and from left to right. Its Digitized by Microsoft® DIAPHRAGMATIC HERNIA. 47 upper extremity was situated about two inches from the oesophageal opening. The left margin was concave in shape, very thick above, but thin throughout the rest of its extent, and was everywhere fibrous except towards its centre, where it appeared injected and hsemorrhagic. At the centre of the tear was a strong fibrous band as thick as a lead pencil. Through this large opening, which had certainly existed for several months, the stomach and spleen had been thrust into the chest cavity, describing a rotary movement forwards, and from left to right, around the cardiac end of the stomach as an axis, causing the right cid-de-sac of the stomach (pylorus) to advance a considerable distance into the thorax. The right lung, congested and emphysematous like the left, was adherent at its posterior part to the sides of the chest. Here again we found food material, which had traversed the posterior mediastinum. Of this mediastinum only traces remained. The pericardium contained about a quart of greyish liquid. The diaphragmatic rupture had existed for a long time ; the fibrous state of its borders showed this clearly. The hernia, at first formed of a few loops of small intestine and epiploon, had scarcely inconvenienced the animal, for the first symptoms of colic were only noted six days before death. Gastric indigestion probably formed the first step towards producing the grave symptoms which preceded the end. The gastric hernia was probably produced by the animal's violent struggles on the night between the i6th and 17th October. In the position the stomach had assumed food could no longer enter it, the oesophageal opening being hermetically closed. To sum up, this horse died from rupture of the stomach, a comph- cation of the hernia from which it had already long suffered, as shown by the state of the walls of the diaphragmatic rent. The stomach was probably ruptured soon after it became herniated. How may such a hernia occur ? What is the primary cause of the diaphragm becoming ruptured ? Cases published during the course of the last half-century afford a reply to these questions. In these the accident has happened in consequence of violent struggles and energetic contraction of the abdominal muscles — either during work, or when animals had been cast. In some the horse was heavily laden, and after a specially great effort suddenly stopped, showed pain, fell, and died from asphyxia ; or again survived for a few hours, showing symptoms cl colic and severe dyspnoea. Sometimes an animal cast for operation, after struggling violently, presented the same alarming symptoms and died rapidly, or Digitized by Microsoft® 48 CLINICAL VETERINARY MEDICINE AND SURGERY. after the lapse of a few days. In either case post-mortem examination showed rupture of the diaphragm, usually in the tendinous portion ; a recent extensive rupture with bleeding margins, through which the abdominal viscera had entered the chest. Contraction of the abdo- minal muscles had thrust the viscera violently against the diaphragm, overcoming its resistance. Overloading of the intestines, and of the stomach in particular, favours rupture. Chronic hernise, consequent on extensive ruptures in the central portion of the diaphragm, are produced by the same mechanism, but in this variet}' the primary symptoms gradually diminish, and the lesions, though never repaired, do not necessarily prove fatal. Injuries to the costal region opposite the insertion of the diaphragm, and fracture of the last ribs, are also fairly frequent causes of diaphrag- matic hernia. In these cases the opening is often of small dimensions, and in the peripheral (muscular) portion of the septum. In fracture of one or several ribs, resulting from a fall, or from the violent impact of a comparatively soft body, the skin may not be penetrated, or may only be excoriated, while the extremities of the bones, being violently thrust back, rupture the muscular zone of the diaphragm at some point, producing a rent through which one of the abdominal organs may enter the thorax. As a rule, hernia soon follows the rupture. It may, however, be postponed to a later period, when the borders of the wound have to some extent cicatrised, — the rent, however, remaining patent. Passage of abdominal organs into the thorax through one of the normal openings in the diaphragm is somewhat rare — it could scarcely occur except after dilatation of the oesophageal foramen. Congenital hernia need only be mentioned — it is still rarer than the preceding. In this case the opening in the diaphragm results from arrest in development. In these various forms of diaphragmatic hernia, intestine and epiploon are the structures oftenest found in the thorax. A narrow slit is sufficient to allow of their passage. Displacement of the stomach and spleen, of the small colon, of a part of the liver, or of one of the flexures of the large colon, is less common, and only occur when the opening is of very large dimensions, as in our case, in which the stomach, spleen, the greater part of the epiploon, a long loop of small intestine, and a loop of the small colon had entered the chest. However small the diaphragmatic rent, several organs may pass through it. The position they assume varies : for instance, a loop of small intestine and a portion of epiploon may become lodged between the two pulmonary lobes ; considerable masses of the same organs, or of Digitized by Microsoft® DIAPHRAGMATIC HERNIA. 49 the small colon, may appear on the floor of the thorax in either of the pleuritic cavities, — oftenest, however, in both, the resistance of the posterior mediastinum being very rapidly overcome. Whatever the variety of hernia, a hernial sac is never seen ; the displaced organs are directly in contact with the pleura, and in herniae of long standing adhesions usually occur between the organs and the costal, pulmonary, or mediastinal pleura. ' The pleural and peritoneal sacs may contain a certain quantity of serosity, but abundant exudate is rare, save after complications due to engorgement or strangula- tion. The dimensions and shape of the diaphragmatic opening vary greatly. In recent hernia the margins are red, ecchymosed, and in- flamed ; in those of long standing thickened, more or less fibrous, and less vascular. The gravity and character of the symptoms depend greatly on whether the condition is recent or of old standing, and on the volume of the organs which have entered the thorax. Recent large hernise produce violent colic. The animal then exhibits an anxious look, the eyes are widely opened, the nostrils extremely dilated; the respiration is markedly difficult, irregular, and jerky. When the volume of the hernia is small the symptoms are much less alarming and significant, consisting chiefly in depression, failure of appetite, and slight colic. The breathing shows little change, though as a rule it is short, and expiration is double. Large chronic hernije are accompanied by irregularity of the pulse. During work the animals soon become exhausted and "blow." It has been noticed that animals with unilateral herniae always lie down on the same side as the hernia. If the herniated parts are of small size there may be no readily appreciable symptoms so long as the digested material and the blood circulate freely, and the animal may continue to ■ do ordinary work for a long time without showing serious dis- turbance. A number of cases show this. Engorgement and strangu- lation, however, readily occur in such concealed hernise, because the diaphragmatic opening is almost always of small dimensions. Com- plications of this kind are possible in all old-standing cases, and are announced by the same symptoms as obstruction ("stoppage") of the bowel. The first series of symptoms produced by diaphragmatic hernia may be summed up as follows : — colic, great anxiety, dyspnoea, irre- gularity, jerkiness, and doubling of the expiratory movement. When hernia is suspected, auscultation and percussion greatly D Digitized by Microsoft® b 50 CLINICAL VETERINARY MEDICINE AND SURGERY. assist diagnosis, provided a considerable portion of the intestine or stomach has passed into the chest cavity. By applying the ear to the lower portions of the chest borborygmus and liquid sounds may both be very clearly heard ; sometimes they are so strong as to give the impression of proceeding from portions of the intestine close to the thoracic wall, or directly under the region auscultated. I should remind you that similar but duller and more distant abdominal sounds may be heard during acute affections of the chest, when pleuritic effusion or pulmonary hepatisation exists. Over the remainder of the chest one usually notes an increased vesicular murmur, and sometimes, towards the middle or lower third, a slight tubal sound. Percussion of the lower part of the thorax reveals a zone of semi- dulness, with or without a tympanitic sound. In the upper parts resonance is normal. In recent or complicated hernia percussion may produce pain, indicated by groaning, or by the animal flinching from the operator. When the indications furnished by auscultation and percussion are not sufficiently characteristic to assure the diagnosis, you have in exploratory puncture a last means of settling the question — I should say, which may settle the question, — for when the trocar or needle fails to bring away fluid from the stomach or intestine, it is sometimes because the instrument has not entered the viscus, despite the latter being displaced ; while should the hernia consist of epiploon or spleen the result is necessarily negative. Although diagnosis is possible, you see that in cases it is extremely difficult, and should be announced with the greatest reserve. In our patient the borborygmus and " glou-glou " sound extended far in advance, and were unmistakable ; the puncture, which I suggested making, would have dissipated any final doubt. On passing the trocar we should have seen issue a little greyish liquid, mixed with fragments of semi-digested material, which had passed into the two pleural cavities from the rupture in the stomach. The prognosis is in the highest degree grave. Large herniae kill in some days, often even in a few hours ; sometimes even more rapidly. Death may result almost instantaneously. When the accident occurs ■during work the animal becomes greatly depressed, groans, reels about, falls to the ground, and dies. The greater number of hernias compatible with life sooner or later become complicated — with fatal results usually through strangulation and gangrene of the herniated organs, some- Digitized by Microsoft® DIAPHRAGMATIC HERNIA. 5 I times through rupture of the intestine or stomach, as in the case we have seen. Prognosis is rendered still graver by the uselessness of treatment. In few conditions is there such a poverty of treatment. The methods suggested are either ineffective, dangerous, or impracticable. Let us shortly consider them. The hernia is diagnosed, and is recent. It has existed for several days, or a day, or for only a few hours. What are we to do ? Some authors recommend the treatment usual in colic, particularly bleed- ing. It is better to leave the animal quiet, to calm pain by morphine or chloral, and to give liquid nourishment — gruel, mashes, or milk. Provided the herniated mass is not too large, and the dimensions and shape of the rupture do not favour strangulation by engorgement, the animal may, after the subsidence of inflammatory symptoms, become capable of light steady work. Many reported cases show this. When strangulation has occurred, death can only be prevented by surgical intervention, consisting in returning the herniated organs to the abdominal cavity. Bouley proposed this method. As, he says, in such cases death is certain, why not try the only possible method of avoiding it ? This consists in introducing the hand into the abdo- men through the left flank, and by gently pulling on the displaced viscera effecting reduction. Such interference, however, would be only palliative. The rent in the diaphragm remaining open, the hernia might at any moment recur with fatal consequences. As to radical cure, i. e. reduction of the hernia and closure of the diaphragmatic wound, it has hitherto been regarded as impracticable in large animals. Digitized by Microsoft® IX.— BLENNORRHCEA IN THE DOG. In dogs brought to the chnique, and in those treated for varying" diseases in our infirmary, you have often noticed a discharge from the prepuce which at first sight seems to present a distinct analogy with the discharge of blennorrhcea in man. Among the twenty-five dogs at this moment in mj- portion of the hospital eight are affected, and at all times of the year j-ou will find a somewhat similar proportion. The condition, therefore, is ^•ery common. It will form the subject of my lecture to-day. This disease has been termed blennorrhcea and gonorrhoea. The first title, under which Renault mentions it in the Recueil of 1834, is the more appropriate, because it does not in any way prejudge the nature of the affection. That of gonorrhoea has the disadvantage of suggesting an analogy between this discharge and that of the same named condition in man. The term " echauffement " is ^^Tong, for the discharge may appear in animals of very phlegmatic temperament, without having been produced by violent sexual excitement or by repeated sexual intercourse. Almost always localised in the mucous membrane lining the prepuce and covering the base of the penis, the common form of this affection consists in a chronic catarrh which e\'en at the outset is very rarely accompanied by appreciable inflammatory symptoms. Some writers aver that the disease is always limited to the lining membrane of the sheath, but in point of fact that of the penis is also affected, particu- larly about and behind the corona glandis. The catarrh produces a more or less abundant though usually trifling muco-purulent secretion, which exudes from the orifice of the sheath, gluing together the hairs surrounding this point. Except when the animal has just urinated, and especially in the morning, these hairs are soiled with a greenish, greyish, or yellowish-white muco-pus, viscous in character, sometimes fairl}- thick, sometimes serous, which, by drying, may form little crusts fixed to the base of the hairs, and covering the parts surrounding the preputial opening. The amount of Digitized by Microsoft® BLENNORRHCEA IN THE DOG. S3 secretion may be estimated by slightly pressing with the fingers along the course of the sheath from behind forwards. The greater portion of the muco-pus contained within the cavity of the sheath is thus expelled. When protruded, the penis is seen to be covered with this niuco-pus, some of which may easily be collected on the flattened end of a director. Very rarely indeed is the mucous membrane of the urethra affected. One may carefully manipulate the whole course of the exposed portion of the penis and of its inferior border (where the urethra is situated) without causing the smallest droplet of pus to exude. Urine is easily and painlessly voided, showing that the mucous membrane of the urethra is unaffected. But although in blennorrhcea in the dog the urethra is very generally healthy, cases are occasionally seen where the process has extended to the entire surface of the penis, and to a short portion of the urethra. Methodical compression from behind forwards then causes the discharge of a little greenish muco-pus. The mucous membrane covering the penis and prepuce may be at first a little infected, especially behind the corona glandis and the cul-de-sac ; after- wards the hypersemia disappears, and the membrane resumes its normal appearance, — the morbid secretion, however, persisting. In time the parts may show small granulations of lymphatic origin, scarcely exceeding a grain of millet in size. When the mucous mem- brane is thus changed, pressure over it is always a little painful. There are neither general nor local complications beyond the genital organs. The disorder produces no febrile symptoms, at least at first. One simply notes that the majority of animals, when lying down, appear to suffer from an itching sensation which causes them to lick the base of the sheath. Blennorrhcea occurs under varying circumstances, and from many different causes. Very frequent in young animals, it appears usually during distemper, and is especially common in dogs, which show exanthematous outbreaks on the belly. At all ages it may accompany eruptive disorders. It is often seen in animals suffering from acute or chronic parasitic or dyscrasic diseases of the skin. It affects even the best nourished during the course of eczematous eruptions, a fact which has caused some to regard it as due to gout. Others have referred it to repeated coitus, especially between large males and small females. For a long time it was regarded as contagious, but this has not been proved either by clinical observations or by experiment. Renault and Delafond in vain tried to communicate the disease from dog to dog. They collected some of the muco-pus and deposited it on the mucous membrane of the prepuce or penis. They even made sure Digitized by Microsoft® 54 CLINICAL VETERINARY MEDICINE AND SURGERY. of its penetrating by infriction or inoculation, but always with the same negative result. I have repeatedly attempted to transmit blennorrhcea to males and females, but whether the pus was placed at the entrance of the sheath and on the penis, or in the vulvo-vaginal cavity, whether it was simply spread on the mucous membrane by rubbing, or by pressure on the preputial sheath, or lips of the vulva, the attempts always failed. Nor was I more successful when applying it to the eye or conjunctival mucous membrane. Nevertheless, and despite the fact that the condi- tion is rare in the bitch, I did not conclude from these experimental results that it is never transmitted during the sexual act. Under favourable circumstances, at present unrecognised, the exudate cover- ing the penis may probably become virulent and infective. Bacteriological examination of this exudate reveals the presence of numbers of common microbes, especially isolated micrococci, strepto- cocci, and sometimes staphylococci and various bacteria. Soiling of the preputial opening when the dog is lying down, and of the penis during the attempts at coitus made by young dogs, readily explains the diversity of germs found in the exudate. The duration of blennorrhcea varies greatly according to the patient's manner of life and the care bestowed on it. In j'oung pet dogs, attacked during distemper, it is generally treated and disappears in a few weeks. In neglected, dirty, and badly fed animals it may persist for months, even for years, the discharge increasing or dimin- ishing from time to time. Though usually easy to cure when recent, it in time becomes obstinate, and can only be dealt with b}/ steady, long-continued treatment. Apart from this benign form of blennorrhcea, the dog occasionally suffers from acute inflammation of the mucous membrane of the pre- puce and penis, which sometimes extends to the first portion of the urethra, and is accompanied by an abundant grej'ish-green discharge, marked itching, and pain during micturition. When lying down the subject continually licks the sheath, which is more or less hot and swollen. Left to itself this disease may become complicated with in- flammation of the inguinal glands and diffuse inflammation of the pre- puce. In common with Siedamgrotzky and Moller, I have seen such cases. I believe this variety of blennorrhcea and its complications are due to one of the micro-organisms found in the former condition, the virulence of which, however, has increased. In pus from an abscess of the sheath I found streptococci in short chains. The diagnosis of blennorrhcea in the dog, whether acute or chronic, offers no difficulty. In those extremely rare cases where the terminal Digitized by Microsoft® BLENNORRHCEA IN THE DOG. 55 portion of the urethra is affected, examination of the urine voided towards the end of the act of micturition enables the disease to be distinguished from affections of the genito-urinary organs proper. Polypi developed on the penis, or lining membrane of the prepuce, gi\'e rise to a sanguinolent discharge, and as a rule produce knobby swellings of the sheath. Even when of small size, or deeply situated, they can immediately be diagnosed by exposing the base of the penis and drawing back the sheath. I should remind you of the occurrence of traumatic blennorrhoea, caused by the accidental entry into the sheath of some foreign body like a fragment of straw, a thorn, a husk of grain, a little fragment of wood, or more rarely by a ligature, which some mischievous person or child has applied to the penis. Local applications are used in all cases, but in some varieties of the disease constitutional treatment appropriate to the general condition of the patient is also necessary. The sheath is cleansed and disinfected by syringing out, for some days in succession, with warm boric solution. This is retained by closing the preputial orifice with the finger, and any fragments of mucus adherent to the lining membrane are removed by gently massaging the parts for a few moments before the liquid is allowed to escape. Boric acid is afterwards replaced by a "i or '05 per cent, sublimate, by i per cent, sulphate or chloride of zinc, or by 2 to 3 per cent, alum or tannin solution. Injections need only be made once a day, or even once every two daj-s. If the discharge diminishes rapidly the injections should still be continued for a time, as when it disappears too soon it is apt to return ; a drop of muco-pus is seen one morning at the opening of the sheath, and each succeeding day increases. The i or 2 per cent, solution of nitrate of silver is rarely necessary, even in old-standing cases, the i per cent, solution of sublimate or chloride of zinc being preferable. In the acute form of blennorrhcea the same treatment with boric or sublimate injections is indicated. In addition, a moist antiseptic com- press is applied to the sheath, and retained in position with a bandage. For distemper or other complications young dogs often require in- ternal medication. According to their age, temperament, and bodily condition, adults are treated with alkalies, arsenical preparations, iodide of potassium, or iodide of iron. Digitized by Microsoft® X.— AMPUTATION OF THE PENIS IN THE HORSE. Some days ago a horse was sent here, on which I at once performed ablation of the penis. I take advantage of this case to recapitulate the particulars of operation, to examine the various available methods of performing it, and to indicate that which I prefer. As a general rule, grave disorders of the penis are distinctly rare in the horse. We see little else but tumours and paralysis, still wrongly described under the old name of paraphimosis. Epithelial tumours — the cancroids — almost ah\ays spring from the lower portion of the penis, from its anterior surface, or from the corona glandis. They commence as indurated nodules, which more or less rapidly extend in area and depth, ulcerate, and discharge a greyish pus streaked with blood. Sometimes the ulcer spreads and perforates the glans, whilst the penis gradually becomes indurated ; sometimes the process is of a markedly hypertrophic character. Exuberant bleeding granulations mask the ulcer, suppuration is abundant, hemorrhage occurs from time to time, and staling may become difficult. The lower portion of the penis grows dense, hard, and painful, forming in advance of the sheath an irregular mass, which may attain the size of a child's head. Sarcomata are much rarer than epitheliomata. In the few published cases the tumour developed towards the base of the sheath, and extended to the penis. Apart from these malignant tumours I should draw attention to verrucous new growths, which also develop on the free extremity of the penis, sometimes become of large size, compress the urethra, and cause difficulty in staling, or even retention of urine. These papillomata have special characteristics by which they may be distinguished from epithe- liomata and sarcomata. They are usually multiple, firm, hard, whitish, and of regular consistency throughout. They do not invade the sub- tegumental tissues, and permanently retain their early characteristics without becoming ulcerated. When very numerous they may become confluent, and, by the enormous development of their connective-tissue Digitized by Microsoft® AMPUTATION OF THE PENIS IN THE HORSE. 57 basis, form fibrous tumours of considerable size. The transformation of papillomata into cancroids and invading new growths is admitted by some authors, and seems estabhshed by several good recorded cases. They can, however, usually be successfully excised, provided thej- are not very numerous, or when in difficult positions their excision is not likely to be followed by interference with micturition. Paralysis of the penis may result from violent local contusions, or from injury to the perinasum. Cases occur where the history quite fails to explain the onset of the condition, and paralysis has several times been seen to occur suddenly in worn-out horses. It is oftenest of secondary character, resulting from certain infectious diseases, chief among which are contagious pneumonia and influenza. Sometimes it seems to have followed simple attacks of colic. There is no paraphimosis, for the base of the penis is in no way strangulated by the sheath. Furthermore the persistence of local sensation, and the active movements still noted in certain cases, show that paralysis seldom becomes complete. Anatomical and pathological researches undertaken for the purpose of clearing up the nature of this condition have, until now, only revealed accessory lesions in the corpus cavernosum, subtegumental* connective tissue, and upper venous trunks. The corpus cavernosum shows considerable thickening of the fibrous septa bounding the alveoli through which the blood passes from the arterial ramifications into the vein. This change is especially marked in the lower portion of the penis ; it results from blood stasis. Free serous infiltration into the subcutaneous connective tissue is soon followed by induration, the parts becoming firm, lardaceous, and difficult to cut. The chief veins traversing this tissue are obliterated by old, hard, stratified clots. These lesions still leave the pathology of the condition obscure. It may result from disturbance due to extravasations of blood following violence, or to haemorrhage, or to phlebitis occurring during some infectious disease, but very generally — like the majority of other local paralyses resulting from infection (and notably from contagious pleuro-pneumonia) — it is of toxic character, due to a lesion of the medulla, or of the nerves of the penis. Whatever its nature and cause, paralysis of the penis, once produced, is marked by objective symptoms, which usually become aggra- vated in time. The penis appears more or less pendulous, increases * The integument covering the penis is intermediate in texture between sliin and mucous membrane. To avoid the inconvenience of repeating "integument," etc., at frequent interval.";, I have taken the liberty of describing it as sl^in. — Jno. A. W. D, Digitized by Microsoft® 58 CLINICAL VETERINARY MEDICINE AND SURGERY. in size, and becomes covered with circular ridges and depressions, which either extend to the whole organ or only to a part. Infil- tration of the subcutaneous connective tissue slowly advances. This layer and the skin undergo a hardening process, the folds disappear, and in time the penis may become five to ten times larger than normal. It then appears as a heavy cylindrical mass which swings about during movement ; its upper part is covered by the exposed and distended skin of the sheath, between which and the scrotum there is no distinct line of delimitation. When animals are kept in this condition the penis is exposed to continual irritation, in consequence of which, and also of trophic disturbance, the skin ulcerates, or patches become gangrenous, particularly about the lower parts. In one case you saw on the glans penis an ulcer as large as a two-shilling piece, produced by mortification of a fragment of skin ; the walls of this ulcer were covered with old- standing indolent granulations. In some cases paralysis of the penis becomes cured naturallj^ ; infiltration of the tissues gradually diminishes, and finally disappears ; but much more frequently it persists even when rationally treated. The chief methods resorted to consist in superficial scarification, or light needle firing, douches, stimulant applications, repeated compression with a rubber bandage, and electricity. The most used are scarification, firing, and cold water treatment. Ten to fifteen narrow perforations are made with the bistoury or cautery around the swollen mass. If necessary, haemorrhage is arrested by cold applications ; on the following days three or four spray douches are given, lasting for five to ten minutes. In a tew instances you have seen these methods succeed, but in the greater number they are disappointing. Failing impro\'ement, the animals may be worked by protecting the penis with a suspensory bandage or a leather sheath fixed to the breeching, and kept in position by one or more straps passed over the lumbar region ; but by rubbing, the sheath often irritates the penis and favours the production, and afterwards the extension, of injuries like those of which I have just been speaking. Where paralysis is of old standing, or malignant tumours exist, it is necessai'}' to amputate the penis. In the case of new growths excision, to give lasting results, must be performed through a healthy portion of the penis, a little above the upper margin of the tumour. When operating for paralysis, the penis is cut through between the middle and upper thirds. The different operative methods are as follo^\'s : Amputation by ligature is more than a century old. Huzard used it Digitized by Microsoft® AMPUTATION OF THE PENIS IN THE HORSE. 59 With success in a horse with enormous papillomata of the glans penis. He introduced into the urethra a metalhc tube, perforated near its free extremity with two holes, through which tapes could be passed and tied over the loins, fixing the tube in position. To\\-ards the centre of the penis he applied a loop of waxed cord, which was gradually drawn tight until, about the eighth day, the lower portion of the penis became detached. The process was hastened by a few strokes of the bistoury. The advantages offered by elastic cords render them preferable to the old forms of ligature. A tube or solid cord, of size proportionate to that of the penis, is chosen. A metallic sound ha^'ing been introduced into the urethra, one end of the cord is grasped by an assistant and tightly stretched, in which condition it is passed three or four times around the penis at the point to be divided, the crossing of the two ends being united with a tightly tied piece of string. The ligature continues to contract until the tissues are completely divided. If at first well applied, it requires no supervision. The cord graduall}- cuts the tissues, closing and obliterating the vessels. There is no haemorrhage, and suppuration is trifling. In a case related by Labat division was complete in eleven days ; in a horse operated on in my clinique in 1889 it occurred on the ninth day. Whatever the nature of the material employed, section proceeds very slowly. For this reason more rapid though still bloodless methods have been recommended. Direct amputation has often been performed with a sharp-edged firing iron at a white heat. The operation is facilitated by introducing into the urethra a metallic sound. The upper and lower parts of the penis are covered with wet cloths, leaving the operation area exposed. An assistant grasps the free extremity of the penis, exercising moderate traction. A circular line is first traced at the point where section has to be performed, and the tissues are gradually cut through until section is complete. A series of irons heated to the proper temperature are generally necessary. M. Nocard has used the galvanic loop. With this instrument operation is complete in about ten minutes. Some practitioners prefer the ecraseur ; by cutting sufficiently slowly the loss of blood is trifling. The corpus cavernosum, however, offers great resistance to the chain, and sometimes renders it necessary to finally resort to tlie knife. In many cases the chain has broken, and the operator been compelled to use the ligature. M. Trasbot recommended introducing a director into the urethra, and using a small ecraseur, the loop of which is passed round the penis, and shortened daily by means of a special catch engaging with the chain. Simple excision with the bistoury is rapid but dangerous. Abundant Digitized by Microsoft® 6o CLINICAL VETERINARY MEDICINE AND SURCtERY. hsemorrhage may occur, even when the principal vessels are ligatured or closed by forceps. Barthelemy used this method in a horse with paralysis of the penis following influenza. He confined himself to amputation pure and simple, without taking any hemostatic precau- tions, without tying the arteries or cauterising the stump. During the following days a considerable discharge of blood occurred when the animal staled. In all a large quantity was lost, " fifty pounds," it was said, but nevertheless the horse was able to return to work on the tenth day. Any of the methods of operation just passed in review may involve a grave complication, which usually appears during the third month after recovery. I refer to contraction of the lower part of the urethra. Contraction of the cicatricial tissue developed in the stump first reduces and then more or less completely closes the urethral orifice. This complication 'is especially to be feared when the penis is of large size at the point where amputation is practised, i. e. in cases of paralysis. As soon as this attains a certain degree, emission of urine becomes difficult ; it escapes in a fine intermittent jet, and ends by being expelled drop by drop. Colicky symptoms then appear, and if relief is not afforded the animal may die of rupture of the bladder. The simplest method of remedying this condition is to introduce into the urethral opening the points of a pair of dressing forceps, or of strong artery forceps, and while opening the jaws to steadily withdraw the instrument. The cicatricial tissue is thus broken down, and the orifice for the time being rendered patent ; but contraction soon recurs, and with it the same difficulty in micturition. A new operation becomes necessary, in consequence of which the walls of the urethra afterwards become indurated for a greater distance ; finally the opera- tion becomes insufficient. Perinaeal urethrotomy must then be per- formed, or the animal slaughtered. Contraction of the urethra may be avoided by one of the two following methods. The first consists in cutting through with the bistoury or thermo- cauter}' all the tissues of the penis except the urethra, which, after having been carefully dissected out, is divided about three quarters of an inch nearer the free end. This kind of artificial urethral tube is afterwards divided vertically and transversely, so as to form four flaps, each of which is fixed to the amputated surface by means of a suture. In the other method, derived from human surgery, where it was first practised by Richet and Ricord, and afterwards skilfully modified by M. Guyon, a reversed V-shaped incision is made immediately above Digitized by Microsoft® AMPUTATION OF THE PENIS IN THE HORSE. 6 1 the line of amputation, and on the lower surface of the penis, the skin being first divided, then the subjacent tissues, the suspensory ligaments, corpora cavernosa, and erectile tissue ; the urethra is next cut through transversely, opposite the base of the V) its inferior surface dissected free from all the exposed tissues, the edges of which are afterwards sutured to those of the cutaneous wound ; lastly, the penis is cut through opposite the point where the urethra was divided, and the chief vessels closed by means of ligatures or forceps. Or, again, a pre- ferable method so far as checking haemorrhage is concerned, consists in applying an elastic ligature opposite the base of the wound, and amputating the penis an inch or so below. At the present time I employ this latter method exclusively. The procedure is as follows : The animal having been cast on the left side, the right hind limb Fig. 7. — Amputation of the penis. is lifted, carried forward, and fixed to the corresponding forearm, as in castration ; the penis is disinfected, together with the posterior abdo- minal and scrotal regions. Having introduced a catheter into the urethra for a distance of ten to twelve inches, an assistant covers the free portion of the penis with a cloth, and draws it gently forwards. Another assistant, placed behind the patient, draws the skin covering the base of the penis towards the perinseum. A ligature is then appHed to the base of the penis. A little above the point where I intend to amputate I trace on the inferior surface of the organ two lines, starting from above the urethra and diverging towards their free ends (an inverted V in fact), the extremities being about i| to i^ inches apart. The base of these Digitized by Microsoft® 62 CLINICAL VETERINARY JIEDICINE AND SURGERY. incisions is united by a transverse incision, and the triangle of skin tiius delimited is removed. I then excise the subjacent tissues, layer by layer, over the space covered by this wound until the urethra is exposed. This is opened at the lower margin of the wound by a transverse section. I then remove the catheter, and pass a grooved director into the exposed end of the divided urethra, the groove being directed towards the lower surface of the tube, and with the bistoury I divide the urethra along its middle line throughout the entire length of the part exposed. I then divide it transversely, and afterwards unite each flap of the mucous membrane of the urethra to the corre- sponding flap of the skin of the penis by silk sutures I complete the operation by applying, just at the base of the wound, four or five turns of a tightly stretched rubber cord. The ends of the cord are fastened together, and the penis divided an inch or so below with a single cut. For several years before adopting the above method of preparing the urethral orifice I was in the habit of dividing the penis with a bistoury, and closing the principal arteries by ligatures, or by applying forceps. Abundant attacks of haemorrhage used then to occur during several days, under the influence of the semi-erections which marked the moment of staling. With the method referred to a mass of dead tissue remains for several days adherent to the end of the penis. Any risk of infection is prevented by antiseptic irrigations. The dead mass and ligature fall away between the sixth and tenth days. The stump is then usually much tumefied, but the swelling and oedema rapidly diminish. The wound suppurates little. A layer of granulations soon covers it, becomes hard, and contracts, gradually drawing the skin over the stump until towards the end of the third month ; the cicatrix is comparatively small. As for the muco-cutaneous wound, when the sutures hold, and the mucous membrane does not cut through, the apposed lips rapidly unite. Most frequently, however, the mucous membrane cuts through at one or more points and becomes separated from the skin ; vegetations occur on the exposed tissues, often becoming so abundant as partially to obstruct the meatus. There is, however, no cause for alarm. Ex- cessive granulation soon ceases, the parts heal ; like the wound on the extremity of the penis, cicatricial contraction results in drawing the mucous membrane towards the skin, and the urethral opening resumes and permanently preserves the shape given to it by the operator. In both cases the final result is the same ; when, the surgeon has done his part well, patency of the urethral opening is ensured. As soon as inflammatory symptoms disappear, the animal stales with the same ease as any other horse. Digitized by Microsoft® AMPUTATION OF THE PENIS IN THE HORSE. 63 Of five cases operated on in my clinique^ during a period of two years, not one has shown after-contraction ; and in those treated be- tween 1890 and 1895 the results — except for hfemorrhage — have been not less satisfactory. Should you have to remove the penis in the horse, do not hesitate to adopt the operation you have seen me perform ; though it demands a little more time and care than other methods, its superiority is beyond question. Digitized by Microsoft® XL— RADIAL PARALYSIS IN THE HORSE. To-day I intend to speak of the cases of radial paralysis we have treated during the course of the present session, and to show you that this paralysis assumes various clinical appearances which it is important you should recognise if you wish to avoid awkward mistakes. Our last patient affected with radial paralysis is still in the clinique. It is a nine-year-old Percheron horse, with only one blemish, \\z. a moderate-sized bog-spavin. You have, I am sure, watched it attentively, for its history is extremely interesting. When sent to us one evening last week it was on the road to the slaughterhouse. An empiric, practising in the department of the Seine and Oise, had the day before fired it in lines on the hock. The horse had thrown itself down violentl}', and on rising was no longer able to place weight on the off fore-limb. The quack declared the animal had fractured a phalanx, and was incurable. The owner thereupon sold it to a butcher in Paris for the sum of loo francs, reserving to himself, however, the right to send it here for examination, so that the question as to its incurability might be finally decided. The animal walked out of the ambulance without much difficulty. The foot of the so-called fractured limb ^vas brought to the ground resting on the toe, and the flexion of the knee, fetlock, and elbow when at rest, as \\ell as the excessive flexion of the last joint when walking, immediately suggested to me that the animal was suffering from radial parahsis. The phalangeal region, like all the other parts of the limb, showed no sign whatever of fracture. I was therefore able to reassure the owner, and the sale was broken off. We placed the animal in slings. Treatment consisted in simple massage of the shoulder, arm, and forearm, especially of the extensors of the forearm and metacarpus. At the end of forty-eight hours improvement was very manifest. At the present time — scarcely a week after the accident — cure is complete, so complete that there is not the slightest irregularity in movement, and it would be impossible for a stranger to say that the animal had suffered from paral\-sis. Digitized by Microsoft® RADIAL PARALYSIS IN THE HORSE. 65 In fny portion of the hospital you have seen three other horses affected with this condition. At the commencement of last March, a seven-year-old mare with paralysis of the left radial nerve, of unknown origin, was left for treat- ment. Having suffered, two months before, from pneumonia, this mare had returned to work without showing any after effects. One morning she was found standing on three legs, quite unable to place weight on the near fore-leg. The coachman, who had driven her the day before, declared that she had neither slipped nor fallen. When at rest the peculiar position of the near fore-limb was strik- ing. The joints were flexed, the extensor muscles of the forearm sunk in, the elbow dropped, and the angle of the shoulder-joint straightened. In consequence of the fetlock being flexed, only the toe of the foot rested on the ground. During movement these symptoms became more marked ; when attempts were made to place weight on the limb the leg collapsed, the point of the elbow descended to an excessive degree. The fetlock was markedly flexed, and almost touched the ground. Sensation was preserved in all parts. The paralysis espe- cially affected the extensors of the forearm, canon-bone, and phalanges. The case was one of radial paralysis, caused, without doubt, by a slip in the stable. The muscles supplied by the radial were blistered, and two drachms of iodide of potash given daily in the food. During the first week there was not the least improvement. At the commencement of the third week a further blister was applied. Although walking was still very painful, the patient was exercised night and morning. On the first occasion it had great difficulty in advancing, but each day the distance v^^as increased, and distinct improvement soon occurred. In a week remarkable progress had been made. The animal still went lame, but the limb was hardl}' flexed at the moment when weight was placed on it. Cure was complete in a month. In November, 1897, we treated a fifteen-year-old mare affected with radial paralysis, which had appeared immediately after a fall. While drawing a cart loaded with a cow the mare stumbled and fell forwards. On being unharnessed and lifted she had great difficulty in placing any weight on the off fore-limb. As the accident happened close to the School, the injured animal was brought in. The off fore-limb was rested on the toe, the fetlock and knee were flexed, the scapulo-humeral angle was excessively open, and the elbow dropped. Inside the upper part of the forearm was a slightly painful swelling, the size of a man's fist, which showed no fluctuation or crepitation such as is usual when blood is extravasated. The muscles E Digitized by Microsoft® 66 CLINICAL ^'ETERINARY MEDICINE AND SURGERY. attached to the olecranon showed occasional slight trembling move- ments. Sensation was nowhere diminished. The temperature and chief fimctions were normal. The mare was placed in slings. Several times per day the extensor muscles of the paralysed limb were massaged; 2^ drachms of iodide of potash and 45- ounces of sulphate of soda were given daily. On the first three daj's the swelling of the forearm remained stationary. Next day the animal was depressed, hung back from the manger, and threw its whole weight on the slings. The elbow region was greatl}' swollen, hard, and only slightly sensitive to pressure ; the swelling extended over the muscles of the forearm. The appetite was good, and temperature normal. On the fifth and sixth days the swelling of the upper part of the forearm increased in prominence and extent. On palpation it seemed as though caused by liquid extravasated between the muscular layers. At the end of fort3--eight hours it began to diminish, but functional disturbance remained almost as marked as on the first day. During the second week the general condition gradually improved. A daily dose of 2 ounces of bicarbonate of soda was added to the draught pre\'iously given. On the fifteenth daj- the animal was taken out of slings and left loose in its box ; it then began to place weight on the affected limb. From this time onwards improvement was rapid, the limb soon being extended with more certainty and freedom. At the commencement of the fourth week the last symptoms had disappeared, and the animal was returned home. At the same time as the preceding patient there was in hospital a horse, in which paralj'sis of the right radial nerve had occurred during operation on the foot. The animal had been cast on the right side, and the off fore-leg dra\\'n backwards and fastened to the corresponding hock. Being very strong the animal had struggled violently. On rising, it was unable to bear weight on the off fore-leg. The upper parts of the limb were blistered. As at the end of a few days no improvement had occurred, the horse was sent to the School. At rest the injured limb was half flexed, the toe of the foot alone touching the ground. The scapulo-humeral angle was ver\- open, the shoulder dropped, and the point of the elbow depressed. The skin covering the shoulder, arm, and forearm was denuded of hair, swollen, discharging and inflamed, in consequence of the blisters which had been applied. Sensation was preserved throughout the limb. When walking, the leg \\'as moved forward ^vith difficult}-, and collapsed when the animal tried to place weight on it. The horse was placed in slings, and, to hasten healing of the skin Digitized by Microsoft® RADIAL PARAFA'SIS IN THE HORSE. 67 wound due to the blister, carbolic lotion was applied to the scapulo- humeral and antibrachial regions. Four drachms of iodide of potas- sium were given daily. The wound o;i the foot was covered with a surgical wool dressing ; it healed rapidly. For a week the paralysis did not diminish in the smallest degree. The horse was exercised for a short time ever)- day, and the parts massaged. During the second week no improvement was recorded. The slings were then removed, the iodide of potassium was discon- tinued, and the animal was exercised for twenty minutes night and morning. Movement was particularly painful at first, and the limb could hardly be extended. Improvement did not commence until after a month. The patient then began to walk more willinglj' than before, the paralysed limb at times being distinctly extended. The muscles having commenced to waste to a marked degree, lo c.c. of a one per cent, solution of sulphate of veratrin were injected under the skin, and the application repeated a week later. For a fortnight more there was little improvement ; afterwards the animal recovered with fair rapidity. As time passed, more and more weight was placed on the limb, and during movement the parts were freely extended. The last symptoms did not disappear until the commencement of the third month. Being almost entirely confined to the horse, and rare in other animals, radial paralysis was long mistaken for articular, bony, or muscular disease of the shoulder and arm. Continental authorities have erro- neously attributed to Glinther the merit of having in 1866 first exactlj- described it in his ' Myologie.' Goubaux, in his " Memoires sur les Paralysies locales," which appeared in the Recueil de Mcdecine Vete- rinaire, just half a century ago set forth the character of complete and of incomplete paralysis of the posterior humeral nerve. Since that time a large number of cases have been recorded. In the fore-limb, movements of extension are specially under the control of the radial. It supplies the muscles attached to the olecranon and the anterior antibrachial muscles, the five extensor muscles of the forearm, the anterior extensor of the metacarpus, both extensors of the phalanges, and by a branch which passes in a backward direction the external flexor muscle of the metacarpus. On account of its position, course, and relations, the radial is exposed to compression and to mechanical violence ; it is therefore much more frequently the seat of injury than the other nerves of the fore-limb. Double radial paralysis of central origin is said to have occurred, but almost all the practitioner is called on to treat are peripheral unilateral paral}'ses. The aetiology is complex, but mechanical injury is by far the com- Digitized by Microsoft® 68 CLIXICAL VETERINARY MEDICINE AND SURGERY. monest cause of this paralysis. Bruises about the shoulder or arm, kicks, blows from the carriage pole, collisions against the jambs of doors, slips, and falls may all produce it. Prolonged compression resulting from the animal lying in an awkward or enforced position is, however, much the most frequent cause. Radial paralysis is often a sequence of casting, when the horse has been kept down for a long time with its legs crossed, or in the ordinary position, and especially when, under such circumstances, it has struggled violently. As a rule, though not always, the lower limb is that affected. Notwithstanding the assertion of Goubaux, and several other authors, the upper limb may be the seat of injury. I myself have seen one case. In operating on a fore-limb, either the diseased limb itself or that of the opposite side, \\hich before casting was perfectly normal, may become affected. Several cases of radial paralysis occurring during work, or in the stable, and quite apart from mechanical injur}', have been recorded. The radial may certainly become paralysed in consequence of excessive contraction of the muscles which it supplies, but in cases of this kind either the nerve itself is injured, the paralysis is due to inflammation of muscle, or to polymyositis (inflammation of several muscles) conse- quent on excessive work. Paralysis ma}- occur in the stable either in consequence of slipping, of a struggle when rising, or of some peculiar position in which the animal is accustomed to lie. Rheumatic paral}-sis, or paralysis a fvigore, and that of infectious or toxic origin, are rare. The co-existence of radial paralysis and fracture of the first rib — a fracture which may result from falls or slips — has been demonstrated in many post-mortems. Hunting, relying on several cases in which fracture of the first rib had been detected, expressed the opinion that radial paralysis was probably always a consequence of such injury. This conjecture, however, is disproved by a study of the pathological anatomy of the condition. In most cases post-mortem examination of animals suffering from the disease fails to demonstrate the existence of fracture of the rib. The converse, howe\-er, is true, viz. that fracture of the upper part of the first rib is usually accompanied by radial paralysis — a result due to the proximity of the radial nerve to the point of fracture. Radial Paralysis generally produces sufficient functional disturbance to permit of diagnosis, but the clinical picture is far from clearly defined. Sometimes the symptoms are very acute and alarming, leading both skilled and unskilled persons to suspect some extremely grave condition like fracture, as in the case we have just seen ; sometimes they are obscure, their significance only becoming clear on careful examination. Digitized by Microsoft® RADIAL PARALYSIS IN THE HORSE. 69 These cases may be divided into three groups, viz. Complete, Incom- plete, and Partial Paralysis. In Complete Paralysis the joints of the affected limb, with the exception of the shoulder, are usuall}- flexed when the horse is resting. In consequence of loss of power in the triceps and anterior brachial muscles, the arm is extended and straightened on the shoulder, the scapulo-humeral angle is open, and the elbow depressed. The forearm is flexed on the arm by the contraction of the coraco-radialis, while the metacarpus and plalanges are bent by the action of the posterior antibrachial muscles. The knee is carried in advance, level with, or in front of, a vertical line dropped from the point of the shoulder. The hoof is usually rested on the toe, but when advanced beyond the above- mentioned vertical line it may be placed flat on the ground, the joints then being less markedly bent. When the limb as a whole is flexed, it may be brought into normal position by thrusting back the knee with sufficient force to counteract the action of the flexor muscles. In walking, the shoulder and arm are more or less "carried," the lame limb being moved as a whole ; but as the lower portions of the limb are insufficiently extended, the stride is much shortened. The least attempt at placing weight on the leg causes all the joints to become flexed, and the shoulder and arm to suddenly drop ; the animal, feeling itself falling, instantly transfers weight to the other limb. At a more rapid pace the animal goes on three legs, as though suffering from sorne exceedingly painful condition. Incomplete Paralysis may either constitute a stage in recovery from complete paralysis, or an independent condition. At rest the limb is held as in the preceding form, but the entire plantar surface of the hoof more frequently comes in contact with the ground. In moving, lame- ness is less marked, and instead of occurring at every step may only appear at intervals, varying in length with the degree of paralysis,. rapidity of movement, and smooth or rough character of the ground. The limb is slowly advanced, the stride shortened, and the hoof carried or dragged along the ground. The animal stumbles o\'er the smallest obstacle, the limb immediately becoming flexed. In Partial Paralysis most of the muscles supplied by the radial retain their function, and disturbance is much less marked. As a rule, the position of the limb at rest is normal. During movement it is freely extended, the stride is of ordinary length, and the joints do not collapse when weight is placed on the limb. Slight lameness is visible at a trot, the shoulder and arm being more or less markedly carried forward, without, however, rolling outwards, as in paral)'sis of the supra- scapular nerve. Digitized by Microsoft® 70 CLINICAL VETERINARY MEDICINE AND SURGERY. Even in cases of complete paralysis, cutaneous sensibility is usually normal, or only slightly diminished, a fact attributed to the less sus- ceptibility to injury of the sensory as compared with the motor fibres. This is probably an error, however, the persistence of sensation being due to collateral innervation, any deficiency being supplied by neigh- bouring nerves. Sometimes sensibility to pain is markedly diminished, and cases are not infrequently seen in which the anterior and external surfaces of the forearm are anaesthetic. Like loss of sensation, vaso- motor disturbance is rare, though abundant perspiration, corresponding in area to that of the paralysed muscles, has been described. I have never seen coldness of the skin. Localised swelling is almost always due to violence, followed by haemorrhage and sanguineous infiltration of the subcutaneous and muscular tissues ; though it may also follow muscular rupture, haemoglobinuria, or local strain. The condition recognised as " radial paralysis " is not invariably of nervous origin ; sometimes it follows muscular injuries. At the post- mortem of certain horses which had been over-driven, and showed symptoms of complete radial paralysis, Frohner found the radial nerve intact, whilst the muscles it supplies were swollen, infiltrated, and yel- lowish ; their fibres had lost the normal striation, and had undergone granular degeneration. In this form the paralytic symptoms are accompanied by those of acute inflammation of muscle. The course taken by radial paralysis depends on its cause, as well as on the gravity of injury to the nerve and neighbouring tissues ; but as it is impossible to detect the actual lesions, nothing precise can be said on this head. Sometimes the symptoms diminish within a few days, and the animal rapidly recovers ; more frequently they persist unchanged for several weeks : improvement then occurs, and usually makes good progress. The paralysis generally persists for a month to six v\'eeks. An important point to remember is that recovery is the common termination of simple unilateral radial paralysis. Of sixty-eight recorded cases, only two proved incurable, i. e. a proportion of about three per cent. In obstinate cases the atrophy of muscle which occurs at a certain stage renders prognosis somewhat graver. Exercise favours reco\'ery, but it is important not to return animals to heavy work too soon. Relapses have often been seen, and are almost always very troublesome. I should add that this paralysis is very grave under two conditions : (i) when it is double-sided, because then the horse is obliged to remain lying for a long time ; and (2) when an animal, in consequence of some severe operation on, say, the right fore-foot, has been forced to remain lying for a long time on the left side (or vice Digitized by Microsoft® RADIAL PARALYSIS IN THE HORSE. 7 1 veysd), and paralysis occurs from continued pressure. If, under such circumstances, the horse cannot stand on the diseased foot, it is evidently in great danger. Diagnosis presents no difficulty except in partial paralysis. It should be remembered that in most attacks of this kind, when the horse is trotted, the point of the shoulder is jerked forward each time the limb comes to the ground, while lameness is marked. You will therefore not confuse this peculiar jerking movement of the point of the shoulder with deviation outwards — a symptom peculiar to paralysis of the supra- scapular nerve before the postea-spinatus muscle becomes atrophied. The symptoms of complete radial paralysis are at first sight somewhat alarming, and explain the \'iew so often taken by owners, dealers, and quacks, that the arm or one of the phalanges is fractured. Differential diagnosis is too simple to require my speaking on it at length. Fracture of the elbow and inflammation of muscle, due to hasmoglobinuria or to over-exertion, are both clearly indicated by their respective symptoms. As radial paralysis often follows casting, precautions should be taken against it, the animal being kept down as short a time as possible, awkward positions being avoided, and if necessary the twitch being applied to diminish struggling. Curative treatment is similar to that of other paralyses of peripheral origin. It consists in massage of the affected parts, cold douches, local hypodermic injections of veratrine or salt solution, the induced electric current, and the administration of potassium iodide or sodium salicylate. In complete paralysis it is often advantageous to sling the animal for a week or two. Massage and cold douches, or light blisters and exercise, are usually sufficient. As soon as the affected muscles begin to recover their contractility, improvement rapidly follows on exercise. The animal only requires to be moved for fifteen or twenty minutes night and morning, and left at liberty in a box. Electricity — and particularly the faradic current — is at present rarely employed. I have not used it in any of my cases. Salicylate of soda is only indicated when the existence of rheumatism is feared. I prescribe potassium iodide with the object of assisting reabsorption of exudate in the traumatic area, an exudate which might otherwise become organised, with serious consequences to the affected nerve. More complex treatment has been recommended, but the above is that almost always followed. Radial paralysis, I may remark in conclusion, tends naturally towards recovery. Digitized by Microsoft® XII.— THE TREATMENT OF SPAVIN. During a previous lecture I stated that spavin, like most other exostoses of mechanical or traumatic origin, produced by violent strains during movement or by concussion, gives rise to lameness during its period of development. This is usually first treated by rest, and blisters to the internal surface of the base of the hock. In this ^\■ay some cases soon become sound, but in the majority lameness either continues unchanged or returns intermittently. Pathological anatomy affords the explanation of this persistent lameness by demonstrating the existence not only of a limited osteo- periostitis of the superficial layers of the affected bones, but of articular lesions. Veterinary surgeons have long been agreed on this point. The question at present in dispute is — Which of the morbid changes in this complex process occurs first ? What is the primary lesion ? Is the mischief at first confined to the points of insertion of ligaments, and must we regard the changes in the lower joints of the hock as secondary ; or, does spavin originate in the depths of the articulation, and is the bony swelling which appears after a certain time, only a consequence of articular inflammation extending to the periosteum ? Or, again, does inflammation of the joint occur simulta- neously with that of the periosteum, and do the two develop together ? Many different opinions have been enunciated. Aronsohn has recently carried out some investigations tending to confirm those of Goubaux and Barrier, and favourable to the doctrine that spavin starts externally. According to this author, the disease commences as a periostitis, due to hyper-extension of the internal tarsal ligaments and tendon of the flexor metatarsi. The arthritis which occurs in the lower tarsal joints is regarded as always secondary. Aronsohn's memoir appeared in 1893. He states that Eberlein, Joly, and Barrier have all carried out important investigations on the pathology of spavin. The conclusions are as follows : According to Eberlein the first lesion of spavin consists in osteo- Digitized by Microsoft® THE TREATME^fT OF SPAVIN. j ■> porosis and rarefying ostitis, in the great majority of cases affecting the cuneiform bones and the metatarsus. This rarefying ostitis is soon succeeded by condensing arthritis. At the same time the corre- sponding articular cartilages become the seat of chondritis, with pro- liferation of cartilage cells and degeneration of the fundamental substance, resulting sooner or later in anchylosis of the joints in question. Often, though not invariably, inflammation extends to the joint, or, possibly, directly from the bone to the periosteum of the small tarsal bones, and there produces an ossifying periostitis, accom- panied by exostoses on the inner surface of the lower line of bones of the hock. The lesions seen in the tissues surrounding the joint are secondary. M. Joly considers that what is called spavin, and treated under that name, is a complex pathological process, the stages of which are as follows : — (i) Dry arthritis of the lower tarsal joints ; this is spavin arthritis. (2) Anchylosis of the inflamed joints — spavin anchj'losis. (3) Exostosis, localised, in consequence of the anatomical formation of the hock, at the infero-internal surface of the joint— spavin exostosis. (4) Extension of the disease to the lower tarsal joints, and invasion of the tarso-metatarsal joints and superior tarsal joints — circular spavin. The author states that these four phases of the disease do not succeed in regular order throughout the entire extent of the hock. On the contrary, they extend by zones, gradually invading wider areas,, one zone having terminated its second or third cycle when the next is only in the primary stages. M. Barrier considers that spavin consists essentially in a dry chronic arthritis, usually leading to anchylosis and deformity. It starts in the joints at the infero-internal surface of the hock, and tends to travel from below upwards, and from within outwards. The evolution of the morbid process which ends in spavin forma- tion may be summarised as follows : — (i) Strain of the ligamentous structures, either at the surface or in the depths of the small tarsal joints. (2) Ostitis and osteo-periostitis, at first of a rarefying, then of a condensing character, of the osseous structures affected, or of neigh- bouring parts, under the influence of concussion. (3) Peripheral anchylosis, sometimes without deformity, but usually with new growths of bone, which later tend to envelop the joint. (4) Dry arthritis, ending either in central, very firm anchylosis, or in progressive osteoporotic deformation, or in eburnation of the diseased articular surfaces. Digitized by Microsoft® 74 CLINICAL VETERINARY MEDICINE AND SURGERY. I believe that on this question of the pathology of spavin, as, for that matter, of the pathology of other affections, it is very necessary to avoid dogmatism. Because it is proved that a certain cause, or process occurs, that is no sufficient reason for absolutely neglecting those whose influence is mere difficult to demonstrate. The causes of spavin are certainly many. Defective conformation of the hock, injury suffered during movement, and strains of ligaments probably play important parts ; while the constitutional condition of the animals and the character of the bony tissue — consequently hereditary predisposition ■ — must not be lost sight of. We cannot explain why or how the bones which form the lower portions of the hock, the synovial membranes interposed between them, and the ligaments which unite them, should be exempt from morbid processes which attack bones and serous and fibrous mem- branes ; whj', for instance, they should be exempt from injury by products of microbic activity. Whatever its cause, however, unless the inflammation in the periosteum, in the bones, or in the affected joints is allaj'ed, lameness results. Another cause of lameness persisting is the mechanical disturbance, the interference with the action of the hock caused by bony growths — a disturbance which is possibly of less importance than is usually admitted, and which is certainly not con- stant. We sometimes see large spavins which, however, do not render horses lame. Furthermore, spavin very rarely interferes with the action ■of the tibio-astragalar joint. The essential point in dealing with spavin lameness is to allay the inflammation developed in, or propagated to the lower tarsal joints, by producing anchylosis of these joints. Even when treatment follows close on the appearance of the disease, it is hopeless to attempt checking the inflammation or arresting its course. Treatment should aim at hastening the evolution of the process and the production of anchylosis. In this way the period of pain may be shortened, and without doubt the extent of the morbid changes diminished. In old spavins, or in those which, though relatively recent, are producing lameness, and which have resisted blisters or superflcial firing, what is the best treatment ? Among the methods suggested three stand pre-eminent, and usually suffice : deep penetrating firing,, tenotomy of the flexor metatarsi tendon, and periosteotomy. Firing in fine deep points is nowadays the treatment most commonly employed, and when used boldly, so that the red-hot needle penetrates the exostosis, often gives good results. Section of the inner tei-minal Digitized by Microsoft® THE TREATMENT OF SPAVIN. 75 tendon of the flexor metatarsi by the old open method has been so successful that certain operators declare it superior to firing. I usually combine these two methods, first piercing the exostosis with a finely pointed Paquelin cautery, or with the end of a medium-sized knitting- needle brought to a bright red, and afterwards making twenty, thirty, or forty similar points, extending a little beyond the area of the swell- ing. In large or old-standing spavins I apply the cautery twice, or sometimes three times, in each puncture. Following this I simply divide the tendon of the flexor metatarsi, or I excise a short portion. The numerous instances I have recorded during the last few years show that this treatment removes spavin lameness in about 30 per cent, of cases. I do not believe that any other direct treatment is so efficient against osteo-arthritis of the hock. The only objection I can make to it is that it leaves a more or less apparent mark. Penetrating firing, nowada^'s used by a large number of practitioners, produces much more intense immediate effects and much better results than the old superficial firing, and does not necessitate nearly so long rest. The time for operation can be shortened. Instead of covering the entire surface with closely placed points, three to six may be used, according to the size of the bony tumour ; and these can be applied after placing a twitch on the upper lip, and lifting one of the fore-feet, i. e. without casting the animal. Frohner, who has treated fifty-nine spavins in this way, states he had very good results last year. You see the advantages of this method : it avoids the necessity for casting the animal and saves a great deal of time, for the operation only lasts a few minutes. It is true that penetrating firing of the hock is some- times followed by arthritis, but this complication has become excep- tionally rare since the introduction of very finely pointed cauteries. It can more certainly be avoided by operating with antiseptic precautions. The hair is cut, and the skin shaven over the entire surface of the bony swelling. The field of operation is disinfected, firing performed, and the cauterised surface covered with iodoform collodion. . . Periosteotomy, when practised aseptically, according to Peters' direction, has the advantage over the preceding of leaving no mark. A narrow transverse incision is made at the base of the swelling, opposite its vertical axis, and the exostosis cut into at several points, using a button-pointed bistoury with a convex cutting edge. But at present I have not sufficient personal experience of this operation to deliver an opinion concerning it. Those authors who have written on the subject vary greatly in opinion regarding it ; but it has given successes and might prove useful, especially in valuable horses. Digitized by Microsoft® 76 CLINICAL VETERINARY MEDICINE AND SURGERY. In a number of cases where the swelling is old, large, diffuse, and especially when it extends far forwards towards the bend of the hock, firing, even if repeated, and section of the terminal branch of the flexor metatarsi tendon fail, or only yield a very modified success ; lame- ness persists or is remittent, being less marked after a certain amount of exercise than on leaving the stable, though sometimes it is equally pronounced before and after exercise : in these rebellious cases double neurotomy of the sciatic and anterior tibial nerve, a deep branch of the external popliteal sciatic, has been recommended. This treatment of obstinate spavin by neurectomy is based on the following anatomical Fig. Fig. 9. Figs. 8 .and 9. — Neurotomy of the anterior tibial nerve. E A, anterior extensor of tlie phalanges. E L, lateral extensor. F M, muscular portion of the flexor metatarsi, N, tibial nerve. V, tibial vein. A, tibial artery. (The operation should be performed a little nearer the hock than indicated on Fig. 8.) facts :- — Opposite the point of the calcis the great sciatic nerve divides into two parts, the internal and external plantar nerves. Behind the hock-joint the external plantar nerve gives off a fairly large branch, which passes under the tendon of the deep flexor of the phalanges, and detaches several twigs, of which some ramify over the surface of the joint, whilst others penetrate into it. In front of the lower extremity of the tibia the tibial nerve gives off several branches, which enter the joint. Neurectomy of the great sciatic is made a hand's breadth above the point of the hock. You know the technique. Digitized by Microsoft® THE TREATMENT OF SPAVIN. 77 In neurectomy of the tibial, the point selected is at the external surface of the lower part of the thigh, approximately at the same height as the former. The anterior tibial nerve is situated on the deep surface of the anterior extensor of the phalanges, between this muscle and the thin muscular portion of the flexor metatarsi which separates it from the tibial artery, and from its large satellite vein — vessels which lie directly on the anterior surface of the tibia, where they are surrounded by a thick layer of connective tissue. The method is as follows : — The point of operation being prepared, the skin and subjacent aponeurosis are incised for a distance of two and a half to three inches, opposite the external margin of the anterior ■extensor of the phalanges. This muscle is separated from the lateral •extensor, then from the muscular portion of the flexor metatarsi, on the anterior surface of which the tibial nerve is readily discovered. A fragment of this, three quarters of an inch to one and a quarter inches in length, is excised. The wound is closed by a few cutaneous sutures, with or without providing for drainage. The operation is easy. It is, however, always necessary to proceed methodically, and to take care not to injure the tibial vein, which thrusts the muscular portion of the flexor metatarsi prominently forwards as soon as the anterior extensor of the phalanges is reflected. This double neurectomy has proved successful when all other methods had failed. Bosi reported six favourable cases, and more recently Frohner has described others. Nevertheless it is not without danger, trophic changes in the extremities, local sloughing, and loss of the hoof sometimes occurring. I may summarise the treatment of spavin as follows : — At first, when the disease is still latent, prolonged rest and blisters ; later, when spavin is apparent, firing in deep penetrating points, and when the exostosis is large, section of the internal terminal tendon of the flexor metatarsi. Should improvement only be partial, repeat the firing; finally, if repeated firing fails, you may, after warning the owner of possible risk, perform neurectomy of the sciatics. The heredity of certain organic conditions which favour the pro- duction of spavin suggests the only prophylactic measure applicable in our practice, viz. to avoid breeding from animals with this disease, or from those with specially defective hocks. Digitized by Microsoft® XIII.— THE TREATMENT OF PICKED-UP NAIL. Since the commencement of the year I have several times lectured on the treatment of wounds of the lower surface of the horse's foot, and have described to j'ou the methods of treating recent and complicated wounds in each of the parts into which this region has been conven- tionall}' divided. To-day I return to the treatment of grave cases of picked-up nail in the middle zone, in order to study in some detail two modifications which can be made in the technique of the complete operation, and to show you the benefits resulting therefrom. I wish to recall to your memory the conditions for which this opera- tion is performed, viz. penetrating wounds, complicated with exten- sive and deep necrosis of the plantar aponeurosis, or with purulent synovitis of the navicular or small sesamoid sheath. The complete operation for picked-up nail, as given by Andre and described by Bouley and Trasbot, consists of — (i) a large incision through the plantar cushion ; (2) transverse section of the plantar aponeurosis opposite the posterior margin of the navicular bone, pro- longed on each side as far as the retrorsal processes; (3) removal of the terminal portion of this aponeurosis ; (4) scraping the lower surface of the na\icular bone and that portion of the pedal bone over which is inserted the above-mentioned aponeurosis. In 1879 M. Nocard recommended preserving the insertion of the apo- neurosis into the pedal bone bj- making, opposite the posterior margin of the navicular bone from one lateral lacuna to the other, an incision perpendicular to the median line of the foot, and b}' giving to the two extremities of this incision, from the lacuna to the semilunar crest, a curved or concave form, looking forwards. Retraction of the stump of the tendon is thus avoided. As the tissue composing the plantar cushion granulates more rapidly than that of the aponeurosis, it used to be the custom to excise this part \'ery freely, dividing it far back at the boun- dary between its middle and posterior thirds, or even within this, the incision taking an oblique direction from behind forwards. Ten years ago I showed that scraping the surface of insertion of the Digitized by Microsoft® THE TREATMENT OF PICKED-UP NAII.. 79, aponeurosis is superfluous, and that under an antiseptic dressing the fibrous tissue left covering the os pedis, far from undergoing necrosis, (as had been suggested), rapidly- becomes \-ascular and co\-ered \\itb granulations, like the other tissues in the wound. E\-en where necrosis, has affected a portion of the end of the aponeurosis, you ha\-e always, seen that I limited removal of the fibrous laj-er and scraping of the bone- to that particular portion. By thus preserving the fibrous covering of the pedal bone over the- entire surface of insertion of the perforans tendon, operation is simpli- fied — scraping being a delicate process, which endangers the interosseous. ligament, — the chance of arthritis is less, and the anterior portion of the- wound fills up more rapidly than after curetting the semilunar crest. But in consequence of the obliquity with \\hich the plantar cushion is divided, especially when the necrotic portion of the aponeurosis extends to or a little behind the posterior margin of the navicular bone, the operation wound is very large, sometimes almost alarming in size ;; and healing, even when uncomplicated, occupies a long time — some six to eight weeks. The majority of patients only return to work after- extended rest. Whatever the position of the necrosis or of the penetrating wound in the navicular sheath, the period of healing and consequent!}- the required rest may be diminished by sparing, as far as possible, the plantar cushion, and reducing to a minimum the loss of substance b}- making the primary incision at right angles to the surface of the plantar region, or even inclined a little obliquely from in front backwards. Antiseptic treatment and plugging of the wound with gauze prevents the complications which caused older operators to excise the plantar cushion so freely. You will at once see the ad\antages of this method,— more rapid closure of the operative wound, and a smaller cicatrix, the tenderness of which is sometimes the only reason for lameness persist- ing ; in a word, more rapid and complete reco\-ery. You have been able personalh' to estimate these advantages in a certain number of our cases. I may repeat to you the history of the most recent. On the 15th March last a hea\y se\en-year-old cart mare entered hospital. Three weeks before she had picked up a nail about the centre of the left hind foot. The nail had penetrated perpendicularly into the internal lacuna, not far from the limit between the middle and posterior zones. A veterinary surgeon had thinned the sole around the wound, which he had laid open and disinfected, and had afterwards covered the parts with an iodoform dressing. Despite this treatment the wound became complicated. Towards the end of the second week Digitized by Microsoft® 8o CLINICAL VETERINARY MEDICINE ANIi SURGERY. lameness was extremely marked, and five or six days later the patient was sent here. When seen by us the left hind foot was scarcely brought in contact with the ground, the lower part of the limb was greatly swollen, and the animal continually lifted the foot, showing signs of darting (lancinating) pain. Pus, mixed with synovia, escaped from the wound on the under surface of the foot, around which, for a distance of an inch, the exposed sensitive tissues were swollen and exuberantly granulating. The case was one of picked-up nail, complicated by suppurative inflammation of the small sesamoid (navi- cular) sheath, and possibly by necrosis of the plantar aponeurosis. We might have thinned the foot, laid open the sinus, and afterwards used baths and antiseptic dressings, but such treatment gave little hope of success. Operation was evidently preferable, and was arranged for the day afterwards. The usual method was employed, with the modification, however, of which I have just spoken. After stripping the sole I divided the plantar cushion at right angles to its surface, so as to preserve the larger part. The plantar aponeurosis, being exposed, was divided transversely, a little in front of the posterior margin of the navicular bone, and dissected away, the sides, however, being spared as much as possible. The nail had touched the inner facet of the navicular, where it had produced a small wound and a patch of ostitis. I curetted the lower surface of the bone, forming a slight depression at the injured point. In the excised portion of the aponeurosis was a necrotic ring surrounding the sinus ; the stump showed a greyish point, where the fibres were a little softened and possibly necrotic, but the terminal portion of the aponeurosis was healthy over its entire area of insertion, and was therefore not touched. I did not interfere with the pedal bone. Having freely irrigated the wound with lukewarm two per cent, carbolic solution, the greyish point on the end of the tendon was touched with tincture of iodine, which was also applied to the hollow formed in the navicular bone, the wound was powdered with iodoform, and after- wards plugged with gauze. To prevent discharge accumulating in the cul-de-sac behind the tendon sheath, I was careful to lift the end of the aponeurosis and pass the gauze under it. Finally I applied the surgical dressing usually employed after serious operations on the foot. On rising the mare placed more weight on the diseased limb, and appeared in less pain than before operation. That evening the tempe- rature rose to 39'3° C. (1027° F.). The day after the foot was rested on the toe, and the animal suffered from lancinating pain ; but it ate most of its food, the general condition was satisfactory, and the fever moderate. During the first week the condition remained prac- Digitized by Microsoft® THE TREATMENT OF PICKED-UP NAIL. tically stationary, any change, however, being towards improvement. The temperature never rose beyond 39-3'' C. (1027° F.). On the eighth day more weight was placed on the foot, and the lancinating pain had disappeared. The dressing was removed. To loosen the gauze which adhered to the deeper parts, the foot was placed in warm carbolic solu- tion. There was only a little reddish discharge ; the wound appeared very healthy and granulations were everywhere springing up, except on the navicular bone and in the stump of the perforans tendon, where preparations for granulation were seen. After thorough cleansing, the parts were again covered with a cotton-wool dressing. On the tenth day the patient's condition was excellent ; fever had ceased, and weight began to be placed on the affected limb. On the four- teenth day the dressing was renewed. The layer of gauze was moist ; the wound, which contained a little pus, was entirely covered with granula- tions. A thin shoe was apphed, with four nails, and the surgical dressing fixed in position with splints. After the eighteenth day improvement occurred rapidly. The animal still walked lame, but placed more weight on the leg. Exercise was commenced, night and morning. A week later the wound was about three quarters healed, and the lameness scarcely noticeable at a walk. Twenty-four days after operation the mare was able to do a little work. She did not leave hospital, however, for another week. At that time lameness was scarcely perceptible when walking. It may be said that, of course, this injury was in a hind foot, and that injuries to fore-feet are graver, and treatment would be more pro- longed. But two months after this case I operated in the same way on another horse, which had picked up a nail in the off fore-foot. The case was also complicated with necrosis of the aponeurosis and with purulent synovitis. The result was as favourable as in the preceding instance, and the period of treatment not much longer. The horse, in fact, returned to work in five weeks. A little later the then existing lameness had completely disappeared. By preserving the larger portion of the plantar cushion not only is the period of healing diminished, but the volume and area of the mass of resulting cicatricial tissue are reduced. This cicatricial tissue often remains excessively sensitive, keeping up lameness even where there is no periostosis or marked swelling about the coronet. The more you preserve the plantar cushion, the smaller will be the cicatrix and the more certain and complete the result of treatment. On this first point, I may remark, it is not always necessary to divide the plantar cushion perpendicularly to the long axis of the foot, as you usually do in the animals provided for exercises in practical F Digitized by Microsoft® 82 CLINICAL VETERINARY MEDICINE AND SURGERY. surgery. To avoid excessive cutting, and to reduce as far as possible the extent of the wound, one may depart from the rule ; and if the sinus is in one of the lateral lacunas, far enough removed from the point of the sensitive frog, if necrosis is limited to one half of the aponeurosis, or is situated near one of its margins, you may make the transverse incision through the aponeurosis and plantar cushion more or less oblique to the long axis of the foot, and thus, while removing the whole of the necrotic patch, preserve on the opposite side the larger propor- tion of the healthy tissues. By lifting the end of the aponeurosis with the flattened end of a director or any blunt object, it becomes easy to separate the cartilaginous material surrounding the navicular bone with a button-pointed knife, or a cautiously handled sharp-pointed knife. In practice, therefore, it is sometimes advisable to depart from the rules of the classical operation. Different cases require different treatment, and it is always important to preserve tissue as far as possible. With the advent of antisepsis the surgery of the foot has become more conservative. In complicated injuries of the plantar region, in particular, we should endeavour to reduce the operative wound to the smallest dimensions. Let us now consider the treatment of necrosis of the plantar aponeurosis, occurring close to the synovial cul-de-sacs in the flexure of the pastern. In this region necrosis is very common as a result of suppurating corns, or of foreign bodies having passed through the central zone in an oblique direction upwards and backwards. In operat- ing for such injuries, excision of the entire eschar would expose us to the risk of opening the synovial cul-de-sacs of the pedal joint and of the great sesamoid sheath. Those of you who have been present at my operations for picked-up nail know how I proceed under such circum- stances. After removing all tissue which can be taken a\\'ay without injuring these synovial sacs, I form a counter-opening in the flexure of the pastern. After preparing the pastern region, shaving away the hair and disinfecting the skin, I introduce the special "sage-leaf" shaped knife at the bottom of the wound at the spot where I ha\-e been obliged to leave a necrotic or doubtful piece of tissue, and from this point push it upwards and backwards between the aponeurosis and plantar cushion (keeping close to the former) until it emerges above the bulb of the heel.* If necessary I enlarge the opening by guiding the knife along a hollow director. Then I pass a piece of gauze to act as a drain, saturate the suspected portion on the stump of the tendon with * The procedure is precisely similar to that in passing a frog-seton. — Jno. A, W. D. Digitized by Microsoft® THE TREATMENT OF PICKED-UP NAIL. 83 tincture of iodine, and apply a first dressing, with or or without a shoe. If the end of the perforans tendon does not granulate throughout, or the necrotic tissue fails to separate, drainage may be supplemented bj- antiseptic injections made through the opening in the bend of the pastern. Some months ago you were able to watch the progress of two cases thus treated. They recovered without further interference. I may briefly recapitulate the facts in connection with the first. At the commencement of last September we received a horse which had picked up a nail in the middle zone of its off hind foot, and had already been twice operated on by the veterinar}- surgeon who sent it. No weight was placed on the foot, and the animal showed evidence of frequent lancinating pain. On examining the hoof the operative wound in the plantar cushion was seen. Its deeper part formed a sinus, from which discharged a considerable quantity of greyish viscous pus. The aponeurosis was necrotic, and the tendon sheath had become trans- formed into a suppurating cavity. The same day I practised the complete operation. Necrosis had extended for a long distance in the perforans tendon, and I was unable, without risking injury of the synovial cul-de-sac, to remove the entire mass of the eschar. I made a counter-opening in the bend of the pastern, irrigated the wound with an antiseptic liquid, inserted a gauze drainage-tube, and then, with the end of a director en\-eloped in wadding, I swabbed \s'ith tincture of iodine that portion of the tendon stump in which I had been obliged to leave a fragment of necrotic tissue. The parts were covered with a layer of iodoform, the foot enveloped in a large dressing. On the four following days the animal showed acute pain. During the greater part of the time it remained lying down, and took little food. Fever was marked, the temperature oscillating between 39'3° and 39-9° C. (1027° and 103-8° F.). On the fifth day the dressing was renewed. I changed the gauze drain, again touched the necrotic portion of the tendon with tincture of iodine, and applied a new cotton-wool dressing. From the next day the condition improved. The appetite increased, the fever diminished, and the lancinating pains became less frequent. The improvement was continued on the following days. Gradually the horse began to place weight on the affected limb. The dressing was allowed to remain until the end of the second week. At that time the wound was granulating throughout almost its entire surface, only the navicular bone still showing a small dry point. The gauze being changed, a dressing and shoe were applied, and antiseptic injections made daily through the Digitized by Microsoft® 84 CLINICAL VETERINARY MEDICINE AND SURGERY. artificial sinus. Still later the dressing was changed each week, and the amount of gauze used as a drain was diminished. At the end of a month weight was freely placed on the limb, the sinus suppurated feebly, and drainage was stopped. From this time the horse was exercised daily. When he left hospital at the beginning of the sixth week he walked almost sound. The second patient entered hospital a short time before the preceding left, ha\'ing been like it unsuccessfully treated for some time by the colleague who finally sent it to us. When I examined the horse it showed marked pain, and could scarcely bring the off fore-foot in contact with the ground. The internal lacuna near the heel showed a fistulous wound, from which ran a little grumous, stinking pus. The hoof was pared out, thoroughlj' cleansed by immersion in a sublimate bath, and enveloped in a dressing of peat wool, the first laj'ers of which had been moistened with an antiseptic solution. I performed the complete operation, making the incision a little larger on the near side by giving to the transverse section, through the plantar cushion and aponeurosis, an oblique direction backwards and towards the inner heel. A few suspicious points, nevertheless, remained on the stump of the tendon. I made a counter-opening in the bend of the pastern, inserted a gauze drain, and dressed the parts with tincture of iodine and iodoform. The progress of the case was practically similar to that of the first. Fever was a little more prolonged ; during the first week the tempera- ture remained at 39"5° C. (103-1° F.). The animal had capricious appetite, placed little weight on the limb, and frequently lifted it with a jerky movement, suggesting lancinating pain. Shortly after operation an abscess developed in the plantar cushion in spite of the drainage. Nevertheless towards the fifteenth day weight was placed on the foot, and improvement was afterwards rapid. In the course of the fourth week a light shoe and a dressing, fixed in position by splints, were applied. Some days later the animal began to stand on the foot, and exercise was commenced finall}-. Drainage was stopped on the thirtieth day. A week later the animal returned to walking work. You may remember another case in which, when attempting to remove the whole of the dead part, I opened a synovial cavit}- — without doubt that of the large sesamoid. A quantity of synovia ran from the bottom of the \vound, and I was forced to cease the operation. The Digitized by Microsoft® THE TREATMENT OF PICKED-UP NAIL. 85 foot was dressed as in the preceding cases. The compHcation I had feared did not occur, but such a good fortune must not be anticipated when the synovial capsule is wounded in the neighbourhood of infected tissue, and by an infected instrument. In conclusion I may say that, apart from all operative accidents, extensive necrosis of the plantar aponeurosis constitutes a very grave condition. From the economic standpoint treatment is not to be recommended or undertaken in more than a certain proportion of cases, and only when the animals are of value, or when it is of importance to keep them alive irrespective of questions of cost, long duration of treat- ment, and uncertainty of result. Digitized by Microsoft® XIV.— PLANTAR NEURECTOMY. In cases of obstinate lameness you have frequently seen me perform plantar neurectomy, both above and below the fetlock, according to the seat and extent of the morbid changes we are called on to remedy. When the lesions are limited to the back part of the foot I prefer the low operation, reserving the other for cases affecting the front or sides of the entire foot, or the coronet or pastern. I wish this morning to draw your attention to the advantages and drawbacks of these operations, and incidentally to clear up a disputed point in their history. Plantar neurectomy was first conceived and performed by Moorcroft, a professor at the Veterinary College in London. At the commence- ment of this century Moorcroft made his earliest experiments on section of the plantar nerves. He did not publish his results until eighteen years later. There is no reason to believe that Sewell was the inventor of this operation, but he helped to extend its use in England, and showed by numerous published cases the benefits to be derived from it. Moorcroft practised indifferently section or excision abo\ e or below the fetlock. Sewell recommended neurectomy below the fetlock, in order to leave a certain degree of sensation in the tissues of the foot. Blaine suggested high double neurotomy for ringbone. Coleman and Goodwin also studied neurectomy, and reported a certain number of observations in support of its efficacy. Percival had given a good description of the operation in his lectures, which Narcisse Girard analysed in 1824 in the first volume of the Reciieil de Mcdccine Vetcrinaire. From this time the operation began to be practised in France. Its introduction was not unopposed. In the discussions concerning it many objections were made, because during the period of trial it had not only given contradictory results, but caused a considerable number of accidents. Renault, Uelafond, Leblanc, and Bouley helped to define its field of usefulness. Neurectomy is a palliative operation. Except in rare cases it pro- duces no curative effect ; it has no direct influence on the lesions, nor on the morbid processes for which it is practised, but by destroying sensation in the regions in which these lesions and processes occur it Digitized by Microsoft® PLANTAR NEURECTOMY. 87 diminishes or entirety removes the lameness for a time, and thus allows the animals to be used. The duration of its effects is very variable. Sometimes the lameness returns in a few months, sometimes only after years. Cases occur when, for example, the morbid changes have arrived at their final stage of development, and the inflammation which caused them has ceased, in which it never returns. From the practical standpoint, neurectomy is a valuable operation when performed with a full knowledge of the state to be treated, and when judiciously employed. Had it not done signal service it would long ago have been abandoned, because it certainly entails the possi- bility of serious accidents. I need only remind you of the permanent weakness of the limb on which neurectomy has been performed, the first objection made to the operation. After neurectomy, it has been said, movement of the limb is less assured, and the animal is liable to stumble and fall. This must be conceded, but such accidents only occur in a small number of cases, even after high neurectomy. Two Army Veterinary Surgeons, MM. Jacoulet and Comeny, who kept animals on which they had operated under prolonged observation, published cases showing that as a general rule neurectomy does not render troopers unsafe to ride, nor prevent them placing full weight on the limb. In a large number of my own cases the results have been excellent. Six years ago I performed high neurectomy on the off fore-leg in an English mare, which has since done continuous saddle work, without ever showing the least hesitation in the action of the limb. From time to time I have seen a horse in which I performed low neurectomy on the near fore-leg four years ago. It recovered perfectly, has not since gone lame, and has in no wa}- lost control over its movements. Another, much graver drawback is the danger of inflammatory and trophic changes developing in the tissues formerly supplied by the divided nerve. These may occur soon after operation, or may be delayed, and usually end in loss of the hoof, or rupture of the flexor tendons. Though comparatively few accidents of this kind have been recorded, many have undoubtedly happened. Sewell, who first practised high double neurectomy, had so many complications of this nature soon after operation, that he abandoned the method, and practised low neurectomy alone. Rabouille, among seven cases, had two of separation of the hoof. Renault, Beugnot, Delafosse, Delafond, and Verheyen, operating like the preceding authors above the fetlock, had similar accidents. Stanley only reports Digitized by Microsoft® 88 CLINICAL VETERINARY MEDICINE AND SURGERY. t\vo cases in one hundred operations, and on each occasion the compli- cation was produced by an injury to the foot. M. Nocard, between 1880 and 1886, performed about one thousand neurectomies without a single accident. This is practically the best recorded series. AI. Comeny, who often performed high double neurectomy, never saw after complications in his patients. Benjamin and Redon give the history of a horse in N\'hich high double neurectomy was followed by periostosis of the pastern, obstinate Fig. 10. — Moist gangrene of the foot after plantar neurectomy above the fetlock. ulceration of the skin, and other changes which necessitated slaughter. In one instance M. Jacoulet saw, two months after operation, inflam- mation of the tissues of the phalanx, with enormous swelling and superficial ulceration of the skin. In a horse suffering from large ring- bones, which had resisted firing, M. Trasbot, after unsuccessfully per- forming low double neurectomy, proceeded to divide the plantar nerves above the fetlock. Three days later the coronet became greatly Digitized by Microsoft® PLANTAR NEURECTOMY. 89 swollen, and the hoof partially loosened. Having to treat a horse affected with ringbones, Palat performed high neurectomy on the side of the larger bony growth, and a fortnight later on the other side. The animal returned home, and continued working regularly for more than a year. During the fifteenth month swelling of the coronet and separation of the hoof were observed ; the animal had to be slaughtered. Hendrickx reported three cases of loss of the hoof after high neurectomy. In one the accident was deferred more than four years. Delamotte and Brocheriou performed neurectomy first below and next above the fetlock, in a mare suffering from navicular disease ; but the animal then deve- loped ringbones, which they treated by firing. Six weeks later the hoof was shed. All these cases refer to loss of the hoof after high double neurectomy, but the same complication may result from section of one of the plantar nerves above the fetlock. Here is an illustration made from a photograph showing the con- dition of the near fore-foot of a horse in which, two years before, I had divided the external plantar nerve above the fetlock. A \-ery large ringbone existed on this side. After five weeks' rest lameness dis- appeared, and the animal was able to resume work. About six months ago lameness returned, and the coronet greatly increased in size, in spite of which the horse was able to work until the commencement of the present month. As the lameness and swelling of the coronet had by that time become very marked, the animal was left in hospital for treatment. No weight was placed on the near fore-limb, which was half flexed, and from time to time convulsively lifted, suggesting lancinating pains. The lower parts of the limb, from the middle of the forearm, were greatly swollen. The coronet showed a diffuse, hard, warm, slightly painful swelling, particularly marked on the outer side, at which point the thin upper edge of the hoof was softened and detached from the enlarged and inflamed coronary band. All the outer quarter of the hoof was separated. Along the plantar commissure the horn was softened and yellowish. The strictest examination of the foot revealed no recent injury. Treatment was by continued irrigation, but as the separation of the wall steadily continued, and in a few days extended as far as the toe, the case was considered incurable, and the horse was slaughtered. On dissecting the foot, the skin and subcutaneous connective tissue were found greatly thickened and indurated ; the coronary band was double its ordinary size, and along the entire external quarter the wall was separated. The posterior branch of the external plantar nerve was Digitized by Microsoft® go CLINICAL VETERINARY MEDICINE AND SURGERY. atrophied. On vertical section of the hoof, the articular synovial membranes and the small sesamoid (navicular) sheath appeared in- flamed, injected, and infiltrated ; the synovia was scanty and reddish in colour. The navicular bone showed signs of rarefying ostitis ; its lower surface was denuded of cartilage, its compact tissue was under- going exfoliation, and its cancellous tissue was hypersemic and friable. Softening and rupture of the flexor tendons may always follow plantar neurectomy, but are commonest when the operation has been performed for navicular disease, appearing due in part to extension of the disease, in part to trophic changes produced by the operation. Among French authors, Renault, Beugnot, and Rabouille were the first to note this. In two cases operated on by Rabouille, rupture of the tendons ended in the fetlock and the bulbs of the heel coming in con- tact with the ground, the digit from the fetlock downwards lying horizontally. In both cases the tendons showed trophic changes in the phalangeal region, and the perforans was completely ruptured close to its insertion into the pedal bone. Bouley, Goubaux, MM. Jacoulet, MoUereau, and many others have seen similar cases, but, I repeat, these lesions occur where neurectomy has been performed for navicular disease, and if the operation has favoured their development it is not entirely responsible for their occurrence. The course taken by injuries affecting a neurectomised foot varies. Bouley states that under the influence of the cerebro-spinal system, "healing inflammation" proceeds normally in the parts affected by neurectomy. This, however, is not always the case. You recently saw a horse, unnerved for a large external sidebone, afterwards develop a quittor on the inner surface. In treating the quittor the lateral cartilage was removed, and the subsequent traumatic inflammation showed very special characters. The wound became indolent and healed very slowly, while the coronet and pastern increased enormously in size ; severe lameness continued, and the animal became useless. The cases I have just mentioned, together with others published abroad and certain collected by human surgeons, show that if removal of nervous influence does not produce immediate and evident effects on the phenomena of nutrition, it may, in combination with other causes, like wounds, infections, etc., produce lesions of rapid or slow develop- ment, and of inflammatory, gangrenous, hypertrophic, or atrophic nature. No organ or tissue, in the region served by the divided nerve, is safe from these changes. They appear especially to affect the skin, Digitized by Microsoft® PLANTAR NEURECTOMY. gi connective tissue, bones, and articulations ; and if, up to the present, their pathology is incompletely understood, it is known that mechanical \'iolence does not appear necessary for their production. It has been shown that after section of nerves the specialised cells of the peripheral end undergo retrogressive changes ending in destruc- tion, and that regeneration occurs by a kind of branching of the fibres of the central end. This reconstitution of nerves explains the occasional return of lameness after operation, and the removal of this secondary lameness when neurectomy is again performed above the point first selected. Stanley related a case of this kind. Two years after the first treatment the horse went lame and he again operated, this time above the cicatrices left by the former intervention. As in the first instance, the animal became sound. But this regeneration, which occurs when only a short portion of the nerve has been removed, is always somewhat imperfect. The permanent good effects of neurectomy, and the delayed complications which it sometimes produces, are both referable to this incomplete regrowth. This view, better than any other, explains the lasting good effects of neurectomy. Success is due to the fact that sensation only returns to a modified extent in the tissues from which it has temporarily been removed. The pathogeny of the after complications, trophic or otherwise, is governed by the same cause. I conclude by reminding you that, on the whole, grave complica- tions after neurectom\' are not frequent, and that even taking them into account, the practical value of the operation remains indisputable. Plantar neurectomy has too often given good results to be condemned. Undoubtedly it is only a kind of ultima ratio, but before abandoning a case of lameness which has improved but little or not at all under other treatment this last resource should certainly be tried. Digitized by Microsoft® XV.— NEURECTOiMY OF THE MEDIAN AND OF THE ULNAR NERVES. At the present time we have in hospital a horse on which I have successively performed neurectomy of the median and of the ulnar nerve. To-day I intend to speak of this horse, and of the t\\'0 opera- tions to which we have been obliged to resort. A little more than a month ago — it was during the first days of May — M. H — , carman at Paris, brought a six-year-old horse for examination. It had long been lame on the off fore-leg. On examin- ing the lower parts of the leg I found chronic changes in the bones, joints, and tendons. This examination show-ed the existence of an old-standing strain of the flexor tendons, an indurated windgall, pha- langeal periostitis, and two sidebones, the inner a little larger than the outer. Furthermore, the fetlock was upright and had commenced to knuckle over. The tendon and coronet showed traces of penetrating firing. On examining the limb the tendons appeared slightl}- painful, especially at their upper part opposite the check ligament. The lameness, \\hich was quite distinct at a walk, was ver^- marked at a trot. M. H — , in bringing his horse, thought that we would again fire the tendon and the ringbones. I assured him that firing would be of no benefit. It could certainly not cure all these chronic changes, nor produce sufficiently marked effects to remove the lameness, but as the animal seemed worth it I proposed median neurectomy, and in your presence explained on what grounds I justified this method of treat- ment, which was accepted. On the 6th May, after having applied thin-heeled shoes to the fore- feet (the heels of which were contracted), I performed median neurec- tomy by the usual method. The animal was cast on the right side, and the near fore-foot secured to the canon-bone of the corresponding hind limb. The hobbles being drawn back, a strip of webbing was applied to the canon-bone of the off fore-leg, which was released from the hobbles and drawn forward into a position of full extension, in which it was secured by two assistants holding the webbing. In this way the Digitized by Microsoft® NEURECTOMY OF THE MEDIAN AND OF THE ULNAR NKRVES. 93 inner surface of the limb is well uncovered, and by kneeling in front of the chest, near the neck, the operator can proceed in comfort and entire safety. [The operation of median neurectomy is as"follo\vs. The median nerve is readily discovered on the inner surface of the forearm, running obliquely downwards and slightly backwards just behind a ridge on the head of the radius, into which is inserted the internal lateral ligament of the elbow. It crosses the posterior radial artery at a very acute angle, and passes with it towards the posterior surface of the radius. The posterior radial vein (or veins) is situated in front of the nerve. The operation is performed opposite the lower portion of the elbow-joint, or immediately behind the upper extremity of the radius towards the upper point in the depression between the radius and the flexor muscles of the fore-limb. The skin having been shaven and disinfected, an incision about an inch in length is made, ti'aversing successively the skin, subcutaneous connective tissue, and the prolongation of the posterior superficial pectoral muscle. Towards the lower angle of the wound the fascia of the forearm is slightly incised, a grooved director passed under it and pushed upwards, parallel with the nerve. By passing the bistoury along the groove the fascia is then laid open. Another method consists in using a probe-pointed bistoury. Certain operators even go so far as to snip away with scissors an elliptical fragment of fascia on either side, thus more freely uncovering the nerve. The skin wound is then held open with retractors. The next step in operation consists in dissecting free the nerve (sometimes a rather tiresome process), and raising the nerve on a grooved director or tenaculum. The nerve is cut through as high up as possible, and again near the lower limit of the wound, a piece about three quarters of an inch in length being removed. The operation is concluded by wiping the wound dry, dusting with iodoform, suturing the skin, and applying a little iodoform collodion or similar dressing. — Jno. A. W. D.J When the incision is skilfully made at the proper point, and the antibrachial aponeurosis opened, the nerve often appears immediately as a flattened whitish cord, which has a tendency to become thrust forward and to protrude between the lips of the incision in the apo- neurosis. This occurred in our horse. The operation only lasted a few minutes. When the nerve does not appear, it is usually sufficient to slightly alter the position of the limb in order to bring it under the Digitized by Microsoft® 94 CLINICAL VETERINARY MEDICINE AND SURGERY. incision ; for this purpose the assistants have only to increase or diminish the pull on the limb. You know that in certain animals operation is rendered dii^icult by an abnormal arrangement of the radial veins, but this is rare. I return to our patient. After excising about .three quarters of an inch of the nevxe I placed a fragment of gauze in the wound to act as a drainage-tube, and over it I united the skin with a couple of sutures. On rising the horse appeai-ed a little less lame than before operation. Next day the sutures were cut, the gauze removed, and the parts treated with anti- septic lotions like an open wound. Healing occurred towards the end of the second week. Unfortunately the result was bad. Lameness was still too marked for the horse to work. Peters, and after him others, showed that division of the median nerve alone may remove lameness resulting from bilateral lesions, — that is to say, occupying both sides of one of the lower parts of the leg, or encircling these regions. The results are explained b)- the pre- ponderating, influence of the median nerve in the innervation of struc- tures below the knee, a preponderance due to the fact that at a \-ariable point in the forearm the nerve terminates by dividing into two branches, one of which is continued as the internal plantar nerve, while the other joins the ulnar at the upper border of the pisiform bone, beneath the tendon of the middle flexor, and is continued as the external plantar nerve. In hospital you have seen horses with various chronic affections, like strained tendons, splints, cartilaginous ringbones, and periostitis of the phalanges, in ^\'hich lameness has been removed, or certain!}- dimin- ished, by dividing the median nerve. But others occur in which section of the nerve fails to remove lame- ness caused by lesions on the outer side of the limb, or at times even on the inner. The persistence of pain and lameness in the latter case is explained by the existence of recurrent fibres. Under such circum- stances, ulnar neurectomy, first practised by Vennerholm, often proves useful. As, in our patient, severe lameness continued after radial neurectomy, division of the ulnar was resorted to. Throughout the whole extent of the forearm the ulnar cutaneous nerve, accompanied by the ulnar artery and vein, is situate between the oblique and external flexors of the metacarpus, and immediately under the fascia uniting them. By palpation with the finger tips the muscular interspace which fixes the line of operation is readily dis- covered. Digitized by Microsoft® NEURECTOMY OF THE MEDIAN AND OF THE ULNAR NERVES. 95 In performing this operation the horse is cast on the sound side. The affected Hmb is left in the hobbles, but drawn tense by means of two strips of webbing, one fixed on the upper portion of the canon- bone being pulled backwards, the other, attached to the coronet, in a forward direction. Two assistants, holding the free ends, keep the parts steady. The operator kneels in front of the upper part of the forearm ; the point selected is four to six inches above the knee. The parts having been prepared, my colleague M. Aim)- made, at the point just indicated, an incision about one inch and a quarter to ^VH, Figs, ii and 12. — Neurectomy of the ulnar nerve. F E, flexor metacarpi externus ; F O, flexor metacarpi obliquus ; N, ulnar nerve ; A V, ulnar artery and nerve. one inch and a half long through the skin. He then divided the sub- cutaneous connective tissue, the antibrachial aponeurosis, and the fascia which unites the aponeurotic covering of the two muscles. With forceps and bistoury he dissected away the connective tissue surrounding the nerve, following the direction of the wound, and care- fully avoiding injury to the ulnar artery and vein which accompany the nerve. Having isolated the nerve, he divided it at the upper angle of the wound, and excised a fragment about one inch and a quarter in length. Digitized by Microsoft® 96 CLINICAL VETERINARY MEDICINE AND SURGERY. The wound was cleansed and the skin brought together with three small sutures. The results of this second operation were satisfactory. On rising the horse no longer walked lame. The wound healed by first intention. At the present moment the animal is exercised night and morning. At a trot it only shows trifling lameness, and as it is used for heavy draught it will soon be able to return to work. I shall recommend the owner to keep careful watch over the con- dition of the foot and of lower parts of the limb. We must bear in mind the possibility of trophic changes and of sloughing, which I referred to when treating of plantar neurectomy. You will not often see this double neurectomj- performed. Even neurectomy of the median alone often has serious drawbacks. It should be reserved, as I have already said, for old-standing chronic affections of the fore-limb, and — particularly in dealing with valuable animals — should not be tried until all other methods of treatment, especially firing, have proved unsuccessful. I do not agree with the advice of the'savant who recommended it for all cases of strained tendon uncured at the end of six weeks. That would have ended in a perfect debauch of neurectomy. Digitized by Microsoft® XVI.— LYMPHANGITIS AND MULTIPLE ABSCESSES IN THE HORSE, DUE TO THE PRESENCE OF STAPHYLOCOCCI. In explaining to you tiie modern doctrine of suppuration, I stated that all suppuration seen in our patients is the work of certain mi- crobes, chief amongst which are the Staphylococcus albm and auyeus and the streptococci — other varieties occurring much less frequently. The microbes enter the tissues by many paths, the commonest being cutaneous or mucous wounds. Very trifling abrasions, often con- cealed by the hair and practicalh' imperceptible, may serve as points of entry. Sometimes they simply produce a local abscess, at others they enter the lymph channels, causing lymphangitis or abscess forma- tion in neighbouring or far-removed lymphatic glands, according to the condition of the lymph channels. Occasionally they enter the circulation, are swept along by the blood, and give rise to varying mischief, according to their degree of virulence. In this way strepto- cocci and staphylococci produce the metastatic abscesses of pyaemia, and the microbe of strangles induces the majority of abscesses seen during the course of this disease. In my part of the hospital you have seen two horses in which staphylococci have thus caused abscesses in different parts. Some months ago a seven-year-old Percheron horse, in which I had removed the lateral cartilage of the off fore-foot on account of quittor, showed four days after operation very marked swelling of the limb, especially pronounced below the knee — a swelling which ex- tended to the forearm, and caused me to fear the existence of deep- seated abscess in this region. All danger of immediate complications was however removed by the use of warm antiseptic baths, followed by iodoform dressings ; the operation wound healed steadily, swelling of the limb at the same time diminishing. The lymphangitis had completely disappeared when a fortnight latfer we discovered a number of small abscesses scattered about the neck, sides, and limbs. Of what nature were these abscesses ? a Digitized by Microsoft® gS CLIXICAL VETERINARY .MEDICINE AND SURGERY. Although there was no chnical sign pointing to farcy the animal was injected with mallein. The result was as I had foreseen ; no local reaction followed, and the temperature rose only half a degree. I had collected with the usual precautions some pus for bacteriological examination and cultivations. The microscope revealed a few staphy- lococci, and the tubes of gelatine which we sowed gave a pure culture of the Staphylococcus albns. Treated by injections of dilute sublimate solution the abscesses rapidly healed. No others formed. The animal's general health was excellent, and to explain the production of these multiple abscesses I see no other possible hypothesis than infection of the blood bj' some pyogenic microbe which had multiplied in the wound in the foot and given rise to the Ij-mphangitis. Against that may be urged the time which elapsed between the acute phase of the lymph- angitis and the appearance of the abscesses, but well-established facts show that secondar\- suppurative lesions may occur after a much longer time. Many other microbes besides staphylococci may cause disturbance after remaining dormant for weeks, months, or even }-ears. The second case is not less interesting than the first, and shows like it that the Staphylococcus albns may be the sole cause of secondary abscesses developing far from the primar}- centre. A fifteen-year-old Percheron mare suffering from circumscribed gangrenous inflammation on the near fore-pastern was received into hospital on the 6th December, 1895. The eschar was removed, and the wound appeared about to heal when diffuse lymphangitis extended throughout the limb, the swelling became enormous, sensibility excessive, and interference with movement \'eT:y marked. The first abscess formed on the inner surface of the knee, and opened spontaneously. During the next few days the wound on the pastern presented a less fa\-ourable appearance ; it dis- charged freeh' : its margins were swollen and painful. The swelling next in\'aded the upper portions of the limb, extending as high as the shoulder. Soon afterwards the hair was shed o\-er a line extending from the wound on the knee. On this line, which corresponded to the course of the inflamed Ij-mphatics, five subcutaneous abscesses deve- loped, and were opened in succession. Close to the point of the shoulder was a circular swelling, denuded of hair, and measuring an inch or more in diameter, produced by another superficial abscess. The wound on the knee, circular in form, and as large as a florin, became covered with firm healthy-looking granulations. Its margins projected slightl}- above the surrounding skin, and its centre showed a Digitized by Microsoft® LViMPHAN(;iTIS AND MULTIPLE AI;StKSSK.> IN THE HORSE. 99 sinus which communicated with a subcutaneous conduit exactly corre- sponding with the depilated line above mentioned. It discharged whitish, thin, slightl)- \-iscous pus, similar in character to that always formed in lymphatic vessels or glands. The lower parts of the limb showed relatively little oedematous swelling. The wound on the pastern was about two and a half to two and three quarter inches long, and half an inch across. These wounds had no resemblance to ulcers, and neither they nor the l3?mphatic vessels were surrounded bj- much induration. The animal had not suffered from an\' disease for years, and its general condition was excellent. For the purpose of bacteriological examination I punctured an abscess on the inner surface of the forearm, and with a sterilised pipette collected a little pus, which I sowed on gelatine and potato. At the temperature of the lecture room colonies of Staphylococcus albiis developed. The clinical course of these lesions differed from those usually seen in glanders. An injection of mallein produced a very trifling reaction. After puncturing the abscesses treatment consisted in antiseptic injec- tions into the sinus. On the i5th December the swelling and wounds on the near fore-limb still showed the same characters. On the i8th we discovered on the outside of the right thigh, a little behind and above the patella, a hot, sensitive oedematous swelling, the centre of which showed fluctuation. It was punctured aseptically, and some pus collected for cultivation. The cultures gave colonies of the same staphylococcus. The animal received daily in its food one and a half ounces of bicarbonate of soda in the morning, and two and a half drachms of sulphate of quinine at night. On the 20th December a warm, painful swelling was noted in the region of the extensor muscles of the right forearm, suggesting the formation of an abscess. Next day oedematous enlargement appeared below the elbow, examination of which revealed the presence of fluctuation in the depths. The abscess was punctured and some of the pus sown on gelatine and potato. The Staphylococcus albns was again found to be the only micro-organism present. Finally, eight days later, a fresh suppurating centre, also produced by the same microbe, formed on the right side of the neck. The wounds having healed and the lymphangitis disappeared, the horse returned to ordinary work. It has not since been seen ; but some months later we were told that it had not developed any further abscesses. Its system, therefore, appeared to have become entirely free from staphylococci. Digitized by Microsoft® XVII.— EXTERNAL TUBERCULOSIS IN THE DOG AND CAT. You know that tuberculous dogs may eject material containing bacilli by the nose, anus, and urethra. To-day I purpose showing you that some also distribute the virus by external lesions, the specific character of which has been overlooked, lesions which may persist for a long time, and discharge pus rich in bacilli. I shall take as my subject tuberculous wounds and sinuses. The region of the neck is that most commonly affected. I have seen wounds of this kind in fourteen patients ; in twelve they were situated at varying points on the anterior margin of the neck ; in one the thoracic wall showed a sinus, and in the last the wound was close to a joint. To show you the danger of such lesions conveying the disease, I shall briefly describe three cases from among those which I have investigated. On the 2ist May, 1895, a two-year-old poodle, belonging to M. V — , Avenue du Maine, Paris, was brought for examination. At the beginning of March, in the same year, this dog had had an abscess at the upper part of the neck. The wound, produced by puncture, instead of healing had become ulcerous, and the animal had lost flesh to a marked degree. When I examined the patient the front of the neck displayed a large ulcer with thin margins, separated from the skin to a consider- able extent, bathed in greyish pus, and with a granular base, pene- trated by a number of sinuses running toward the larynx and origin of the trachea. The animal's thin condition and the appearance of the wound immediately suggested tuberculosis. Bacteriological examina- tion of the pus revealed numerous bacilli. This poodle lived in the suite of rooms occupied by its owners. The lesion in the neck having been regarded as a simple wound had been unsuccessfully treated for two months with all kinds of applications, and had even been sutured. Digitized by Microsoft® EXTERNAL TUBERCULOSIS IN THE DOG AND CAT, Fig. 13. — Tuberculous ulcer in the throat. Fig. 14. — Tuberculous ulcer in the neck. Digitized by Microsoft® 102 CLINICAL VETERINARY MEDICINE AND SURGERY. On the 23rd July, 1895, a small bitch belonging to M. L — , Rue de Charenton, Paris, \\as brougl t for examination. For about six weeks this bitch had shown, nearly over the centre line of the front of the neck, two sinuous wounds. During the journey from Paris to Alfort the child who brought it had bandaged the animal's neck ^^•ith her handkerchief, and in our presence she wiped away the pus running from the wounds with this same handkerchief. The appearance of the wounds, the thinness of the patient, and the dyspnoea, awakened suspicion of tuberculosis. I made cover-glass pre- parations \s'ith the pus ; all contained bacilli. This animal was left, and kept in the stable belonging to the surgical clinique. Five months later it died from generalised tuberculosis. The sinuses never healed. On the i6th May last, M. H— , living in the Rue St. Martin, Paris, brought us a four-year-old dog, which had suffered for three months from an ulcerous wound one and a quarter inches in length and three quarters of an inch in width about the middle of the neck. The margins were separated from the skin, eroded, and covered with crusts and blood-stained pus. Four inches below this lesion was a slender sinus masked by the agglutinated hair. As in the cases just mentioned, pus from these lesions was found to contain large numbers of bacilli. Until the day it was brought to Alfort this dog lived in a corner of the single room inhabited by M- M — , his wife, and their child. These tuberculous wounds of the neck are of lymphatic origin. Only one case had been published pre^■ious to my researches, and the author, Miiller of Dresden, regarded the case as of primary cutaneous origin. I have been able to follow the development in several subjects. It is similar to that of tuberculous suppurating adenitis in man, and exhibits three principal stages: (i) Glandular disease; (2) Abscess formation in, or around a lymphatic gland ; {3) Ulceration of the skin. When a lesion of this kind is fully developed, or has existed for some weeks, it usually presents the following appearance : A circular, oval, or irregular wound, the margins of which are denuded of hair, torn or thinned, and separated from the subjacent tissues; with reddish, uneven base covered with indolent granulations, or dotted over with jellowish points, from which sinuous tracts lead towards the trachea, or along the line of adjacent vessels. The wound discharges greyish or blood-stained pus, always purulent, and sometimes rich in bacilli. Their true nature not being recognised, these lesions are treated like simple wounds ; the}- continue to suppurate. In certain patients Digitized by Microsoft® EXTERNAL TUBERCULOSIS IN THE DOG AND CAT. I03 the cutaneous ulcer contracts ; in others it gradually increases. Abscesses sometimes develop in the neighbourhood and open externally, producing small wounds, which may unite with the first ; sometimes the skin becomes separated from subjacent structures oxer a large area, and is rapidly riddled with ulcers. The muscular and connective tissues traversed by the sinuses are inflamed, hardened, and fused together. On dissection granulations and caseous tubercles are found. The retro-pharyngeal and cervical lymphatic glands are always affected ; either they are hypertrophied, inflamed, and on section appear dotted over with yellowish points formed by the granulations, or they appear as little swellings the size of a haricot bean or a hazel nut, with softened purulent centres. I 'ha^'e twice seen the cervical glands connected by knotted lymphatic vessels with the tracheo-bronchial lymphatic glands. The mucous membranes in the domain of the affected Ij-mphatics rarely show specific lesions. I have onh' seen three such. One showed tuberculous ulceration of the left tonsil ; another, a submucous tubercle in the pharynx ; and the third, ulceration of the mucous membrane of the larynx. Despite the very rare occurrence of lesions indicating the point of entrance of bacilli, these tuberculous ulcers of the neck result from auto-inoculation of the pharyngeal, laryngeal, or nasal mucous mem- branes, by purulent products formed in the lung and coughed into the pharynx or posterior nasal cavities. Of the above-mentioned twehe patients showing tuberculous ulcer of the neck ten had ^•ery marked disease of the lungs, which were partially destroyed by the formation of cavernous spaces. Pharjngeal catarrh is known to be fairly common in the dog. Under these circumstances auto-inoculation occurs readily. The mucous membrane, whether normal or deprived of its epithelium, when covered with \-irulent muco-pus is penetrated by the bacilli, which afterwards extend to the neighbouring l\-mphatic glands. Pres- sure of the collar causes inflammation of the infected glands, favours suppuration of the surrounding tissues, and ulceration of the skin. This is the true pathogeny of tuberculous ulcers in the dog's neck. Subcutaneous or open tuberculous lesions are also seen in the cat. In addition to the three cases of this nature mentioned I may cite the two following : At the beginning of April, 1895, a seven-year-old female cat was brought to the clinique. It had been ill for some time, and already showed marked wasting. The owner had particularly noted difficulty in breathing, attacks of coughing, and at certain times a little nasal Digitized by Microsoft® I04 CLINICAL VETERINAKV MEDICINE AND SURGERY. discharge. Although the appetite was sometimes capricious, the animal usuall}' ate the greater part of its food. It belonged to a woman who had long suffered from chronic cough, which she regarded as asthmatic, though to a better-informed person she clearlj- had the appearance of a consumptive. About six weeks before a suppurating -wound had been noticed at the upper part of the cat's neck. Situated near the origin of the trachea, this wound was circular in form, hardly two lines in diameter, and had thin separated edges. It communicated with a long sinuous track, ending on the left surface of the trachea. It discharged Fig. 15. — Tuberculous ulcer of the nose. a gre3-ish pus, in which bacilli were discovered on bacteriological exami- nation. I was unable to prevail on the owner to lea\-e this cat, and it was never brought back again. A 3'ear later, in 1896, a three-year-old cat was brought for examina- tion \\hilst still in good health. For five or six months it had suffered from an ulcerous ^\■ound of the nose and face. I kept this patient in hospital for some time. The wound was rounded in form, occupied the entire dorsal region of the nose and a por- tion of the face and forehead, and measured nearly an inch and a half in diameter. Its margins were indurated and excavated perpendicularly. Digitized by Microsoft® EXTERNAL TUBERCULOSIS IN THE UOG AND CAT. 105. Its base was greyish, fairly level, and presented the general appearance of an ulcerated cancer. Yellowish granulations, howe\-er, appeared at points ; and around its outer edge, beneath the separated skin, caseous material could be seen. Greyish pus ran from the nostrils, which were soiled and co\ered with crusts. Both submaxillar)- lymphatic glands were slightly enlarged. The lesion was, therefore, of tuberculous character, and ver)- virulent. The nasal discharge, pus, and caseous material from the wound contained considerable numbers of bacilli. On post-mortem examination we found disease of the precsecal mesenteric glands, which were as large as a hazel nut, hard, gritty on section, and showed caseous, and even chalky, points. The li\-er also^ presented some tubercles. The lungs contained numerous caseous centres ; the tracheo-bronchial, retro-pharyngeal, and submaxillary glands were diseased. The ulcer on the nose had not onlj- destro3'ed the soft tissues, but had invaded the subjacent bone, which was soft and friable, eroded in places, and infiltrated with caseous material. The upper wall of the nasal ca-\'ities was, however, onh- pierced at one point, between the nasal and superior maxillary bones, mid\\-a3' between the eye and base of the nose, whence communication existed with the left nasal cavit}- by an orifice which had escaped notice during life. For a distance of about three eighths of an inch around the ulcer, the skin and sub- cutaneous connective tissue showed on section yellowish points de- noting softened tubercles. In the thickness of the end of the nose similar lesions were found. Close to the perforation, and particularlj' over the turbinated bones, the pituitary membrane was thickened, ulcerated in places, and covered with fine tuberculous granules ; thick- ening of the mucous membrane was specially marked towards the opening of the nostrils, ^\•hich it partiall}- blocked. Ulceration of the tissues of the nose \\as probabl}' secondary ; a centre having first formed on the pituitar}- membrane, extended to the turbinated bones, thence to the lower portion of the nasal bones, and lastly to the skin. The process would be favoured by rubbing or scratching the parts. It is also possible that the skin may have been directly inoculated by the action of the paws. Digitized by Microsoft® XVIII.— A CASE OF SARCOMATOUS DISEASE. During the past month vou have had opportunities of following in hospital the progress of a rare form of sarcomatous disease in the horse, distinguished by its clinical characters from the varieties hitherto ■described in animals. In our patient development of the disease was indicated by the appearance of numerous tumours of varying size in the subcutaneous connective tissue and muscular interstices, without the skin or l}-mphatic glands being invaded, as is the rule in sarcoma, and, until the last few days at least, without grave symptoms pointing to the existence of visceral new growths having occurred. Sarcomata ha\-e a marked preference for the connective tissue. The\' may occur wherever this tissue exists, i.e. in all organs. The majority ha\e a well-marked tendency to generalisation. This process, which occurs by the venous channels, is often very irregular. Secon- dary tumours sometimes de\elop in large numbers in almost all the viscera ; sometimes they are comparatively rare. The lung is most frequently invaded when infection is general, and usually shows the greatest number of growths. Cases occur, however, where sarcomata appear to extend s\'stematicall3', affecting almost exclusively the bones, skin, or subcutaneous connective tissue, and producing particular varieties of disease, distinguished by special clinical and anatomical pathological characters. Thirty years ago Kaposi described, under the name of cutaneous sarcoma, a human disease characterised by circumscribed swellings of the skin, raised patches, and flattened, isolated, or confluent swellings, the structure of which was that of sarcoma. A similar affection occurs in animals. AI. Trasbot described it in the article on Sarcoma in the Didionuairc dc Mcdccinc I'ctcrinaire, under the title " Varietes Ver- ruqueuses.'' In solipeds, says M. Trasbot, this \ariety is confined to surfaces where the skin is fine — around the e^-es, nose, mouth, ears, sheath, and mammary gland, and on the inner surfaces of the limbs; sometimes it invades the abdominal, thoracic, and inferior cervical regions. The tumours may assume one of two forms, appearing either as warts adherent to and projecting, more or less, above the surface of the skin, or as globular masses lodged in the subcutaneous connective Digitized by Microsoft® A CASK OF SARCOMATOUS DISEASE. I07 tissue ; both forms, however, are always associated in the same subject. The tissue of these new growths is pale grey, without marbling, is firmer and denser than that of other sarcomata, and is composed ex- clusively of fusiform cells. Round-cells never occur. Such were not the clinical or anatomical features of the disease in ■our patient. The skin was altogether unaffected ; the tumours were dispersed throughout the subcutaneous and intra-muscular connective tissue ; only a few adhered to the skin, and even they did not penetrate it. Moreover post-morteiii examination showed much more extensive visceral lesions than we had anticipated. The visceral lesions pre- ceded those in the subcutaneous connective tissue, but we were unable to make out any close connection between the subcutaneous and the visceral tumours from the point of view of their origin. No vascular lesions existed to explain the geneialisation. The patient died at the commencement of the sixth week after admission to hospital. I wish to remind you of its history. The report of the post-mortem examination leaves no room for wonder at the animal's death. A Dutch gelding, about twelve years old, in fairly good condition. Sent to the College on account of subcutaneous swellings in different regions. The largest was situated on the right side of the chest, •opposite the fourth, fifth, and sixth ribs, a little above the line of the elbow. Hemispherical in form, it measured nearly six inches in diameter. Another of about the same size lay immediately in front of the cervical angle of the scapula. A third, as large as a fowl's egg> was noted about halfway up the left side of the chest, opposite the sixth rib. At the lowest part of the same side of the chest, opposite the twelfth rib, was a nodule the size of a nut. On the left side again, over the thirteenth rib, was a tumour as large as a pigeon's egg. All were practically of the same character, being firm, slightly elastic, painless, sharply defined, moveable under the skin and over the sub- jacent parts, or in cases slightly adherent to the latter. The temperature, respiration, and circulation were normal. The urine showed considerable sediment, consisting largely of carbonate and phosphate of lime, but contained no albumen, sugar, or bile pig- ments. There was no change in the proportion of urea. The blood was normal. The number of blood-corpuscles was found to be as follows : Red corpuscles . . ■ 5>6o2,875 per cubic millimetre. White corpuscles . . 5864 ,. >> Proportion . . . . i to 955. Digitized by Microsoft® I08 CLINICAL VETERINARY MEDICINE AND SURGERY. This horse was sent to us by a colleague, who regarded it as suffer- ing from " cold abscesses." But subcutaneous cold abscesses are less sharply defined than were the tumours ; they grow more rapidly, are adherent to the skin, and pressure on them produces pain ; finally,, they are usually found in parts covered by the harness. Exploratory puncture through the centre of the two largest swellings gave a nega- tive result. We began to consider whether the case was one of tuberculosis. There was no enlargement of the glands at the entrance of the chest, in the groin, or under the lumbar vertebrae. On the supposition of tuberculosis some at least of these swellings should have been accom- panied by lymphangitis and by specific inflammation of lymphatic glands, as in the case of which I recently spoke. We cleared up this question, however, by testing with tuberculin, by bacteriological examination, and by inoculation. One of the tumours was remo-\'ed from the right side of the chest. It was flattened, circular in form, and its tissue greyish-white, and slightly firm. Microscopic examination showed it to be entirely formed of round-cells, with large nuclei. It contained neither tuber- culous centres nor giant-cells ; and bacteriological examination pro- duced no bacilli. An emulsion formed by crushing a fragment of the tumour in a little sterilised water was injected into the peritoneum of two guinea-pigs. The day afterwards 30 centigrammes of tuberculin were injected on the right side of the horse's neck. This was followed by no appreciable reaction, no fever, no rise in pulse-rate, etc., nothing except a very trifling swelling. We then inferred the new growths to. be sarcomatous in character. I may here add, to avoid having afterwards to return to the ques- tion, that the result of inoculation was negative. When killed at the end of five weeks neither guinea-pig showed any tuberculous or sarco- matous lesion whatever on post-mortem examination. There was no hope of removing the tumours. I prescribed 2 drachms potassium iodide, and at a later stage 15 grains of arsenious- acid daily. No tangible improvement occurred. I now return to the clinical history. Some days after the horse entered hospital new tumours appeared in different regions, and others successively followed. At a trot the animal's breathing at once became laboured. The horse was unable to work, and as the number and size of the tumours- increased it progressively became weaker. During the first week the general condition showed little change ;. Digitized by Microsoft® A CASE OF SARCOMATOUS DISKASE. I09 the temperature never rose above 38-4° C. (ioi-i° F.). The patient only ate a part of its food, and was usually dull and sleepy. The respiration was short, and tended to become more rapid. A week later a fresh examination gave the following results : General condition worse ; muscular wasting more marked ; the bones appeared more prominent ; the coat stared ; the lower portions of the limb were swollen ; the heart's action was rapid and strong ; temperature 38-6° C. (101-4° F.) ; pulse 80; respirations 30. Nearly fifty tumours were counted ; all the old ones had increased in size, and a number of new tumours were scattered throughout various regions. We noted — On the left side of the body, behind the shoulder and about the middle line of the ribs, two new growths the size of a large hen's egg ; immediately beneath the skin three smaller flattened tumours ; one behind the acromion process ; another in the precordial region ; a third under the girth, near the median line ; nine tumours the size of a shilling to that of a five-shilling-piece formed a string along the hypochondriac region ; over the thin part of the flank were four similar tumours ; in the inguinal region, especially along the upper border of the internal surface of the thigh, was a chain of tumours, some the size of a pigeon's egg ; a large number of nodules were scattered through- out the connective tissue. On the right side were a few small tumours around the large growth in front of the scapula ; along the hypochondriac region a dozen flat- tened tumours, arranged in a string ; in the thin part of the flank, six inches below the angle of the haunch, a tumour the size of a pigeon's egg; in the groin and inner surface of the thigh numerous hard, isolated, or agglomerated nodules ; immediately below the inguinal ring a tumour, difficult to examine, on account of its deep-seated position, but which appeared large in size. On the inner surface of the left forearm a subcutaneous tumour as large as a two-shilhng piece ; nothing on the right limb ; nothing about the head or upper two thirds of the neck. There was no enlargement of the sublumbar lymphatic glands. Rectal exploration only revealed the presence of a tumour the size of a hen's egg on the anterior margin of the left ilium at the height of the ilio-pectineal crest. The temperature was only a few tenths above normal ; the heart's action was rapid and tumultuous, the first sound being strong, the second replaced by a diastolic murmur. One morning a few days after this examination, when the patient seemed in the same condition as on the preceding days, and had taken Digitized by Microsoft® no CLINICAL VETERINARY MEDICINE AND SURGERY. a part of its food, the condition suddenl}' became aggravated. The horse was found stretched on the ground, the face drawn, the respira- tion very rapid, dyspnoea marked, and the mucous membrane cyanotic. It rose with much difficuUy, but almost immediately fell again, and struggled violently. The dyspnoea became more and more marked ; the animal broke out in perspiration ; the limbs became cold ; and death followed. Autopsy. — Lesions of asphyxia ; mucous membranes cyanotic; mus- cular tissues deep red in colour ; the capillaries of the subcutaneous cellular tissue engorged with blackish liquid blood, which turned red and coagulated rapidly on contact with air ; viscera congested ; patches of ecchymosis in the lungs, cavities of the heart, and under the endo- cardium. The new growth was more generalised than had been suspected during life. Tumours existed in very large numbers. Some were globular ; the greater number flattened ; a few thinner at the centre than at the periphery. Their dimensions varied between those of a pea and of a child's head. All were sharply circumscribed; all developed in the connective tissue — the majority in the subcutaneous connective tissue, — some under the serous membranes, and in the muscular inter- stices. Sections through muscles failed to reveal any in the muscular tissue itself. The majority of these tumours, especially those of small size, or recent formation, had produced no change in the surrounding tissues Others had caused inflammation as indicated by sclerosis, or the formation of a fibrous limiting membrane ; others, again, were sur- rounded by a gelatinous yellowish or blood-stained exudate. Their physical characters and structure varied according to their age. The smaller, or more recent, were soft and friable, formed of a homo- geneous whitish tissue ; others, of larger size and firmer consistence, were greyish towards the centre ; in the largest, three concentric zones could be distinguished— an external friable zone, light in colour, resembling in structure the recent tumours ; a middle, greyish ; finally, a central, light yellow in colour and irregularly defined, formed by broken-down tissue. The superficial layers of many of these new growths showed fine ecchymoses. In the left hind leg, between the muscular portion of the short adductor, the pectineus and the adductors of the thigh, was a tumour weighing 3I lbs. ; above the right shoulder, under the cervical trapezius and the rhomboideus, another, weighing 25^ oz. ; behind this shoulder, between the great serratus and great dorsal muscle, still another, more than 21 oz. in weight. We counted fifty between the muscles of the right arm and the Digitized by Microsoft® A CASE OF SARCOMATOUS llISKASE. Ill great serratus muscle ; thirty below the left shoulder. They were very numerous in the pectoral, abdominal, and costal muscles. On opening the abdomen we were struck by the abundance of fat still remaining in the lumbar region, around the kidneys, and in the pelvis. We only found one tumour there, that which had been recog- nised by rectal exploration at the anterior margin of the ihum. There were none in the liver, spleen, kidne3-s, or bladder ; nor in the walls of the stomach or intestine. Dissection showed a few in the interstices of the psose muscles. The pleurae contained a little lemon-yellow liquid, but showed neither tumours nor granulations. The left lung only exhibited the ordinary lesions of hypostatic congestion. Sections through the centre of the right lung revealed four recent whitish, friable tumours, the size of a nut, but not surrounded by any congestive or inflam- matory zone. The pericardium contained a little lemon-yellow liquid. Both its layers were normal ; between the external and the mediastinum, dis- tributed in a layer of adipose tissue, were about twenty small flattened tumours. The heart showed remarkable lesions. The mj'ocardium appeared slightly h)-pertrophied, softened, and pale yellow in colour. All the valves were deformed by the presence of little flattened biconvex tumours, developed in their thickness ; the largest the size of a sixpence, the smallest of a pea. In general thej- were closer to the line of insertion than to the free margin ; the}- were especially thick in the aortic semilunar valves. The diastolic murmur noted during the last days of life had resulted from their interfering with the action of the valves. All were formed of a friable, gre3-ish-white tissue, punctated with fine hsemorrhagic spots. Finally, at the base of the heart was a large lesion, which explained both the fatal termination and its sudden character. Astride the bifurcation of the common aorta and closely in contact with both its branches was a large tumour, 8 inches in length, 5 in depth, and 2| in thickness, weighing 2 lbs. 10 oz., surrounded by a number of small satellite new growths, distributed in a layer of connective tissue enveloping the whole. This tumour, which had invaded the tunica adventitia of the aorta, was intimately adherent to the middle coat ; the parts could not be separated with a director ; it was necessary to use the bistoury. On section, however, the line of demarcation W3.s very clear, the new greyish-white tissue showing up distinctly against the yellow ground of the arterial wall. Like those abo\e mentioned, this tumour could be divided into three zones: a soft reddish tissue Digitized by Microsoft® 112 CLINICAL VETERINARY MEDICINE AND SURGERY. occupying the periphery, a denser greyish tissue the intermediate part, and yellowish irregularly-defined patches the centre. The two former zones were marked with numerous haemorrhagic points. The pneumo- gastric nerves were surrounded by the peripheral layer of this tumour. The submaxillary and tracheo-bronchial lymphatic glands were slightly enlarged, but not in consequence of sarcomatous growths. The sublumbar, inguinal, and prepectoral glands were healthy, despite the fact that lymph from highly infected regions passed through them. Nothing whatever in the nervous centres. Four days before death examination of the blood had shown a proportion of 4,562,750 red blood-corpuscles to I2,gi8 leucocytes per cubic millimetre, i. e. one white corpuscle to 353 red. Generalisation of the sarcomatous process had, therefore, been followed by marked leucocytosis. There, then, you have a very exact and detailed description of this peculiar case. I have said that to the naked eye and under the microscope these tumours showed the appearances of sarcomata ; but of what variety ? You know that four principal kinds are distinguished : (i) encephaloid or globo-cellular sarcoma, formed of round-cells with large nuclei and scanty protoplasm, interspersed with thin-walled embryonic blood- vessels ; (2) fasciculated or fuso-cellular sarcoma, formed of elongated fusiform cells and blood-vessels, resembling those just mentioned ; (3) myeloid sarcoma, a new growth affecting bony tissue, in which large multi-nucleated cells resembling the myeloplaxes of bone-marrow predominate ; (4) and finally, melanotic sarcoma, the tumour of white horses, in which the cells are full of grey or black pigment granules. The tumours in our patient did not belong to any of these varieties. They were formed of cells of unequal size, the majority rounded, but some irregular, and of vessels without clearly-defined walls. In addi- tion we detected a reticulum, varying in thickness according to the points examined and the age of the tumours. In recent tumours all the cells were round, while the reticulum was delicate and scanty, though quite clear in sections which had been carefully manipulated with a brush. In the larger, older, and there- fore harder tumours, a certain number of the cells were irregular or fusiform, and the reticulum more abundant, forming at certain points narrow interlacing bands. Their histological characters placed these tumours between the sarcomata and lymphadenomata ; they were lymphoid or lymphadenomatous sarcomata. Digitized by Microsoft® A CASE OF SARCOMATOUS DISKASE. II3 You must not, however, hastily conclude that all generalised or localised dermic or hypodermic tumours, whether distributed irregu- larly or systematically, are necessarily sarcomata. Tuberculosis may produce similar growths. I have given you an example. Other new growths may also behave in the same way. In the horse and dog several cases of fibromatosis have been reported. Some years ago I saw a bitch affected with numerous fibrous tumours in and below the skin, but confined exclusively to the ex- tremities. Some months before a few little tumours had appeared on the head and limbs, had increased in size, and been followed by others. At the first glance one's attention was attracted to an irregular flattened tumour the size of a five-shilling piece on the free portion of the right ear, the centre of which was excoriated and bleeding. The left ear, nose, cheek, tail, and all four limbs showed other new growths in the skin and subcutaneous tissue. On the limbs at least 100 could be counted. None were seen about the trunk or neck. Except that on the right ear, all the tumours exhibited nearly the same characters. They appeared as little flattened, rounded, firm, slightly prominent, insensitive patches. Sections were hard, white, and dry, no liquid exuding even on pressure. Under the microscope they showed the histological characters of fasciculated fibromata. Palpation, percussion, and auscultation revealed nothing abnormal in the abdominal and thoracic organs. The urine was albuminous. Examination of the blood showed it to be healthy. I kept this patient for a time. At first' it remained in good condi- tion, eating well, and not appearing to suffer in any way. Later it became dull, lost its appetite, had attacks of vomiting, suffered from diarrhoea, rapidly lost strength, and died in very thin condition. At the post-mortem examination we found cj'Stic degeneration of both kidneys ; there was no new growth in the viscera, or in the different tissues. The tumours were exclusively confined to the skin and connective tissue of the extremities, head, limbs, and tail. For several weeks both patients received iodine and arsenious preparations given alternately. No improvement followed. I have often tried these drugs in other animals — horses and dogs — affected with various new growths, and in several cases of lymphadenoma ; but always with the same want of success. Digitized by Microsoft® Digitized by Microsoft® PART II. MEDICAL PATHOLOGY AND PRACTICE. XIX.— ACUTE ENDOCARDITIS IN THE HORSE. For the past half-century acute inflammation of the endocardium in animals has been the subject of interesting researches, among which those of MM. Leblanc and Trasbot merit special mention. It is still generally regarded as a very rare affection, partly because it is fre- quently overlooked, partly because of the conditions under which it usually develops.* The published clinical records on this subject refer to various forms of the disease, such as primary endocarditis, traumatic endocarditis, and endocarditis a frigore, and secondary endocarditis, especially of rheumatic character. In the horse, as in other animals, primary endocarditis when occurring must be of exceptional rarity. I have never seen a case ; all that have come under my notice were ex- amples of acute secondary endocarditis, the majority in animals suffering with or convalescent from pneumonia. I will describe two cases. Last winter I had anopportunity of examining a case of pneumonia, in which the pulmonary disease was complicated with endocarditis. The history of the case is shortly as follows : One morning towards the end of January the animal left a portion of its first feed, and, although it was put to work, the coachman noticed that it was dull, appeared tired, and stopped from time to * In 1863, at the Central Society of Veterinary Medicine, Colin still disputed the occurrence of endocarditis and myocarditis in the horse. He declared he had never seen false membranes on the endocardium, nor valvular insufficiency. He referred the white patches formed by cicatricial tissue, which he had often seen in the horse, to partial ruptures of the muscular fibres. Digitized by Microsoft® Il6 CLINICAL VETERINARY MEDICINE AND SURGERY, time ; expiration was accompanied by a moaning sound. On returning to the stable it only took a little food and refused its corn. Next day these symptoms were supplemented by cough, and slight discharge from both nostrils. A veterinary surgeon who was called in diagnosed the case as one of commencing pneumonia, bled the animal to the extent of 8i pints, and prescribed tartar emetic and iodide of potassium. Up to the seventh day, although both lungs were attacked, no alarming symptoms appeared. Between the morning and evening of the eighth, however, the patient's condition became greatly aggravated. I examined it on the following afternoon. Both lungs gave signs of hepatisation ; and on auscultating the heart (the action of which was rapid and feeble) I noted a slight soft murmur during the second sound and the pause, a murmur indicating aortic insufficiency. The history of the animal left very little doubt as to the significance of this symptom. Nevertheless, with due reserve — because this murmur might have been due to a valvular lesion anterior to the pneumonia ; a not uncommon condition in hard-worked horses — with due reserve, I say, I declared that the endocardium was inflamed, and that the sudden aggravation in the animal's condition was caused in part at least by this complication. Some days later the animal died. At the post-mortem examination we found, in addition to numerous ■centres of pulmonary gangrene, lesions of acute endocarditis, which I now submit to you. On the upper surface of the mitral valves and lower surface of the aortic semilunar valves, principally towards their free margins, you will see little greyish vegetations ; some fairly firm, others soft and friable. You will also note that these valves are slightly injected and infiltrated, and that they show no old-standing lesion. Five years ago I saw a similar case, so far as concerns the stiology and localisation of the endocardial lesions. In this case also endocar- ditis of the aortic valves had occurred during the course of pneumonia. The animal recovered, and although final proof that the aortic valves were attacked could not be furnished, as in the first case, it was clearly established by the subsequent symptoms. The pneumonia ended in resolution ; but the endocarditis produced chronic lesions. After a short convalescence this horse returned to work. A year later I again examined him, when he was suffering from aortic insufficiency, clearly shown by a strong diastolic murmur. This valvular lesion neither disappeared nor diminished ; on the contrary, it ended by producing complications, of which I shall speak in a subsequent lecture. A fairly large number of cases of acute secondary mitral endocar- ditis have been published. You might read with profit those published Digitized by Microsoft® ACUTE ENDOCARDITIS IN THE HORSE. II7 by M. Trasbot in the Archives VeUrinaircs for the years 1878 and I Although the causation and pathology of acute endocarditis are complex, you may regard it as certain that the affection is always secondary, and produced by toxic infection ; and furthermore, that it is much more frequently due to pulmonary inflammation than has hitherto been admitted. The endocardium is known to be par- ticularly sensitive to the action of infectious processes, and to be easil}' injured by microbes and their toxins. In pneumonia, and especially in the contagious form, the lung is the seat of active microbic growth. Infectious agents passing into the still per\ious pulmonary vessels have but a short distance to traverse before reaching the heart, and we well know that they are capable of producing disturbance in ^'iscera much more distant from the lung. Suspended in the blood they neces- saril}- pass through the left heart ; they ma}^ adhere to the endocardium, appearing in such case specially to affect the irregularities, prominences, and folds in the serous coat, especially in that covering the valves, which, as we know, are the most common seat of the lesions of acute endocarditis. This localisation of the process on the valves is evidently due to incessantly repeated " quasi injuries," resulting from the heart's own action, the free edges of the auriculo-ventricular valves during systole, and of the semilunar valves during diastole being violently hurled backwards and forwards. This explains their vulner- ability at these points, and the readiness wiih which they become inoculated when bathed in infected blood. In addition to surgical infections, strangles, influenza, pneumo- enteritis resulting from bad fodder, glanders, and, in fact, all morbid conditions due to the presence of microbes in the lungs, may be accompanied by endocarditis. The blood may become infected through trifling lesions of the skin or mucous membrane — in fact the points of entry for pathogenic organisms are innumerable, and though sometimes easy to identify, are oftener undiscoverable. At the autopsy of an old horse, M. Blanc found ulcerative endo- carditis consecutive to inflammation of the biliary ducts. A less careful observer would have recorded this as primary in origin, or due to chill. It should be remarked that the lesions are usually locahsed in the left heart, even when the infectious agents enter the veins of the systemic circulation, and therefore first reach the right heart. This commoner affection of the left heart has been explained in various ways. Some consider it due to the more active function of this part of the organ, Digitized by Microsoft® Il8 CLINICAL VETERINARY MEDICINE AND SURGERY. and the more intense strain and rubbing to which the serous mem- brane is subject. Others declare that, as endocarditis is usually caused by aerobic microbes, the superior richness in oxygen of the left heart blood constitutes a predisposing factor. In the horse the pre- dominance of left endocarditis is probably a result of the frequence of pulmonary inflammation, during which the endocardium of the left side is particularly exposed to infection. Acute endocarditis may be produced by different microbes. In man, where the subject has been much better studied than in animals, the lesions most commonly contain micrococci, staphylo- and strepto- cocci, pneumococci, gonococci, and less commonly Eberth's bacillus, the Bacillus coli comumnis, and the Bacillus tuberculosis. MM. Gilbert and Lyon have noted a paracoli bacillus. Weichselbaum discovered a microbe never before seen in other diseases. The same species of microbes have been found in the principal anatomical forms of endo- carditis — the vegetating and the ulcerating. The characters of the lesions seem, then, to depend especially on the degree of virulence of the infectious agents. In addition to these, one sees so-called cryptogenic endocarditis, from which pathological agents have not yet been isolated. In endocarditis lesions in the horse Penberthy and Fuchs found micrococci. In a case of tuberculosis I detected the specific bacillus. Inflammation of the endocardium frequently complicates rheu- matism, and is due to the same cause as the arthritis, synovitis, pleurisy, and pericarditis. Apart, however, from the pseudo-rheu- matism which follows pneumonia, acute rheumatism is rare in the horse, and endocarditis arising from this cause is much less common than the forms of which I have just spoken. At the present day we are all agreed as to the extreme rarity of acute primary endocarditis — what has been called endocarditis a frigore. Cold alone can no more produce it than can an aseptic injury ; its action must be preceded, or accompanied, by some other pathological influence which plays the principal part, that is to say, the entrance of some microbe. Cold here acts as in pneumonia a frigore, by diminishing the resistance of the organism, thus favouring infection, the latent centres of which are numerous. Infection may occur through the uninjured membrane of the respiratory tract ; ex- periments seem to have established that various microbes can traverse the pulmonary epithelium without any preliminary lesion, and pass into the circulation by way of the lymphatic channels. It has been suggested that certain therapeutic or toxic materials, internally administered, are capable of producing acute inflammation Digitized by Microsoft® ACUTE ENDOCARDITIS IN THE HORSE. II9 of the endocardium. Digitalis was said to have this effect, especially when given in large doses, intermittently, and for a long time. It is quite certain that such substances can do no more than favour infection. Traumatic endocarditis, resulting from cardiac lesions produced by infected foreign bodies, is chiefly a laboratory disease. Endocarditis and myocarditis sometimes co-exist, and it has been sought to explain the former on the basis of extension to the serous membrane of inflammation of the heart muscle ; but, in most cases of this kind, the muscular and serous tissues are simultaneously attacked. Depending on its nature, and the species or virulence of the microbic agents which produce it, endocarditis may remain localised, soon lose its infectious character, become chronic, and only produce a few innocent fibrous lesions, being then described as benign (the form most commonly seen in the horse) ; or it may preserve its original infective, spreading character, when it is known as malignant endo- carditis. I need only rapidly recite the generally accepted symptomatology in order to convince you that this disease has been credited with effects for which it is in no way answerable, but which result from a general infection, of which the endocarditis is only an accompaniment. Pro- found depression, absolute loss of appetite, high fever, warmth of the skin, acceleration of the chief functions, dyspnoea, violent cardiac action, "purring tremor" (fremissement cataire), metallic heart sounds, sometimes irregularity of the heart, intermittencies, venous pulse, a murmur during the first or second sound ; at a later stage, paresis or paralysis, albuminuria, and icterus (produced by visceral emboli) ; finally, loss of strength and collapse ; such are said to be the principal symptoms produced by acute endocarditis, under the varying forms which it may assume. In point of fact the condition generally passes unperceived, masked by the symptoms of the accompanying disease. When it occurs as a primary affection the general symptoms scarcely differ from those accompanying many other diseases of the viscera. The only special symptoms are those recognised on auscultation, and the sole symptom by which it is identified is the murmur. This is sometimes systolic, originating in the auriculo-ventricular orifice — a feeble, soft sound, deep in some patients, strong and vibrating in others. In the latter case, which is exceptional, the "purring or vibratory tremor " maybe detected by applying the hand over the precordial region ; but the symptom, though mentioned by all authors, is distinctly uncommon. Sometimes the murmur is Digitized by Microsoft® I20 CLINICAL VETERINARY MEDICINE AND SURGERY. diastolic, produced by aortic insufficiency. Finally, at times one first hears a systolic, followed by a diastolic murmur ; the diastolic sound always appears at a later stage than the systolic, the lesions of the semilunar valves being of slower development, or progressing less rapidly than those of the mitral. In certain patients the heart- beats occur at regular intervals, only seeming rather stronger than usual, and the pulse is normal or somewhat weak. In others the action of the heart is more or less irregular ; intermittencies are rare, and always of brief duration. In the simple forms of acute endocar- ditis, true palpitation and dyspnoea are not seen at rest ; the heart muscle being only affected to a very trifling extent, the lesions do not produce any noteworthy external symptoms. Nevertheless, mitral insufficiency may occur in consequence of weakness, or of paresis of the musculi papillares. When endocardium and myocardium are simultaneously affected^ or when endo-pericarditis exists, the symptoms are more complicated. The descriptions just referred to seem most suggestive of infective endomyocarditis, or of endocarditis preceded, or complicated, by grave pulmonary mischief. When in vegetative endocarditis the inflammatory growths on the valves are of large size, the same train of S3'mptoms occurs, but in a more marked form. To sj-mptoms indicative of mitral and aortic insufficiency are added others suggesting stenosis of these orifices. And as, furthermore, the risks of embolism are greater than in simple endocarditis, symptoms pointing to obliteration of vessels in internal organs are more frequent. Cerebral embolism — rare in all animals — ■ is rapidly followed b}' death, or by more or less extensive paralysis ; renal embolism produces albuminuria and hsematuria ; intestinal embolism colic ; that of an important artery in a limb, lameness, and sometimes, more or less extensive gangrene ; that of the spleen, and of some other organs and tissues, gives rise to no visible symptoms. Malignant ulcerative, or septic endocarditis is recognised, not only by the general signs drawn from auscultation, but by s3'mptoms usually of an extremely grave character, similar to those of a rapidly progressive infection or intoxication, which point to general poisoning of the .system by pathogenic organisms, or their toxins. Fever is intense; there is great prostration, rigors, sweating, diarrhoea, albuminuria^ hsematuria, colic, frequent groaning, cyanosis of the mucous mem- branes, rapid acceleratir ■^ ^f the heart's action, loss of pulse, and sometimes local hasmoiinages. The symptoms soon become more marked, and collapse is followed by death. This endocarditis may be due to the presence of one or more species of organisms, but is always. Digitized by Microsoft® ACUTE ENDOCARDITIS IN THK HORSE. 121 exceedingly infective, and its real nature is often misinterpreted, until after death. In animals, the changes shown by the endocardium after acute inflammation are very diversified. On reading reported cases of " acute endocarditis " in journals, it is clear that in many instances the changes noted do not justify the signification attributed to them. Cases have been published under this title in which the existence of endocarditis was in no way demonstrated, even by the lesions. The diffuse reddening of the serous membrane, the ecchymoses, the irregular blackish patches, even the little fibrinous grains which have been found, are by no means sufficient indications on which to base the diagnosis of acute endocarditis. Diffuse reddening of the endo- cardium results from staining with altered haemoglobin, derived from red blood-corpuscles destroyed during the course of certain infectious pro- cesses. The other lesions are not infrequent^ seen in horses which die from over-exertion, especially in extremely hot weather. They also occur when death is preceded by violent struggling and long-continued agony. In the ordinary form of acute endocarditis the serous membrane is thickened or elevated in places, has lost its polished appearance, is covered with little, friable, greyish or reddish vegetations, at times capped with a fibrinous layer, and marked at the seat of these lesions and for some distance round them by fine branching vessels. There is nothing more. These lesions sometimes extend over a considerable portion of the endocardium ; they commonly affect the val\-es, and are there always most marked. They are generally confined to the left heart. The mitral and aortic valves are swollen, irregularly thickened, often covered with little sessile vegetations adherent to and continuous with the membrane, some greyish in colour, others of a light red ; sometimes very small, very numerous and almost confluent ; they give the membrane a roughened appearance. In the specimen I exhibit,, you see they are collected at a short distance from the free border of the valve. In many cases they first appear in the vascular portion of the valves, and extend thence towards the free margin ; where they attain the free edge of the valves the endocarditis is termed marginal. The abnormal coloration is not removed by washing, and closer examination of the patches, especially of their circumference, reveals little vascular loops ; but the reddish-brown or blackish tints which appear so rapidly in inflammation of richly vascular organs are rarely seen. The majority of these vegetations are covered with a fibrinous deposit seldom very adherent. On removing it the serous, membrane appears superficially eroded. Digitized by Microsoft® 122 CLINICAL VETERINARY iMEDlCINE AND SURGERY. At one time new growths on the endocardium were always regarded as fibrinous. They are really formed of embryonic cells and leucocytes, held together by a small quantity of structureless exudate. Beneath and around them the endocardium appears infiltrated with similar cells, the number of which diminishes in proportion to the distance from the vegetation. The persistence of the endothelium over the surface of certain deposits indicates that the process develops partly in the deep layer of the serous membrane ; as a rule, however, the superficial layer is first loosened, and afterwards destroyed. There is little or no discharge from the point ; acute endocarditis is pro- liferative, not exudative. When the chordae tendineas are invaded, or that portion of the endocardium into which they are inserted is affected, they may snap or become detached from their insertion — an accident sometimes followed by mitral insufficienc)'. When the inflammation extends from the deep layer of the endocardium to the heart muscle itself, it always remains limited to a very thin stratum. It is possible, however, as I before stated, for both the muscle and serous membrane to be simultaneously affected, and during infectious diseases this occurs more frequently than might be imagined from the few cases published. Vegetative, or verrucous, endocarditis is characterised by the abundance and size of the granulations developed on the endo- cardium. The proliferation of cells and exudation of leucocytes rapidly produce luxuriant, vegetations, varying greatly in size and shape. In this case, also, the valves show the maximum of develop- ment. Sometimes the growths resemble branching stalactites, covered with conical prolongations, the long axes of which correspond in direction with that of the blood-stream ; those fixed to the mitral valve pointing towards the base of the ventricle ; those on the semi- lunar valves towards the aorta. These large new growths are com- posed of cells, etc., similar in nature to those forming the limited vegetations of simple endocarditis. They usually show a superficial fibrinous, and a deep organised layer, the latter continuous with the endocardium ; some, however, are organised nearly throughout ; others are almost exclusively fibrinous. Such large new growths are rare in the horse, but are commoner in the dog. Not only do they diminish the size of the orifices around which they are situated, and thus produce functional disturbance, but they threaten embolism of in- ternal organs. Incessantly agitated by the blood-stream, the fibrinous coagula covering these vegetations may become detached and carried to a distance, produce infarcts in the viscera and in various tissues, thus giving rise to symptoms of very varying gravity. Under the influence Digitized by Microsoft® ACUTE ENDOCARDITIS IN THK HORSE. 1 23 •of active microbic growth, or of degenerative changes, the vegetations may break down suddenly, throwing into the blood-stream large numbers of fragments, which produce multiple, simple, or specific ■embolisms, and in some cases rapidly progressive septicaemia. In ulcerative endocarditis (which is still rarer than the preceding) the serous membrane shows loss of substance ; true ulcers may •develop on the walls of the ventricles, or on the valves ; most fre-. quently on the mitral. Starting in the endocardium, and at first limited in extent, these ulcers extend more or less rapidly in size and ■depth, and may perforate and partially destroy the valves. When affecting the parietal endocardium they sometimes extend beyond its ■deep layer, erode the myocardium, and produce a kind of aneurism. Visceral complications due to emboli are frequent. The blood is ■charged with micro-organisms, masses of cells, and broken-down material from the ulceration, and is greatly changed in character. Pysemic or septicsemic lesions are not infrequent. In acute endocarditis affecting the valves diagnosis becomes possible as soon as a murmur develops. When, however, localised in the parietal endocardium or affecting the valves, but without causing insufficiency, detection is impossible. It is perhaps well to repeat that even when alarming general symptoms occur, suggesting acute ■endocarditis, the existence of a murmur is of doubtful significance, and may be due to old-standing heart disease, the accompanying disturb- ance resulting from some other affection, such as pneumonia. In most ■cases minute examination of the patient is necessary before giving an opinion, and sometimes a few days must be allowed to elapse for the •condition to develop. The prognosis of acute endocarditis is very grave ; although in the horse it may not prove fatal, it produces lesions which are not only incurable, but which become more marked with lapse of time, and •often make rapid progress when animals are put to heavy work soon :after leaving hospital. Treatment is of little value. Bleeding, counter- irritation, and the internal administration of digitalis, salicylate of soda, iodide of potas- sium, alcohol, and diuretics have been recommended. When endocarditis appears during the course of another disease, a general infection or a microbic disease of any kind, it forms a menacing ■complication ; but treatment should still be principally directed against the primary morbid condition, and not against the complication. The belief that acute endocarditis can be cut short by any system Digitized by Microsoft® 124 CLINICAL VETERINARY MEDICINE AND SURGERY. of medication is a pure illusion. Even rheumatic endocarditis, against which we have drugs of a specific character, always passes through its various phases, and leaves permanent lesions in the endocardium. In a certain number of cases ^ve can diminish the intensity of the inflam- matory process in the endocardium, moderate development of new growths, and consequentl)- reduce the dangers of embolism and of visceral thrombosis ; but that is the full extent of our powers. Even then success is distincth* problematical. In primar}- and secondary endocarditis it is usual first to bleed and apply counter-irritants. Six to ten pints of blood are withdrawn, and a large mustard plaster applied to the lower half of the chest ; or the left surface of the chest over the heart is blistered. Some authors claim to have had good results from continued irrigation of, or appli- cation of ice to, the praecordial region. Internally the most useful agents are sulphate of quinine, given in electuary in doses of 2i to 5 drachms per day; and in the rheumatic form, salicylate of soda in doses of 5 to 10 drachms. Digitalis, empirically prescribed in all cardiac diseases, is here of real use if the rhythm of the heart is irregular, or if m\'ocarditis has accompanied or followed inflammation of the endocardium ; it regulates the action of the heart muscle. At the end of some days moderate doses of potassium iodide have a good effect, appearing to favour absorption of exudates. If fever is high antipyrin and cold enemata ma}' be given ; when weakness is marked, stimulants and antiseptics seem indicated. In his Lecons siir les Antiseptiques M. Bouchard draws attention to the good effects produced by internal administration of antiseptics in many microbic diseases. In infectious forms of endocarditis the ideal method of treatment would consist in destroying the organisms in or on the endocardium. At present this is impossible, but by using antiseptics we can arrest or diminish many primary infectious processes, of which endocarditis only forms a complication. Digitized by Microsoft® XX.— AORTIC INSUFFICIENCY IN THE HORSE. To-day we saw in the clinique a horse with very well-marked aortic insufficiency, and I mentioned to you in some detail the pecu- liarities shown by the animal. I have had opportunities of seeing a very considerable number of similar cases. To-day I intend to treat of this condition, and while describing certain cases, to point out the diagnostic symptoms. In the horse aortic insufficiency is by far the most frequent of all heart diseases. It may be seen in animals of all ages, without distinc- tion of sex or breed, though the majority of published cases refer to old animals slaughtered for experimental or anatomical purposes. In animals of this class M. Nocard and I found thirty-eight aortic and four associated aortic and mitral lesions in a total of forty-two cases. Aortic insufficiency sometimes forms an isolated lesion, sometimes an accompaniment of other lesions of the endocardium, or of arterial atheroma. In man, where the latter condition is very common, aortic insufficiency of cardiac origin, consecutive to endocarditis, is distin- guished from insufficiency of arterial origin associated with sclerosis of the arteries. In the horse valvular lesions are sometimes accom- panied by atheroma of the aorta, but very generally atheroma is absent, and the valvular disease simple, or only combined with other valvular changes. With very rare exceptions, it results from some infectious process, during which the endocardium has been injured by blood-borne micro- organisms, or their toxins. It may also follow acute inflammation of the lung, especially the contagious form, and the typhoid form of influenza. Rheumatism, which, as you know, is rare in the horse, also appears to produce it. In human medicine it has long been known that rheumatic lesions appear to have a decided predilection for the endocardium, etc., which they permanently affect. " Rheumatism," said a celebrated clinician, "licks the joints, the pleura, and even the meninges, but it gnaws the heart." Whatever the determining cause, inflammation of the semilunar valves soon assumes a chronic character, and determines a series of Digitized by Microsoft® 126 CLINICAL VETERINARY MEDICINE AND SURGERY. changes ending in insufficiency. These changes may assume very varying anatomical appearances. You may judge of this by examining the specimens I place before you. Sometimes the valves are simply thickened, rigid, v/rinkled, and shrivelled ; sometimes they show losses of substance, giving them a reticulated or fenestrated appearance ; in some cases they exhibit aneurismal dilatations, projecting above the surface of the heart, the wall of the aneurism being either intact or perforated ; in others, again, the}' are fungous and covered with pea- like or strawberry-like vegetations ; finally, they may contract adhe- sions one with the other, or with adjacent tissues. Usually these lesions are unequally marked on the three valves ; sometimes they Fig. i6. — Chronic endocarditis of the aortic valves. only affect one, though even in this case they may be very pro- nounced. The valves never close completely, an opening of varjdng form and size remaining between them through which blood regurgitates. When the aortic ring has not been divided the insufficiency can readily be detected. After removing its lower third, one has only to place the heart in a vertical position, and to pour a little water into the aorta ; the valves no longer closing exactly, liquid escapes by the space between the valves, and passes into the ventricle. These changes in the aortic opening are always accompanied by a certain degree of hypertrophy of the left ventricle, consequent on insufficiency, and due to a very simple mechanism. After each systole, the blood injected into the aorta, which should be retained by closure of the semilunar valves, returns in part into the ventricle. This returned blood being added to that coming from the auricle, two abnormal conditions successively arise; the ventricle dilates excessively, Digitized by Microsoft® AORTIC INSUFFICIENCY IN THE HORSE. 12/ and then contracts with a degree of energy greater in proportion to the quantity of blood which it contains, and to the diminution in the arterial pressure in the common aorta. Now this more active contrac- tion of the left ventricle is repeated about 50,000 times per twenty-four hours. The increase in work ends by causing hypertrophy of the cardiac muscle, which, for a certain time at least, renders the heart capable of overcoming the increased demand imposed on it by the - condition of the valves, but which culminates in the period of asystole ;, the heart muscle, enfeebled by over- exertion, undergoes degenerative changes, finally leading to death. The heart may attain very great dimensions. Whilst the medium weight for a heakhy heart is about ria that of the whole body, a heart with aortic lesions and insufficiency often attains ^^ to -g\ of this weight. Sclerotic changes of the muscular substance are rare, because most patients are slaughtered before they can develop. Nevertheless I have seen a certain number of cases in the school, one of which I will describe in a later lecture. Aortic insufficiency is indicated by two principal symptoms : (i) a diastolic murmur, loudest at the base of the heart ; (2) a strong pulse, readily perceptible in all accessible arteries. The murmur commences with diastole, and continues during the second sound, and a portion, or the whole, of the pause ; it immediately follows the short pause, at the moment when the semilunar valves have returned to their horizontal position, and continues until the first period of the following cardiac cycle, i. e. until the prsecordial impulse produced by ventricular systole. I said that it was loudest at the base of the heart ; it may also be heard, though less distinctly, as low as the apex, and more rarely in the region above the heart over the aortic trunk. The tone (timbre) of this murmur varies ; usually it is soft and hissing ; sometimes it is rough, grating, or musical. I may add that no close connection can be established between these variations in sound and the age, degree, or peculiarities of the valvular lesions. The changes in the pulse are due to the energy with which the ventricle contracts, and to the low blood-pressure in the arterial system. The large wave of blood rapidly injected into relaxed vessels lifts their walls suddenly, and to a greater degree than normal ; but, as consider- able quantities immediately leak back towards the ventricle through the pervious valves, the vessels again collapse, a fact which gives the pulse its peculiar fugitive, elusive character. The pulse is readily discovered by the finger in all accessible arteries, but only in excep- tional cases can it be seen. Few cases of " dancing of the arteries " Digitized by Microsoft® 128 CLINICAL VETERINARY MEDICINE AND SURGERY. have been chronicled in veterinary hterature, the most interesting being that by Polansky. To those recorded I could add several, one of which I saw here during the present year. My assistant will read you a summar}'. Case i. — A fourteen-year-old gelding. For some weeks the animal had fed badly, shown difficulty in breathing, and rapidly become fatigued during work. Examination of the digestive and respiratory ■organs revealed nothing abnormal. On auscultation of the heart, we heard on both sides, but more particularly on the left, a rough metallic murmur, beginning with diastole and extending throughout the whole pause ; almost as distinct at the apex as at the base of the heart, and extending above and behind the latter as far as the middle of the chest. The first sound and the short pause were normal. The second sound was absent. The arterial circulation was greatly disturbed. The pulse was very strong at the submaxillary, and could readily be detected at all the superficial arteries — the temporal, masseter, posterior auricular, sub- maxillary, radial, coccygeal, metacarpal, and digital. At the lower portion of the jugular furrow a distinct carotid pulse was seen at each systole. The small superficial arteries, but especially the temporal and metacarpal, bounded at each contraction of the heart ; there was a true "arterial dance." Examination of the aorta only revealed violent pulsation, but no murmur. \\^ith this patient we only received the following information : — ^' For some time it had eaten less than usual, and became fatigued on the least exertion." After glancing at the buccal cavity and con- junctiva, I examined the pulse at the submaxillary ; it was strong and bounding. On auscultating the heart I noted during the second sound and pause a rough metallic murmur, most distinct at the base, but audible (though less clearly) towards the apex and along the course of the aorta for a height of about eight inches. The horse was suffering from aortic insufficiency. Up to this point the case revealed nothing extraordinary, but, while again taking the pulse at the submaxillary, I happened to glance towards the temporo-maxillary articulation, and then noted that each time the submaxillary dilated under my finger the subzygomatic visibly bounded. The other superficial arteries showed the same phenomenon, especially the two carotids, at the lower portion of the jugular furrows, and the metacarpals. On that day I was only able to make a rapid examination, and unfortunately the patient was not brought back. Digitized by Microsoft® AORTIC INSUFFICIKNCV IN THK HORSE. IZg Here, in very condensed form, are three similar cases observed among horses in hospital, or in the external cHnique. Case 2. — Ten-year-old entire horse. When submitting this animal for examination the owner gave the following information. The horse was " soft " in work, soon got short of breath, and stopped when ascending hills. On auscultating the heart we noted a remarkable change in the sounds. The first was strong, prolonged, and with a tendency to re- duplication. The apex-beat was violent. The short pause was followed by a murmur which replaced the second sound, and was prolonged throughout the long pause. This diastolic murmur was soft, clearest opposite the base of the heart, less marked towards the lower parts of the chest and around the apex. The pulsations were normal in number, the artery was tense, the pulse very strong, bounding, and slightly dicrotic. The pulse could be visibly counted at the subzj'gomatic artery. It was also very readily felt at the digital artery. Pulsation of the gluteal ? (arterc fessicre) arteries was visible towards the centre of the quarter on either side. Auscultation of the posterior aorta failed to reveal any abnormal sound. A jugular pulse could be detected. The animal was emphysematous. Case 3. — A twelve-year-old gelding. For some time the animal's appetite had been bad. The driver stated that it did not stop during work, but breathed very heavily. On examining the heart we detected a murmur during the second sound, and the pause was most distinctlj- marked opposite the base. Furthermore, each third heart-beat \\'as followed by an intermittency lasting from three to four seconds. The pulse was strong and bounding. It could be seen at the subzygomatic arteiy, where the vessel passes under the ridge of the maxilla. Case 4. — A mare about fifteen years old. A week before, this mare, which usually had an excellent appetite, ate badly, and left a portion of her food. Chnical examination discovered no disturbance of the digestive apparatus. On auscultating the heart a strong, rough, prolonged murmur was heard, to which succeeded a normal sound— at first regarded as the second heart-sound, but at the moment that the normal sound occurred the ear clearly perceived the sensation of systolic contraction. What had been regarded as the second sound was therefore in reality the first. I heard in succession the first sound. Digitized by Microsoft® 130 CLINICAL VETERINARY MEDICINE AND SURGERY. the short pause, and finally the murmur which covered the second sound, and was prolonged throughout the long pause. The pulse was very strong, but was not, however, visible at the superficial arteries. By placing a stethoscope over the carotid towards the lower part of the neck a diastolic murmur could be heard. On auscultating the aorta no abnormal sound was detected. In horses suffering from aortic insufficiency the pulse is almost always strong. You will sometimes find it of normal volume, but rarely feeble. Only a moment's reflection on the changes produced in the heart by aortic insufficiency is required to show that the pulse cannot be feeble so long as the heart muscle continues its function actively. Aortic insufficiency produces a number of other symptoms, though they are not special to it. Like all diseases of the heart, it is accom- panied sooner or later by functional troubles, the most important of which are rapid loss of breath when at work, dyspnoea, pain (causing the animal to wear an anxious look), and a tendency to vertigo. When animals are kept sufficiently long, disturbance of the pulmonary circu- lation may be noted ; passi\e congestion of the lung in consequence of mitral insufficiency, which again is due to dilatation of the left ventricle, and mechanical enlargement of the auriculo-ventricular orifice ; later still, passive congestion of other viscera, resulting from degeneration of the heart muscle and exhaustion of the heart. But in few horses is the process allowed to reach its last stage, the animals usually being slaughtered as soon as they become incapable of sus- tained work. Sudden death following arrest of the heart is rare in horses with aortic insufficiency, though it may occur. I will give you an instance. Five or six years ago a colleague asked me to examine an old cart- horse, which he considered broken-winded. At work the animal's breathing soon became embarrassed, especially when climbing hills and during hot weather, but the cough was not that of emiphysema. On auscultating the heart I diagnosed aortic insufficiency, which was clearly indicated by a strong musical diastolic murmur. As other severe constitutional symptoms had existed for a considerable time, my prognosis was grave. The animal worked for a further period of three years. Several times it fell down, but at once rose again, gradu- ally recovered, and after twenty-four hours' rest resumed light work. Finally, one hot day, it fell in the shafts and died in a few moments. The diagnosis of aortic insufficiency is easy. The two symptoms Digitized by Microsoft® AORTIC INSUP'FICIENCY IN THE HORSE. 13I tjn which I have laid stress — the diastohc murmur and the bounding pulse — are absolutely characteristic. In certain cases, when the heart's impulse is weak and the murmur very loud, it may be regarded as systolic. I have often corrected this error. In order to avoid it one need only trot the animal for a few moments. The impulse of the heart becomes very marked, and no doubt can exist of the diastolic character of the murmur. The most useful indications may, however, be wanting. Some animals with valvular lesions and insufficienc)' continue work as usual without showing dyspnoea or weakness ; it is not until later that functional troubles attract attention. Aortic insufficiency cannot well be mistaken for any other disease of the heart. In the horse insufficiency of the pulmonary sigmoid valves is extremely rare, and the pulse (which is sometimes small) differs entirely from that of aortic insufficiency. The prognosis is grave, not only because the condition causes immediate danger and may produce death in a very short time, but because it generally interferes to a large extent with the animal's use- fulness. As a rule animals suffering from it pass successively into the hands of poorer and poorer owners, who expect more and more v>'ork. Some lose condition rapidly, others retain it for a considerable time. In all, the normal vigour and working powers steadily diminish ; when the patients become incapable of further work they are usually slaughtered. Most of them, however, are sold and resold several times before death. This is evident from animals being brought here at intervals of a few weeks after having changed hands. In 1890 one was thus brought on three separate occasions during a single month. A little later we saw it again — this time amongst the animals purchased for surgical exercises. Like all other chronic valvular changes, those of the aortic semi- lunar valves producing aortic insufficiency are incurable. Treatment is purely palliative. The principal drugs employed are the iodides of potassium and sodium, given for periods of two to three weeks ; and when signs of cardiac failure appear, digitalis and diuretics. Digitized by Microsoft® XXL— MITRAL INSUFFICIENCY IN THE HORSE. At the present time we have in stable No. 4 a horse with mitral insufficiency of considerable standing, in which the clinical signs are so well marked as to leave no doubt regarding the prognosis. Although the horse is incurable, we have permission to detain it for some days. I have particularly drawn your attention to it, and profiting by the opportunity offered, I intend this morning to speak of chronic mitral endocarditis, and to relate an interesting case. The principal symptoms shown by our patient may be summarised as follows : — A loud systolic murmur perceptible over an extensive area on both sides of the chest, of greatest intensity towards the middle portion of the heart, and very clearly audible on appljang the ear over the caput muscles ; a feeble, irregular, intermittent pulse, cardiac intermittenc}' alternating with two or three rapid irregular heart- beats ; finally, loss of breath and dyspnoea after a few moments' exercise. With these facts before us diagnosis is easy. We have to deal with a case of old-standing mitral insufficiency in which the period of compensation is past, and which is complicated by changes in the muscular tissue of the heart. In the horse, chronic mitral endocarditis is less frequent than aortic insufficiency. Its aetiology is that of all valvular changes. With rare exceptions it results from acute endocarditis complicating certain infectious diseases. In solipeds these are generally represented by strangles, one of the various forms of pneumonia, or by the typhoid form of influenza, which almost always gives rise to acute endocarditis and to valvular changes. Inflammation of the mitral vaKe produces changes which finally render it insufficient ; the flaps become irregularly thickened, contract, draw apart, and cease to entirely close the opening. The chronically -inflamed mitral valves show less varied and less deep anatomical changes than the aortic valves ; it is exceptional to see centres of Digitized by Microsoft® MITRAL INSUFFICIENCY IN THE HORSE. 1 33 degeneration, vegetations, aneurisms, perforations, partial ruptures, or adhesion between a flap and the ventricular wall. With the exception of a case of rupture of the principal valve, of two others where a small aneurismal depression existed, and of a few cases of rupture of one or several of the chorda; tendineae, I have never met with anything moie than sclerotic changes — thickening, folding, and more or less pro- nounced contraction of the valves of the auriculo-ventricular opening. But the anatomical peculiarities which mitral lesions exhibit are not of great importance ; what dominates the after consequences, the intensity of the symptoms, and the rapidity of their succession is the degree of insufficiency. Once insufficiency is established, the cycle of vascular troubles commences. What are these troubles ? The mitral valve incompletely closing the auriculo-ventricular orifice during ventricular systole, the blood makes its exit from the left ventricle by two orifices ; (i) by the normal aortic opening, and (2) b}- the abnormal auriculo-ventricular opening, resulting from insufficiency of the mitral valve. At each heart-beat a portion of the blood which should pass into the aorta escapes by the auriculo-ventricular hiatus, and enters the left auricle. The first effect of this reflux of blood under pressure is to dilate the affected auricle, which, in order to overcome the distension, becomes hypertrophied. During a period of variable duration, termed the compensation stage, matters rest thus, and the primary lesion produces no functional disturbance likely to attract attention. At the autopsy of horses dead of accidents or internal disease, lesions of the mitral vai\'e, sufficiently developed to cause insufficiency, are sometimes found, without during life having attracted any attention whatever. Up to the last moment the animals have been able to perform ordinary work. Here is a case of compensated mitral insufficiency seen in a horse which died from rupture of the stomach. A ten-year-old Percheron horse, which had worked very hard for some years, but the general condition of which had always been satis- factory and the health good, was brought to the College on account of impaction of the stomach, from which it finally died. At the post-mortem examination we found, in addition to ruptured stomach, an enlarged heart. The left auricle was greatly dilated and its walls thickened. On opening the left ventricle we detected old-standing mitral lesions. The anterior and the left valves were little changed, but the principal flap was thickened and contracted, and exhibited at its right extremity an irregular fibrous vegetation ; the right valve was shrivelled, and showed near its free borders a large hardened area. The right heart was normal. These mitral lesions certainly caused insufficiency. Digitized by Microsoft® 134 CLINICAI. VETERINARY MEDICINE AND SURGERY. Ne^•ertheless the animal had been able to regularly perform trotting work up to the day of its death. Although the mitral changes were of old standing, they had been compensated. The increased functional activity of the left auricle had proved sufficient to overcome the obstacle resulting from the valvular lesion, and to prevent the appearance of symptoms which would have betraj-ed the altered conditions. As a rule, this phase of mitral insufficiency, where regurgitation of blood is confined to the left auricle, is not of long duration. The pulmonary veins soon become engorged and dilated ; stasis gradually extends to the pulmonary capillaries, the main arterial trunks of the pulmonic circulation, and the right ventricle. In turn the right ventricle becomes distended, with or without its walls hypertro- phying ; then, on account of the tricuspid insufficiency which follows, the right auricle undergoes similar changes. These disturbances extend to the veins of the greater circulation, to the portal system, to the sj'stemic capillaries and to the whole arterial system. The increased tension in the latter is finally felt in the left ventricle, which, being overworked, becomes dilated and to a certain extent hypertrophied. Such is the cycle of troubles produced by mitral insufficiency. The heart is their point of origin, and the object on which in the last instance they react. But ^'er3' rarely indeed are they allowed to develop in their entirety in \\'orking animals, the patient being almost abs'ays destroyed when incapable of further work, that is, as soon as blood-stasis in the pulmonary capillaries produces grave respiratory disease. Let us now consider the changes which occur, first in the lung and then in the other viscera, under the influence of blood-stasis. The effects produced by dilatation of the pulmonar}' vessels and retardation of the blood-current through them grow rapidl}- in im- portance. The capillaries become varicose, their walls thinned, and the nutrition of the cells composing them suffers. Congestion of the bronchial mucous membrane follows distension of the pulmonary capiUaries, and by diminishing the calibre of the air conduits tends to produce dyspnoea. Blood-plasma filters through the thin vessel walls and becomes extravasated, partly into the alveoli, partly into the pulmonary tissue itself. In time pulmonary oedema increases ; in places induration may occur, and disseminated centres of interstitial pneumonia appear. The respiratory surface is thus considerably diminished, oxj-genation of the blood becomes very imperfect, and dyspnoea follows. As soon as general venous stasis occurs internal organs become Digitized by Microsoft® MITRAL INSUFFICIENCY IN THE HORSE. 1 35 congested, transudation takes place into the splanclmic cavities, and oedema appears about the lower portions of the body. In consequence of its position close to the heart, and of the rich- ness and peculiar arrangement of its vascular suppl)-, the hver is the first of the viscera to be affected. Stasis in the posterior vena cava first reacts on the hepatic and intra- lobular veins, then on the capil- laries and interlobular or perilobular vessels. In the first stage the changes are simply congestive ; the liver is very large and engorged with blood, and incisions show a marbled appearance, a crowd of little blackish points being scattered over a lighter ground. All the lobules show the same abnormal appearance ; the central portion, dark in colour, is formed by the enlarged orifice of the intra-lobular vein ; the periphery is whitish or greyish white. To this peculiar modifica- tion of the hepatic tissue, seen in old-standing diseases of the heart, has been given the name of cardiac or nutmeg liver. The microscope shows dilatation of the intra-lobular veins, enlargement of the capil- laries, and more or less pronounced compression of the hepatic trabeculse throughout the entire area of the lobules. At a more advanced stage inflammatory supplement the preceding phenomena. Examined with the naked eye the liver is still large, consistent, and spotted. The microscope reveals diffuse sclerotic lesions, both in the inter- and intra-lobular regions, the walls of the intra-lobular veins are thickened, and appear as though surrounded by a connective-tissue sheath ; the portal spaces are slightly enlarged by trifling hyperplasia of the same character, which in time may extend to the entire peri- phery of the lobules. Deformed first of all by dilatation of the hepatic capillaries, and then compressed by this double series of new growths within and around the lobules, the hepatic cells undergo fatty degene- ration. Does hepatic congestion of cardiac origin in the horse ever end in rupture of the liver ? This has been affirmed, and some cases have been recorded. In the post-mortem examinations I have made the liver has always appeared simply congested, or firm, consistent, and more or less cirrhotic. "Where rupture has occurred in horses with heart disease it seems possible that special degenerative changes had existed side by side with those due to circulatory disturbance. This point has not yet been carefully studied. Although much less pronounced than those of the liver, the changes undergone by the intestine and stomach are not less evident. As soon as the portal circulation is impeded the mucous membrane of these organs becomes passively congested, the muscular tissue loses power and acts less energetically, and gastro-intestinal catarrh may develop. Like the liver, the spleen first shows simple passive con- Digitized by Microsoft® 136 CLINICAL VETERINARY MEDICINE AND SURGERY. gestion, but later inflammation occurs, producing new connecti\e- tissue growth and sclerotic changes. The capsule becomes thickened in places, or covered with little fibrous tufts. The kidneys are affected in their turn by the stasis in the vena cava, but at first, and for a certain time, only show congestive changes. They are slightly larger and of deeper colour than usual ; but even at this stage the microscope may show proliferation of the epithelium lining the straight tubules. At a later period interstitial nephritis here and there produces atrophy of the uriniferous tubules, and forma- tion of tracts of fibrous tissue, contraction of which renders the surface of the organ irregular and knobby. In sections of this "cardiac kidney " the Malpighian tufts appear injected and slightly prominent. At certain points the tissue is hardened, whitish in colour, and of lardaceous appearance. A time arrives when the various organs, including the brain and spinal cord, and all vascular tissues feel the effects of this distension of the general venous system ; but dropsy, oedema, and inflammation of the meninges, generalised hardening of extensive tracts of tissue and skin lesions are final complications which only appear at a very late period. Ascites, hydrothorax, and hydropericardium are usually too little marked to be recognised during life. Changes in the blood, such as diminution in red blood-corpuscles, and alteration of the plasma, also belong to the group of later complications. They slowly become more marked, and lead to cardiac cachexia. Whether chronic mitral endocarditis follow acute inflammation, or appear as a primary condition, its onset is always insidious ; even when the mitral valve is contracted and insufficient, no special dis- turbance may exist to attract attention, provided the insufficiency is compensated. This latent period terminates as soon as the lungs become en- gorged. Then the patients rapidly lose breath at work, and show symptoms which are usually referred to broken wind. Many fail to come under the veterinary surgeon's notice until an advanced stage, when the symptoms are already so numerous as immediately to suggest heart disease. Moreover the animal's history is often sufficient to arouse such suspicion. When examining an animal apparently in health, but the liistory of which tells of weakness, diminished capacity for work, sweating, rapid loss of breath after moderate exercise Ivinc down immediately on returning to the stable, capricious appetite, or total loss of appetite ; then, provided these symptoms have existed for a certain time, one should suspect heart disease whatever the animal's age. Digitized by Microsoft® MITRAL INSUFFICIENCY IN THE HORSE. I37 The two principal signs of mitral insufficiency are a systolic murmur and feebleness and small size of the pulse. On auscultat- ing the heart one hears a murmur commencing with systole, covering the short pause, and ending with the second sound ; the latter and the long pause are usually normal. This murmur may extend not only over the base, centre, and apex of the heart, but over a considerable area of the surrounding parts. It is clearly a mistake to say that it is heard most loudly over the apex. Being due to reflux of blood from the left ventricle into the auricle, it is produced in the auriculo- ventricular opening, which is situated about one and a quarter inches below the aortic orifice, and about six to eight inches from the apex. The point of maximum intensity corresponds to the depression in the left pulmonary lobe, or to the mesocardiac zone. Like the aortic murmur, it varies greatly in strength and tone, depending on the degree of insufficiency and on the existence or absence of vegetations on the valvular flaps. The configuration of the margins of the valve changes as the process develops, and the character of the murmur may thus undergo modification at uncertain intervals. In one horse which I kept under observation the sound was at first soft, afterwards harder and vibrating. As in the case of diastolic murmurs, the modification in character of systolic murmurs bears no relation to the changes in the valvular condition as determined hy post-mortem examination. All one can say is that soft murmurs usually denote either trifling or very large insufficiencies, and rough strong murmurs insufficiencies of moderate extent. The pulse of mitral insufficiency contrasts with that of aortic insufficiency. Whilst in the latter the pulsations are strong and bounding, in the former they are feeble, often almost indistinguishable or uncountable. At the moment of ventricular contraction one portion of the blood contained in the left ventricle escapes by the mitral orifice ; only a small wave enters the aorta, scarcely lifting the arterial wall, and the pulse is invariably small. For a long time no other change is apparent ; but when the valvular lesion has reacted on the heart muscle a want of rhythm becomes apparent ; the cardiac contractions and the pulse at first become unequal ; later, inter- mittences occur, alternating with the series of normal heart-beats. In one of the patients of which I have spoken disturbance of the circula- tion could be detected, pointing to change in the heart muscle or to a cardiac complication of the mitral disease. The other symptoms which occur result from stasis of blood in the viscera. Passive congestion of the lung produces oppression, dyspnoea, cough, and later bronchorrhcea. In some subjects reflex disturbance Digitized by Microsoft® 138 CLINICAL VETERINARY MEDICINE AND SURGERY. is brought about through the medium of the pneumogastric nerve, as shown bj' irregular or complete loss of appetite, anxiety, somnolence^ or depression. Transudates in the large serous cavities, cedema of the lower portions of the body, intestinal catarrh, icterus, and albuminuria only appear at an advanced stage. I may repeat that chronic mitral endocarditis with complications due to stasis in the veins of the systemic circulation is rarely seen, the patients not being kept sufficiently long for such remote complications to occur. Last summer, however, we saw a case which I will recall to you. In the month of June a farmer at Bonneuil sent us a horse, bought the preceding year, which for months had appeared in good health, but about six weeks before had begun to fall away in condition, and had up to that time lost about 100 lbs. in weight. One day an oede- matous swelling was seen under the chest, but nothing else being observed no precautions were taken, and the horse drawing a heavy wagon set out from Bonneuil for Maisons-Alfort. During the journey it frequently stopped for want of breath, and was thrashed bj^ the brute who drove it. On returning to the stable it lay down without touching its food. The morning after it was brought to the clinique. It was very thin and depressed ; the mucous membranes, and especially the conjunctivae, were pale. The respiration was rapid, irregular, and showed a well- marked double expiratory effort ; but the cough was strong and loud, in no wa}' resembling that of emphysema. Percussion of the chest revealed diminished resonance in the lower third, especially on the left side. On auscultation the respiratory mur- mur was feeble. The heart beat rapidl}-, and on examination two murmurs could be heard, one systolic, the other diastolic ; while irregu- lar intermittences lasting for one or two pulsations could be detected. Certain of the contractions were bounding, and gave a distinct impulse to the thoracic wall. The pulse was small, unequal, and intermittent. The pulsations of the posterior aorta corresponded to the beating of the heart, were unequal, and 70 to 76 per minute. Each heart-beat produced an aortic pulsation, but the more feeble were not transmitted to distant arteries. The jugulars were prominent, and showed a pulse synchronous with the heart. The swelling under the chest had almost disappeared. The temperature was normal. The urine contained neither albumen nor sugar. These symptoms, the known frequence of left heart disease in the horse, the absence of the arterial sign of aortic insufficiency — Digitized by Microsoft® MITRAL INSUFFICIENCY IN THE HORSK. 139, Corrigan's pulse, — and the signs of dyspncea produced by a few minutes' exercise, led me to diagnose old-standing mitral endocarditis with insufficiency. On the other hand, the diastolic murmur, the very marked venous pulse, and the oedema indicated dilatation of the right heart, with reflux and stasis of blood in the vessels of the systemic circulation. I kept this case for a time to afford you an opportunity of following the course of the disease. At the end of a week the hind limbs became swollen. The lower surface of the abdomen and of the chest showed extensive oedema. The animal was slaughtered. The principal lesions found on post- mortem examination were as follows : — The abdominal cavities con- tained some quarts of a yellowish limpid serosity without fibrinous flocculi. The veins of the systemic circulation were dilated. Over almost its entire surface, but especially along the course of its vessels, the large colon showed abundant subserous oedema. The liver was very large ; on incision the condition known as "cardiac liver'' was seen to be well developed. The other abdominal viscera, especially the kidneys and spleen, were engorged with blood. The pleural cavities contained 4 to 5 quarts of serous fluid, resem- bling that in the peritoneum. The lung was blackish, heavy, and congested ; its tissue was in some places oedematous, in others dense and sclerosed. The heart was enormous ; the right heart especially had become enlarged ; its cavities were greatly dilated, the auricle being almost four times its normal capacitj-. The left auricle was also much dilated, and the walls of the corresponding ventricle (which were slightly hypertrophied) showed areas of sclerosis. The flaps of the mitral valve, more particularly the principal, were thickened, shortened, puckered, and at certain points of ahnost cartilaginous consistence. The course of the morbid condition produced by mitral lesions is fatally progressive. Whether or not insufficiency be complicated by contraction, the circulation gradually becomes impeded, and the resulting symptoms more marked ; the general condition steadily increases in gravity, until at last death terminates the case. Chronic mitral endocarditis being in the long run fatal, how does death occur ? Mitral lesions usually kill slowly. Among the organs (which are all gravely affected) two, the heart and lung, still actively continue their functions. Though first affected, overloaded in the beginning, and in the last stages burdened with the ever-increasing arterial tension, the heart continues to struggle against the growing vascular Digitized by Microsoft® 140 CLINICAL VETERINARY MEDICINE AND SURGERY. obstruction, which finally reacts on the left ventricle. In the lung the useful respiratory surface becomes more and more reduced ; the oedema, inflammation, and obliteration of capillaries steadily diminish- ing the small number of pulmonary alveoli still capable of carrying on oxygenation of blood. Toxic blood completes the disorganisation produced by mechanical disturbance. The heart, already exhausted, is arrested by the increasing asphyxia. At advanced stages of mitral disease death may occur rapidly by another process. On account of the slovi^ness of circulation coagula- tion may occur in the arteries of organs essential to life. This explains how patients sometimes die in a few days, in a few hours, indeed in a few moments, either from thrombosis of the coronary arteries or from thrombosis or embolism of the pulmonary artery. Sudden death, however, is rarer than in aortic insufficiency. The diagnosis of mitral insufficiency offers little difficulty in the horse. Tricuspid insufficiency (which is much less common) is almost always brought on by dilatation of the right heart, consequent on chronic pulmonary affections, especially old-standing emphysema. It is soon accompanied by a well-marked venous pulse, and the tricuspid systolic murmur, usually softer, less prolonged than the mitral sound, is also heard at a more anterior point. With a little practice, no mistake need be made between this and the diastolic murmur of aortic insufficiency. The presystolic murmur produced by mitral contraction is extremely rare. What I have already said of the course of the disease will guide you in prognosis, which is of extreme gravity. No improvement is possible, nor can the development of the cardiac lesions or the accidents which follow in their train be arrested. You have seen that irregularities of the heart and pulse add to the gravity of prognosis. When they appear, the heart has undergone a secondary change, either in its muscular tissue or in its nervous apparatus. The treatment of mitral insufficiency is of little interest. As soon as the compensation period is over, the animal is slaughtered, or passes into fresh hands. Even when the disease is recognised in its eusystolic stage, before actual organic change has occurred, the various drugs recommended are useless. The most reasonable treatment consists of rest, moderate exercise, and good hjgienic surroundings — treatment inapplicable to working animals. At the asystolic stage the drugs indicated are those capable of Digitized by Microsoft® MITRAL INSUFFICIENCY IN THE HORSK. 141 rendering the heart equal to its increased task. DigitaUs is of service, but given before the proper time — that is to say, when the mitral lesion is still compensated — digitalis is often injurious; it increases the work of the heart without purpose, fatigues the muscular tissue, and may finally bring about degenerative changes. Under certain circum- stances, bromide and iodide of potassium or sodium may be given to combat cardiac asthma and sclerotic changes — purgatives and diuretics are indicated in oedema and dropsy. Digitized by Microsoft® XXII.— MYOCARDITIS. In animals, and particularly in the horse, inilammation of the myocardium, either acute or chronic, is much more frequent than might be supposed from the small number of published cases. Our present knowledge on this subject is still very defective, especially from the clinical point of view, because, as I shall almost immediately show you, mj-ocarditis is characterised by less striking symptoms than endocarditis and pericarditis, and because many cases having only been diagnosed on post-inortciii examination, the observers have necessarily been restricted to describing the anatomical lesions. The specimens which I place before you may be separated into two groups : one, illustrating the changes in acute myocarditis, are derived from horses dead of various infectious diseases, — usually, how- ever, contagious pneumonia ; the others, showing lesions of chronic myocarditis, have almost all been obtained during post-iiwrtcin exami- nation of animals used for the exercises in practical surgery. Among these are two in which the anatomical and pathological characteristics of the two great varieties of myocarditis are typical, though excessively pronounced. First of all I show you the heart of a horse dead of contagious pneumonia on the eleventh day, in which gangrene of both pulmonary lobes existed as a complication. It is very large — weighs more than eight and a half pounds, and has been the seat of acute diffuse myocarditis. It shows large yellowish patches, irregularly distributed, but principally occupying the left ventricle and auricle. On the left ventricle, starting from the auriculo-ventricular furrow, is a large zone of fatty degenera- tion, measuring from one and a half inches to three inches in width, according to the point selected, and sharply differentiated from adjacent tissues by its yellow colour. Sections through the wall and cardiac septum vary in colour from brown to red, grey, or yellow, according to the point chosen. Small haemorrhagic centres also exist. Several large areas of degeneration extend through the entire thickness Digitized by Microsoft® MYOCARDITIS. 143 of the ventricular wall. The pericardium and endocardium are hardly affected. On macroscopic examination the valves show no appreci- able lesion, but microscopic examination reveals lesions of acute diffuse myocarditis. Even where the myocardium appears least ahered its fibres prove to have undergone granular degeneration. In the other specimen we see advanced lesions of chronic myocar- ditis. This heart is moderately hypertrophied, and exhibits scattered, whitish, irregular, more or less depressed areas, some isolated, others united by narrow bands of the same colour ; the largest are seen on the left ventricle, principalh- about the auriculo-ventricular furrow. Sec- tions through the wall of this ventricle reveal similar whitish areas, fibrous in appearance, star-shaped, isolated or united. At these points the mj/ocardium has undergone a fibrous change and the muscular fibres have disappeared, having become atrophied or affected with granular degeneration under the compression exercised by the fibrous tissue. In addition the aortic semilunar valves show old-standing change. Acute or chronic inflammation of the myocardium is usually diffuse, extends to the greater part of the muscle, and is in most cases unequally marked in the left and right hearts, the former being com- monly the most markedty affected. This inflammation sometimes occurs as an isolated affection, without co-existent changes in the endo- cardium or pericardium ; more frequently mj'ocarditis is accompanied by endocarditis or endopericarditis, facts explained by the general pathogen}' of heart disease, the muscle and serous membranes co\-ering it being simultaneously attacked by the same infectious or toxic agent. Acute myocarditis has been divided into primary and secondary. The first is stated to be produced by cold, over-exertion, or mechanical injury. Apart from infection or rheumatism, m^-ocarditis a frigore cannot be said to occur. Deeph' placed in the thorax, the heart is one of the organs least susceptible to the action of cold, which, at the most, only favours other agents capable of injuring the myocardium. Some cases in man seemed to prove the occurrence of lesions of the myo- cardium and endocardium after excessive and prolonged efforts. Similar cases have also been observed in creatures used for draught, the horse particularly ; but although the horse is probably the hardest worked of all animals, it is very doubtful if it ever suff'ers from myocarditis due exclusively to excessive work. Recent investigations have explained the pathogeny of that form of myocarditis which follows excessive exertion of the cardiac muscle. Contrary to the views formerly held, we now believe that excessive exertion does not directly produce Digitized by Microsoft® 144 CLINICAL VETERINARY MEDICINE AND SURGERV. inflammation of the muscular tissue of the heart, but only diminishes its resistance to the attacks of pathogenic organisms — a theory strongly corroborated by bacteriological experiments made during the past few years, especially by those of M. Roger. Mj'ocarditis due to " over- exertion " is therefore included in the group of infectious myocardites. Mechanical injury of the thorax over the heart only causes inflam- mation of the cardiac muscle v\'hen a penetrating wound is produced, or when the muscle itself is immediately injured, and the lesion be- comes infected. I have only observed acute myocarditis in the horse as a secondary affection ; nor have I seen its characteristic lesions, except in animals which had died of toxic or infectious disease, and in which, conse- quently, myocarditis had occurred as a complication of the original disease. The various forms of pneumonia, the typhoid form of influenza, strangles, hemoglobinuria, septicaemia, pyaemia, and other microbic diseases may be accompanied by myocarditis, either be- cause of pathogenic organisms dispersed by the blood-stream arriving at the myocardium through the medium of the coronary arteries, and arrested there, producing embolism of more or less extensive tracts ; or even more frequently because of injury to the myocardium by the toxins of microbes multiplying at a distant point. M. Charrin produced myocarditis in animals by injecting filtered cultures free of all living organisms ; but, whether infectious or toxic, these forms of myocarditis are primarily due to the life processes of microbes. Diffuse or localised mj-ocarditis, whether limited to the deep or superficial layers of muscle, always results from the extension of inflam- mation from the endocardium or epicardium. They show that Stokes's law on extension of inflammatory processes from mucous membranes to subjacent muscles also holds true in regard to serous membranes. The changes produced in the heart muscle by acute diffuse inflam- mation are usually well marked, and quite apparent on superficial examination, though seldom to such an extent as in the specimen I exhibit, where they are trul}' remarkable. Usuall}- the heart is more or less enlarged, dilated, flabby, and decolourised. Sometimes its surface is almost uniformly pale greyish, or the colour of a dead leaf; sometimes it is marked with j'ellowish patches of varying form and size, the majority irregular in shape, with sharply defined margins, and usually more numerous and larger in size on the ventricles. Under the epicardium and endocardium little hsemorrhagic centres can be seen. Sections made through the myocardium appear of a dull Digitized by Microsoft® MYOCARDITIS. 1 45 leaden colour, or the muscular tissue is slightly infiltrated, and of the same tint as the surface of the organ ; on the more or less discoloured base are scattered greyish-yellow patches and a few blackish areas or points, the former corresponding to centres of degeneration, the others to haemorrhages. On microscopic examination, inflammatory and other degenerative esions are seen. Many of the fibres appear swollen, fusiform in shape, and slightly granular ; their striation is less marked than normal, or may be altogether lost. Of the interstitial lesions, the chief is hyper- semia and infiltration with leucocytes. At a later stage the affected fibres undergo granular, fatty, or hyaline degeneration, become sepa- rated, more or less filled with fine granulations, or partly broken down, while signs of obliterating endarteritis, or periarteritis, and abundant cellular infiltration may be seen. As a rule these lesions are diffuse, and irregularly distributed ; alongside degenerated fibres others are sometimes found which have remained healthy, or appear scarcely changed. In purulent myocarditis section of the muscle exposes little ab- scesses disseminated throughout its substance. They are generally metastatic, and due to embolism, as in other viscera. They may also be the direct consequence of infectious inflammation of the cardiac muscle, in which case they are not found in other organs. The tissue surrounding them is markedly hyperaemic, infiltrated, and softened. Superficial abscesses may break into the interior of the heart, or into the pericardium. Cases of complete perforation of the septum be- tween the ventricles, by abscesses developed in its thickness, have been published. In a general sense the symptoms of acute myocarditis all point to enfeeblement of the heart. Nevertheless, at first symptoms of irrita- tion almost always occur. There is a period of abnormal irritability ; the heart beats faster and more strongly ; sometimes the contractions are violent, rapid, and tumultuous ; the pulse is accelerated and strong ; the respiration short, and suggestive of dyspnoea. The local changes gradually develop, and the vague early symptoms are exchanged for others of a precise character. The heart beats more slowly and feebly, and is often irregular or intermittent. Little by little the first sound diminishes in intensity until it becomes scarcely perceptible. The second sometimes remains normal, sometimes it also diminishes. In certain patients a slight systolic murmur can be heard, due to weakness of the papillary muscles. Percussion occa- sionally produces pain ; at an advanced stage it is said to reveal K Digitized by Microsoft® T46 CLINICAL VETERINARY MEDICINE AND SURGERY. enlargement of the precordial area of dulness ; but these are theoreti- cal points difficult to determine. In common with the action of the heart the pulse becomes feeble, irregular, and intermittent. The functional disturbance produced by myocarditis is seldom pronounced during the first stage of the disease ; and as the condition is almost always secondary, this functional disturbance cannot be differentiated from that due to the infectious disorder of which the heart trouble is only a complication. But the symptoms, especially the dyspnoea, are always aggravated by myocarditis. Contrary to what one might imagine, considering the extremely important function of the heart, acute myocarditis terminates in a fairly large number of cases in recovery. This is the rule in the slight forms accompanying infectious conditions. Resolution slowly pro- ceeds, the heart gradually becomes more active, and its contractions more powerful, until at length the sounds resume their normal charac- ter. Clinically recovery is complete, and if anatomically it remains imperfect the disease leaves few traces. In a proportion of cases the inflammation assumes a chronic form. Death may occur at all stages ; sometimes suddenly by syncope, sometimes less rapidly by asphyxia. When by asphyxia dyspnoea increases, the face appears extremely anxious, the apex beat of the heart becomes imperceptible, the pulse is lost, cold sweats cover the body ; finally the patient, completely prostrated and unsteady on its legs, falls to the ground and dies in a state of painful collapse. During convalescence death is sometimes produced by granular or hyaline degeneration of the muscular tissue. If in purulent myocar- ditis an abscess opens through the endocardium, death results from purulent infection or cerebral embolism. Cases of this kind are seen in strangles. When myocarditis accompanies an infectious disease which has gravely affected the lung, kidney, or nervous centres, the lesions in these organs play a certain part in producing death. The diagnosis of acute myocarditis is difficult. Many infectious diseases entail disturbance of the heart simulating myocarditis, and in addition certain of the local symptoms of myocarditis are also common to pericarditis. Nevertheless, if the practitioner follows the development of the latter disease, other symptoms will be detected which forbid confusion ; and when pericardial effusion is abundant, the precordial dulness and weakness of the heart sounds are much more marked than in myocarditis. Speaking generally, the prognosis is grave. Acute myocarditis may lead to sudden death ; in point of fact it kills many animals suffering Digitized by Microsoft® MYOCARDITIS. 147 primarily from pneumonia. You have also seen that it may assume a chronic form, and, after a varying period, render the animal useless. As in most other heart diseases, treatment is of doubtful efficacy. We cannot stop the processes going on in the heart muscle by admin- istering drugs. Moreover, the practitioner's attention is often exclu- sively confined to the primary disease. If myocarditis is recognised or suspected, treatment must be directed towards combating the weakness of the heart, and supporting the animal's strength. The food should be fluid, consisting of mashes, gruel, hay tea, or milk. If the patient will eat nothing, beef tea may be given by the rectum. The drugs indicated comprise stimulants like alcohol, wine, and coffee given by the mouth ; caffeine, strychnine, and ether hypoder- mically ; and, if myocarditis is secondary to pneumonia, digitalis. Counter-irritation by means of a mustard plaster applied to both sides of the chest, or refrigeration of the precordial region, may also be tried. In contrast with the acute form, chronic myocarditis often occurs as an isolated affection, apart from any other existing disease, or only associated with lesions of the cardiac serous membranes ; and inasmuch as it only produces vague functional disturbance, and very imperfectly recognised local symptoms, it often escapes notice altogether. No hesitation is felt in affirming the existence of cardiac disease when a murmur exists, but it is quite otherwise when the symptoms, though apparently due to heart trouble, are unaccompanied by any abnormal sound. When, however, the constitutional symptoms are supple- mented by modifications in the action of the heart — irregularities, momentary arrests, or intermittencies — the patient in the majority of cases is suffering from a condition which, though insidious and of slow progress, is nevertheless extremely grave. Most frequently these symptoms are due to chronic inflammation of the cardiac muscle. As a general rule, chronic myocarditis follows the acute form. Inflammation of the myocardium continues in a less degree, slowly producing degenerative changes, and later, functional disturbance. In certain cases this inflammation occurs spontaneously and indirectly, in consequence of cardiac or pulmonary lesions, which produce passive permanent congestion of the heart muscle. It is described as being produced directly by excessive functional activity of the heart, i. e. by over-exertion. Now in draught animals, and especially in horses, nothing is commoner than over-exertion, but the usual result is simply to produce hypertrophy of the heart, with or without dilatation of its cavities. Myocarditis due to this cause alone is very rare, if indeed it ever occurs. The cases seen are usually the consequence either of the Digitized by Microsoft® I40 CLINICAL VETERINARY MEDICINE AND SURGERY. acute form or of ^-alvular lesions ; or, again, of some obstacle to circula- tion reacting on the cardiac muscle, and forcing it to work more ■actively — a condition which first produces hypertroph}^ and sooner or later changes of the nature of degenerative myocarditis. In these cases functional hyperactivity is not acting alone, but is supplemented by permanent passive congestion of the cardiac muscle, consequent on the impediment to circulation. Under this double influence, changes occur both in the fibres and the sarcolemma. The latter, being con- tinuously irritated, responds by active proliferation (hyperplasia), while the muscular fibres undergo granular degeneration, lose their striation and contractility, and finally disappear under the pressure of the new connective-tissue growth. Like the valvular lesions (of which it is a consequence) this myocarditis is oftenest seen in the left heart. The myocarditis following pulmonary emphysema, and specially marked in the right heart, is due to a similar mechanism. In consequence of stasis and increased pressure in the pulmonary artery, cardiac circulation is impeded ; the blood escapes with difficulty from the coronary veins ; the cardiac muscle therefore becomes congested, and the conditions for degenerative and hyperplastic changes are at once realised. But, I repeat, diffuse chronic myocarditis is almost always a deferred con- sequence of infectious disease, during which the heart has been affected ; it is the last stage of inflammation of the muscle of the heart. Partial or superficial myocarditis, developed by contiguity of tissue, i. e. by extension to the cardiac muscle of inflammation at first localised in the pericardium or endocardium, is sometimes seen. Though ver}- rare in the horse, it is common in the dog. In exceptional instances, myocarditis may result from the presence of sclerostomata (parasitic worms) in one of the coronary arteries. I reported a case in an ass suffering from chronic myocarditis, in which the left coronary artery had become thrombosed, and close to its origin showed an aneurism containing a dozen of these parasites. The anatomical changes shown by the cardiac muscle when the seat of chronic inflammation result from t\\o constantly associated factors, the effects of which, however, may be developed to any degree, and most frequently are unequally marked. In the majority of cases the dominant lesion is the proliferation of interstitial connective tissue leading to sclerosis of the myocardium ; in others it is the granulo-fatty degeneration of the muscular fibres. When the contractile tissue is specially affected, the heart usually remains of normal size, being simply softer and more relaxed, though it may have undergone preliminary hypertrophj-. After recent attacks. Digitized by Microsoft® MYOCARDITIS. I4g sections through its walls appear yellowish-red, marked with patches or stripes of a lighter colour. Examined microscopically, the fibres are seen to have lost their striation, and to be more or less infiltrated with proteid granulations, broken up and partially destroyed. In addition, there is often a shght increase in quantity of connective tissue. These lesions are found irregularly distributed in both hearts, but especially in the thickness of the septum and of the wall of the left ventricle. They may be little marked at certain points, while well developed, or even of old standing, in others. Cases occur where the quantity of new connective-tissue growth is very small, and where the process appears to consist essentially in simple granulo-fatty degenera- tion of the muscular fibres. In fibrous or sclerosing myocarditis, by far the most common form, the heart may be hypertrophied, of normal volume, or more or less atrophied. When increased in size the hypertrophy must not be ascribed to the myocarditis ; it has preceded the latter, having resulted from excessive functional activity of the muscular tissue, necessitated by the presence of some obstruction to the free circulation of blood. The heart's surface is marked with irregular depressions, corresponding to portions of the cardiac muscle which have undergone fibrous trans- formation, followed by contraction of the new connective tissue. The sclerosis is of varying depth and area. In a general sense it is always of vascular origin, resulting primarily from proliferation of the cells forming the walls of small vessels, and gradually extending to the interfascicular tissue, producing fibrous new growths, which afterwards compress and destroy the true muscular fibres. This cardiac sclerosis is sometimes periarterial, related to arterio-sclerosis, sometimes peri- venous, due to stasis produced in the last period of valvular disease, and peculiar to what M. Huchard has called in man " cardiac heart." Microscopic examination reveals patches, bands, and anastomosing networks of fibrous tissue, of varying size, between the muscular fibres, many of which, in consequence of their pressure, have undergone degenerative changes or have altogether disappeared. The changes due to myocarditis when accompanying endocarditis or pericarditis, and developed by contiguity of structure, sometimes extend to the entire cortical layer of the muscle ; the latter showing on section a zone, several millimetres in thickness, of a reddish pale }ellow or whitish tint, depending on the stage and form of the disease. In this layer the muscular fibres have undergone granulo-fatty degenera- tion, or have become atrophied by pressure of the new tissue and fibrous networks. Instead of thus being spread over the entire surface of the myocardium, the lesions are in many cases circumscribed. In Digitized by Microsoft® 150 CI.INICAr. VETERINARY MEDICINE AND SURGERY. valvular endocarditis they are almost alwa3's localised near the auriculo- ventricular or arterial openings. The process extends from the base of the valves into the adjacent zone of muscle, and thus may produce so-called '"' annular " myocarditis. Through the medium of the chorda: tendinece it may extend to the iniisculi papillares, and end by transforming them almost entirely into fibrous cords. Similarly in pericarditis, secondary localised myocarditis is sometimes seen in certain parts of the superficial layers of the muscle. Localised myocarditis, followed either by fibrous or fatty degenera- tion, may weaken the ventricular wall until it yields to the pressure of blood, and finally undergoes saccular dilatation, producing a partial chronic aneurism. Bearing in mind the functional importance of the heart, and the grave nature of the lesions described, it might be expected that chronic myocarditis would produce very marked symptoms clearly indicating its existence. On the contrary, however, the disease often continues unperceived for months or even years, its stages succeeding one another very slowly. When chronic myocarditis appears as a primary condition, animals can often be kept at their usual work for a long time ; and e\en when it succeeds to the acute form, they are able to return to work after termination of the latter. In either case a time arrives when the previously latent disease produces disturbance which can no longer be ignored. The most ordinary is that complex condition known as broken wind, especially marked by dyspnoea. At work, difficulty in breathing soon occurs, the heart's action becomes strong and tumultuous, and true palpitation is perceptible on applying the hand over the precordial region. In some cases the horse stops suddenly during work, and is often thought to be suffering from colic, but in animals angina pectoris, like vertigo, fainting, and syncope, appears to be rare. During this preliminary period, which has been described as irritative, palpitation of the heart and acceleration of the pulse can be detected, even when at rest in the stable. With the lapse of time, dyspnoea increases during work, occurring in paroxysms, while the heart's action becomes modified and the pulse weak, infrequent, and intermittent. Not only does palpitation cease, but the contractions of the heart may be weaker than normal, and, like the pulse, infrequent, irregular, and intermittent. On ausculta- tion, the heart-sounds are rather attenuated in granulo-fatty myo- carditis, but prolonged and accompanied by a rolling or double sound in sclerosing myocarditis, with hypertrophy of the left ventricle. In Digitized by Microsoft® MYOCARDITIS. I5I neither of these forms of chronic inflammation of the myocardium is there a murmur unless a valvular lesion simultaneously exists, or unless the auriculo-ventricular valves are imperfectly controlled in consequence of weakness of the papillary muscles. In some cases percussion reveals enlargement of the area of cardiac dulness due to relaxation of the walls of the heart, and, in granulo-fatty myocarditis, to dilatation of these cavities, in fibrous myocarditis to hypertrophy of the left ventricle. But, as in the acute form, this symptom is difficult of detection. If the animals are kept, the symptoms become continuously aggra- vated, and may be supplemented by respiratory and gastric troubles of reflex character. These are later complicated by disturbance due to slowing of the circulation and weakness of the heart, vascular stasis, engorgement of the lung and of other viscera, dropsy, oedema, and finally by changes which indicate exhaustion of the heart. Degenera- tive myocarditis marks the last phase in the series of disorders pro- duced by valvular lesions. The successive changes seen during the disease originate in the endocardium ; they end in degeneration of the myocardium. Cortical or partial myocarditis produces much less pronounced and much vaguer symptoms. In the horse it is sometimes only indicated by intermittency. Chronic myocarditis always takes a very slow course ; it continues for years, gradually becoming more marked, though it may for a time remain stationary. It never tends towards recovery, however. If the patients are kept, death follows from increasing feebleness and wasting, or unexpectedly from syncope or rupture of the heart. The ass whose case I described was found dead in its stall, without having stopped work a single day, and without having shown any serious respiratory trouble, despite the fact that in its case myocarditis was complicated with disease and insufficiency of the aortic valves. Rupture of the heart is very rare in all animals, though it may occur under the influence of excessive excitement, or of a fall, or violent effort during work. The heart then contracts with excessive energy, the intra-cardiac pressure suddenly increases, and the muscular wall having undergone degenerative change yields at its weakest point — oftenest in one of the ventricles, at the seat of an aneurism, or of some fatty or fibrous alteration. The diagnosis of myocarditis is surrounded with many difficulties. In all species of animals mistakes are difficult to avoid, and diagnosis should be delivered with great circumspection. The disease is sug- Digitized by Microsoft® 155 CLINICAL VETERINARY MEDICINE AND SURGERY. gested by the history, by the visible symptoms, and especially by the attacks of dyspnoea w^hich affect most patients during work. The cardiac symptoms must be viewed as a whole, particular attention being given to those detected on auscultation, and examination of the pulse ; while other diseases capable of producing the functional dis- turbances noted must be disposed of by a process of exclusion. The prognosis is very grave. If the disease is not immediately threatening it always ends by disabling its subjects, and sooner or later entails death. The only useful treatment consists in endeavouring to control inflammation of the cardiac muscle by the administration of salts of iodine, and in stimulating those cardiac fibres which have escaped destruction. For this purpose heart stimulants and tonics like nux vomica and its derivatives, or caffeine, may be given ; where, however, symptoms of broken wind exist and the myocarditis is little pro- nounced, arsenic and sometimes digitalis give better results. Digitized by Microsoft® XXIII.— OSSIFICATION OF THE CARDIAC AURICLES. This morning I purpose speaking of ossification of the righ auricle, a lesion which is sometimes seen in the horse, and though not mentioned in the majority of classic works, has occasionally been reported in French and other periodical publications. I will give you the details of a case. This specimen which I exhibit was obtained by M. Barillot, a veterinary surgeon practising in Paris, at the post-mortem examination of a pony. It is a greatly enlarged and almost completely ossified right auricle ; its anterior portion is thickened and of bony consistence throughout, but the upper part has only undergone this change to a limited extent. It -presents rounded irregular areas of spongy bone tissue, varying in size between that of a large pea and of a sixpence ; almost all project more or less on both surfaces of the auricle. In the Conipte Rendu des Travaux de I'Ecole d'Alfort for the session 1836-7, Renault mentioned in the following terms a case of the same nature seen in a glandered horse, whose age, however, is not given. " The right auricle was considerably enlarged and weighed 2 lbs., was thickened and ossified throughout nine tenths of its extent, and the muscular fibres had been compressed and atrophied by the bony new growth. The lesions on the convex surface of the auricle were as hard and resonant as bone. They were less developed in the interior, where they had the appearance and consistence of cartilage. Ossifica- tion suddenly ceased at the junction of the auricle with the ventricle, and at the upper part where the auricle becomes continuous with the venae cavae. At their junction the veins formed an accidental pouch with muscular walls, the substance of which was continuous with that of the auricle, and appeared to have assisted the latter in its function. The other portions of the heart were healthy." Renault adds that cases of partial ossification of the heart, and especially of the auricles, had previously been noted in men and animals. Digitized by Microsoft® 154 CLINICAL VETERINARY MEDICINE AND SURGERY. In 1840 Bouley the younger, acting on behalf of Barthelemy, vete- rinary surgeon at Paris, communicated to the Academic de Medecine a case of hypertrophy of the heart, with complete ossification of the right auricle, in a six-year-old horse. The animal had been bought five months before, and was unable to do regular work. It did not cough, but rapidly lost breath after the least work; the respiration, while remaining regular, was sometimes extremely rapid, and suggested dyspncea. As it was thought that improvement would follow a rest at grass, the animal was sent to a farm in the neighbourhood, where it remained for two months. On returning it was put to work, but found to be in nowise improved, and some time later died from pneu- monia. The post-mortem examination revealed, in addition to recent and old-standing pulmonary lesions, hypertrophy of the heart and ossification of the right auricle, which was fixed to the pericardium by fibrous bands. The capacity of the auricle was at least doubled, and its walls, thickened to the extent of one inch and a quarter to one inch and a half, were completely ossified. In this communication Bouley refers to Renault's case, mentions a case of complete ossification of one auricle seen by Barthelemy the elder, in a cow affected with pulmonary tuberculosis ; and another, mentioned by Riquet, of partial ossification of one of the ventricles in a horse. He regards ossification of the auricles as extremely rare, inasmuch as Girard and Rigot do not appear to have seen a single case in the animals destroyed at Alfort for practical surgical operations and anatomical purposes during a period of nearly forty years. In Godwing's case the horse's age is not mentioned, though we are told that it several times showed serious symptoms, which were referred to " disease of the liver, complicated by interference with circulation." It was finally slaughtered. The post-mortem examination showed the existence of fibrous pericarditis. The auricle was cartilaginous through- out most of its upper part, and its anterior sections were ossified. Among the many horses examined after death at Alfort between 1848 and 1863, Colin twice found the right auricle completely ossified, and twice saw tracts of bony tissue of varying size. The horse, whose case was reported in 1884 by Chouchou to the Societe Centrale de Medecine Veterinaire, was eight years old. For three years it had belonged to a firm of carriers, and had always worked well, showing no sign of disease. One day, without apparent cause, it appeared depressed, and had to be rested for a week. For a time it seemed to recover, but soon returned to hospital with oedematous swellings in different regions and marked enlargement of the hind limbs, symptoms at first regarded as due to purpura haemorrhagica Digitized by Microsoft® OSSIFICATION OF THE CARDIAC AURICLES. 155 and afterwards to glanders. Soon afterwards a sarcocele developed and was operated on. With a little pus taken from the end of the epididymis a guinea-pig was inoculated. The result was negative. The patient steadily became weaker, and was finally slaughtered. On incising the pericardium lesions of fibrinous pericarditis were found. The heart was very large, the ventricles dilated and their walls thinned. The right auricle was whitish and hard, its cavity diminished in size, and Its walls ossified throughout almost their entire extent. It weighed nearly four pounds. Veret's case was that of a seventeen-year-old trooper which died in consequence of a fracture. On post-mortem the right heart was found to be " calcified." I pass over in silence some other cases reported abroad. The)- add nothing interesting to what I have just related. Let us now return to the horse, in which M. Barillot found the specimen he has sent us. Its history can be given in a few words : — A pony bought in London, in October, 1895, attacked with some chest disease soon after its arrival in Paris. Became convalescent in a fortnight, and was sent to grass in the He Saint-Denis, for three weeks. Before its illness this pony was- very lively, and had good action, for which reason it cost a considerable sum. On being returned to its owner it had lost its vigour and pace, was " soft " in work, dull in the stable, hung back from the manger, and its extremities were cold. On the 5th January an cedematous swelling appeared under the chest. My colleague, who was at once called, carefully examined the animal, and diagnosed pleurisy, at the same time noting certain signs of heart disease. Treatment proved unsuccessful, and two days later the pony died. On post-mortem the pleural cavity was found to contain an abundant exudate ; the heart was hypertrophied ; and the walls of the right auricle were thickened, hard, and ossified throughout the greater portion of their surface. The case, therefore, was one of ossification of the heart muscle. Sections showed the characteristic appearances of bony tissue, concentric bony lamellae, and osteoplasts. Ossification of the auricles is most common in aged animals, though sometimes seen in relatively young subjects. The pony of which I have just spoken was only five years old. A further curious point is that the right auricle is almost always the sole point attacked ; even when it is completely ossified the left auricle is usually entirely free. The causes of this peculiar change in the heart are unknown. In Digitized by Microsoft® 156 CLINICAL VETERINARY MEDICINE AND SURGERY. most reported cases heart lesions have either been complicated by others like pericarditis, or by emphysema, glanders, or tuberculosis ; while the cavity of the right auricle has been found greatly enlarged, owing without doubt to insufficiency of the tricuspid valve. When limited to one part of the auricle and only affecting the roof or cul-de-sac, for example, ossification produces no appreciable sym- ptoms, and is always a surprise on post-morteui ; but when extended to the greater part, or to the entire auricle, particularly if the latter be dilated, and the auriculo-ventricular opening more or less enlarged — troubles occur which clearly suggest the existence of heart disease. They include dyspncea, palpitation, venous pulse, and at a later stage swellings about the thorax and extremities. Even in presence of these complications, however, exact diagnosis is impossible. The most one can discover is that the disease is located in the heart. The various drugs which have been used all appear equally useless. In point of fact no treatment is efficacious. Digitized by Microsoft® XXIV.— CARDIAC INTERMITTENCY IN THE HORSE. For ten days past we have had in stable No. 6 a horse recovering from pneumonia, in which the day after entry we discovered by auscultation true cardiac intermittency, certainly of older standing than the pulmonary disease. I called your attention to this patient, and to the character of the intermittency. Allow me to-day to return to this variety of cardiac disturbance, which is common in the horse, but concerning which \ou will find very little in text-books and periodicals. In a normal state, and under normal conditions, the heart beats with perfect regularity. In an animal of any given species it contracts the same number of times within the same period, though its sounds are not invariably of one character. In the horse especially it is not uncommon to find modifications in their intensity and tone, and a tendency to doubling of one or other. To convince yourselves of this, you have only to auscultate a number of the patients now under treatment. The action of the heart is subject to an entire series of disturbances, some common and ephemeral, others produced by change in the organ itself, or in the nerves supplying it. The number of contractions may be modified, increased, or diminished by many pathological states. Sometimes the rhythm is slowed, a condition known as bradycardia ; more frequently accelerated, tachycardia. Either of the two sounds noted during each heart cycle may be doubled or replaced by a murmur. The cardiac systole and the pulsations of the arteries may be of unequal force. In all these cases the regularity of rhythm of the heart and of the pulse are generally preserved, the pulsations succeeding one another at equal intervals. But in some animals the cardiac systole and the arterial pulsations, whether equal or unequal in force, no longer succeed one another regularly. At more or less frequent intervals the heart's activity is completely suspended for a short period, or the contractions are feeble. Digitized by Microsoft® 158 CLINICAL VETERINARY MEDICINE AND SURGERY. and in both cases one or more arterial pulsations may be absent. These troubles characterise both varieties of cardiac intermittency seen in man by Laennec. In true intermittency it seems as though the heart were really arrested for the moment, its contractions completely ceasing. In false intermittency a certain number of cardiac cycles, normal as regards strength, are followed by a feeble abortive contrac- tion, which has no effect on the arteries, and which does not, therefore, cause their walls to rise ; only the pulse is then really intermittent. In both these varieties of intermittency, therefore, the regular cardiac or arterial pulsation is merely interrupted, whilst in true irregularity (arj'thmia) the pulsations are irregular or unequal, and the period of the cardiac cycle is prolonged or shortened ; in intermittency the heart usually beats normally save during the period of arrest. Both these conditions may be found associated. I merely mention the false intermittencies usuall}' seen during diseases of the heart and of some other viscera. In patients showing this condition the pulse is not only intermittent, but irregular, unequal, and frequently almost imperceptible. In patients with true intermittency, auscultation of the heart reveals a regular succession of orderly and equal beats, followed by a long silence, coinciding with an abnormal prolonged rest of the heart, then a new series of normal pulsations, to which succeeds a further silence, and so on. Apart from these suspensions, which from time to time and more or less periodically break the series, the heart acts regularly. The frequence of the arrests varies greatly. Sometimes they are separated by unequal periods of time, and are repeated every second, third, tenth, twelfth, or fifteenth pulsation ; som.etimes the}' succeed at equal intervals, /. e. after the same number of pulsations, usually from two to six. One sees horses in which the pauses are rhythmical to a very remarkable degree ; in others the periodicity is subject to variation. During the course of the day the same animal may at certain times show regular, and at others irregular intermittency. In some rare cases the series of pulsations are separated by long intermittencies, which again are interrupted by a false beat. The duration of the arrests is generally in inverse proportion to the number of pulsations in the series. It usually corresponds to one or two cardiac cycles, though occasionally shorter or longer. In a case mentioned by Siedamgrotzky the heart beat sixteen to twenty times per minute, the beats occurring singly or in groups of two, three, or four, separated by arrests corresponding in duration to two, three, or four pulsations. At the post-mortem of this horse the heart was found Digitized by Microsoft® CARDIAC INTERMITTENCY IN THE HORSE. 1 59 hypertrophied, and its muscular substance degenerated. Some months ago in the outer clinique we saw a horse in which the beats occurred in groups of three, four, or five, separated by pauses equal in length to two cardiac cycles. Whatever the duration of the series of beats or pauses, the first contraction after the intermittency is almost always stronger than the others. Sometimes, and particularly when the animal has just been exercised, it is violent, recalling palpitation, while the second contrac- tion always follows rapidly and at a shorter interval than the others. In some instances the usual cardiac stimuli fail to act, or have little effect on the intermittency. If, in order to accelerate the beating of the heart, the patient is trotted for a few moments, they may continue as before ; but in general the intermittencies noted during rest diminish in frequency, or temporarily disappear under the influence of exercise. Last month I examined a patient showing this peculiarity. The horse was five years old, had been bought six months before, and was at first a good worker. Two months before being brought here it began to lose its hard condition, showed difficulty in breathing, and was unfit for even moderate work, though it still appeared well-nourished. On watching the flank, expiration was seen to be double. On ausculta- tion every fourth or fifth heart-beat was found to be followed by an intermittency equal in length to one or two pulsations. Both cardiac sounds were abnormal, the first being prolonged and the second double. After a few minutes' exercise the intermittency disappeared, the beats succeeding at regular intervals ; but after a further few minutes the arrests recurred at first at rare intervals, then more and more frequently. During the last few years I have noted true intermittency, certainly of old standing, in several horses undergoing treatment in hospital for external diseases, but which had never shown symptoms of heart disease. I will describe two cases. In 1895 we had in the infirmary a horse suffering from picked-up nail, which showed intermittency of the pulse and arrest of the heart ; neither condition, I need scarcely say, had any causal connection with the injury. The heart-beats occurred in series of three to six, sepa- rated by silent periods of uniform length, lasting as long as one pulsation. The first systole of each series was sudden, bounding, and immediately followed by a second much weaker contraction, then by others of diminishing strength. The violent struggles during operation, and the traumatic fever which followed it, had no effect on the intermit- tency. The animal left here in the same condition as when it entered ; the periodicity and duration of the arrests were precisely the same. Digitized by Microsoft® l6o CLINICAL VETERINARY MEDICINE AND SURGERY. Previous to the accident for which the horse was sent here no dis- turbance or symptom suggesting cardiac irregularity had been remarked. According to its driver's account the horse even seemed brighter and more spirited than the animals with which it worked. In 1894 we discovered similar disturbance in a ten-year-old carriage horse, sent here from the department of the Maine-et-Loire on account of spavin lameness. This horse was very fast and powerful, and had never shown symptoms of heart disease. The pupil who attended it was instructed to keep me informed of the changes in the pulse and heart. The intermittency lasted as long as two complete heart cycles, and occurred after every three or six pulsations, long and short series succeeding one another in an extremely irregular fashion. The aetiology of cardiac intermittency is complex, and its pathology even more obscure. In certain cases where it has been observed apart from any manifest organic change it has been attributed to overwork or digestive trouble ; but, except when produced by excessive doses of digitalis, it usually indicates some heart disturbance. Of the organic lesions it most frequently accompanies myocarditis, at times endocarditis and pericarditis. Its final cause always appears to be either primary or secondary disease of the cardiac muscle, or some disturbance of the nervous apparatus of the heart. On account of intermittency being usually due to myocarditis, it is often accom- panied by other symptoms like dulness, rolling, and doubling of the heart-sounds, which indicate or at least suggest disease of the heart muscle. Temporary intermittency, true or false, regular or irregular, often appears during various specific diseases in consequence of the heart being attacked by infectious organisms or their toxins. I have often observed intermittency during pneumonia, and those practitioners who auscultate the heart during such attacks have certainly had similar experience. In the Bulletin de la Societe Centrale de Medecine Vete- rinaire for 1894 I described a case. I may here mention a more recent instance. At the commencement of last December I received into hospital a six-year-old horse with acute pneumonia of three days' standing. The disease was of moderate gravity, rather benign in character ; the tem- perature did not exceed 40-5 " C. (104-9° F-); and the fever declined on the sixth day. Every morning after having examined the state of the lung I auscultated the heart. During resolution, the tenth day of the attack, I noted intermittency ; a pause, equal in length to that of one cardiac cycle, following series of six to ten contractions, normal in Digitized by Microsoft® CARLllAC INTKRMITTENCY IN THE HORSE. l6l respect of strength and rhythm. During the following days these intermittencies became more frequent, one occurring after each fourth or fifth pulsation. At the end of a week they could only be noted after a regular series of eight to ten pulsations. They did not change before the animal left the hospital ; I may add that digitalis had not been given. Usually ephemeral in character, but sometimes obstinate or even permanent, such intermittency is commonest in cases of pneumonia which at the onset have shown other cardiac disturbance like marked acceleration and violent action of the heart, or modification in the sounds. The seriousness of intermittency depends on many conditions, but especially on its frequency, duration, and the presence or absence of other cardiac troubles. When recent, and occurring during the course of or during convalescence from acute diseases, it generally disappears rapidly, and does not return. When of old standing (whatever the primary disease to which it is due) it commonly indicates change in the heart muscle, or in its nervous supply, and caution must be observed in delivering an opinion. Though not necessarily implying the existence of any organic disease, or material change in the heart, yet in the great majority of cases it follows injury to the heart muscle or its nervous supply. Certain horses still continue useful for years,, but are none the less affected in one of their most important organs. The treatment resembles that of myocarditis, the principal agents being the iodide of potassium or sodium and digitalis. In old-stand- ing intermittency drugs have little effect ; they are only useful within a comparatively short time after the onset of disease. In a patient which had suffered from strangles, and in which inter- mittency followed ever}- three or four pulsations, I prescribed a 2J- drachm dose of iodide of potassium daity, afterwards increasing it to 3f drachms. This treatment was onh- commenced three months after recovery from strangles, and was continued for six weeks, with two interruptions of a week, the animal being meanwhile kept at quiet work. At the end pf two months the intermittencj' still continued, but at longer intervals, being separated by series of six, eight, or ten pulsa- tions. It afterwards became less frequent and finally disappeared. Digitized by Microsoft® XXV.— PERICARDITIS IN THE DOG. During the past few months we have seen a considerable number ■of cases of peritoneal dropsy in the dog, and I have shown you that in these animals ascites is very often associated with tuberculosis, peri- carditis, or valvular endocarditis. This fact must always be borne in mind when giving an opinion and directing treatment. You will therefore understand why, when called on to treat dogs with abdominal dropsy, I do not confine myself, as was usually so long and is still the custom, to evacuating the liquid collected in the peritoneum and pre- scribing wine of squills or similar remedy ; but always examine the heart by palpation, percussion, and auscultation, and submit the patient to the tuberculin test. In order to estimate the gravity of the condition, and decide whether the patient is or is not amenable to treatment, it is not sufficient merely to show that the ascites depends on pericarditis, for, as I have already shown during a previous lecture, pericarditis in the dog is often of tuberculous character. When, therefore, dogs with pericardial effusion distinctly react to tuberculin, the pericardial disease is probably tuber- culous ; and although failure to react does not entirely eliminate the question of tuberculosis, it at least greatly strengthens our belief that a cure may be effected. It is this latter point which I wish to emphasise to-day. I shall first describe a case affected with pericarditis and ascites, which was cured by puncturing the abdomen and pericardium. Towards the middle of last April a three-year-old sheep-dog, which had always enjoyed good health, was brought to hospital on account of disease of a fortnight's standing. Without doubt it had suffered from distemper, but of so trifling a character as to have escaped observation. At the beginning of April the dog lost its spirits ; its appetite became capricious, and was afterwards lost ; the abdomen increased in size ; walking was painful, and soon caused loss of breath. When submitted to our notice this patient showed all the external ■signs of some gra\e visceral disease. Apart from the emaciation and Digitized by Microsoft® PERICARDITIS IN THE DOG. 1 63 weakness, three points immediately attracted attention— the rapid breathing, size of the abdomen, and presence of a swelhng under the chest. The abdomen was largest about its lower part, which was dull when percussed and showed fluctuation, pointing to the presence of ascitic exudate. The respiration was rapid, short and sighing, numbered thirty-five to forty per minute, and movement and exertion of any kind like walking caused oppression. On auscultating the chest the vesi- cular murmur was only heard distinctly in the upper half of either lung. The heart-beats were difficult to feel, and the normal heart-sounds were obscure, distant, and smothered. The pulse at the femoral artery was very feeble, and about 130 per minute. The jugulars showed very clearly marked venous pulse. The temperature was 39-2° C. (102-5° F.). On the same day we tapped the abdomen, and withdrew about two quarts of a slightly red serous liquid. During the evening and the next day the animal was spoon-fed with milk, and 15 eg. (2-25 grains) of calomel were given. Tuberculin produced no reaction. On the following day, although fever was slight (the temperature not exceeding 38-9° C. = 102° F.), the condition had become more alarming. The abdomen, reduced after tapping, had again increased, and the swelling under the chest was somewhat larger. The impulse and beating of the heart were imperceptible ; the. arterial pulse was still feebler than on the previous day, but the venous pulse more marked. The respirations were forty-five per minute ; the depression appeared greater, and death imminent. After morning hospital inspection I punctured the pericardium with an aspirator and fine needle opposite the fifth intra-costal space, about two and a quarter inches above the line of the sternum, withdrawing nearly six and a half ounces of slightly red-stained liquid similar to that obtained from the abdomen on the previous day. Immediate improvement followed. The patient's face lost its anxious expression, the dyspncea diminished, and the respiration became easier. During the evening and night the animal several times took milk. Next day the improvement continued. The morning temperature was 38*6° (ioi'4° F.), the respiration 27, and the pulse 112. The heart-beats could be felt, both normal sounds were heard, and the venous pulse disappeared. I prescribed infrictions of antimonial oint- ment over the precordial region. Milk feeding was continued. Within a few days disturbance rapidly diminished. At the end of a week the appetite and general spirits returned. Fed on meat, rice, and milk, the convalescent rapidly regained strength and condition. Digitized by Microsoft® 164 CLINICAL VETERINARY MEDICINE AND SURGERY. When returned to its owner a fortnight after the second operation it was almost completely cured. ^^'hen, however, pericarditis in the dog results frotn tuberculosis, or has given rise to local or visceral lesions of a mpre or less per- manent character, the results of tapping the pericardium are seldom as successful as in the above case. But in certain forms of pericarditis which develop slowly, rapid cure is possible even when the condition has existed for a comparatively long time. The following case bears witness to this. During August, 1896, a four-j-ear-old setter, which had been ill for nearly six weeks, was brought for examination. Though usually very bright and affectionate, this dog had become dull, had kept out of sight and remained continuall}- lying down, while it scarcely touched food. On the few occasions \\hen it accompanied its master, walking was followed by loss of breath, which forced it to stop, gasping for breath. When brought here its emaciated state and enlarged abdomen at once arrested attention. Palpation of the abdomen re\ealed the presence of a large quantit}- of ascitic exudate. The respiration was rapid and painful, inspiration being slow and prolonged, expiration rapid. On auscultation the vesicular murmur was almost normal in the upper parts of both pulmonarj- lobes, but absent in the lower. On applying the hand to the left thoracic wall, over the cardiac region the heart's impulse could not be felt, and on auscultation both normal sounds were verj- feeble and difficult to detect. Percussion showed the zone of cardiac dulness to be much more extensi\e in front, towards the back, and in an upward direction than normal. The limits of this dull zone were practically the same \\hether percussion were performed with the animal in the ordinary standing position, lifted by its fore-limbs, or allowed to stand on its hind. The pulse was rapid, verj- feeble, and irregular. Both jugulars showed a marked venous pulse, especially in their lower portions. The pulse was 120, the respirations thirty-six per minute ; the temperature 39" C. (i02'2° F.). I diagnosed the condition as pericarditis, probably of tuberculous character complicated \\-ith ascites. Injection of tuberculin produced no reaction. On the third day I successively performed, under antiseptic pre- cautions, puncture of the abdomen and of the pericardium, using an aspirator. I slowly withdrew from the abdomen nearly three pints of a greyish serous fluid, and from the pericardium twelve fluid ounces of a similar liquid. A part of the left thoracic wall, as large as the palm of a man's hand, over the heart region, was rubbed with anti- Digitized by Microsoft® PERICARDITIS IN THE DOG. 165 monial ointment, and the abdomen was bandaged. The food con- sisted of milk and a little raw meat. This treatment gave immediate relief. Next day the respirations were only 30 and freer, the pulse was 100, and the appetite returned. The animal took a pint of milk and some meat. On the following days slow improvement continued. Recovery was uneventful ; no occasion arose for repeating the puncture, the hquid left in the pericardium and peritoneum becoming reabsorbed. A month later the animal returned home cured. It had quite recovered its appetite, was bright, walked and trotted without showing dyspnoea, and the impulse and sounds of the heart had become normal. We heard somewhat later that the animal had recovered its condition and strength. In addition, however, to narrating these two cases, I wish to direct your attention to the principal varieties of pericarditis in the dog, and to teach you the lessons of my own experience. Though very generally of secondary character, and due either to tuberculosis or some other infectious disease like pneumonia, rheu- matism, or distemper, pericarditis is sometimes primary, the result of cold or injury. You will rarely see traumatic pericarditis, most of the cases we are called on to treat being attributed to chill. As in pleurisy, pneumonia, and endocarditis, cold is not, however, the sole factor in producing the disease, its action being confined to exciting general disturbance, congestion, etc., which favour and render possible infection of the pericardium by microbes brought from neighbouring or distant organs through the circulation. Pericarditis a frigore is certainly rare, and can only occur in animals predisposed to it by their constitutional condition, though its occurrence is indisputable. You will see it especially in water-spaniels and sporting dogs used in marshy country. During Alarch, 1895, I made a post-iiiortcm examination of a little poodle, in which exudative pericarditis had been produced by baths prescribed for skin disease. A week after commencing treatment the patient suddenly showed very grave symptoms, which were attributed to pleurisy. Bathing was stopped, and the animal treated for the chest affection ; but the treatment proved abortive, and death occurred on the tenth day. The body was brought here. The pleurae and lungs were Jiealthy, but the pericardium was acutely inilamed and contained abundance of a slightly reddish fibrinous liquid, in the precipitate from .which I found streptococci. There were no tubercle bacilli, and no tuberculous lesions in any of the organs. Digitized by Microsoft® 1 66 CLINICAL VETERINARY MEDICINE AND SURGERY. In the dog, exudative pericarditis occurs in the acute and chronic forms. Attention is always first attracted by the physical symptoms. The acute form is indicated by loss of appetite, weakness, rapid breathing, anxiety, dyspnoea, and fever, amounting to I'S'' — 2 C. Physical signs soon develop indicating its character. At the very commencement auscultation may reveal a rubbing sound, produced b}^ friction between the two roughened pericardial layers ; but this sound is fugitive, and can rarely be detected. Furthermore it is not constant, for exudation may accompany the onset of the disease. At this initial stage palpitation may also occur, particularly when the patient walks or makes any marked effort ; percussion sometimes produces pain. As soon as the pericardium contains a certain quantity of liquid,, the heart is thrust upwards and a little forwards, the degree of dis- placement depending on the amount of exudate. The pericardial sac becomes distended, especially about its base, lifting the pulmonary lobes, and pushing them upwards towards the vertebrse, though to a much less degree than in pleurisy. Thus on palpation of the pre- cordial region the heart's impulse appears weak, or seems lost. On auscultation the normal sounds, clearly detected in health even in very small patients, are dull, distant, and smothered, or completely inaudible. When the heart is but slightly compressed the pulse pre- serves its character ; but as soon as pressure becomes marked the pulse grows small, fugitive, and weak, sometimes almost imperceptible and uncountable. Compression of the auricles — the portions of the heart which col- lapse most readilj- — impedes the flow of blood, produces cyanosis, venous pulse in the jugulars, and mechanical dyspnoea owing to stasis of blood in the lungs. The symptoms of oppression at first seen are un- doubtedly of reflex origin, due to the pain in the inflamed pericardium. If not treated, acute pericarditis may rapidly lead to death, some- times in less than a week. It may also (though exceptionally) ter- minate in recovery, the exudate becoming reabsorbed, the symptoms gradualh" diminishing and finally disappearing. In certain cases it assumes the chronic form. The variet)- of pericarditis to which the term hsemorrhagic has been applied is characterised by a reddish, sanguineous exudate, and occurs somewhat frequently in the dog. During the course of the last two jears I have seen fi\'e cases. In three the pericardial inflammation was of tuberculous origin, and in one there was no other tuberculous focus save in th.e pericardium. In two cases the disease was of a special character, independent of tuberculosis. The ^ haemorrhage occurring during the course of the disease originates in the very Digitized by Microsoft® PERICARDITIS IN THE DOG. 167 vascular and fragile new membranes which develop on the surface of the pericardium, especially towards the base of the heart, at the point where the serous membrane is reflected. This form is always very grave. The five patients which I saw all died rapidly. In 1894 I had sent to me the body of a bitch which had died from hsemorrhagic pericarditis, and in which the peritoneal exudate was very abundant. ■ A year before I had tapped this animal for abdominal ascites, apparentl}- curing her — at least for a period of six months. In this case, again, we found no tuberculous lesion, and animals inocu- lated with the exudate gave no result. In a considerable number of instances, instead of following this well-marked course, pericarditis assumes a chronic character from the beginning. Its onset is insidious, its course slow; and until the exudate is sufficiently abundant to produce difficulty in breathing, it remains unrecognised. Then on methodical examination one notes, as in the acute form, certain signs furnished by auscultation and percussion. At a more advanced stage the physical signs become aggravated, and are supplemented by loss of appetite, feebleness, emaciation, and swelling of the limbs — final complications which you have seen in several patients. The dog occasionally suffers from "dry" pericarditis of simple or tuberculous character, which ends -by producing numerous adhesions between the two opposing layers of the pericardium. In this form functional disturbance is seldom much marked, and the disease some- times remains unrecognised until post-mortem examination. Even in the first stages digital pressure over the intercostal spaces of the pre- cordial region produces no marked pain. The only constant sign is the rubbing sound, which usually persists for a considerable time, and may occur either during systole or diastole, but is always synchronous with the movement of the heart — a character differentiating it from the pleuritic rubbing sound which is synchronous with respiration. When adhesions have occurred the heart's action seems feeble, or the cardiac impulse may be imperceptible on palpation. You noted this latter symptom in a tuberculous dog killed a few weeks ago, at the post- mortem examination of which we found ver}- complete adhesion of the two pericardial layers. At a later stage adhesion between these layers may be complicated by degeneration of the heart muscle, producing cyanosis, dyspnoea, ascites, and oedema of the limbs. In general, when the x'eterinar}' surgeon is called on to examine a dog affected with exudative pericarditis, the disease has already been in Digitized by Microsoft® 1 68 CLINICAL VETERINAR^' MEDICINE AND SURGERY. existence for some time, occasionally for several weeks ; and, provided he makes a complete examination of the patient, and does not forget the heart, a careful consideration of the signs furnished by palpation, percussion, and auscultation should enable him to arrive at a correct diagnosis. Ascites is often the most striking symptom, and puts one on the right path. It is usually easy to differentiate between pericar- ditis and pleurisy. In pleurisy with moderate exudation, resembling that of pericarditis, the zone of dulness changes with the animal's position. By standing the animal on its hind legs the heart-sounds and vesicular murmur become readily perceptible, while the upper part of the thorax is resonant ; in the normal standing position the reso- nance disappears or becomes dulled. Pericarditis having been diagnosed, the question remains whether Fig. 17. — Chest bandage. or not it be of tuberculous character. The patient's bodily condition, the clinical signs, and the history only form a basis for presumptions. But in most cases the matter can be solved by an injection of tuber- culin ; and even when this appears to fail, recourse may be had to inoculation of a guinea-pig with a little pericardial serosity. As I said at the commencement, most of our patients are affected with pericarditis complicated with ascites. Unless the pericardial symptoms appear menacing, tapping may be deferred, and attempts made to assist reabsorption of exudate by counter-irritants, diuretics and purgatives. I am in the habit of rubbing the precordial region with antimonial ointment, and to prevent the animal licking it, I apply a bandage over the spot (Fig. 17). I prefer this to cold compresses or sinapisms. In addition to milk diet, I prescribe internally calomel or bicarbonate of soda and digitalis. Digitized by Microsoft® PERICARDITIS IN THE l)0(i. , 1 69 When, despite treatment, the exudate increases and the symptoms become more marked and alarming, or when even on first examination the general condition appears dangerous, I puncture the pericardium. Operation is as follows ; — The precordial region is prepared by clipping away the hair, and shaving the skin a little below the centre of the zone of dulness for a distance of two or three square inches. The parts are afterwards washed with alcohol, and with a 'i per cent, solu- tion of sublimate. I prefer an aspirator provided with an india-rubber tube, and I proceed as 3'ou saw in the case of our last patient. The air being exhausted from the cylinder of the aspirator, the instrument IS passed to an assistant : I introduce the point of the needle at the centre of the prepared surface, through the fifth intercostal space three or four fingers' breadth above the lower margin of the thorax. As soon as its end has fairly entered the thoracic wall I open the tap connected with the aspirator ; then I very gently push forward the needle until liquid appears in the glass index of the rubber tube. Operating in this way the needle need only just enter the pericardium, and with a short point, injury of the heart (which is always pushed upwards and shortened in its vertical axis) need not be feared. Furthermore, by using a small needle, fluid is very slowly withdrawn and danger of syncope prevented. In the absence of an aspirator, puncture may be effected with a fine trocar. After operation the wound is closed by painting with collodion, and the parts covered with a cotton-wool dressing- Should the exudate again form, reproducing the symptoms, operation must be repeated. To prevent further recurrence in such a case, a few drachms of very dilute iodine solution or some other antiseptic liquid may be injected into the pericardial sac after removing the exudate. During the following days the patient is fed on milk, milk prepara- tions, meat juice, or fragments of raw meat. When appetite returns, more substantial food and tonics may be given. When pericarditis is complicated with ascites I generally remove the peritoneal fluid by tapping the abdomen, but this is not always necessary. Once the pericardium is relie\ed, the peritoneal exudate tends naturally to become absorbed. Its disappearance is assisted by administration of diuretics. The reason why treatment so generally fails is that, in the majority of cases, pericarditis is produced by tuberculosis. In such case, puncture, whether or not followed by iodine injections, can only produce tem- porary improvement. Even when tuberculosis is exclusively confined to the pericardium (I have seen a case of this kind) the liquid is repro- duced, and the patient dies from complications of pericarditis, or from progressive emaciation. Digitized by Microsoft® XXVI.— PNEUMONIA IN THE HORSE. At the present time we have in hospital three horses which have recently been attacked with pneumonia, affording us a particularly favourable opportunity for studying the disease. You have closely examined all three, and have seen that as regards the symptoms and course of the disease they present notable differences. The first of these patients, a nine-year-old gelding, entered on the 14th April suffering from pneumonia of three days' standing. It was very dull, but still took note of what went on around it. The conjunc- tivas were saffron -yellow in colour, the respiration and circulation accelerated, the pulse strong and regular. From both nostrils, and especially from the right, a little yellowish rusty discharge escaped. Percussion showed partial dulness in the lower third of the right lung. On auscultation a moist crepitant rale was heard ; the temperature was 40° C. (104° P.). We were informed that on the previous day the animal was seen to be ill. It had been at work from morning till night, and had been caught in . several showers of rain. When placed in a box after exa- mination the patient took some mash, hay tea, and a few oats. Treat- ment was as follows : — A mustard plaster was applied to the lower half of the chest, six ounces of '8 per cent, salt solution were subcutane- ously injected, and one and a half ounces of bicarbonate of soda were given internally. Food consisted of six quarts of milk per day, bran mashes, ha}' tea, and chilled water ad libitum. Next day the general condition remained practicall}' unaltered. The respiration, circulation, and temperature had undergone no marked change. On auscultation a tubal sound was heard opposite the centre of the left lobe. In the upper third of this lobe, and throughout the right lobe, the vesicular murmur was exaggerated. On the following day the animal appeared distinctl}' better and brighter. I drew your attention to the tubal sound, which, being heard in the centre of an otherwise absolutely silent area, was unusually well defined. The appetite was good. The temperature had fallen half a degree (C). Digitized by Microsoft® SIMPLE PNEUMONIA IN THE HORSE. 171 On the fourth daj- (that is the seventh of the disease) improvement was again marked. The animal was brighter and more HN-ely, and ate all Its food. The temperature was only 38-5° C. (101-3° F.), the tubal sound was feebler, and crepitation was returning. 1 he last symptoms soon disappeared, and the patient being con- valescent left hospital. It had remained about twelve days. This first horse illustrated in a remarkable degree the regular deve- lopment of pneumonia ; it was, in fact, a typical case of what is termed simple pneumonia. The second patient, brought to the College on the evening of the 19th April, was a five-year-old entire horse, from a stable in which, during the preceding weeks, several cases of pneumonia had occurred. On the morning of entering hospital the horse had made a journey at a slow trot, and though it appeared less willing than usual, this was attributed to fatigue and the hard work of the previous few days. On returning at midday it refused food, and was seen to be dull and to be " blowing " slightly. At six o'clock when we examined it the animal showed unmistakable signs of a grave morbid condition, which, according to the information furnished, would appear to have been pneumonia. The patient was greatly depressed, the conjunctiva injected, the mouth drj- and hot, the pulse sevent}' per minute, the respirations forty-eight, and the tempera- ture 40'3° C. (io4-3° F.). Auscultation and percussion of the chest revealed no abnormal sound either in the lungs or the heart. All that was noticed was a certain exaggeration of the \'esicular murmur, and impulse of the heart. I prescribed mustard plasters to the chest, friction with mustard to the limbs, and the internal administration of six ounces of alcohol, four drachms of sulphate of quinine, and one and a half ounces of bicar- bonate of soda. The animal was given gruel and milk every two hours. At a later stage we also had recourse to digitalis, calomel, subcutaneous injections of serum and of ether, and finall}- to warm carbolic enemata. On the two following days the temperature remained between 40"5'^ and 41° C. (i04'9° and 105'8° F.), the respirations thirty-five to forty, and the pulse sevent}' to eighty per minute. There was triiling cough and very little discharge. On the 22nd percussion re\ealed dulness over. the lower half of both pulmonarj- lobes; on auscultation moist crepitus was heard. During the following days the area of dulness and crepitation increased, especially on the right side ; respiration became difficult, expiration sighing, and the heart's action violent, while fe\'er remained intense. Each afternoon the patient was well covered up. Digitized by Microsoft® 172 CLINICAL VETERINARY MEDICINE AND SURGERY. taken out of the stable, and left for some hours in the open air. On the fifth and six days we noted on the right side a slight deep-seated tubal sound, although crepitation persisted in parts of the lower region of both lobes. On the eighth day the temperature still remained at 40° C. (104° F.). Next day it began to decline, but the general and local s\'mptoms diminished less rapidly than in the first patient, only disap- pearing completely on the fourteenth day. In our third patient the disease behaved very much as in the preceding. Both lungs were affected, the left more severely than the right. For several da\-s there was marked depression and cardiac disturbance. The temperature rose to 4I"4° C. (io6"5° F.). defer- vescence only setting in on the eighth day. On the twelfth the more important functions had become normal. Although these two patients showed no symptoms pointing to the existence of grave lesions in other organs than the lungs, they had suffered from contagious pneumonia, contracted in their own stable. During the last few months you have seen a number of other cases of sporadic and contagious pneumonia. I called your attention to their special features. I showed y(ju that in simple pneumonia the inilam- mator\- centre is early revealed and limited, the course is regular and t\-pical, the defervescence is clearly marked and occurs on a fixed date, complications are rare, convalescence is short, prognosis favourable, and recovery almost constant. On the other hand, in contagious pneumonia the pulmonary lesion is generally at first deep-seated, invades neigh- bouring parts, or occurs at several points— is, in a word, multiple; the course is atypical or protracted, the defervescence slow, and sometimes attended by relapses ; complications are numerous ; con\'alescence is slow, and the prognosis grave. Future investigations may possibly establish the essential identity of these two conditions — the unicity of pneumonia in the horse ; possibly they will prove that simple and contagious, benign and malignant pneumonias are all produced by the same microbe, the virulence of which becomes diminished or exalted under the influence of ascertained or occult conditions. BL:t up to the present we have only \-ague guidance on these points, and although from simple clinical signs it is sometimes difficult, and even impossible to say to which variety a particular case belongs, I risk the chance of criticism, and consider it better to study the disease under the two forms of simple or sporadic, and contagious pneumonia. Let us begin with the former. Acute Sporadic Pneumonia (also termed Fibrinous, or Croupous) is Digitized by Microsoft® SIMPLE PNEUMONIA IN THE HORSE. I 73-. a common disease in the horse. Its frequency is explained, especially m horses used for heavy work in large towns, by the changes of tem- perature to which they are exposed, by the very active function of the lung during work, and by the susceptibilit}- to cold presented by those kept in ill-\-entilated stables. Liability to pneumonia varies with age. The disease is commonest m young unseasoned animals, which are particularly sensitive to the action of changes in the weather, and in which the lung has not yet become accustomed to active work. In them, and in old animals which have arrived at the decadent period, the disease is gravest. Among predisposing influences are close, low-roofed, badly ventilated stables ; debility ; sluggish circulation ; and various other causes which commonly favour the development of visceral diseases. The chief exciting cause of pneumonia is the action of cold. In this respect authors are unanimous, and in consequence the disease has often been termed Pneumonia a frigorc. The largest number of cases occur during the first four and last three months of the year. It is par- ticularly frequent at the seasons of greatest changes in temperature — at the beginning of spring, and in the autumn. Sudden changes of tempera- ture, and rain or moist weather, appear more dangerous than prolonged uniform cold. Chills, thus produced, may be assisted by other influences,, especially by functional hyper-activity of the lung. The most favourable conditions for producing pneumonia are found when animals have been clipped, and whilst sweating are wetted by a shower, or suddenly exposed to a current of cold air. It is said that since the custom of clipping has become general, pneumonia has diminished in frequence. Nevertheless cases occur where it clearlj- appears to have favoured inflammation of the lung. In one of our patients, which had not been overworked or exposed to showers, pneumonia developed ten days after clipping. Man)- similar cases ha\e been observed amongst the horses of the great Omnibus Company of Paris, where clipping has been gi\en up. For a long time it was believed that the action of cold was alone sufficient to produce pneumonia, but this is erroneous. The constant failures which followed attempts to produce pneumonia experimentally were explained by a special resistance of the organism, and by the absence of conditions which predispose to the disease. Bacteriological experiments in man have, however, shown the existence of another factor, which is, in fact, the causa catisans. They proved that pneu- monia is an infectious disease, produced by the entrance into and growth within the lung of a special microbe — the pneumococcus. The first experiments on this point date from 1877. Some years. Digitized by Microsoft® 174 CLINICAL VETERINARY MEDICINE AND SURGERY. later Friedlander discovered in centres of pulmonary inflammation an encapsuled bacillus, which he regarded as the cause of the disease. Talamon afterwards found that the microbe of the disease is a coccus occurring in the form of little elongated grains, isolated or arranged in couples, and enclosed in a capsule ; it colours readily with aniline dyes and by Gram's method. This pneumococcus had previously been dis- covered by Pasteur in normal saliva. It exists in the bucco-pharyngeal cavity, and has also been found in the nasal fossse, Eustachian tubes, and even in the bronchi. Nor is its held of pathological activity limited to the lung. It may produce pleurisy. It is also capable of passing into the blood-stream and causing other visceral diseases like endo- carditis, nephritis, and meningitis — only to mention the principal. Cultures of this pneumococcus injected into the blood produce pneu- monia, sometimes complicated with pleurisy, endocarditis, and peri- carditis. In human pneumonia it is constantly present, and without it the disease does not develop. Invasion of the lung is favoured by cold, which, however, only acts as an exciting cause by producing vascular ■or cellular disturbance, and by momentarily diminishing the resistance of the organism. The pneumococcus does not always act alone, being sometimes accompanied by streptococci or staphylococci. Even when the pathogenic organisms are confined to the lung grave disturbance may be produced in other viscera or tissues by the toxins they elaborate — that is, by soluble poisons, the injurious effects of which are specially marked in the heart and kidneys. Simple pneumonia in the horse is certainly an infectious disease also, but its microbe has not yet been satisfactorily identified. In hepatised areas various germs are found, among others a micrococcus which presents certain analogies with the pneumococcus of man, and a diplo-streptococcus which, according to certain authors, is only a modified form of the microbe of contagious pneumonia. It is possible that, as in man, the microbe which produces simple pneumonia acquires greater virulence by growth in the favourable medium offered by the inflamed pulmonary tissue, and that, having gained this increased activity, it may unaided produce pneumonia in animals exposed to infection. Such infection might easily occur through the medium of the discharge, which always contains a certain number of the infective organisms. Against this theory of the contagious character of simple pneu- monia, suggested by Cagnat in 1884, have been advanced innumerable recorded cases where the disease remains isolated, and where, in spite Digitized by Microsoft® SIMPLE PNEUMONIA IN THE HORSE. 175 of the cohabitation oi an affected patient with other horses of all ages, the latter successfully resist. Many continue to consider contagious pneumonia and simple pneumonia (or pneumonia a frigore) as different affections, chiefly because the latter has not the eminently infectious character of the former ; but also because it generally shows special clinical ' and anatomical pathological characters. Nevertheless I repeat, that very often when examining a patient it is impossible to decide by the clinical symptoms alone what form of disease we have to deal with, and it is now known that lobar hepatisation is not an ana- tomical character peculiar to pneumonia a frigore. Many a^athors state that a first attack predisposes to a return of the disease. This opinion, founded on the widely accepted belief that after inflammation the lung remains more or less injured and enfeebled, is in no way confirmed by clinical observation. Not only have I failed to observe this predisposition, but I believe, on the contrary, that a horse which has previously suffered from pneumonia is less exposed to the disease, and that it acquires a certain degree of immunity. I consider that in animals which have made Osgood recovery from pneumonia we should regard the traces left by blisters, etc., on the chest as an indica- tion of greater resistance,^ instead of considering them, as many prac- titioners do, as signs of grave depreciation. And when the disease returns in such horses, the second attack is almost always benign in character. Simple pneumonia is ushered in by general disturbance, often by rigors, soon followed by gradual rise in temperature. The animals tremble slightly ; the majority are depressed and stiff, the appetite falls off, the mouth is hot and dry, the bowels are constipated ; the conjunctiva is injected, or yellowish in colour, and the skin is warm and moist. The respiratory movements are less frequent, expiration is sometimes sighing, there is often more or less oppression, and a dry, paiaful, deep cough. The pulse is rapid, full and strong. On auscultating the lung the vesicular murmur is found to be diminished in the lower portion of one or other lobe, sometimes of both. Per- cussion reveals lessened resonance. These symptoms become gradually more marked, and in twenty-four to forty-eight hours others appear. A reddish or rusty-coloured discharge runs from the nostrils, the colour being due to blood elements contained in the pulmonary exudate. Drying around the nostrils it forms a friable crust, resembling saffron, sulphur, or iron rust in colour. As a general rule this discharge remains somewhat abundant for several days. Sometimes a sanguino- Jent discharge is seen from the outset. Digitized by Microsoft® 176 CLINICAL VETERmARV MEDICINE AND SUK(;p;RY. Auscultation of the lower portion of the affected lung reveals a well-marked moist crepitant rale during inspiration, and immediatel)- after the paroxysms of coughing. At this point partial or almost complete dulness is noted on auscultation ; while in the upper zone, which has undergone no change, the vesicular murmur is increased. Hepatisation commences on the fourth or fifth day. The fever persists, the pulse and respiration reach their highest point, at certain moments expiration is sighing ; the pulse is usually strong and full, but sometimes small and soft ; cough is less frequent and discharge disappears, because the exudate collected in the pulmonary alveoli coagulates there. On auscultation over the large bronchi and surround- ing parts one hears during inspiration and expiration, or onlj' during the first part of the latter, an abnormal sound, sometimes strong, sometimes feeble and deep-seated — the tubal murmur. On the diseased side the lower part of the lung is silent, or only abdominal sounds transmitted b}- the solidified lung are audible ; in the upper healthy part the vesicular sound is increased ; towards the borders of the hepatised zone the crepitant rale often persists. On percussion dulness is complete throughout the entire pulmonary area invaded. The constitutional symptoms are usually most marked from the fourth to the sixth day. When the disease develops regularly and promises a favourable termination, diminution commences from about the seventh, day, marking the crisis. The patient is livelier, takes note of its surroundings, shows better appetite, respiration is less rapid and painful, the pulse less frequent, and the temperature falls. The cough returns, or if it has persisted becomes more frequent, and discharge reappears — now usually mucous in character, greyish, sometimes rusty or streaked with blood. The mouth is cooler, the excretions are moister, occasionally diarrhoea occurs. The urine increases in quantity, and through it are eliminated certain of the toxic products accumu- lated in the body. In some patients sweating occurs, in others little subcutaneous abscesses, termed critical abscesses, appear in different regions. On auscultation the crepitant rale begins to replace the tubal murmur formerly heard, and gradually advances from above dov^'n- wards throughout the entire pulmonary area invaded, being in its turn soon replaced by the vesicular murmur. The percussion dulness simultaneously decreases, and in a few daj's the sounds again become normal. Comparison of a certain nuffl-ber of cases of simple uncomplicated pneumonia shows that in this disease the temperature curve is typical. It steadily rises from the outset, reaches its highest point with con- siderable rapidity, remains for some days with slight morning and Digitized by Microsoft® SIMPLE PNKUMONIA IN THE HORSK, 1 77 ■evening oscillations, then on the iifth to se\enth day suddenly and rapidly falls. The temperature often diminishes two to three degrees in forty-eight hours. In exceptional cases it falls below normal, but soon returns to that point. Convalescence is short. Animals can generally return to work at the end of a fortnight. Such is the regular course of simple pneumonia. It falls naturally into three periods — invasion, hepatisation, and resolution, which succeed one another at almost fixed intervals. Provided the patient is kept quiet and under good hygienic conditions from the outset, the disease almost always assumes this regular form, independently of treatment. In certain cases pneumonia does not pass through all the above stages. It may become arrested, and resolution occur before the period of hepatisation is arrived at. Under such circumstances recovery is exceptionally rapid. This variety has been termed ephemeral or abortive pneumonia. You saw a case in one of our patients ; moist crepitation persisted in the lower part of the left lung for two days, and was then suddenl}' replaced b}- the vesicular murmur. In some cases complications occur. Diffuse pulmonary congestion,, oedema of the lung, or myocarditis may produce asphyxia and death. Endocarditis, pleurisy, synovitis, arthritis, and para- or meta-pneu- monic localisations are rarer than in contagious pneumonia. Suppuration in the hepatised parenchyma is undoubtedly due to secondary infection by streptococci or staphylococci, and forms a very rare complication. M. Trasbot has only seen seven cases in a total of i68 personal observations. It is marked by sudden aggravation of symptoms ; the fever increases, the skin becomes hot and dry, or from time to time moistened with sweat. Signs of excitement may occur, but most frequently the patient is profoundly depressed. Appetite is completely lost ; thirst is marked ; the heart's action becomes strong and rapid, the pulse more and more feeble, the respiration very rapid, short, and tremulous. On auscultation a gurgling or amphoric sound can be heard; on percussion a " hritit de pot file" (cracked-pot sound). In addition, there is often a purulent greyish or sanguinolent dis- charge. When the abscess breaks into a bronchus its contents may be discharged through the trachea, and recovery is possible. But usually the hepatised portions of lung become infiltrated with pus, or purulent pleurisy develops and the animal succumbs. Pulmonary gangrene is scarcely commoner than abscess formation. Digitized by Microsoft® lyS CLINICAL VETERINARY MEDICINE AND SURGERY. Among igo patients ti"eated in his clinique, M. Trasbot only saw twelve cases. It produces general symptoms resembling those of pulmonary suppuration, and almost always rapidly leads to death. The principal symptoms are intense fever, with marked oscillation of temperature ; profound depression ; violent heart's action ; loss of pulse ; coldness of the extremities, and double-sided putrid discharge from the nostrils. It is well to remember, however, that putrid discharge is not (as many believe) an infallible sign of pulmonary gangrene ; it may result from putrefaction of exudate in the dilated bronchioles. Simple pneumonia very seldom assumes the chronic form. When this occurs certain symptoms disappear, but the cough, discharge, and difficulty in breathing persist, and the animals remain thin, feeble, and incapable of any considerable effort. Let us now glance at the anatomical changes during the different stages of simple pneumonia. I have said that the disease is usually localised in one lobe, of which a greater or less area is invaded ; it never occurs at several irregular centres, as is often the case in con- tagious pneumonia. During the period of engorgement the diseased portion of lung is hypersemic, infiltrated, and oedematous. It seems swollen and deep red or violet in colour ; its tissue is denser, firmer, less elastic, and less crepitant than usual. Sections are smooth, of a livid red or marbled appearance, and the cut surfaces discharge large quantities of reddish sanguinolent or frothy serosity. The alveolar texture of the lung, however, can still be distinguished. iMicroscopic examination shows the capillary vessels to be dilated, engorged with blood, or ruptured. The epithelium lining the alveoli is partly shed, and the spaces them- selves are filled with a liquid exudate containing large numbers of leucocytes, red blood-corpuscles, and multinuclear cells of epithelial origin. A similar exudate is found in the interlobular spaces, which are thickened, infiltrated, and oedematous. During the hepatisation stage the portion of lung affected is more markedly swollen and no longer crepitant ; its colour is deeper ; its density and compactness are increased, causing it to resemble liver, and its tissue has become friable, so that it breaks down readily under the pressure of the thumb, forming a reddish pulp. Fragments removed from the hepatised mass, and dropped into water, slowly sink to the bottom. Sections are dark reddish-brown or blackish in colour, but on close examination this coloration is seen to be irre- gular ; from the dark ground formed by the inflamed pulmonary tissue numerous little greyish-white rounded points stand out, as though Digitized by Microsoft® SIMPLE PNEUMONIA IN THE HORSE. 1 79 " set " in the tissue, indicating small masses of exudate which have been poured into the pulmonary alveoli, where they have coagulated and become adherent to the walls of the air vesicles. Sections are less smooth than at the former period ; they have a granular appear- ance due to projection above the general surface of fibrinous coagula. Moreover they no longer transude liquid, but on scraping yield small quantities of blood-stained serosity, holding in suspension small opaque whitish granules. One might be led to regard these modifica- tions in appearance of the pulmonary tissue as indicating complete disorganisation, but such is not the case. Microscopic examination shows the following condition : — The air-cells are plugged by fibrous clots containing leucocytes, red blood-corpuscles, epithelial cells, and large migratory cells, exhibiting highly refractile granules ; in many cases the epithelium is partly preserved ; many capillaries are oblite- rated, but the alveolar ducts, though thickened and infiltrated, are seldom much injured. In human pneumonia, pneumococci are almost invariably found in the affected area, whatever the stage of the disease. The lesions of simple lobar pneumonia in the horse contain various microbes, the pathogenic action of which has yet to be demonstrated. When resolution occurs, the exudate contained in the air-cells is freed, detached, and liquefied ; the resulting material, which is got rid of through the bronchi, forms the discharge seen at this stage ; the hyperaemia disappears, the alveolar ducts regain their normal cha- racter ; the liquid which filtered into them becomes reabsorbed ; the epithelium is restored at the points where it had been lost, and the lung soon regains its function in an almost perfect degree. '* The post-mortem examination of patients dead of pneumonia some- times reveals generalised pulmonary congestion, pleurisy, or myo- carditis, sometimes purulent or gangrenous centres in the hepatised tissue. Pulmonary suppuration assumes several forms ; in certain cases small abscesses are found scattered throughout a mass of hepatised tissue ; in others there are present one or more large abscesses, which usually communicate with large bronchi. The contained pus is whitish, creamy, and odourless, or reddish in colour, resembling wine lees, and offensive. Gangrene is oftenest represented by little greyish-yellow tracts scattered through the hepatised part. Sometirries it is "massive,^' and affects a large portion of the diseased lobe ; it may assume various appearances, the dead tissue being soft, blackish, violet, greenish grey, or reduced to the condition of a granular mass. The periphery of Digitized by Microsoft® i8o CLINICAL \'etp:rixarv medicine and surgery. these gangrenous patches is not usually well defined, but shades off into the adjacent hepatised tissue, which is gradually invaded by the necrotic process. During the course of the disease the bronchial lymphatic glands become swollen, but never of great size. The diagnosis of pneumonia is eas}-. The veterinary surgeon is seldom called in until the second or third day after the onset. The somnolence, depression, rapid, painful, and often moaning respiration, and the yellowish colour of the conjunctiva are all significant. In many cases pneumonia can be surmised after examination of the con- junctiva and a glance at the flank. With a little practice in clinical observation one is rarely mistaken. The rusty discharge, when present, is pathognomonic. Auscultation and percussion indicate the position and extent of the inflamed area. In bronchitis the cough is strong and paroxysmal, the discharge muco-purulent, the respiration less frequent, and the fever less active. From the point of view of their relative frequence pleurisy is rare as compared with pneumonia ; and you know, furthermore, that differen- tial symptoms exist. As to acute primary endocarditis, you may possibly ne\-er meet with it. Provided the ordinary course and characters of pneumonia are known, complications should early be detected. In a patient in which resolution was deferred beyond the ninth day I discovered secondary pleuris}', the only case which I have seen during the course of the present j-ear. The prognosis of simple pneumonia is serious, on account of the functional importance of the affected organ ; but except in the cases of old, feeble, and emphysematous patients, and those suffering from cardiac disease, pneumonia only proves fatal when followed by com- plications, such as diffuse congestion of both lungs, oedema, suppura- tion, gangrene of the lung, or inflammation of the heart muscle. Careful treatment usually prevents such accidents. The mortality of uncomplicated cases is scarcel}- 5 per cent. When simple inflammation of the lung develops regularly and is unattended with comphcations it tends towards resolution. Prompti- tude in treatment is very important. If the disease is not recognised at the beginning it ma}- become greatly aggravated by work. The animal is isolated in an airy box, which should be kept at a moderate and regular temperature, and is kept warm by abundant clothing. If appetite is retained, mashes, barley or oatmeal gruel, hay Digitized by Microsoft® SIMPLE PNEUMONIA IN THE HORSE. l8l tea, etc., may be given. The patient should have constant access to chilled water or gruel ; perfectly cold water is sometimes injurious. If it eats little, and will not touch ordinary food, milk may be prescribed. Most horses take milk readily to the extent of six, eight, or ten quarts per day. Some, however, refuse it, and will not swallow even a mouthful, appearing to have a distaste for it ; but, after a little patience, end by taking it well. The attendant should hold the animal's head, bring the bucket containing the milk near its mouth, and introduce a little by means of the hand. This may be repeated several times, and the milk then be offered in the bucket. If the horse will only swallow a little he very often ends by emptying the bucket at a draught, and afterwards makes no difficulty about taking it. To starve cases of pneumonia (as is still done by many practitioners) is a mistake. They should, on the contrary, be carefully fed and their strength sustained with such foods as they seem most to like. A first case of pneumonia should not necessarily be regarded as sporadic, to the exclusion of prophylactic measures. It is always better to isolate the animal, especially if other young horses are in the same stable. I do not recognise any specific treatment of pneumonia. The management of the case varies according to the animal's constitution, the intensity and stage of the disease, the degree of fever, and the predominance of particular symptoms. Bleeding, again revived at the present day in the treatment of pneumonia in man, has never been entirely abandoned in veterinary practice. It may prove of real service by its double mechanical and chemical action. During the hepatisation stage of pneumonia especially the greatest danger is often to be found in the condition of the heart. In consequence of the obliteration of vessels in the hepatised area the right heart finds its work greatly increased ; it may falter, and even succumb. The removal of three to six quarts of blood, depending on the animal's weight, diminishes the circulatory disturbance and assists the heart, which beats more easily. In addition to this purely mechanical effect bleeding has two others, not less valuable. In patients in which the blood is greatly vitiated by the presence of microbic poisons, bleeding before the crisis removes from the circulation a. notable amount of these poisons, at the same time increasing the bactericidal power of the serum ; and if supplemented by injection of the chemical solutions of which I shall shortly speak, this antitoxic action is favoured. Furthermore it is proved that bleeding increases oxida- tion processes, and thus assists in eliminating poisons from the blood and tissues. But to pretend that removal of blood can check the Digitized by Microsoft® 1 82 CLINICAL VETERINARY MEDICINE AND SURGERY. infectious process itself is evidently an exaggeration. It never arrests the course of pneumonia, and I regard it as simpl}' shortening its duration. Counter-irritants almost alwajs give relief, especially when early resorted to. Mustard is perhaps the best, and is applied in the form of a plaster to the sides and under parts of the chest. It may also be used for rubbing the limbs ; but it is ill-judged to extend its application excessively. The plaster is left in position for several hours. The essential oil which it gives off produces smart irritation of the skin, and abundant infiltration into the subcutaneous connective tissue. During the hours succeeding its use the patient is less depressed, the breathing and circulation are markedly relieved, and there is often temporary diminution in the fever. Counter-irritation also renders, phagocytosis more active. Essential oil of mustard applied with friction has the same effects as a plaster. In grave cases of pneu- monia, where the hepatisation stage is abnormally prolonged or marked by serious heart symptoms, many practitioners use blisters. Not only is the effect of blisters mediocre and; doubtful, but they have the disadvantage of rendering the patient uneasy, and of preventing the practitioner afterwards following the course of the disease by ausculta- tion, etc. They often blemish, and are not without other grave draw- backs. In some cases absorption occurs, producing irritation of the kidneys. The value of "issues" has also been exaggerated, and they are much less used than formerly, being now practically confined to the region of the chest. They produce acute suppurative inflammation around the points of insertion ; similar results follow the subcutaneous injection of oil of turpentine, or of any irritant liquid. Such means of treatment, however, may even facilitate infection. Some practitioners claim to draw valuable conclusions from their action ; if suppuration is free, the pneumonia is taking a favourable course ; but failure in this, respect always constitutes an unfavourable sign. As in other infectious diseases, saline or alkaline solutions have an excellent effect. The resistance of the organism to infection is propor- tionate to the degree of alkalinity of the blood, but as this alkalinity tends to diminish I often utilise subcutaneous injections of different chemical solutions, particularly of 7 to '8 per cent, salt solution in daily doses of six to fifteen fluid ounces. These salines affect the blood- plasma, rendering it more alkaline and increasing its bactericidal properties, at the same time stimulating secretion and the elimination of toxins. Alkalinity of the blood may also be favoured by the adminis- tration of daily doses of one and a half to three ounces of bicarbonate Digitized by Microsoft® SIMPLE PNKUMONIA IN THE HORSE. 1 83 of soda, given in the drinking-water. Its effects are excellent at all stages of the disease. Antimonial preparations — tartar emetic and sulphide of antimony — adopted from human medicine, have similar antiphlogistic effects to bleeding, though they act in a different manner. Tartar emetic is given in doses of one and a half to three drachms per day in the food. It renders the breathing easier, and slows the circulation, but Jn general its therapeutic value has been greatl}' over-estimated. Dilute alcohol in the form of brandy, whisky, rum, or wine is much used, and not without benefit. It checks excessive tissue metabolism, supports the animal's powers, acts as a tonic, tends to lower tempera- ture, and has the advantage of being readily taken in the drinking- water or in electuary. I frequently prescribe four to eight fluid ounces of brandy per day. It can be given from the commencement and con- tinued until resolution begins, the dose being varied according to the symptSms'. Digitalis is of unquestionable value, especially \\hen the heart muscle shows signs of exhaustion, as indicated by rapidity and feeble- ness of the pulse. It is given in doses of three quarters to one and a half drachms in electuary, and continued for several days. In many cases change in the heart's action and the condition of the vessels follows in a few hours, the heart beats becoming less powerful and sudden, and the pulse stronger and more regular. Doses of two to three drachms, given by some practitioners, are excessive. When long continued, digitalis produces change in the heart fibres, which appear to undergo fatty degeneration. Iodide of potassium has been given at all stages of the disease in doses of one and a half to three drachms per day. 'Various good effects are attributed to it, such as those of moderating the circulation and respiration and of lowering temperature. Its value, however, is slight except during the period of resolution, when it favours absorption of newly formed tissue in the bronchial glands, and thus prevents com- pression and atrophy of the left recurrent nerve, one of the causes of chronic roaring. Salicylate of soda may pro\e of value in lowering temperature, while as a general antiseptic it is preferable to salicylic acid, which irritates the gastro-intestinal mucous membrane. It has been strongly recommended during the period of resolution in order to prevent the attacks of synovitis seen during or after pneumonia. Quinine salts, like the sulphate and hydrobromate, have recently been used by many practitioners. They temporaril}- lower temperature and slow the circulation, thus exercising an antifebrile and tonic effect. Digitized by Microsoft® t84 clinical veterinary medicine and surgery. They are also recommended where suppuration or gangrene is feared, and can be given in electuary in daily doses of one and a half to four drachms. Sulphate of soda in doses of three to six ounces stimulates the intestinal secretion and favours free circulation of digested material. During the early febrile and hepatisation periods it is given like the bicarbonate in drinking-water or mashes. Cold enemas to diminish constipation and fever, nourishing enemas to sustain the bodily strength when ordinary food is refused, and anti- septic enemas to prevent or limit suppuration or pulmonary gangrene, are also measures deserving of attention. Suppuration and pulmonary gangrene, as I have said, almost always prove fatal. An abscess formed in the midst of pulmonary tissue may under exceptional circumstances open into a bronchus, its contents become evacuated and its walls cicatrised : a gangrenous fragment may similarly be got rid of or may become encysted, the patient in either ■case surviving ; but such endings are rare, and treatment is of little value. The patient's strength must be supported b}' milk, hay tea, and fluid nourishment to which has been added alcohol. Antiseptics are employed in the form of fumigations, intra-tracheal, subcutaneous, or intra-venous injections. Solutions of iodine or carbolic acid are often administered by the last method. Direct injection of antiseptics into the gangrenous centres has been little used in the horse, and on the several occasions I have performed it the result was unsatisfactory. Puncture of a purulent or gangrenous centre through the thoracic wall, followed by evacuation of the contents and drainage of the cavity, has been attempted as a last resource where the diseased lung was adherent to the wall of the chest. Digitized by Microsoft® XXVII.— PNEUMONIA IN THE HORSE (CONCLUSION). Ix- equine patholog}' the name of Contagious Pneumonia is given to a form of int^ammation of the lung which was long confused with simple pneumonia, and with the abdominal form of iniluenza. J^Iore than half a centurj- ago the horse was known to suffer from an inflammatorj' lung disease, which simultaneous!}' affected numbers of animals, and differed in its course from pneumonia a frigovc. It was described under the titles bilious pneumonia, adynamic or ataxic pneumonia, and stable pneumonia. Veterinary journals contain reports regarding this affection, which are now more or less ancient history. The cases related are always referred to simple causes, especially to the action of cold on a number of patients placed under similar conditions of hygiene, feeding, and work. The views at present held in regard to contagious pneumonia are founded on clinical observation and laboratory- work, and onlv date back about ten years. In France, Cagnat, of St. Denis, published in the Archives vctcrinaires for 1884, the first cases clearh- establish- ing the occurrence of contagious pulmonary inflammation in the horse. Some years later Messrs. Benjamin and Brun adduced others. About the same time Siedamgrotzk}- and Dieckerhoff in German}- published essays on this affection, each observer regarding it from his own par- ticular standpoint. In 18S7 Schiitz isolated and cultivated a micro- organism, which he considered the specific agent. Since then investi- gations have become ver\- numerous. MM. Chantemesse and Delamotte, Galtier and Violet, have found in the lesions two microbes, which they considered different from that isolated by Schiitz. MM. Cadeac and Leclainche have written good monographs on the subject. M. Trasbot, who described thedisease in -his lectures Under the name of " Stable Pneumonia,"' penned a learned article on it in the eighteenth volume of the Didionnaire pratique de Medecine et de Chirurgie vetcrinaire. Finally, Digitized by Microsoft® l86 CLINICAL VETERINARY MEDICINE AND SURGERV. we owe the histor}' of several carefull}' studied epidemics to certain of our military coUeatjues. Contagious pleuro-pneumonia of the horse results from the entrance into and development within the organism of a specific pathogenic microbe. Sometimes the animal is infected by contact with a diseased subject, at others infection is mediate. The disease is most commonly seen in large stables where the work necessitates frequent renewals of stock. One of the new-comers is first affected ; a week to fourteen days later a second shows symptoms, and the disease successively attacks a number of animals, comprising one third, one half, or two thirds of the whole number, sometimes e\'en more — in one of Cagnat's series twelve out of fifteen, and in some I have myself seen, seven out of nine. The stables of horse dealers, omnibus companies, remount depots, cavalr}- quarters, and veterinary infirmaries, are most commonly invaded. Once introduced the disease may continue for a long time in an enzootic form, diminishing and again reviving, the revivals almost always following the introduction of freshly bought horses. It attacks young, adult, and old animals, though certain ages are more subject than others. Horses between four to eight years old, especially if recently brought into work, are those most commonly affected ; aged animals are less subject. If during an outbreak of this form of pneumonia it becomes necessarj- to introduce fresh horses, aged animals should always be given the preference, }'oung horses almost invariably becoming infected. In stables where the disease was raging I have often noticed that horses which had previously suffered from an attack remained quite unaffected. Many other practitioners have made the same observation.. An attack undoubtedly confers immunity for a certain period, some- times during the animal's whole life; though in most instances this immunity diminishes and maj- entirel}- disappear \vith lapse of time. Instances of recurrence, adduced in opposition to this idea, in no wise weaken it, being readily explained -by the many forms assumed by pneumonia, and by the gradual loss of acquired immunity. Generally speaking, then, experience shows that one attack renders, the subject refractory or little susceptible to a second. Cagnat well understood this, and with the courage of his convictions even went so far as to recommend that when purchasing preference should be given to horses whose chtsts showed traces of the counter-irritants applied during a previous attack of pneumonia. That is to say, he recom- mended exactly the contrarj- of what is usually practised. Digitized by Microsoft® CONTAGIOUS PNEUMONIA, 1 87 In comparing contagious pneumonia and the abdominal form of in- fluenza from the point of view of the subtlety of infection and rapidity of extension marked differences, however, are apparent. As Fried- berger and Frohner remarlc, the diffusion of the specific agent is usually slower in the former case, and its method of propagation different. . Although in certain outbreaks among army horses con- tagious pneumonia affected ten, twenty, or thirty subjects within a few days, the occurrence is exxeptional ; whilst in the same period the abdominal form of influenza might have attacked hundreds of animals. Another difference noted by the same authors, confirmed by many practitioners, and again recently mentioned by M. Laporte, has reference to the mode in which the infection spreads. Contagious pneumonia attacks irregularl}^, often affecting animals far removed from the first case, while influenza is more frequently transmitted from one case to another, following a fairly regular line. Direct transmission is the rarest method of contagion. The disease is generally spread by intermediate channels, such as the air, forage, manure, pails, or mangers, or even by attendants, grooms, owners, or veterinary surgeons. In one instance the disease was communicated to a mare, isolated far from the infected stable in a special place, by means of a mash taken from the manger of a horse suffering from pneumonia. In order to prevent it being "wasted" the groom had given this mare the bran left by the patient. Many veterinary surgeons have seen enzootics of contagious pneu- monia in stables without infection having been introduced by recently bought animals, and in towns or parts of the country where the disease did not previously exist. In these cases the locality and. especiall}- the soil have been blamed. In all probability the infectious organisms had been in existence, but had long remained dormant or continued growing as saprophytes, and afterwards, under the influence of un- determined conditions, recovered their virulence and primary activity, causing an outbreak of disease. The contagious material enters by the respiratory passages sus- pended in the inspired air, or by the digestive mucous membrane along with food or drink. Schiitz declared the specific agent to consist of a little ovoid bacterium generally arranged in twos, the biological characters of which he described. Though pathogenic in the horse, rabbit, guinea-pig, mouse, and pigeon, it is without action on the pig and fowl. Inoculation of a culture of this microbe into the horse reproduces the disease. If introduced into the parenchyma of the lung by transfixing the wall of the chest and the pleura with an antiseptic needle or trocar, the symptoms of contagious pneumonia appeared in Digitized by Microsoft® 1 88 CLINICAL VETERINARY .MEDICINE AND SURGERY. a few hours, developing in the usual way and producing necrotic lesions in the lung and degenerative changes in the viscera. In con- tradistinction to the pneumococcus of man, which is delicate and ephemeral, and sometimes disappears from the lesions after a very few days, the bacteria in question show considerable resistance to destruc- tive influences. In patients which survive they may long preserve their vitality, multiplying in the necrotic centres surrounded by a zone of fibrous tissue, and when these centres are in communication with the bronchi being continually discharged, and rendering the nasal dis- charge virulent for months. Convalescent or apparently cured cases in which the lung contains such centres long remain dangerous. They perpetuate the disease in certain stables, or introduce it into other previously healthy quarters, where the first cases are naturally referred to the action of atmospheric changes. Though admitted by some authors, the specific character of this microbe and the powers attributed to it by Schiitz have been contested by others, especially by Hell and Baumgarten. In i8go Hell under- took certain researches consisting in cultivating, staining, and inocu- lating with the organism, in order to determine the analogies and differences which existed between it and the several streptococci. From them he concluded that by the bacteriological methods then in use no clearly marked difference could be established between the microbe in question on the one hand, and the Streptococcus pyogenes of the horse and the streptococcus of erysipelas in man on the other ; and further- more, that these species are similar from the morphological and biological points of view, and from the manner in which they behave when inoculated.* Recent researches by M. Lignieres seem to show that the microbe described by Schutz is the streptococcus of strangles, and that it only plays a secondary part in the aetiology of pneumonia inthe horse. It is generally, but not alw^ays, found in the lungs of horses dead of pneumonia. The true microbe of pneumonia is said to be the " cocco-bacille typhique'' of the order Pasteurella. This micro-organism, which grows as a saprophyte in forage, manure, water', and '^oil, and becomes pathogenic under the influence of causes at present unknown, appears as a monococcus, diplococcus, or as a little bacillus with rounded extremities. The last is the "true" form of the microbe; at the moment when it divides it appears as a diplococcus. The monococci result from complete and recent separation of the diplococci. Finally, under certain conditions these microbes take the form of " strepto- cocco-hacilUy The organism is aerobic, produces no spores, and is killed in less than a quarter of an hour by a temperature of 65° C, but grows freely in peptonised bouillon and on gelatine at 20° C. It is pathogenic for the guinea-pig, rabbit, and horse, and rapidly kills these animals on subcutaneous inoculation. M. Lignieres has found it in cases of pleurisy, infectious pleuro-pneumonia, in broncho-pneumonia, and in infectious sore throat, in pneumonia n frigore, in the abdominal form of influenza, in the pneumonia of strangles, and in " stable pneumonia." All these affections are said to be but varieties of " Pasteitrellosisy Infectious pneumonia is due to the " bacille typhiqiie," which is able to multiply in Digitized by Microsoft® CONTA(;i'OUS PNEUMONIA. igg The symptoms of contagious pneumonia are by no means so constant or so uniform as has been suggested by certain authors. Among those regarded as most important some are susceptible of modifications in their expression and intensity, which are apt to deceive the practitioner who only looks for tj-pical cases. As in the simple form, three periods may be distinguished : (i) onset and increase ; (2) hepatisation ; and (3) resolution, gangrene or suppuration. The onset is usually sudden, and too well marked to be overlooked. A few patients remain fairly bright and lively, and continue to take part of their food ; but the majority are dull and depressed, hang back from the manger, and do not touch anything. They show rigors, trembling fits, and signs of sore throat, bronchitis, or slight colic. In the play of symptoms now commencing two signs, however, overshadow all others, the acceleration of breathing and the fever. With rare exceptions the flank movement is already very rapid, and attracts attention. The respirations are from 20 to 30 per minute ; sometimes inspira'tion is fairl}' free, sometimes \-ery shallow. The temperature rapidly rises to a high point, often marking 40°, 40-5°, or even 41° C. (104'= F. to 105-8° F.), before the animals are noticed to be ill. I twice noted the latter figure on first examining animals which only the evening before had appeared healthy both in regard to \\'ork and feeding. Where patients have been observed from the outset the temperature has often risen 3° C. in twenty-four hours. The conjunctiva is usuall\- reddish, sometimes of a yellowish tint, the ihe lung chiefly in consequence of being associated with the streptococcus of strangles. At the moment when the " bacille typhique" affects the organism, the streptococcus of strangles (which is widely distributed) is often to be found in the upper air-passages, without, however, having produced any manifest indic.ations of its existence. Thanks to the depression of the system produced by the " cocco-bacille,^' the streptococcus multiplies in the lungs, forms caseous centres around the bronchi, and then gradually invades the paren- chyma of the lung and more pr less completely the entire organism. Inoculation of healthy animals with attenuated " bacilles typhiques " should render them proof not only against the abdominal form of influenza, but also against pneumonia of the same character. Hence the use of vaccination as a prophylactic measure in affected stables. Sick horses should be simultaneously treated with injections of protective strangles serum and of ^' serum antityphiquer Experience has not yet pronounced on these laboratory suggestions. The first test of the protective method with the vaccine of ^^ Pasteurellose eqiiine,^^ however, was made in the stables of the Compagnie Generale des Voitures de Paris. The result was as follows : " From the 4th October, 1897, to the 12th May, 1898, 5007 horses were bought. All the odd numbers were twice vaccinated, whilst the even numbers were left as controls. Up to the 31st October, 1898, two hundred and fifty-four horses had died from chest diseases, one hundred and fifty-eight which had not been vaccinated, — that is to say, a loss of 601 per cent. ; and ninety-six which had been twice vaccinated, that is a loss of 4'03 per cent. Sevea horses were killed by the use of insufficiently attenuated vaccine." Digitized by Microsoft® 190 CLINICAL VETERINARY MEDICINE AND SURCIERY. mucous membrane of the mouth warm, the tongue coated, the ears and extremities are cold. Movement appears painful, and the patient is sometimes unsteady on its legs. In most the cough is deep, paroxysmal, and accompanied by discharge of a little greyish or rusty mucus, which may be streaked with blood. In some there is slight haemorrhage from both nostrils, a symptom which may recur several times during the course of the disease. Auscultation and percussion of the lung seldom reveal any modifi- cation in the pulmonary sounds or pulmonary resonance. The early lesions appear to affect the deeper seated portions of the lung around the bronchi, the superficial layers of the affected lung remaining unchanged, so that percussion and auscultation are only useful at a later stage. You have seen this in many of our patients. Excep- tions, however, occur. In some animals various stethoscopic signs like disappearance of the vesicular murmur, or the existence of crepi- tation, may be noted soon after appearance of the first symptoms. In •one case we heard the tubal murmur on the right side after the third day, the percussion sound over the corresponding lower half of the thorax being simultaneously dull. It must be remembered that cases ■of this nature — in which the auscultation and percussion signs resemble those of simple pneumonia — are somewhat frequent, because, as in that disease, the pulmonary lesions may be extensive, involving an entire lobe or the whole thickness of the lung almost from the first. Auscul- tation over the prsecordial region reveals increase both in power and frequency of the heart's action, while the two normal sounds are slightly accentuated. The pulse is rapid, full, and strong, or may already have become distinctly weak. During the stage of augmentation the first symptoms become aggra- vated or variously modified, and others appear. The temperature often exceeds 41° C. (i05'8° F.), and shows daily oscillations to the extent of one degree or more. Respiration remains very rapid and shallow ; occasionally it appears hesitating. In some patients auscultation and percussion still reveal no pulmonary change. Crepitation and partial dulness usually occur on the third or fourth day, murmurs and dulness twenty-four or fortj'-eight hours later. The circulation is always rapid ; the heart beats violently, the sounds being either normal or modified in intensity and sometimes in rhythm ; the pulse loses its strength and fulness. The conjunctiva is reddish yellow or icteric ; sometimes hyperasmia is more marked, and accompanied by slight infiltration. Many animals still take mashes, milk and a little hay ; some pass dry, hard, coated faeces; in almost all thirst is great; dulness and loss of strength are more marked, the gait is vacillating, and the tail hangs Digitized by Microsoft® CONTAGIOUS PNEUMONIA. 19I limp. Some, however, appear much less depressed, and in entire horses erections occasionally occur. During the period of hepatisation most of the preceding symptoms subside. Respiration, however, becomes more and more rapid, is painful, difficult, and sometimes moaning ; when pleurisy occurs as a complication, inspiration and expiration are separated by a distinct pause. The cough and discharge usually disappear. In one of our patients I noted on three occasions discharge of blood from both nostrils, due undoubtedly to pulmonary hsemorrhage ; but this is a rare occurrence. The pulse is very rapid, small and feeble, occasionally irregular or intermittent ; sometimes there is a venous pulse. The temperature usually remains stationary except as regards the afore- mentioned daily oscillations, but it may rise to 41 "8° or even to 42° C* (i07"2° F. to I07"6° F.) ; sometimes it is very irregular, and shows varia- tions of 1° to 2° C. within twenty-four hours. After the fourth day pulmonary changes can usually be readily detected, though, as you have seen in one of our cases, they may remain concealed until the fifth day. Some months ago a colleague asked me to examine one of his horses which had been very ill for several days, and which he thought was suffering from endocarditis. On auscultation I certainly detected cardiac disturbance, but I also noted absence of the vesicular murmur on the right side, and slight crepitation at several spots. The diagnosis was clear. Next day there was a tubal murmur; the pneumonia had been in existence for six days. Depending on whether pneumonia is lobular or lobar, the signs recognised on auscultation and percussion differ very greatly. In the lobar type the stethoscopic sounds are those of simple pneumonia ; in the lobular the vesicular murmur is at several spots replaced by a crepitant rale ; but if the centres of lobular pneumonia become con- fluent the signs noted are those of extensive hepatisation, a tubal murmur being heard with more or less complete dulness in the lower region of one or both sides. At this period, if at all, pleurisy sets in. Its onset is insidious, and it remains unrecognised until exudate becomes abundant. Physical examination then reveals bilateral dulness extending to a varying height, and limited towards the centre of the chest by a horizontal line ; loss of the vesicular murmur over the whole of this region ; existence of a tubal sound ; and disturbance in the respiratory movements of the chest and flank. When these phenomena coincide with diminution in the pneu- monia symptoms, as you saw in one of our last patients, pleurisy is clearly indicated. * M. Brun observed a rise in temperature to 42° C. in a horse which afterwards re- covered. Professor Cadiot had a similar case where the temperature rose to 419° C. Digitized by Microsoft® 192 CLINICAL VKTERINARY MEDICINK A^'I) SURCERY. Resolution, announced bj' improvement in the general symptoms, by return of appetite, sinking of temperature, polyuria, and sometimes by the appearance in different parts of the bod\' of "critical abscesses," usually occurs a little later and rather more slowl}' than in simple pneumonia. As in the latter, the crepitant rdlc returns in the hepatised regions, and is everywhere gradually replaced by the vesicular murmur. For some da}s the patients have a loose paroxysmal cough, and muco- purulent discharge from both nostrils. Under suitable h\gienic con- ditions relapses are rare. A serious and unfortunately somewhat frequent termination is gan- grene, produced by tissue-destroying toxins elaborated b}' the pneumo- bacteria alone or in association with other organisms. Gangrene is, therefore, either mono- or poly-microbic. The general symptoms then become still more aggravated, appetite is entirely lost, the heart beats tumultuously, the pulse becomes very feeble or is even lost, the tempe- rature remains high, but with sudden oscillations, and a grej-ish stinking discharge sometimes containing fragments of necrotic tissue runs from the nostrils. On auscultation various sounds are heard : tubal murmurs, crepitation, gurgling, amphoric, or cavernous sounds, and sibilant rales. At certain points the percussion sound is dull, at others tympanitic ; sometimes the bruit de pot fclc ("cracked-pot sound") is well marked. As the gangrene and consequent septic intoxication progress, the general symptoms become more and more alarming. Rigors, trembling fits, and sweating occur ; the extremities and skin become cold, weakness is extreme, and the face very anxious. At last the patient falls to the ground exhausted, struggles more or less, and speedilj- succumbs. Though gangrene is not always fatal, recover}- is rare. Abscess formation in the lung sometimes occurs as an original com- plication, or accompanies gangrene. It may be suspected, towards the end of the hepatisation period, if, while remaining high, the tempe- rature oscillate markedly and be accompanied by rigors, trembling, sweating, groaning, and great loss of strength. So long as the abscess remains closed, auscultation and percussion give little information ; but if one break into a bronchus a cavernous or gurgling murmur ma}' be detected, while on percussion t}'mpanitic resonance or the " cracked- pot sound " is heard. A more or less foetid purulent discharge escapes from the nostrils. Whilst not invariably fatal, pulmonar}- suppuration, like gangrene, is extremel}- grave. Among extra-pulmonar}- complications myocarditis occupies the chief place. Inflammation of the heart muscle occurs secondaril}- during the course of infectious pneumonia, and is clinically revealed', as I have told }'ou, b}- disturbance of the heart and pulse. The cardiac contrac- Digitized by Microsoft® CONTAGIOUS PNEUMONIA. 193 tions are at first violent and palpitating, afterwards becoming more and more feeble in proportion as the muscular fibres are more numerouslj- affected with fatty degeneration. Intermittency is often observed. On auscultation a doubling, rolling, or prolonged first sound ma\' be heard, or in exceptional cases a trifling sj'stolic or diastohc murmur. The pulse is irregular, intermittent, and almost imperceptible. Like the heart muscle, the endocardium may be injuriously affected by microbes suspended in the blood, or by toxins emanating from the pulmonary centres. Sometimes endocarditis accompanies m\'ocarditis, sometimes it develops singly. It usually affects the mitral or aortic valves, and is generally accompanied by stethoscopic signs permitting of diagnosis. But too often during an attack of pneumonia the state of the heart is neglected, and this complication altogether escapes notice, being only recognised long afterwards when the valvular insufficienc}- produced by contraction of the injured valves, or by \'egetations deve- loped near their free borders causes grave functional disturbance. Exudative inflammation of the pericardium is much rarer than that of the endocardium. Its presence is indicated by the usual signs. When trifling in quantity the exudate is only discovered on post-mortem examination, but when abundant it may be recognised by the increased area of praecordial dulness and by the diminution or absence of the cardiac sounds. Nephritis is another fairly common complication, marked by colic, restlessness, difficulty in moving the hind limbs, and sometimes by hematuria. The urine contains red blood-corpuscles and renal casts in which microbes may be detected, ^^'hen double, nephritis usuall}' kills rapidly, though in occasional instances death is long deferred. Enteritis first produces dull colicky pains, which gradually become more severe and are accompanied by diarrhoea, sometimes by blood- stained evacuations. Meningo-encephalitis is rare. It gives rise to excessive excitement, convulsions, and epileptiform attacks, which may or may not alternate with periods of coma, and usually proves fatal in a few days. You sa\\' this complication in a patient which died rapidly from bulbar haemor- rhage. Meningo-myelitis and various forms of toxic paralysis may be seen affecting among other structures the recurrent and sciatic nerves, the bladder, rectum, and penis. The most frequent is paralysis of the penis ; it almost alwajs appears during the period of resolution ; in a few days the organ may become greatly swollen and entirely beyond control. Contagious pneumonia, like the abdominal form of influenza, is Digitized by Microsoft® 194 CLINICAL VETERINARY MEDICINE AND SURGERY. sometimes followed by laminitis affecting the front, the hind, or all four feet. Certain myopathic paralyses, phlebitis, and purpura are also possible accidents. Finally, the disease may be complicated with ■ophthalmia or deafness. Secondary inflammations of articular and tendinous synovial mem- brane may appear early or late in the disease. Sometimes they are deferred for several weeks or even months after the resolution period. The commonest are those of the sheaths of the great sesamoid, and of the carpus or tarsus. Their development was long considered due to retention in the body of injurious products resulting from reabsorption of pulmonary exudates, but like other complications of pneumonia they are produced by infectious organisms or their toxins. The anatomical changes in contagious pneumonia are seldom limited to the lung and pleura, but extend to the intestine, liver, kidneys, heart, and sometimes to the serous membrane, nerve centres, or to other organs. The lungs are almost always gravely affected, — sometimes, however, only over a very limited area. In the patient which died from brain complication you saw that the hepatised portion of lung was hardly as large as two lingers, and occupied the anterior part of the right lobe. Friedberger and Frohner believe that the organism which usually produces pneumonia may affect a patient without in any way damaging the lung, but this is certainly very exceptional. In general both lobes are partially invaded. Hepatisation usually occurs in the antero-inferior portion, extending upwards to a varying and unequal height in either lung. Not infrequently the middle (vertical) section of the lobe shows the greatest change, hepatisation extending higher there than in the anterior or posterior parts ; some- times the lesion is limited to the neighbourhood of the large bronchi, the superficial layers escaping. The hepatised parts are distinguished from the rest of the lobe by their deep blackish coloration, and by their much greater density and firmness, even when the healthy parts of the organ are more or less hypersemic. Sometimes they form a single uniform mass, sometimes they show prominences and depressions somewhat resembling the condition seen in canine distemper. The bronchial glands are always enlarged and infiltrated to some extent. The appearance of sections through hepatised parts depends on the duration of the condition, and on whether the pneumonia is lobular or lobar. In recent cases of lobar pneumonia the areas of hepatisation are blackish in colour, rounded or irregular in outline, and separated by Digitized by Microsoft® CONTAGIOUS PNEUMONIA. 1 95 tracts of less inflamed, less hypersemic and still permeable parenchyma. Sections through these hepatised areas present a dry appearance, though elsewhere a considerable quantity of frothy or sanguinolent serosity escapes from the mouths of the bronchioles and vessels. Where hepatisation is still more advanced the section appears dotted with yellow, grey, or greenish points, and presents a marbled appear- ance resulting from the blending of these colours, which indicate pulmonary gangrene. Little necrotic areas undergoing delimitation, or already separated from the adjacent tissues, and bathed in greyish or blood-stained pus, may be seen. The bronchioles, and sometimes the bronchi themselves, are inflamed. In the lobar form the lesions extend to the greater portion of one or both lobes. The non-hepatised tissue is more or less hypersemic and firm, but not friable, becomes red on contact with air, and gives exit to an abundance of blood-stained serosity ; the inflamed portion is firm, smooth, or slightly granular on the surface, and varies in colour. In the neighbourhood of the congested parts, that is to say in the last affected layer, sections are deep red with greyish points and lines ; around the bronchi, towards the inferior margin and anterior extremity of the lung where the inflammation has longest existed, sections are less dark in colour ; they exhibit an entire scale of colours, varying between pale grey and brownish yellow ; little grey or yellow spots are seen scattered over a brownish ground, indicating necrotic fragments, some still in continuity with neighbouring tissue, some in process of delimitation and already infiltrated with pus. Whether or not suppura- tion exist, these necrotic spots always exhale a foetid odour, which is absent from areas of simple hepatisation. Finally, cavernous spaces of all sizes between that of a small nut and of a man's fist ma}' be seen. Destruction of pulmonary tissue is sometimes very extensive. At the post-mortem of a horse which died on the tenth day I found a large cavernous space filled with sanious material in the anterior portion of the right lobe. The pleura was thickened, much injected, and out- wardly adherent to the thoracic wall from the second to the seventh rib ; inwardly to the anterior mediastinum. The organs within this mediastinum were glued together by abundant exudate. Furthermore, in other portions of the lungs — particularly in the lower parts — similar cavernous spaces, multiple abscesses containing creamy pus, and necrotic areas were found. These lesions all contained many varying species of microbes. Bacteriological examination showed the presence among others of strepto- and staphylo-cocci. The specimen obtained from our last case of pneumonia exhibited lesions indicating various stages of contagious lobar pneumonia. With Digitized by Microsoft® 196 CLINICAL VETERINARY MEDICINE AND SURGERY. the exception of a strip as thick as a man's arm occupying the upper border, the entire left lobe w as in\-aded and of a blackish tint. Vertical sections through the lung exhibited varying coloration. In the lower third, where the parenchyma was becoming or had in places become necrotic, the colour was grej'ish j-ellow marbled with darker lines and spots ; in the middle third the tissue was firmer, blackish in colour, and permeated with little grey patches indicating gangrenous tissue ; in the superior third, again, where hepatisation was recent, the appear- ance of the pulmonary tissue recalled that of peripneumonia (con- tagious pleuro-pneumonia) of the ox, exhibiting greyish tracts of irregular thickness, surrounding pulmonary areas of a pale brown, deep red, or even blackish tint. Microscopic examination of the pulmonary parenchyma reveals more complex lesions than in simple pneumonia. We note first of all marked changes in the intra-lobular spaces, more intense hyperaemia, more abundant diapedesis of leucocytes, which have accumulated in the alveoli and around their walls ; finalh', considerable hsemorrhages at many of the points examined — hemorrhages which result in entire groups of lobules being surrounded with red blood-corpuscles, and which b)' extending in all directions through the intra-lobular spaces produce a kind of dissecting effect. The pleura, which is always attacked secondarily, appears affected with acute diffuse pseudo-membranous, exudati\-e, or purulent in- flammation. Two patients with this complication died. One showed lesions of exudative pleuris}', the other of empyema. At the posi-inortem of the first we found in the pleural ca^•ity about seven- teen quarts of a )-ellowish-grey liquid holding in suspension fine fibrinous flocculi. In its lower parts, but especiallj' over its \'isceral layer, the pleura was covered with a layer of fibrin, on remo\-ing which the serous membrane appeared dull, infiltrated, injected, and closel}- dotted over with fine granulations. In the other the exudate was reddish, unmistakably purulent, and rich in staphylococci. Sown on gelatine it produced white and yellow cultures, liquefying the medium. Other changes are inconstant, and result from diffusion by the blood-stream of infectious organisms or their toxins. These changes can be found in most of the viscera and tissues. I shall only refer to the principal. The heart is often affected. In certain cases the myocardium shows granular degeneration, is more or less swollen and softened, ecchymosed in places, its surface marked with greyish or yellowish patches, which also appear on the surface of sections ; on microscopic Digitized by Microsoft® CONTAGIOUS PNEUMONIA. igy examination the striation of the fibres is ill-defined, their contour is irregular, and their substance infiltrated with fine granulations. If the endocardium is inflamed the valves are injected and infiltrated ; some- times they show a crop of little yellowish fibrinous deposits, especially near the free border. These changes almost always affect the left heart. Sometimes the pericardium contains a little greyish liquid, is dull, covered with a thin pseudo-membranous layer, or with fine vascular arborescent growths. The liver is large, yellowish, friable, and permeated with little hemorrhagic centres. The hepatic cells show fatty degeneration. The spleen is swollen or bosselated, its tissue congested and ecchy- mosed. The kidneys display signs of diffuse nephritis. On section (which reveals numbers of fine ecchymoses) the cortical layer is markedly hyperaemic, and apparently more extensive than normal ; the medullary layer is reddish in tint. The microscope shows bacterial emboli and degenerative changes in the epithelium. The intestinal mucous membrane is sometimes hardly affected, sometimes greatly congested, infiltrated, and at certain points ecchymosed ; at others its epithelium has undergone desquamation ; the lymph follicles are hypertrophied and may be necrotic. The changes in the nervous centres usually consist in more or less intense hyperemia of the meninges and of the nervous substance. In some cases the meninges contain a sanguinolent exudate, and occasionally fine ecchymoses are found disseminated through the brain and cerebellum, giving the nerve substance a "sandy" appearance. I have seen this condition in several animals ; it has been noted by various authors ; the first two instances were described by Laporte. In the patient of which I was just speaking we found two hsemorrhagic centres in the medulla, in addition to lesions of the brain proper. Certain muscular groups may become acutely inflamed, the micro- scope revealing changes in structure similar to those of the mj-ocardium. The synovial membranes of tendons and joints sometimes show signs of synovitis or of simple arthritis. The blood, which carries the agents producing all these lesions, is itself more or less changed in character. Its coagulability seems scarcely diminished, but many of the red blood-corpuscles appear shrunken and in process of destruction, the number of leucocytes is increased, more than one species of microbes may be present, and the serum shows toxic qualities. When infectious pneumonia develops regularly and terminates in recovery, the entire process may be complete within a fortnight. As a Digitized by Microsoft® 198 CLINICAL VETERINARY MEDICINE AND SURGERY. rule patients become convalescent between the tenth and fifteenth days, and resume work a week or two later. Instead of terminating in resolution, pneumonia may assume the chronic form. Sometimes a few areas of necrotic parenchyma become surrounded by an indurated zone, and produce centres communicating with the bronchi, into which they pour infectious material, facilitating the spread of contagion bj- animals to all appearance cured. In general^ however, such animals show capricious appetite, cough, do not attain hard condition, and soon become exhausted by work — symptoms usually referred to broken wind. Such chronic lesions when limited in area may long persist without producing appreciable disturbance, though at last bringing about acute fatal pulmonary or pleural complications. When the disease has already affected a certain number of animals,, diagnosis offers no difficulty. Among the initial symptoms two are particularly important and significant, viz. the rapid onset of fever and the marked acceleration of breathing. A certain method of recognising the onset of disease is to note the night and morning temperatures of animals exposed to infection. The first cases may be mistaken for the abdominal form of influenza, but the regularity with which the principal S3'mptoms appear in almost all patients, and the constancy of the pulmonary affection (whose sj-mptoms dominate all the others), soon remove any uncertainty. I have drawn attention to the difficult}- in differentiating between infectious and simple pneumonia. I do not share the opinion of authors who suggest that these two forms are at first clearly distinguishable one from the other. Apart from the history — which of itself is a useful guide in the absence of well-marked clinical symptoms — the contagious character of the one form is soon shown by the number of cases ^\'hich occur. Diagnosis is confirmed b}' the course of the disease, and by its contagious or sporadic cha- racter, as the case may be. At the present time the differential diagnosis of these two varieties of pneumonia cannot be finally established either by bacteriological examination or bj' cultivation methods. The prognosis of contagious pneumonia is grave. The mortality varies \\idely according to the time of year, character of the outbreak, and surroundings of the affected animals, but not infrequently attains to 20 per cent. You have seen that numbers of secondary affections occur, rendering the outlook graver. Loss of appetite, prolonged intense fever (41'' C. — 105-8° F.), and continual lying down (decubitus) are all grave symptoms. Epidemics of pneumonia are not of equal Digitized by Microsoft® CONTAGIOUS PNEUMONIA. I99 malignancy throughout. The greater number of deaths occur during the first half of the period, probably because young or very susceptible animals are first affected. Complex morbid conditions formed by association of contagious pneumonia with strangles or influenza are particularly grave. Many different methods of treatment have been suggested. The most popular comprise counter-irritation and administration of febri- fuges, antiseptics, and stimulants. As the general lines follow closely on those laid down when speaking of sporadic pneumonia I shall only indicate the modifications peculiar to the contagious form. Free application of mustard to the thorax, abdomen, and upper parts of the limbs is always advantageous. Bleeding is most useful where depression is marked and dyspnoea menacing. Subcutaneous injections of chemical solutions and internal administration of bicar- bonate of soda restore the alkalinity of the blood and hasten elimination of toxins. Fever is diminished by administration of sulphate of quinine,* antipyrin, antifebrin, or cold enemata. Among antiseptics, creolin, carbolic acid, naphthol, and salicylate of soda are used. If refused in the drinking-water these drugs may be administered per rectum. To favour disinfection of the intestine salicylate of soda or benzoate or subnitrate of bismuth, in doses of ij to 2i drachms, or 3 to 15 grains of calomel may be administered daily during the acute stage. Intra-tracheal injections of antiseptics have given encouraging results. Alcohol is generally well taken, and its action at least compares favourably with that of most of the other substances recommended. In common with acetate of ammonia it is specially indicated when the strength shows signs of failing. Brandy in doses of 4 to 10 ounces may be given in drinking-water or electuary. Cardiac failure is com- bated by digitalis and by subcutaneous injections of caffeine or ether. Purgatives may be cautiously administered to relieve constipation. The strength is sustained by liquid nourishment, especially milk, and if necessary by nourishing enemata. In this disease good hygiene is of primary importance. The animals must be carefully fed, and " M. Leblanc recently drew attention to the value of quinine salts in the treatment of contagious pneumonia and the abdominal form of influenza : " At the commencement, when the temperature suddenly rises to 40° or 41° C. (104° to 105-8° F.), and other symptoms have not yet attained the gravity seen during the following days, administration of minimum doses of one and a quarter drachms of quinine sulphate night and morning rapidly produces in most cases notable diminution in temperature and in the later symptoms. Instead of the disease continuing for weeks convalescence begins on the seventh or eighth day, and never lasts beyond a fortnight." Digitized by Microsoft® 200 CLINICAL VETERINARY MEDICINE AND SURGERY. encouraged to take food and drink at short intervals, — every two hours, or every hour during the day and night. If everything is refused, gruel, milk,, or beef tea can be administered by the rectum. Intelligent nursing is of the greatest value. It is also very important to keep careful watch on healthy animals so as to detect the onset of disease at the earliest possible moment. Volatile antiseptics, like oil of turpentine and carbolic acid solution, should be sprayed or scattered about the floor and over the walls of the stable. During the last few years treatment has been enriched by two special methods of medication, hydrotherapy and serotherapy. Hydrotherapy, already repeatedly tested during the present century, consists essentially in the use of the cold pack, that is the application to the chest of compresses moistened with cold water. To produce the most intense effects Woronzow used ice. In i8go he published the results obtained in 250 cases of pneumonia. Specially arranged packs containing powdered ice were applied to the thorax, and renewed several times per day during the acute stage of the disease, the patients receiving in addition daily doses of i^ to 3 ounces of sulphate of soda. Of 250 animals thus treated only 10 died, the mortality, therefore, being 4 per cent. — a proportion certainly below the average mortality of contagious pneumonia treated by ordinary methods.* The seropathic treatment consists in injecting under the skin during the febrile and hepatisation periods serum obtained from animals which have recovered from pneumonia. The blood is collected aseptically in sterilised vessels by the usual method. Next day, or even two days later, the serum is distributed in sterilised bottles, containing i2.\ to 25 fluid drachms. In use it is injected with aseptic precautions into the subcutaneous connective tissue of the neck. Each day five to ten injections of 5 fluid drachms each are made alternately on either surface of the neck, or into the chest region over the extensor muscles of the forearm. The liquid is rapidly absorbtd without producing abscesses or induration. Though Hell, W'ittich, and some other veterinary surgeons have only obtained negative or doubtful results with this serum. Topper, Zschokke, Jansen, and Jacquot credit it with immunising and curative properties. Granting that a previous attack of pneumonia really confers immunity (full or modified), the blood should contain antitoxic substances during convalescence. But to obtain any benefit from the ' During an outbreak of contagious pneumonia which attaclied the horses of the Bon- JWarche at Paris M. Brim obtained very good results by applying powdered ice to the thorax by means of india-rubber bags. Digitized by Microsoft® CONTAGIOUS PNEUMONIA. 201 serum at least 25 to 60 fluid drachms should be injected daily during the periods of onset and hepatisation. Complications must at once receive proper attention. If signs of suppuration or pulmonary gangrene appear antiseptics are indicated. Creolin or carbolic enemata and hypodermic or intra-venous injections of carbolic or iodine solutions should be given. I need not repeat what I have already said on this subject in speaking of complications of sporadic pneumonia. The transmissibility of the disease by the various methods of con- tagion necessitates patients being isolated in a stable entirely apart from that occupied by healthy animals, while both localities should be thoroughly cleansed and disinfected, and a separate attendant provided for the diseased. When contagious pneumonia appears in large stables, the affected animals should at once be placed as far as possible from the healthy. Even if immediately removed from the common stable to a neighbouring infirmar}', isolation may be insufficient and illusory so far as checking the spread of disease. The patients should, if possible, be sent to a distant stable or to the country, for it seems clearly established that change of surroundings almost alwa\-s has a favourable influence, pro- vided the animals can be removed at the outset and without fatigue. Digitized by Microsoft® XXVIII.— CHRONIC PLEURISY IN THE HORSE. Last week a six-year-old horse with chronic pleurisy was received into hospital, where, however, it only remained a short time. It was sent because during work its breathing soon became distressed, a slight roaring sound being produced. The animal had just been bought. The purchaser noticed an abnormal respiratory sound, but referred the accelerated and oppressed breathing to broken wind. The student who brought this case before me had not recognised the condition from which it was suffering from the usual rapid preliminary examination. You saw how I arri\'ed at the diagnosis. The animal ap- peared bright and in good health, but breathed rapidly, with exaggerated movements of the flank and chest ; there was complete dulness over more than one third of the lower part of the chest, and loss of the vesicular murmur over the whole of this region on either side ; more- over towards the centre line of the chest a tubal sound could be detected. These symptoms sufficiently indicated that the horse was suffering from chronic pleurisj? or h)'drothorax. Of these two expres- sions, still used b}- many as synonj-mous, the first conveys the idea of a local disease, of inflammation of the serous membrane with pleural exudate ; the second (hydrothorax) suggests simply dropsy of the chest, a non-inflammator}- collection of fluid in the pleural sac produced by mechanical or constitutional causes, by tumours, by some disease of the lung, heart, or kidney, or by cachectic conditions. Now our patient shows no disease of this character. Its general condition is good, and, I repeat, at first sight appears perfectly compatible with health. We are, therefore, not dealing with hydrothorax, but with chronic pleurisy. The existence of roaring tends to confirm the inflammatory origin of the condition. It is, in fact, extremel}- probable that the pleurisy and roaring depend on one and the same cause, viz. a previous attack of pneumonia. The principal symptoms noted on examining this animal were recorded as follows : — " When placed in a box the patient appears Digitized by Microsoft® CHRONIC PLEURISY IN THE HORSE. 203 rather dull and drowsy. It remains standing with the head lowered and the nostrils dilated. The conjunctiva is pale and slightly infiltrated. The submaxillary artery is tense, and rolls under the finger ; the pulse is small, fifty per minute. The cough is infrequent, slight and dry. Percussion is painful ; the animal threatens to kick, and if its head is firmly held, constantly backs away from the pleximeter hammer. The area of dulness occupies almost half the lower part of the chest on both sides, and is limited by a horizontal line. On auscultation the whole of this zone is absolutely silent, except over about eight inches of its upper part, where a tubal murmur can be heard. The rhythm of the heart is normal ; the two sounds are, however, dull. There is no serous infil- tration under the chest, or cedema of the limbs. The temperature is 39° C. (io2"2° F.). The urine deposits a large quantity of sediment, but contains neither albumen nor sugar." During the two days following this examination the condition remained stationary. On the door of the box being cautiously opened the horse took no notice, but suddenly lifted its head at the least sound. When excited its appearance became more animated, but in a few moments it again appeared somnolent, or began to gather a few fragments of hay from amongst its litter. The temperature varied between 38-8° and 39-3" C. (ioi-8° and 1027° F.). The owner would not undertake the cost of treatment. He con- sented to our tapping the chest to remove a portion of the liquid which was interfering with the lung's action, knowing, however, that improve- ment would only be temporary. We withdrew eight and a half quarts of liquid. On the following day the patient was removed. Some years ago I several times saw an interesting case of chronic pleurisy in a horse which had previousl)' suffered from acute pleuro- pneumonia. In spite of the use of mercurials internally and externally the disease had assumed a chronic form. The animal was bought by a small horse dealer. It was then rather thin and soon became "blown" at exercise, but when at rest showed no \\'ell-marked morbid S}-mptom if we except a dribbling of saliva from the mouth, consequent on the action of the mercury. This, however, the new owner explained to us, was in a wa}- an advantage in selling the animal, as he referred the trifling symptoms shown to injuries about the mouth. A buyer was soon found. The horse was five years old, and the price moderate. But from the first day this buyer noted that the animal showed little appetite, and soon had difficulty in breathing during work. He had its teeth rasped, but finding the condition did not improve he brought it here for inspection. We dispelled his doubts as to the animal's condi- Digitized by Microsoft® -204 CLINICAL VETERINARY MEDICINE AND SURGERY. tion. It returned to the seller. The latter (as happens almost always under similar circumstances) after making a number of difficulties consented to an exchange, needless to say on terms advantageous to himself. He succeeded in successively selling this animal to two other ■persons, who brought it here at intervals of a few weeks. We im- mediately recognised it by its black colour, and by the discharge of saliva which the dealer took means to sustain. The history of these two horses shows you how little marked may be the s\'mptoms of chronic pleurisy even when exudate is considerable. In many cases the animal appears perfectly well. All that can be detected in the external appearance is a little dulness, trifling loss of condition, and that peculiar state of the coat .expressed by the word " staring." Appetite is usually fair; at times capricious and irregular, hay especially being partly left. The conjunctiva is pale or clay- coloured and infiltrated ; the pulse somewhat rapid, of normal force or rather weak. Fever is always trifling, and the temperature curve only shows slight oscillations. Some patients have an occasional dry cough, louder than that of broken wind. However slight the exudate, work soon produces dyspnoea ; the animal becomes distressed, and finally stops for want of breath. These symptoms grow more marked as the area of active lung is encroached •on b\- fluid exudate. Even when the pleura contains a considerable quantity of liquid some animals, when at rest, show little change in the •character of the respiration ; but in the majority — especially when exudate is abundant — the breathing is rapid and the "discordance" striking. You have all noticed that in normal respiration the sides of the chest and the flank move simultaneously and in the same direction during both inspiration and expiration. The flank flattens slightly at the same moment as the ribs are depressed, and bulges when they rise. '■ Discordance " is said to exist when during expiration the flank bulges while the ribs fall, and vice versa. This discordance is a common S3'mptom in various affections of the lungs and pleura, and in some other very rare diseases, — in diaphragmatic hernia, for example. If very marked it almost always indicates pleuritic exudate. Percussion of the thorax reveals the existence of a double-sided zone of dulness which extends upwards to a greater or less distance, reaching to — or even beyond — the centre line of the chest. Above this zone the sounds are normal or tympanitic. On auscultation the dull area is usually silent, above this a tubal sound is heard, and above this again the vesicular murmur. In ■exceptional cases where pleuritic adhesions exist a tubal murmur and Digitized by Microsoft® CHRONIC PLEURISY IN THE HORSK. 205, liquid sound may be heard — a kind of splashing produced b}- the exudate striking against bands of fibrous tissue below the \e\el of its surface (if the expression be permissible). The phenomena discovered on auscultation and percussion almost always exist on both sides of the chest and to a similar height. Certain cases, howe\er, prove that exudate may be confined to one pleural sac, and the fact that the physical signs are unilateral does not at once exclude the diagnosis of pleurisy. As a rule the costal walls are not abnormally sensitive e.xcept as a result of repeated stimulating applications. In some patients the lower part of the chest shows trifling oedematous swelling, and infiltra- tion of the subcutaneous tissues may be detected by pressing with the tips of the fingers o^'er the intercostal spaces. Chronic pleurisy usually persists and becomes aggra\-ated, slowl}- if the patients are carefully nursed and fed, but rapidly if they are worked and exposed to chills or inclement weather. The dyspnoea increases in proportion to the increase of exudate. The cough, wasting, and loss of strength become accentuated, the heart-sounds and pulse weaker and weaker. \\'hen the increase of exudate is very slow signs of general debility appear ; the limbs swell, and the animals finall)- die of exhaustion. In the contrarj- case respiration soon becomes %er3- painful, the animals remain standing with the limbs spread widely apart, struggle for breath, and on falling die of asphyxia. Chronic pleurisy in the horse may, however, terminate in resolution. In rare cases the exudate ceases to increase, and after an inter\al gradually becomes re-absorbed. The general disturbance and special SN'mptoms recede, appetite and strength return, respiration becomes less frequent and difficult, the area of dulness diminishes, the bronchial sounds disappear, and the \-esicular murmur returns in the lower parts of the chest. Recovery is almost alwaj-s incomplete, the respiratory movements generally remaining irregular, and a little drj- cough resembling that of emphysema persisting. On post-mortem examination of horses which die of chronic pleurisy the pleurae contain a more or less abundant, clear, transparent, or slightl}- yellowish serosity, with or without fibrous flocculi ; some- times the exudate is purulent. The pleura is irregularly thickened, whitish, rough with villous processes, and partial!}- covered with masses of_ fibrous deposit of all shapes and sizes ; sometimes the pulmonary and costal or diaphragmatic pleura are adherent. If death Digitized by Microsoft® 206 CLINICAL VETERINARY MEDICINE AND SURGERY. results in consequence of a fresh acute attack, these organised new membranes are covered with fibrinous or purulent exudate. Chronic pleurisy being sometimes curable, what are the best means of treatment ? Internal medication is of little value. In the acute form bicarbonate and salicylate of soda, given in the drinking-water, and pilocarpine or arecoline administered subcutaneously appear useful, but are of little value in the chronic stage. Laxatives and diuretics internally, together with rubefacients and blisters applied to the walls of the chest, constitute the usual treat- ment. Repeated mild blistering of both sides of the chest, as high as the line of exudate, is sometimes successful. When recent pleurisy is in process of becoming chronic these most probably act by favouring vascularisa- tion of the new membrane, and thus multiplying the channels through which absorption may occur. They are less effectual in old-standing distinctly chronic pleurisy. In such cases they should be associated with tapping the chest. Many cases are said to have been permanently cured by this treatment. In addition to their questionable efficacy in chronic pleurisy blisters entail serious disadvantages if tapping has afterwards to be performed. The purulent dermatitis they produce renders it difficult to disinfect the seat of operation, and exposes the patient to danger of pleural infection. When the methods are combined the chest should first be punctured, and if a repetition of the operation become necessary the parts should be very carefully disinfected. Tapping the chest is unquestionably the most rational and efficacious method of treat-ing chronic pleurisy. As the two plejural sacs almost always communicate, puncture of one side results in withdrawal of most of the contained liquid. If the orifices in the posterior mediastinum are plugged (shown by the per- sistence of exudate in the side removed from that of operation), both sides must be tapped. In chronic as in acute pleurisy operation should be resorted to as soon as breathing becomes distressed and exudate abundant. Very generally the two conditions march together, dyspnoea being propor- tional to the quantity of liquid in the thorax. Nevertheless exceptions occur, pulmonary or cardiac disturbance sometimes rendering breathing difficult even when the exudate is scanty. Conversely, cases occur in which dyspnoea is trifling, while the pleuritic exudate is con- siderable. You will see horses with double-sided abundant exudates, Digitized by Microsoft® CHRONIC PLEURISY IN THE HORSE. 207 which only appear to be suffering from broken wind. Ahhough in practice these cases are seldom surgically treated, operation is justi- fiable and necessary, as large pleural exudates may cause sudden death by asphyxia. A colleague recently described to me a case of pleurisy following pneumonia, in which the horse died in this way during the fifth week. Having recognised how abundant was the exudate, he had thought of tapping the chest ; but as the breathing did not appear alarming he postponed operation until next day. The patient died during the night. We may therefore lay down as a general rule that thoracentesis is indicated whenever exudate is abundant. When it approaches the middle line of the chest any temporising is dangerous, and operation should at once be performed. The operation dates from the earliest historical period. In the case of man it was performed by the Cnidians and the doctors of Cos. At that time it was usual to incise the thoracic wall through an inter- costal space, or to trephine a rib. The " hippiatres," predecessors of the first veterinary practitioners, applied this treatment to the horse, Lafosse indeed going so far as to declare that pleurisy could onlj- be cured by operation. Following them, some veterinary surgeons, during the last and commencement of the present centuries, opened the pleura by passing the point of a knife through an intercostal space. Thus performed, operation produced immediate relief, but was too often followed by infection of the pleura and passage of air into the thorax, which almost always proved fatal. The first improvement consisted in substituting a trocar for the bis- toury. Even Lafosse, in his Dictionnaire d'Hippiatriqite, gives a short description of thoracentesis by means of the trocar. He recommends passing the instrument between the lower portions of the seventh and eighth ribs, opposite the costal cartilages, drawing off about half the contained fluid, and afterwards injecting slightly stimulating liquids (liquides legerement vulneraires). He adds that the treatment is " almost always certain " when the condition is of inflammatory origin. For a long time the trocars used were too large ; complications were very frequent and success rare. The operation had almost been abandoned when it was rehabilitated by St. Cyr, who showed the good results obtained by using a fine trocar. To prevent air entering the chest Reybard suggested providing the cannula with a .short tube of goldbeater's skin, which allowed liquid to escape but prevented air entering, the thin walls collapsing and closing the orifice when pres- Digitized by Microsoft® 2o8 CLINICAL VETERINARY iMEDICINE ANll SURGERY. sure became negative. Despite these successive modifications the operation always entailed risk until the introduction of antisepsis. Though it produced momentary improvement it was often followed by aggravation of the disease, the pleuritic exudate becoming purulent, and patients dying of empj-ema. Thanks to antisepsis, and possiblj- in some degree to the invention of M. Dieulafoy's aspirator, thoracentesis has become a comparativelj- innocent operation. Even without an aspirator the operation can be perfectly well performed, proxided a slender trocar be used and anti- sepsis observed. The seat of operation having been shaved and dis- infected, the trocar, covered by its cannula, is introduced at the lower part of the seventh or eighth intercostal space close to the spur vein ; the trocar is next withdrawn, allowing the liquid to escape, after which the cannula is removed and the little cutaneous wound covered with a layer of iodoform or sublimate collodion. This constitutes the entire operation. With the aspirator the wound in the thoracic wall and the danger of infecting the serous membrane are reduced to a minimum. The taps at the base of the aspirator are first closed, and the air exhausted from the barrel. A rubber tube, provided at its free end with a fine hollow needle previously sterilised by immersion in a disinfectant, or by passage through the flame, is then slipped over one of the aspirator nozzles. The skin having been prepared the needle is passed into the intercostal space at the point chosen, and the lower tap of the aspirator opened. The needle is then pushed forward until it enters the thoracic cavit)'. Under the influence of the vacuum in the aspirator, liquid rushes rapidly into the barrel. Exudate may thus be removed in a ver)- short time, but it is better to proceed somewhat slowly. When the liquid contains fibrous clots the needle becomes blocked from time to time, but a little pressure on the piston expels the fragments, and the flow recommences. It is not necessai'}' to remo\-e all the exuded liquid, as has been recommended b}- some. Four to tweh'e quarts are usually sufficient, depending on the size of the animal and the amount of exudate. Puncture may afterwards be repeated if necessary. Unless very abundant, the remainder of the exudate becomes absorbed sponta- neousl}-. Resorption is favoured by administering alkalies, diuretics, or certain drugs which, like arecoline or pilocarpine, stimulate secretion. Last year you saw in hospital a horse with pleuris}- following pneumonia, which was onlj- tapped once, one month after the pleuritic affection had appeared, and was afterwards treated by alkalies and hypodermic Digitized by Microsoft® CHRONIC PLEURISY IN THE HORSE. 209 injections of pilocarpine, the chest not being bhstered. The animal recovered. When the operation is properly performed the general health always improves, breathing becoming easier and less frequent. The only accident really to be feared when the operation has been slowly per- formed is purulent change in the exudate, but this is avoided by antiseptic precautions. In another patient affected with pleurisy communicated from the lung, you noted on the third occasion of tapping that the liquid was clearly purulent, although on the second occasion it had only been slightly turbid, and on the first had appeared purely serous ; but cultivations from the liquid first obtained showed pyogenic germs ; the exudate ^\"as then already purulent, a character- istic which had simply become more accentuated. In this case tapping could not be held responsible for the change in the exudate. Performed with proper precautions the operation is innocent. It is always useful, and has been found of the greatest service in treating obstinate cases of pleurisy. Digitized by Microsoft® XXIX.— THE ABDOMINAL FORM OF INFLUENZA* IN THE HORSE. During a comparatively short period we have received into hospital eight horses suffering from an infectious disease which is almost always present in the Seine and neighbouring departments, and at times assumes the form of a true enzooty. I refer to the affection formerly known as gastro-enteritis, and now termed "typhoid disease," "typhoid fever," or influenza. It is a morbid condition special to the horse, and has nothing in common with the human disease known by the same titles. On the 2ist March last, five horses belonging to M. A — , carrier. Boulevard Soult, Paris, were suddenly taken ill. They were greatly depressed, and would not touch their food. My colleague, M. Moret, was called in next day, and finding them undoubtedly suffering from influenza had them sent to the School. On the 30th of the same month three further cases from this stable were sent here, and during the interval several more had been affected. I will read you an extract from the notes made about these animals. Case i. — Four-year-old entire horse. Entered the 22nd March. Symptoms. — Extreme depression and dulness, eyelids swollen and closed, eyes painful on exposure to light, conjunctiva cyanotic, mouth hot and drj', tongue slimy, a narrow violet-coloured stripe along the gums, active thirst, heart-beats rapid and violent; pulse 92, small and perceptible with difficulty; respirations 21. Nothing abnormal on percussing the thorax. On auscultation, strong vesicular murmur over the entire lung. Temperature 4i"3^ C. (io6'3° F.). ' {Maladie typhoide du cheval.) To distinguish this form of influenza, of which I saw a large number of cases in France, and have recently seen others in England, from " pink- eye," the form of influenza best known to English practitioners, I have ventured to adopt the above title, thus avoiding a long and cumbrous periphrasis. — Jno. A. W. D. Digitized by Microsoft® THE ABDOMINAL FORJI OF INFLUENZA IN THE HORSE. 211 Treatnient.—AppUcation of mustard under the chest and abdomen, and over upper part of the limbs. Alcohol, digitalis, and salicylate of soda in draught. Carbohc enemas of a strength of -5 to i per cent. Next day the symptoms were little changed ; the temperature, however, was only 40-6° C. (105° F.) ; the pulse still frequent and feeble; respirations 18 per minute. The animal took part of its food. After the 25th the condition markedly improved. The temperature did not rise beyond 39-6° C. (103-2° F.) ; the pulse was better and less frequent than on the previous day ; the respirations 16. On the following days the symptoms gradually diminished. Recovery was complete on the 29th March. Case 2. — Four-year-old entire horse, entered hospital 22nd March. The animal was very depressed and sleepy ; the head was held low ; the gait was rolling ; the animal took no notice of its surroundings ; the conjunctiva was reddish violet; the eyelids were swollen, hot, and very sensitive ; the gums showed a broad bluish band ; the buccal mucous membrane was dry ; thirst was intense ; appetite completely lost ; the heart beat tumultuously ; the pulse was thready, 82 per minute ; respirations 20; temperature 40'8° C. (io5'4°F.); nothing abnormal could be detected on auscultation or percussion of the thorax. In the evening the temperature was 40'5° C. (i04'9° F.) ; pulse 72 ; respirations 18. The fasces were soft. Treatment similar to that of the first case. Next day the general condition was stationary. Morning temperature 40-5° C. (i04'9° F.) ; evening 40-8° C. (i05-4° F.). On the following days the symptoms diminished and the temperature fell. On the 31st March the animal had entirely recovered. Case 3. — Six-year-old entire horse, entered 22nd March. This animal appeared externally like the others. The eyelids were swollen and painful, tears running from the eyes : the conjunctiva was injected, infiltrated, and of a very marked mahogany colour. The mouth was hot ; the mucous membrane of the gums violet in colour ; the fasces were dry. The temperature was 40-6° C. (105° F.) ; the circulation very rapid ; the pulse 90 and difficult to detect ; respirations 20 per minute. Treatment as before with the addition of eight ounces of sulphate of soda. The first three days the condition remained nearly stationary. Temperature 40'5° C. (104-9° F-) ! pulse 88 ; respirations 18. Subse- quent course of the disease similar to that in the above patients. Digitized by Microsoft® 212 CLINICAL -iKTERIXARV MEDICINE ANIl SURGERY. Case 4. — Se\en-year-old entire horse, entered 22nd March. The animal was dull and stiff, and remained standing in a corner of its box. The eyes were weeping ; the eyelids swollen, infiltrated, and painful ; the conjunctiva of a reddish mahogany colour ; the cornea had lost its transparency, and was encircled by a yellowish aureola ; the anterior chamber contained a deposit resembling hypopyon. These symptoms were particularly marked in the left eye. The mouth was hot and dry, the tongue slimy, the gums marginated by a bluish line; appetite slight ; thirst severe ; temperature 40'6° C. (105° F.) ; pulse 78 ; respirations 22. Treatment the same as for the two previous cases. On the following day trifling improvement was noted. The horse was less depressed, and ate the greater part of its food. Temperature 39'8° C. (i03'6° F.), pulse 80, respirations 20. The faeces were small, dry, and shinw Eight ounces of sulphate of soda were given in the drinking-water. Marked improvement occurred on the following days. Recovery was complete on the seventh daj-, except that the circle around the cornea had not quite disappeared. Case 5. — Six-year-old entire horse, entered 22nd March. The following sj-mptoms were noted : — The attitude suggested great fatigue, the face appeared sleepy, the eyes were half closed, discharging tears, and ver}' sensitive on palpation ; the eyelids were swollen, the con- junctivae violet-red, the mouth hot and past}-. The patient took the greater part of its food, but would not touch the chaff; thirst was severe. The heart-beats were regular, the pulse feeble, temperature 397" C. (i03-4° F.), pulse 56, respirations 20. Treatment expectant. Next day the general condition was stationary. On the 24th improvement occurred and rapidly increased. On the 28th the animal was removed, cured. Case 6. — Eight-year-old entire horse, brought to the College 30th March. Had been ill since the previous night. The animal was depressed and somnolent, and carried the head low. The eyelids were swollen, the eyes weeping, the conjunctivae reddish violet, the cornea was surrounded by a greyish cedematous circle, the mouth was dry, the tongue coated, the line along the gums well marked. The bowels were constipated, the faeces dry and covered with a layer of mucus. The temperature was 40'!° C. (i04'i'^ F.), respirations 19, pulse 75, very small. Treatment similar to that of Case 3. Recovery in eight days. Digitized by Microsoft® THE ABDOJIINAL FORM OF INFLUENZA IN THE HORSE. 2 13 Case 7. — Five-year-old entire horse, recognised as ill on the 2gth March ; brought to the College on the afternoon of the 30th. The animal was greatly depressed, and walked with a rolling motion, the muscular weakness being such that the hmbs almost collapsed at each step. The ears and membranes were cold. Placed in a box the animal stood constantly in one position, the head depressed, the ej^elids almost completely closed, and tears running abundantly over the face; the conjunctiva was of a very marked violet-red tint ; the gums were bordered by a stripe of the same colour, more especially marked in the lower jaw ; the temperature was 4i'3° C. {io6'3° F.). The animal occasionally had paroxysms of coughing, the cough being strong and dry. On auscultation the vesicular murmur was absent from the lower part of both pulmonary lobes, being replaced by moist rales. The respiration was 22 per minute, the circulation rapid, the cardiac beats being strong though rhythmic ; the pulse was 70, small and thready. Although appearing severely attacked the patient voluntarily took food. The fasces were normal. Same treatment as for Case i. Condition stationary for forty-eight hours. On the third day improvement was noted. The normal respi- ratory murmur had returned at points where it was previously imper- ceptible. Temperature 40"i° C. (i04'i° F.), respirations 14, pulse 55. The improvement gradually continued without incident. On the 5th April the animal recovered its usual appearance, ate all its food, the stiffness had disappeared, the conjunctiva showed a yellowish tint, temperature 38° C. (ioo"4° F.), respirations 15, pulse 40. On the 8th April the patient was sent home cured. Case 8. — Six-year-old entire horse, entered the School 30th March. Principal Symptoms.- — Very pronounced depression, somnolence and rolling gait ; eyelids half closed and swollen ; conjunctiva hyperjemic ; mouth hot ; tongue coated ; gums bordered by a narrow violet-coloured stripe. Auscultation and percussion of the thorax revealed nothing ab- normal. Temperature 40-2° C. (104-3° F.) ; respirations 26 ; pulse 70, difficult to discover in the arteries of the extremities. Treatment. — Expectant. The animal took a portion of its food. On the 31st March and ist April the condition was stationary. On the 2nd April the animal was less depressed, and the discharge from the eyes had diminished. The temperature was only 39'3° C. (I02'7° F.). Recovery was complete on the sixth day. These are typical cases of benign influenza, rapid in onset and in Digitized by Microsoft® 214 CLINICAL ^'ETERINARV MEDICINE AND SURGERY. de\'elopment, and unaccompanied bj- any grave complication. Even in this form the disease appears suddenly, and soon reveals its presence by three clearlj- marked symptoms — extreme depression, high fever, and deep red or violet tint of the conjunctiva. If you have carefully observed and followed these cases you have noted other morbid pheno- mena. In all the mouth was hot and dr}', its mucous membrane in- jected, and the gums showed the classical reddish-violet line. The majorit}- showed no intestinal trouble. The fseces were of normal consistence. Three patients were constipated during the earlier period ; only one had diarrhoea. In none was palpation of the abdo- men painful. The circulation -was greatly accelerated, the pulse often numbering 90 per minute, and the force with which the heart beat contrasted markedly with the weakness of the pulse, which was small and thready — in some patients so feeble as to be difficult to count during the first few da}s. Auscultation of the heart revealed no abnormal sound. The breathing movements were little affected, either in number or rhythm. Auscultation of the lung only showed a trifling exaggeration of the vesicular sound. In one patient, however, during the second and third days the lower portion of both lobes, and especially of the left, was the seat of moist rales and loss of the vesicular murmur — signs which were referred to congestion of the lower portion of the lung. This was the only animal which had anj' attacks of coughing. The skin of the trunk and upper portions of the limbs was hot. In most of the patients the ears and extremities were cold. In almost all the fever was marked, the temperature rising above 40° C. (104° F.), in several even above 41° C. (105*8° F.). In two cases the eyes were specially affected. In addition to the epiphora, the violet coloration and infiltration of the conjunctiva, the cornea and deeper portions of the eye showed lesions. In these patients the cornea of both eyes was surrounded by a greyish cede- matous circle, and in one of the two the anterior chamber of the eye contained a deposit resembhng hypopyon. These troubles disap- peared in a few days. The fear of light at first observed only per- sisted for forty-eight hours. There was no oedematous swelling of the lower parts of the limbs, and no paralj-sis of the penis or other organs. The rapid diminu- tion in symptoms, prompt and complete resolution, and short con- valescence were particularly remarkable in all cases". The animals were put to work soon after leaving hospital. Influenza, however, does not always present this benign character, and when it takes a malignant form many patients die of intestinal, Digitized by Microsoft® THE ABDOMINAL FORM OK INFLUENZA IN THE HORSE. 2 15 pulmonary, cardiac, or encephalic complications. Since it has per- manently taken up its residence here it seems in a general sense to have lost some of its gravity. During 1890 and 1891 it is said to have produced many deaths in Paris and the neighbourhood, but the evidence is not entirely satisfactory as to \\'hether the cause of these losses was influenza pure and simple. In great commercial and industrial centres, where circumstances favour the development and propagation of contagious equine diseases, several infections may simultaneously be active in one stable. Thus influenza sometimes co-exists with strangles, contagious pneumonia, or the pneumo-enteritis caused by bad forage. I have observed cases of the kind. You will there- fore see how difficult it sometimes is to soh-e these questions, and how much more complicated the problems offered by practice really are than you might imagine by perusing text-books on pathology. At the post-mortem examination of animals dead of influenza most of the organs exhibit extensive changes : congestion, ecchymoses, infiltrations, and degenerative changes only revealed by the microscope occur in varied combination, but the principal lesions are confined to the mucous membranes of the digestive and respiratory apparatus. The intestinal mucous membrane is h3'per£emic, swollen, ecchymosed, and in places deprived of its epithelium. When incised it appears infiltrated with liquid which escapes from the cut surfaces, and coagulates in thin layers of gelatinous character. The submucous connective tissue is often engorged with greyish or amber-coloured liquid. The mucous membrane of the p3doric end of the stomach and sometimes of the pharynx shows similar changes. Swelling of Peyer's patches is by no means constant, and I have never observed necrosis or ulceration, lesions characteristic of typhoid fever in man ; moreover Eberth's bacillus, the causal microbe of typhoid, is never found either in these patches or at any other point in the intestine. The respiratory mucous membrane is affected to a varying degree. Often there is only reddening and slight swelling of the larynx and bronchi ; in some cases pulmonary lesions, such as catarrhal or fibrinous pneumonia, or cedema of the lung, with or without pleural exudate, predominate. Disease of the myocardium and endocardium is rarer than in pneumonia. Even when nervous sj-mptoms occur, change in the brain, spinal cord, or meninges is seldom marked ; very often there is only trifling injection of the meninges and slight infiltra- tion of the plexuses, the true nerve substance either of the brain or medulla being rarely ecchymosed or softened. When the disease is com- plicated with laminitis the podophyllous tissue is more or less congested. Digitized by Microsoft® 2l6 CLINICAL VETERINARY 5IEDIC1NE AND bURGERY. The blood and affected organs may contain various microbes, but none of those at present isolated can be regarded as the specific agent of influenza. That remains to be discovered.* Diagnosis is easy. The sudden appearance, rapid aggravation of symptoms, extreme depression, and the ocular symptoms constitute the principal indications. Any doubts which might at first exist are soon dissipated by the rapid spread of disease to large numbers of fresh subjects. In less than a fortnight one half or two thirds of the animals in a large stable may be attacked. The disease can be distinguished from contagious pneumonia and from the pneumo-enteritis said to be produced by bad fodder. Contagious pneumonia is recognised by the predominance of pul- monary symptoms ; the rapidity of breathing from the outset ; the slighter depression ; the absence of epiphora ; the yellowish colour and moderate injection of the conjunctiva, and the slow extension of the epidemic. The embarrassing cases are those where infection is of a mixed character, — influenza and contagious pneumonia, for instance, being both present in one stable. The existence of pneumo-enteritis is usually announced by some- what alarming symptoms, but in general the onset is less striking and the contagion less active than in influenza. The conjunctiva is less swollen, and lacks the violet or mahogany colour. If the colour, appearance, and smell of the hay and oats leave nothing to be desired, if they are clean, have been well got and carefully stored — if, in a word, they are of excellent quality, pneumo-enteritis maybe placed out of the question. It is always easy to distinguish influenza from sore throat, or bronchitis affecting a number of animals. The prognosis is usually favourable, but varies according to the character of the prevailing outbreak, the time of }'ear, and the animals' surroundings. When the disease seizes on a locality from which it has long been absent, more animals are lik-ely to succumb than in large towns where it exists, so to speak, permanently. This year we have seen little but benign cases which developed regularly and rapidly. All our cases of simple influenza recovered, but the mortality is some- times severe, varying between i and 15 per cent., the medium being ' M. Lignieres isolated and cultivated a microbe vvhich'he termed the cocco-bacilhis,?Lnd which he regarded as the specific cause of influenza in the horse. He states that " inocu- lation of a horse with a culture of this microbe produces most characteristic symptoms of influenza." Suitably attenuated and inoculated into a healthy horse it produces no grave symptom and affords immunity. By vaccinal inoculation in the horse a preventive and curative serum was obtained. Digitized by Microsoft® THK AIJDOJUNAL FORM OF INFLUENZA IN THK HORSE. 217 from 3 to 5 per cent. The outbreaks in which losses rose to 25, 50, or 60 per cent, were not due simply to influenza, but were the result of double infection. An interesting point to consider is whether the virus of influenza has immunising properties, and whether animals which have recovered are protected from fresh attacks. In this respect experience shows that the disease generally affords immunity for a period of twelve to fifteen months. In 1891 a stable of twenty horses was invaded by mfluenza, and I noted that two animals which had been attacked ten months before resisted. Cases of more prolonged immunity have been mentioned, some extending to three, five, or six years. These are exceptional, even admitting that the disease has not been erroneously described as influenza. Treatment consists primarily in good hjgiene. In recent outbreaks where the number of cases is still small the patients should be isolated and their stalls disinfected ; the stable should be kept well ventilated and very clean ; the drains being flushed and the floor and walls moistened with carbolic, creolin, or turpentine solutions. In this way the epidemic may be arrested, but its contagious character is too pronounced for such measures often to succeed ; nevertheless they should not be neglected. If the form of disease is severe and many animals are affected, it may be necessary to remove all. In warm weather they can be turned out to grass, living in the open air under a shed ; at least they should be removed to a new stable and the infected stable thoroughly disinfected. By observing these precautions in grave outbreaks of influenza many practitioners have succeeded in checking the heavy mortality and the disease itself. Patients which still drink freely should receive gruel, hay tea, or milk at frequent intervals. Milk is particularly valuable; most animals drink it readily ; in grave cases it is alone sufficient to sustain their strength and carry them on beyond the dangerous period. As in pneumonia, patients which refuse everything should be fed by the rectum. Medical treatment comprises various methods, the principal being bleeding, application of large mustard plasters to the chest and abdomen, and the internal administration of drugs. Those most commonly given are sulphate of soda in doses of 3 to 6 ounces per day, bicarbonate of soda I5 to 3 ounces, salicylate of soda 2i to 6 drachms, digitalis i to i^ drachms, and quinine salts 2^ to 5 drachms. The Digitized by Microsoft® 2 IS CLINICAL VETERINARY MEDICINE AND SURGERY. ej-es are treated with lukewarm fomentations and warm collyria containing atropine, creolin, or boric acid. If fever remains high anti- pyretics and cold enemata (to which i^ to 3 drachms of carbolic acid per quart ma}- be added) are useful. AVhen influenza is complicated with laminitis, hypodermic injections of arecoline or pilocarpine are valuable ; the feet should be surrounded with moist compresses, frequenth' saturated \vith cold water. In the various forms of influenza, moderate doses of alcohol, and especially brandy, maj' be given either in the drinking-water or in the form of electuary. You have often seen valuable effects thus obtained. The mode in which alcohol acts has long been discussed, but whether it undergoes a series of transformations in the blood, whether it principally affects the nervous system or nutrition, is of little importance. What we do know is that it gi\es excellent results. In six of our patients treatment consisted in application of mustard plasters and the administration in mashes or gruel of sulphate of soda, bicarbonate of soda, salic}'late of soda, and brandy. For several I also ordered i to i^ drachms of powdered digitalis and cold carbolic enemata. All cases recovered very rapidly. I wish to impress on you that in the benign form of influenza internal medication is only of secondarj' importance. I left two patients to take care of themselves, ^\•ithout assisting them in an}- way whatever, onl}- watching them in case it should become needful to intervene. No necessity arose, and both recovered as quickly as those treated. Digitized by Microsoft® XXX.— A CASE OF PHARYNGITIS DUE TO STRANGLES. We have just completed the autopsy of a horse which died of acute sore throat due to strangles, complicated b}? paralysis of the pharynx. Up to the last day or two we anticipated improvement and recovery ; the symptoms never appeared alarming or likel)- to end in death, and in fact were even less pronounced than usual in such attacks. For that reason alone the case is of special clinical interest. The history of this patient will form the subject of my lecture to-day. The animal was brought for advice on the 6th September. It was five 3-ears old, and had only been four days in the new owner's stable. On that morning, and even on the evening before, it left the greater part of its food, and seemed tired and depressed ; the skin was hot, the eye injected ; a greyish inodorous discharge mixed with fragments of food ran from both nostrils ; saliva accumulated in the mouth, and escaped freely on introducing the hand. The throat was painful on pressure. The right submaxillary gland was slightly enlarged, the left formed a swelling the size of a walnut, and was surrounded by an oedematous zone ; the centre showed obscurely fluctuation. A few small papules were noticed at different points, especially on the neck and sides. The patient's age and the fact that it had just been bought at once suggested to us the diagnosis of pharyngitis due to strangles. I opened an abscess under the jaw with the usual precautions, and collected a little pus, which I found to contain streptococci in short chains. Being left for treatment the animal was placed in my portion of the hospital. My assistant will read you the animal's history from the time when it entered hospital until the da}- of its death. " On entering hospital the animal was depressed and took no notice of its surroundings. It scarcely touched food. A greyish discharge mixed with small quantities of food ran from the nostrils, and long strings of saliva occasionally fell from the mouth : the conjunctivae Digitized by Microsoft® 220 CLIXICAI. VEI'KRINARY IIEDICIXK AND SUR(;ERV. were deep red in colour. The pulse was 70 per minute and strong ; the respirations ^1 ; the temperature 40'5'' C. (io4'9° F.). The vesicular murmur was loud over the entire area of both pulmonary lobes. The subm.axillary glands were swollen, the left showing fluctuation. A papule-vesicular eruption was visible on the neck, sides, flanks, and croup. Treatment. — The abscess was opened and the cavity washed out with a water}- solution of iodine. The sides and under surface of the thorax, throat, and limbs were dressed with mustard. Food as usual, hay tea, and milk. Fumigations : 25 drachms of sulphide of antimony (Kermes' mineral), 5 ounces of brandy, and creolin enemas. Until the loth September the temperature remained at 40° C. (104° F.), the pulse varied between 55 and 70, and the respirations between 22 and 30 ; cough was infrequent. On auscultating the lung mucous rales were heard ; the vesicular murmur appeared diminished ■over the inferior third of both lobes. The animal readily took mashes, etc., and 10 quarts of milk per day. The Kermes' mineral, alcohol, and creolin were continued. A daily dose of 2\ drachms of potassium iodide was added. From the nth to the i8th September the symptoms continued, though slight improvement occurred and slowly became more marked. On certain days the temperature fell to 39° C. (i02"2° F.), the pulse to 48, and the breathing to 20. The patient occasionally attempted to eat oats and hay ; it masticated them, but had great difficulty in swallowing the little boluses of food, so that although it continued to take gruel, ha}- tea, and milk, wasting occurred. On the 13th a second abscess developed under the jaw behind the previous one, and was opened. Bacteriological examination of the pus revealed the presence of streptococci. On the 19th the general condition \\'as distinctly better, and the discharge less abundant than on the preceding days. Saliva still ran from the mouth, but when the animal, drank less water returned through the nostrils. The submaxillar}- space still showed inflammatory s-welling occupying the posterior half and extending over the laryngeal region. A few oats given by hand were masticated, but not swallowed. On examining the throat nothing could be found to explain this inability to swallow. The parotid region was not swollen or more prominent than normal, and pressure over it only caused dull pain, the animal scarcely attempting to withdraw. Three little abscesses the size of hazel-nuts had developed in the subcutaneous connective tissue of the right shoulder. They were opened. Careful examination of the buccal cavity, especially towards the back and base of the tongue, Digitized by Microsoft® A CASE OF PHARYNGITIS DUK TO STRANGLES. 22 1 showed nothing abnormal. Nothing was discovered on rectal examina- tion. Temperature 38-8° C. (ior8° F.), respirations 18, pulse 40. The urine contained no sugar, though a little bile pigment and traces of albumen were found. " On the 20th the general condition was stationarj-. The penis had become relaxed and pendent. As slight signs of iodism had occurred and tears ran over the cheeks the potassium iodide was stopped. " On the two following daj's the penis became more markedly para- lysed. Emaciation also increased. " On the 23rd the general condition was less favourable, and saliva- tion more abundant. The patient showed greater depression, hung back from the manger, and touched neither gruel nor milk. At 8 o'clock the temperature was 39-3° C. (1027° F.), respirations 32, pulse 54. There was no thoracic dulness, and on auscultation of the lungs no- abnormal sound. On examining the throat externally nothing fresh could be detected. " On the three following daj-s the condition slightly improved. The temperature varied between 38-6° and 39° C. (101-4° and 102-2° F.) ; the breathing was calmer. The patient refused milk, but took a little gruel, hay, and oats. " On the evening of the 27th the condition became aggravated. The temperature rose more than a degree. The apex-beat of the heart was violent, and could be heard on the right side of the chest. The small quantity of faeces passed was covered with blood-stained mucus. As the animal entirely refused food, six quarts of milk were given per rectum. In the evening it drank the liquid portion of its gruel, ap- peared more depressed than formerl)-, and laj- down on its side. A subcutaneous injection of 15 grains of caffeine was given. " On the 28th the animal was standing, and seemed rather less depressed than on the previous evening. It ate a few mouthfuls of fresh lucerne. Swallowing appeared easier. Temperature 39° C. (i02-2° F.) ; respirations 30 ; pulse 45. Two small abscesses which had developed on the left shoulder were opened. Pus mixed with saliva ran from the second submaxillary abscess ; a salivary fistula evidently existed on the left side. The same evening the animal readily took six quarts of milk. Temperature 39-2° C. (102-5^' F.). " On the morning of the 29th September the patient drank four quarts of milk, but refused other food. It showed difficult}- in breath- ing ; expiration was double. Percussion and auscultation revealed nothing new. The throat and parotid region were insensitive on pressure ; the scapular muscles showed slight twitching movements. The animal seemed unsteady on its front legs, and at times sat down Digitized by Microsoft® 222 CLINICAL VETERINARY MEDICINE AND SURGERY. like a dog. On passing the catheter only a small quantity of urine was drawn off. Temperature 38"9° C. (102^ F.) ; respirations 39; pulse 48. At midda)- temperature 39"3° C. (1027" F.) ; respirations 46 ; pulse 75. Breathing remained difficult, and trembling of the muscles attached to the olecranon was more marked. The horse drank a little gruel and then lay down on its chest. It rose in a few minutes, the face assuming an anxious expression, and again sat down on its hind quarters like a dog. " Towards three o'clock it took a few mouthfuls of gruel, and once more lay down. Ten minutes later it died without a struggle. '' A utopsy. — Nothing in the peritoneal cavity ; little food in the intes- tine ; the mucous membrane of the small intestine was congested in places. The stomach contained a few quarts of liquid ; its walls were contracted and wrinkled. The liver was large and yellowish brown in colour. The kidneys were pale on section ; the pelvis of the kidney contained a little viscous j-ellowish liquid. With the exception of a small abscess in the anterior part of the right lobe the lungs were normal. The bronchial glands were slightly swollen. Nothing ab- normal in the bronchi or trachea. " The heart had stopped in diastole. The blood which escaped on section was liquid and blackish, but coagulated rapidly. "The lower and lateral surfaces of the tongue showed several ecchy- mosed patches, over which the mucous membrane was denuded of epithelium. The epithelium covering the upper surface was at many points greatly thickened. At the entrance to the pharynx were several blind sacs (Morgagni's diverticula) ; the buccal mucous membrane showed nothing unusual. " The mucous membrane of the pharynx was thickened, \iolet in colour, ulcerated in places, and covered with whitish spots indicating little abscesses developed in the submucous connective tissue. Gentle pressure caused them to discharge thick yellowish-white foetid pus. The mucous membrane covering the anterior surface and base of the epiglottis was also thickened and violet in colour. The arytsenoid cartilages were of similar appearance. The mucous membrane of the pharynx was in places three eighths of an inch thick ; its superficial layer was hypersemic, thickened, and infiltrated with offensive pus. The subjacent muscles were similarly thickened, discoloured, and whitish, and contained numerous small abscesses. "The retro-pharyngeal glands were as large as a hen's egg, and contained purulent centres, some of considerable size ; all were filled with whitish creamy stinking pus." This horse, therefore, died of diffuse inflammatory pharyngitis Digitized by Microsoft® A CASE OF PHARYXGITIb DUE TO STRANGLES. 223 developed during strangles. Among the complications of this disease pharj-ngitis is one of the commonest and least dangerous. It is indi- cated, like other forms of sore throat, by loss of appetite, discharge from the nostrils of fluid mixed with food and of part of the drinking- water, by swelhng and abnormal sensibility of the throat region. In pharyngitis resulting from strangles the lymphatic glands in the poste- rior portion of the intermaxillary space become inflamed, causing oedematous swelling, which is soon followed by abscess formation. In the majority of cases the only surgical treatment necessary is puncture of the abscess, recovery occurring in from a fortnight to a month. The grave forms of pharyngitis due to strangles are those in which abscesses develop deep in the guttural region near the subparotid or retro-pharyngeal b'mphatic glands. Functional symptoms are then more marked and often alarming, swelling of the throat and of the parotid region being sometimes enormous. To prevent rapidly fatal complications the pus must, as soon as possible, be evacuated. Provided free drainage is secured, the swelling which accompanies these abscesses usually disappears rapidly. Unless expectant treatment is too long pursued, respiration seldom becomes so embarrassed as to necessitate tracheotomy. In any case, if dyspnoea become intense and the pus cannot be discovered even after several exploratory punctures, no hesitation need be felt in operating, as in the horse the method is very simple, never proves harmful, gives immediate relief, and removes one cause of aggravation of the pharyngitis. [Operation is as follows: — A twitch having been applied, and the seat of operation cleansed and disinfected, an incision is made through the skin over the highest part of the swelling, and if possible below the edge of the parotid, the underlying fascia divided, and the forefinger inserted. The thick connective tissue or gland structure is now broken down, the free hand meanwhile pressing on the swelhng and guiding the inserted finger towards the abscess, which, on being localised, is broken by a sharp, powerful thrust. A stream of pus escapes, often spurting to a distance of several yards. The opening may afterwards be enlarged, and a gauze or rubber drain inserted. — Jxo. A. W. D.J In our patient the pharyngeal inflammation was never really menacing. We could scarcely discover any swelhng or pain on pres- sure over the throat region. The abscess beneath the jaw was the only complication in that neighbourhood. The persistence of functional disturbance after the fifteenth day, and the absence of local lesions capable of explaining it, caused me to Digitized by Microsoft® 2 24 CLINICAL VETERINARV MEDICIXE AND SURGERY. suspect paralysis of the pharynx. Even when inflammatory symptoms are relatively slight this paralysis may occur, as proved by manj- recorded cases. During February last we had in hospital a five-year- old mare in which pharyngeal paralysis occurred as a complication of benign strangles. Cauterisation in points — the treatment usually recommended, and the dail}' administration of two and a half to eight drachms of potassium iodide until signs of iodism appeared, gave no beneficial result though twice repeated. Nor did greater success attend the opening and washing out of the guttural pouches on both sides — an operation which, however, has sometimes succeeded, and which probably acts in a different way from cauterisation. I thought of performing this operation in the case of the first horse, but deferred interfering, alwajs hoping for improvement. In this animal, however, opening the guttural pouches could only have favoured rupture of the retro-pharyngeal abscesses. Even supposing this had occurred we should not have saved our patient. The gravest lesions — those which proved fatal — occurred in the walls of the pharynx itself, and in regard to them we could do nothing energetic or directly bene- ficial. Nevertheless I have no hesitation in giving the following advice : If in phar3'ngeal paralj-sis resulting from strangles, or from in- flammatory sore throat of any character, the classical treatment fail, one should before giving up the case as hopeless suggest opening the guttural pouches — hyovertebrotomy. Digitized by Microsoft® XXXI.— TUBERCULOSIS IN THE HORSE. During the past week an eight-year-old Norman gelding was brought for examination with the history that six months before it had suffered from "inflammation of the lungs," from which it seemed to recover, but that at the commencement of last month it had again fallen ill without any apparent cause. Its condition gradually became aggravated in spite of treatment. The animal was extremely thin, and its general condition suggested a wasting disease. Breathing was not very rapid, but appeared painful. I was only able to make a partial examination, but exploration of the chest having revealed extensive diffuse changes in both pulmonary lobes, I mentioned to you that this discovery, together with the chronic character of the disease and the debilitated condition of the animal, aroused suspicion of tuberculosis. The patient was left in hospital. One of you made a note during the evening of the principal symptoms which it presented. I may briefly recapitulate them. " The mucous membrane of the mouth is pale and cold to the touch, as are the trunk and limbs. The conjunctiva is whitish and slightly infiltrated ; the pulse from 50 to 55 per minute, small and irregular ; the respiration 20 per minute, accelerated, painful, and interrupted. On auscultating the lung the respiratory murmur is diminished in the lower portion of both lobes. In the middle portion, crepitant, sibilant, and cavernous rales are heard, and in the upper an increased vesicular murmur. On percussion the upper and middle zones are normally resonant, but the lower is partially dull. Palpation of the abdomen and rectal exploration reveal nothing abnormal. The anterior part of the sternal region is oedematous. Urine is passed frequently and in large quantities, saturating the litter and giving off a strong odour. The patient has taken a part of its food." I purposed testing this horse with tuberculin, but it died during the night. Autopsy. — " In the abdominal cavity the kidneys and supra-renal p Digitized by Microsoft® 2 26 CLINICAL VETERINARY MEDICINE AND SURGERY. capsules are the only organs which have undergone change. On incising the former, tubercles appeared scattered throughout both portions of the parenchyma. The supra-renal capsules are hyper- trophied, and shov^^ on section several little yellowish softened tubercles, the pus from which contains bacilli. In the anterior portion of the sublumbar region, and adherent to the diaphragm, is a lymphatic gland as large as a walnut, the centre purulent. " In the thoracic cavity disease is marked. Both lungs are large, dense, and firm to the touch ; their surface is dotted over with greyish-, white points and little patches. Palpation reveals hardened granules and a few small areas of fibrous consistence in the superficial layers. " Vertical sections have a very diversified appearance, depending on the part of the lobe examined. The anterior part of both lobes shows fine greyish granules, varying in size between a grain of sand and a millet seed ; at certain points these become confluent, forming narrow lines or slender irregular bands of lighter colour, which stand out prominently against the deeper tint of the adjacent unchanged tissue, where the vessels are simply engorged with blood. No softened centres are seen in these preliminary sections. Towards the base, and in the upper third of the lobes, a few small areas remain in which the lung has preserved its physiological characters. Sections through these are of similar aspect to the preceding. In other regions they show very numerous unsoftened miliary tubercles, at many points confluent, at others separated by hepatised or indurated pulmonary tissue. Certain sections which appear greyish, and of the same firm consistence as in chronic pneumonia, contain enormous numbers of whitish or yellowish granules, masses of broken-down tubercles and irregular cavernous spaces, varying in size up to two inches in diameter, containing pus rich in bacilli : the walls of several of these cavernous spaces are lined by a kind of yellowish diphtheroid exudate. Other sections again show irregular greenish-grey patches, indicating frag- ments of necrotic tissue. In most of the large bronchi the mucous membrane is inflamed and thickened. " The right bronchial glands form a number of swellings the size of an almond. The left are fused together into an egg-sized mass, the centre of which contains a cavity filled with viscous, greenish-yellow pus. " Immediately in front of the diaphragm, beneath the vertebral column, are several hypertrophied glands the size of hazel-nuts, with purulent centres. In the posterior mediastinum the supra-oesophageal gland is also swollen and has undergone suppuration ; the chain of oesophageal glands and the lymphatic vessels connecting them are hardened." Digitized by Microsoft® TUBERCULOSIS IN THK HORSE. 227 In the horse, as in other species of animals, tuberculous changes are sometimes generalised, sometimes — and most frequently— localised in the thoracic or abdominal viscera. Analysis of the cases published in France and other countries shows that the organs may be arranged in the following order with regard to the relative frequence with which they are affected : — lungs, bronchial glands, mesenteric and sub- lumbar glands, mediastinal glands, spleen, liver, pleura, peritoneum, intestine. The proportion of cases of pulmonary tuberculosis is about 70 per cent. ; of tuberculosis of the mesenteric and sublumbar glands and of the spleen about 40 per cent. ; of the liver, pleura, and perito- neum 20 per cent. ; of the intestine 15 per cent. Pleurisy has been noted in about a fifth of the cases. Ascites is more rare. Tuberculosis of the kidney, though common in certain species, especially in the dog, appears to be exceptional in the horse. The pericardium, heart, bones, muscles, and other tissues are rarely affected. I have seen only two cases of tuberculosis of the endocardium, two of the pericardium, two of the bones, and one of the mammary gland. In one of his reported cases Mauri mentions tuberculous lesions of the pharyngeal glands, of the pharyngo-tracheal mucous membrane, and of the endocardium. Wolstenholme claims to have seen several cases of tuberculosis of the brain, but without furnishing any proof that the lesions were really due to tubercle bacilli. In one case showing pulmo- nary lesions and cavernous spaces, ossification of the right auricle of the heart was noted. The changes in the thoracic organs, and especially in the lung, do not always present the characters found in our patient. Sometimes the pulmonary lobes are crammed with recent miliary granules, such as may be seen in the other specimen. These granules are whitish or yellowish in colour, dense, hard, and without central softening ; they are dispersed throughout the entire lung, isolated in most instances, confluent in a certain number, but always firm and unsoftened. In general, the parenchyma of the lung in which they are embedded is of normal colour and consistence. In other cases tubercles have developed in considerable numbers in the connective tissue of the lung without producing signs of acute inflammation. Here is a specimen of such tubercular infiltration. The surface of sections appears almost entirely covered with whitish, very dense masses of tubercle, irregular in outline, united by bands of the same appearance and nature which run in all directions, inter- twining and enclosing portions of apparently healthy or slightly hyper- aemic parenchyma. You will note that such lesions are particularly large towards the upper part of the lung. On bacteriological examina- Digitized by Microsoft® 2 25 CLINICAL VETERINARY MEDICINE AND SURGERY. tion we found very few bacilli, whether the rubbings or sections were treated by Ehrlich's, Ziehl's, or Kuhne's methods. In this form, and in the preceding, the two pulmonary lobes may weigh as much as eighty-eight pounds or even more. Finally the lung sometimes exhibits lesions which to the naked eye resemble sarcomata. Here are sections of lung from a twelve-year-old horse slaughtered during the surgical exercises, in which you may observe this form of lesion. Both lungs were at points bosselated, and quite deformed by spherical tumours, developed more especially towards their upper border. Five of these, three in the right and two in the left lobe, were as large as a man's fist, appearing externally as large hemispherical projections. Regularly rounded in outline and easily separable from the surrounding tissues, these swellings were built up of little globular masses, pale grey or slightly yellowish on section, with a few softened centres. At points, and especially towards the periphery of the lung, these growths were separated by bands or tracts of whitish fibrous tissue, denser and firmer than the substance of the lobules. The growths were surrounded by a thin fibrous layer ; their surroundings showed no signs of acute inflammation or sclerosis, the pulmonary tissue immediately encircling them being of normal appearance, except at a few points where tubercles varying in size between a hemp-seed and a small nut were found. One, however, was surrounded by a layer of pulmonary tissue, between | and f of an inch thick, infiltrated with granules. Of these medium and small- sized masses some showed the same microscopic appearances as the preceding, others were dotted with yellowish points indicating softened granules, while still others were marked with little brownish, irregular spots ; all were remarkably rich in giant-cells, but scarcely contained more bacilli than the larger growths. Bacilli, in fact, were only found in a proportion of the sections. The tracheo-bronchial lymphatic glands sometimes form very large, dense, firm swellings of uniform fibrous consistence, or softened, caseous, or partially calcified growths, embracing the terminal portion of the trachea and neighbourhood of the bronchi. In exceptional instances such lesions may be found at the post-mortem of animals with healthy lungs. Nielsen has related a curious case of this nature. Tuberculosis of serous membranes is less common than in the ox. It exhibits the same naked-eye appearances and very nearly the same microscopic characters as in the bovine species ; sometimes granules and tubercles are found in large numbers with or without a greyish or Digitized by Microsoft® TUBERCULOSIS IN THE HORSE. 229 sanguinolent exudate. It is usually confined to the pleura or perito- neum. Lesions of the pericardium, endocardium, and meninges are rare. In that form of tuberculosis known as abdominal the sublumbar lymphatic glands are transformed into enormous bosselated swellings covering the terminal portion of the aorta and origin of its branches, and sometimes occupying the entire subvertebral groove from the diaphragm to the pelvis. These swellings are superficially of uniform consistence, but on section often show caseous or even calcified centres. Their weight may even exceed 65 lbs. The mesenteric glands are more or less hypertrophied and caseous, or partly calcified. The intestine may exhibit ulcerations or tubercles. The liver and spleen are always larger than normal, and may either be crowded with fine granules or bosselated, covered with whitish swellings varying in size between a hazel-nut and a child's head, uniformly dense, of the consistence of sarcoma, or partially calcified, especially in the case of the spleen. The common form of tuberculosis of the spleen can only be differentiated from sarcoma and lymphadenoma by microscopical examination and inoculation. In cases of old standing and extensive abdominal lesions the lungs usually contained large numbers of granules and tubercles.* The statement of certain authors that calcification is not seen in tuberculous lesions in the horse is incorrect. This change has really been mentioned in a number of instances. I may add that athero- matous degeneration and calcification of the walls of the common and posterior aortse are fairly frequent in tuberculous horses. When infection has occurred by the respiratory passages lesions may be confined to thoracic organs like the lung, tracheo-bronchial and mediastinal glands, pleura, and pericardium, but usually the abdominal viscera, especially the mesenteric glands and spleen, are simultaneously affected. When the bacilli have penetrated by the intestine the abdo- minal organs, and particularly the mesenteric glands, liver, spleen, and peritoneum — sometimes even the intestine — show older and usually more extensive lesions than are met with in the thoracic cavity. Iden- tification of the point of entry of the virus is not always so easy a matter as one might be led to believe. It is principally based on the size and age of the lesions in the abdominal and thoracic organs respectively, and on the existence or absence of centres of degeneration. When recent pulmonary tuberculosis is accompanied by extensive and old-standing changes in the abdominal viscera, the virus has certainly entered by the intestine ; but when the pulmonary lesions are of old * Bacteriological and experimental Investigations have led M. Nocard to conclude that the pulmonary form of equine tuberculosis resembles human tuberculosis, and the abdominal form avian tuberculosis. Digitized by Microsoft® 230 CLINICAL VETERINARY MEDICINE AND SURGERY. Standing, and contain degenerative centres like those in the abdomen, it becorhes difficult to decide whether they are primary or secondary. The development of equine tuberculosis is usually slow, insidious, and accompanied only by disturbance common to a number of visceral diseases. The first indications consist in gradually increasing weak- ness, signs of fatigue, perspiration after slight exertion, capricious or diminished appetite, febrile attacks, and lastly wasting. When the lung is invaded to a certain degree, signs of chronic broncho-pneumonia or broken wind may occur ; the animal shows paroxysms of coughing, dyspnoea, acceleration of the respiratory move- ments, with a double, jerky, expiratory effort, and a mucous or muco- purulent discharge, sometimes foetid or streaked with blood. On auscultation the vesicular murmur is usually audible over the entire area of both lobes, sometimes diminished, sometimes locally increased ; crepitant or sibilant rales may be heard, but the tubal murmur is rare. The parts continue resonant on percussion, though small areas may appear partially or completely dull. At a later stage the swelling formed by the enlarged tracheo-bronchial glands may in some animals be seen at the entrance of the thorax and on the sides of the trachea. Pulmonary tuberculosis of rapid development may at first sight give the impression of pneumonia, or, if accompanied by pleural exudate, of pleuro-pneumonia. The existence of abdominal tuberculosis is often scarcely suspected until the moment of death. In occasional instances visceral lesions may produce colic ; or those of the intestine cause chronic enteritis with profuse diarrhoea, the fluid being blood-stained when the mucous membrane is ulcerated. When the disease is suspected rectal explora- tion very often reveals the presence of sublumbar swellings. Specific glandular enlargement may appear externally in various regions, especially in the submaxillary space and in front of the chest. Those in the submaxillary space have often been mistaken for glanderous lesions. Ehrhardt followed the progress of a case which commenced with symptoms of sore throat and swelling of the submaxillary glands. For a time he suspected the animal of glanders, but three years later it died from generalised tuberculosis. In a horse mentioned by Johne a swelling resembling a cold abscess appeared in front of the chest, over the seat of the prepectoral glands, and was removed. The wound refused to heal. Shortly afterwards emaciation set in, the animal appeared feeble, and the symptoms seemed to point to lesions in the lungs and abdominal viscera. The nature of the disease was not recognised until post-morteiii examination. Robert published an almost Digitized by Microsoft® TUBERCULOSIS IN THE HORSE. 231 similar case. Multiple and bilateral swelling of lymphatic glands may at first glance suggest lymphangitis. At a varying but usually late stage in the disease most patients show abundant polyuria, followed by rapid wasting, a fact to which M. Nocard called attention ten years ago in an " Etude clinique de la Phthisie tuberculeuse du Cheval." The urine contains large quanti- ties of urea and uric acid. In the horse tuberculosis usually follows a very slow course, certain patients continuing work for months, or even years, and showing little tendency to emaciation or to febrile attacks. The changes may long remain localised in the abdominal glands, but finally the subjects either become very feeble or the bacilli enter the venous circulation, causing general infection. Febrile symptoms are then seen. The tempe- rature rises to 40° C. or 40"5° C. (104° F. or i04"9° F.), and wasting makes rapid strides. Sometimes the hind limbs become swollen. In the horse tuberculosis may also assume unusual forms, liable to be mistaken for other diseases, which differ so widely from classical types as not even to suggest the idea of tuberculous infection. I will describe two cases from my own clinique. The first was that of an eight-year-old horse brought for examina- tion in April, 1889, by a contractor who had bought it three years before. Different points on the surface of the body showed indolent tumours of fibrous consistence and varying size, the largest about the diameter of a two-shilling piece and the thickness of a man's little finger. Some had developed in the skin, others in the subcutaneous connective tissue; both varieties were accompanied by disease of lymphatic glands. At certain points the largest swellings were con- nected with neighbouring lymphatic glands by corded lymph vessels. The patient was left here for more thorough examination. Rectal exploration revealed nothing. The temperature oscillated between 39° C. and 39"5° C. (i02'2° F. and i03'i° F.). The urine was of normal amount, but slightly albuminous. The proportion of red and white blood-corpuscles was normal. One of the subcutaneous swellings was excised for histological study. Its structure was that of a sarcoma. The horse was removed home and put to work, but grew more and more feeble. At a trot its breathing became steadily aggravated, and a loud roaring sound was produced. Certain tumours diminished and disappeared, but many others developed. Having become incapable of work the animal was slaughtered. On post-mortem examination we found numerous swellings in the skin and subcutaneous connective tissue, together with neoplastic and sclerosing infiltration of certain Digitized by Microsoft® 232 CLINICAL VETERINARY MEDICINE AND SURGERY. groups of muscles, especially of the adductors of the hind limbs and superficial gluteal muscles ; nodules in the liver and spleen, and hyper- trophy of the sublumbar lymphatic glands. Bacteriological examina- tion showed these lesions to be of tuberculous origin, though bacilli were very scanty. Up to the present time only two cases of dermic and hypodermic tuberculosis in the horse have been published. Excluding the lymphan- gitis and inflammation of lymphatic glands, the symptoms are those of subcutaneous sarcoma — a disease which formed the subject of a previous lecture, but is also very rare. The case I am about to mention is exceedingly instructive from the clinical point of view. It is shortly as follows. At the commencement of May last we received into hospital a very well nourished seven-year-old entire horse, bought in 1894, which had done excellent service for nearly two years, viz. until February, 1896. It had simply shown swelling of the scrotum. As, however, the swelling increased in size until finally it interfered with the action of the hind limbs, the animal was brought here to be castrated. On examination we detected chronic inflammation of the right testicle and its envelopes. The animal not having reacted to mallein, castration was performed. The testicle, enlarged to three times its normal dimensions, was removed with the ecraseur ; its parenchyma had undergone little change; the head of the epididymis was as large as an orange, its tissue whitish and sclerosed ; the cord was healthy, except that its serous covering was dotted over with reddish granula- tions varying in size between that of a millet seed and a small pea. These granulations were regarded as innocent inflammatory products. Considerable swelling occurred round the wound, but soon became absorbed, and the wound itself appeared to heal regularly. At the owner's request the other testicle was removed fifteen days after the first operation, the ecraseur again being employed. It was about one third larger than normal, the vaginal tunic contained a little lemon-coloured liquid, the cord was slightly swollen, and its serous covering partly dotted over with granulations like those seen on the former occasion. During the following days the general condition and appetite were good. Nevertheless fever was marked, the temperature rising nearly to 40° C. (104° F.). The scrotal swelling was large. This condition persisted for a week without any appreciable change except that the animal became rather thinner. One morning, however, the horse was found dead in its stall. On the previous evening it had eaten all its food, and the student in charge had noted nothing alarming. Digitized by Microsoft® TUBERCULOSIS IN THE HORSE. 233, On post-mortem examination it became clear that the horse had died from tuberculosis. The spermatic cords were swollen, indurated, and covered with granulations. The liver, spleen, lungs, sublumbar and bronchial glands, peritoneum, pleura, and pericardium all contained numerous tubercles. The intestinal mucous membrane, and especially that of the large colon, was crowded with ulcerations, most of which were very rich in bacilli. The heart showed remarkable changes. Large tracts of the endocardium of the left ventricle were thickened, wrinkled, and contracted. Histological and bacteriological examina- tion revealed the presence in it of tuberculous foUicles containing very few bacilli. Situated slightly below the aortic orifice in the muscular tissue of the heart was a tuberculous abscess as large as a hazel-nut, the pus from which contained numerous bacilli. A dog, a rabbit, two guinea-pigs, and two fowls were intra-peri- toneally inoculated With an emulsion prepared by crushing a fragment from a sublumbar lymphatic gland and a tuberculous growth from the gastro-colic omentum in a little sterilised water. The dog, rabbit, and guinea-pigs became tuberculous, the fowls resisted. Bearing in mind the varying forms which tuberculosis may assume in the horse, it is rare that some of the complex assemblage of symptoms fails to suggest the correct diagnosis. The final conclusion is assisted by auscultation, percussion, rectal exploration, and palpation of accessible lymphatic glands, and is confirmed by bacteriological examination, injection with tuberculin, or inoculation. The clinical signs suffice to differentiate tuberculous inflammation of lymphatic glands from the simple form (adenitis) ; in the latter the swellings are always numerous, generalised, bilateral, and nearly uniform in each of a pair of glands. Injection of 30 centigrammes of tuberculin is followed in tuberculous horses by a reaction, which usually attains its maximum about the fifteenth hour, the temperature rising 2 to 3 degrees C. In the stable attached to the surgical clinique you have seen a horse retained for experiments which developed tuberculosis after a double intra-peri- toneal and subcutaneous injection of tuberculous material from a dog. After the lapse of more than a year tuberculin still produces a febrile reaction of i to 2"5 degrees C. At the present moment there is no treatment for tuberculosis in large animals : diagnosis is followed by slaughter. The veterinary surgeon's function is limited to recognising the cHnical forms and the anatomical and pathological appearances. Digitized by Microsoft® XXXII.— TUBERCULOSIS IN THE DOG. Among the canine patients received into hospital during the past week two were entered as suffering from tuberculosis. Both were suffering from pulmonary lesions, and were capable of spreading the tuberculous poison throughout the places where they lived. I will recall the history of the first. This was a fine two-year-old poodle, which was in the habit of accompanying its master each evening to the tavern, where a prolonged stay was often made. About three months ago this dog was noticed to leave portions of its food, to suffer from cough, and to be wasting. It was unsuccessfully treated with various tonic preparations. One morning, after having followed its master, who was riding a bicycle, it returned home, lay down, and refused food. Next day it still refused food, and would not leave its kennel. The day after it was brought to the College. It was exceedingly dull and already much emaciated ; the temporal muscles were wasted ; the respiration was rapid and discordant ; on percussion the entire lower half of both sides of the chest was dull. The chest was tapped on the right side, and a greyish turbid fluid drawn off, in which bacteriological examination failed to discover bacilli. But the thin bodily condition and the pleurisy left little doubt regarding diagnosis : the dog was tuberculous. The owner consented to leave it in hospital. The temperature was 39"8° C. (i03"6° F.), nevertheless I injected lo centigrammes of tuberculin ; it produced a reaction of three tenths of a degree C. ('5° F.). During the next two days the temperature showed slight variations around sg'S*^ C. (i03"i° F.), the respiration steadily becoming quicker and more difficult. In spite of a fresh tapping operation, in which more than one and three- quarter pints of fluid were withdrawn, the condition continued to grow more serious, and death resulted forty-eight hours later. We found no tuberculous lesion in the abdomen. The chest cavity, however, still contained a certain quantity of greyish turbid liquid holding in suspension opaque particles. The pleura was Digitized by Microsoft® TUBERCULOSIS IN THE DOG. 235 thickened, showed rounded elevations at certain points, granulations and tubercles at others. The mediastinum and its lymphatic glands were enlarged. Opposite the division between the diaphragmatic and cardiac lobes of the left lung was a small ulcerous wound due to the opening of a cavernous space. The diaphragmatic lobe contained an inflammatory centre as large as a nut, the central portion of which had broken down and was full of greenish-grey pus ; around it the pul- monary tissue was dotted with little purulent centres. The right lung showed a few cicatricial patches, and its surface was adherent to the parietal pleura at several points. Bacteriological examination revealed numerous bacilli in the pus from the cavernous space. Our second patient was a three-year-old sheep-dog bought at the age of six months by its present owner. It was allowed to run about freely in a restaurant patronised chiefly by workmen and shop assistants, and was in the habit of turning over the scraps of food from the plates and the heaps of rubbish. Six weeks before, the animal lost its appetite. From this time it became markedly thinner, and when examined could scarcely stand upright. The face suggested extreme depression ; the eye was retracted within the orbit ; the temporal and all the usually prominent muscles were wasted ; the skin was dry and adherent to the subjacent tissues. Respiration was rapid and painful, and during expiration a portion of the air escaped from between the lips. On auscultating the chest crepitant and mucous rales were noted on either side. The percussion sound was partially dull. There was no discharge from the nostrils. Suspecting tuberculosis, we insisted on the animal being left in hospital for observation. The day afterwards we administered a dose of tuberculin ; the temperature was 38-1° C. (100-5° F-) before injection, and five hours afterwards rose to 39-3° C. (1027° F.). Tuberculin had therefore produced fever to the extent of 1-2° C. (2-4° F.). Three days later the animal was killed at the owner's request. On post-mortem examination we found the mesentery covered with myriads of little tubercles between the sizes of a grain of millet and a pea. The mesenteric glands were slightly enlarged. The liver was increased in size and infiltrated with tubercles of all dimensions. In the thoracic cavity the pleura was covered with granulations and tubercles. The mediastinum was greatly thickened, and appeared bosselated in consequence of disease of the lymphatic glands. The lungs contained numerous tubercles and some cavernous spaces filled with fluid rich in bacilli. Digitized by Microsoft® 236 CLINICAL VETERINARY MEDICINE AND SURGERY. I have often mentioned canine tuberculosis, its different forms, the symptoms which it produces, and the pecuHarities seen in certain patients. Furthermore, I have shown you that the disease may easily be mistaken even on post-mortem examination. As this morning occasion has again arisen for speaking of the disease, I will cast a rapid glance over the cases I have collected, and briefly describe some which deserve remembrance. Before Villemin published his experiments, the existence of tubercu- losis in the dog, though described by some authors, was still contested by most. The discovery that the disease was inoculable, and the later identification of the bacillus which produced it, showed that the dog was subject to tuberculosis, and allowed of distinguishing this infection from other morbid processes anatomically characterised by lesions of a tubercle-like character. During a further period of nearly ten years — until 1891 — canine tuberculosis was usually regarded as exceptionally rare. This opinion was founded on the few cases published in France and abroad previous to the latter date, despite the new power of confirming diagnosis, either during the patient's life or after death. During 1891 I turned my attention to this form of tuberculosis.' 1 looked for it at Alfort in patients in my own portion of the hospital and among those brought for consultation. I was soon convinced that it could not be considered rare, and that the reason for its continuing to be so regarded was because observers failed to differentiate it, because its pulmonary localisations were mistaken for chronic pneu- monia, and its other lesions — especially those in the liver, serous mem- branes, and lymphatic glands — for cancer. In 1893 I had collected statistics of forty cases. These sufficed for a description of the principal forms of the infection, its localisations, and its anatomical and pathological characters.* Pursuing my researches on the patients brought to the outer clinique, and assisted by students who followed them up in the surgical hospital, I was able to collect 165 new cases in which diagnosis was verified bj' post-mortem examination. In the dog the localisations of tuberculosis are as varied as in other species. Sometimes lesions are rare, limited to a few organs, or even to only one ; much more frequently they are found in the majority of the viscera and lymphatic glands, and with a fair degree of frequency in the pleura and peritoneum. In the 205 cases at present collected the thoracic and abdominal viscera have been invaded in 140 cases, in * Cadiot, ' La Tuberculose du Chien,' Paris, 1893. Digitized by Microsoft® TUBERCULOSIS IN THE DOG. 237 53 the lesions have been confined to the thoracic, and in 12 to the abdominal organs. The figures are as follows : Thoracic Cavity. Tuberculosis of the lung „ ,, bronchial and mediastinal glands pleura ,, ,, pericardium .... ,, „ myocardium .... ,, ,, endocardium .... A bdominal Cavity. Tuberculosis of the liver ,, kidney . „ ,, mesenteric glands . ,, ,, peritoneum . ,, ,, intestine . 158 cases . 114 • 83 • 39 . 16 3 . 119 cases ■ 76 T) . 62 >) • 57 ) J . 18 The pleura, pericardium, and peritoneum are frequently the seat of serous or sero-fibrinous, and sometimes purulent or haemorrhagic exudation. I have seen pleurisy in ninety cases, pericarditis in twenty- eight, and ascites in forty-nine. I have laid stress on the frequency of pleurisy as a common accident in tuberculosis ; specific inflammation of the pleura, with serous or purulent exudate, has been found in almost one half of the subjects examined. And just as pleural inflammation is common in dogs affected with tuberculosis, it is exceptional in non-tuberculous patients ; so far as canine pathology is concerned, this is with me a fixed idea. Examining my last fifty cases of canine pleurisy from this point of view ■ — I am now only speaking of cases in which diagnosis was checked by post-mortem and bacteriological examination — I found tuberculosis to be the cause in forty-one instances, that is to say in 82 per cent, of cases — a proportion approximately the same as that arrived at for man by the most recent researches. Exudative pericarditis also is usually symptomatic of tuberculous infection, though, like pleurisy, it may be seen alone, without any other specific localisation. Certain manifestations of tuberculosis in the dog are atypical, and sometimes very difl'erent from those usually seen, the lesions of the liver and epiploon being the most remarkable. You know that the tuber- culous liver generally shows a large number of little whitish, greyish, or Digitized by Microsoft® 238 CLINICAL VETERINARY MEDICINE AND SURGERY. yellowish nodules, of rather firm, uniform consistence, the majority varying in size between a hemp-seed and large pea. Many of those in the superficial layers of the organ are hemispherical or conical — their base resting on Glisson's capsule — with finely dentated circumference (Fig. 1 8). The largest have a whitish periphery and slightly depressed yellowish centre ; a few of smaller size sometimes present a glistening -1 JOy Fig. i8. — Tuberculosis of the liver. nacreous appearance, and a central opaque, caseous point. In this form the lesions are somewhat similar to those seen in hepatic tuber- culosis of fowls, and have often been mistaken for cancer. Straus himself, on examining the liver I sent him, at first thought I must have been mistaken, so similar were the lesions to cancerous nodules. In some subjects, instead of presenting this appearance, the liver is deformed by large yellowish-white tuberculous areas of uniform sar- comatous consistence, or softened and excavated at their centre by a more or less spacious cavity filled with greyish or lactescent fluid. In this liver, which was removed from a dog killed a few months ago, you see this atypical form of tuberculosis ; the lesions appear as large yellowish-white cystic tumours, fluctuating throughout the greater portion of their area, covered with branching vessels, but firmer towards their margins, which are sharply defined (Fig. ig). The mesentery and epiploon, which are sometimes thickened and indurated, are generally dotted over with granules and isolated or con- fluent tubercles. They may also be the seat of hyperplastic changes producing atypical lesions described as sarcomatous. The epiploon Digitized by Microsoft® TUBERCULOSIS IN THE DOG. 23S^ especially may become so large as to be almost unrecognisable. In a dog dead of generalised chronic tuberculosis I found the epiploon had Fig. 19.— Tuberculosis of the liver (atypical form). Fig. 20. — Tuberculosis of the epiploon. R, spleen. assumed the form of a flattened rectangular, slightly incurved mass, with irregular, rounded projections, marked by vascular stria; ; the Digitized by Microsoft® .240 CLINICAL VETERINARY MEDICINE AND SURGERY. spleen, which rested on it, was absolutely unaffected (Fig. 20). Its tissue was very dense, of fibrous consistence, and creaked under the knife ; transverse sections were nearly an inch in thickness, appeared whitish in colour, and were dotted over with caseous or cretaceous granulations, which could be shelled out without much difficulty. In only two cases have I seen "tuberculous septicaemia," and in both the dogs were less than a year old. In one the blood had become infected from a pulmonary cavernous space ; in the other, from an abscess in a lymphatic gland. The latter case dates from September, 1893. It was brought here ■on account of steadily progressive emaciation and enlargement of the abdomen. On noting the ascites, and learning that the dog belonged to a wine-shop keeper, I suspected tuberculosis. The animal was left at the School to be tested with tuberculin. It died next day. The lesions found on post-mortem examination were of quite a different character from those usually seen in tuberculous patients. I preserved the liver and spleen. These organs were free of tubercles and granulations, and only attracted attention by their enormous size and the appearance of their tissue; the liver, which weighed nearly 2 lbs., was yellowish, and had undergone fatty degeneration ; the spleen was blackish, its tissue very friable, and except for the difference in colour resembled a lymphade- nomatous spleen. Both organs contained enormous quantities of bacilli, which on microscopical examination appeared as broad tracts, and were as numerous as in cover-glass preparations from a culture. The diagnosis of tuberculosis in the dog may be founded on clinical signs and the use of tuberculin, and is confirmed by discovery of bacilli in the nasal discharge or in the pus, and by inoculation. Although the usual symptoms are by no means characteristic they ■can scarcely be mistaken for those of visceral cancer (sarcoma or car- cinoma) ; and the fact of their existence implies a great probability that the disease is tuberculous, for in the dog — contrary to the still widely held opinion — tuberculosis is much commoner than generalised cancer. In post-mortem examinations carried out during the last five years I have several times had series of ten, fifteen, and even twenty cases of tuberculosis for each case of generalised cancer. As in other species of animals, tuberculin is a good test for tubercu- losis. At the commencement of my experiments I injected many suspected dogs without producing any apparent reaction. But if tuberculin appeared so unreliable, it was because my method was faulty ; I injected the dogs in the evening about 9 p.m., and only took the temperature every two hours after 6 a.m. next morning : in most Digitized by Microsoft® TUBERCULOSIS IN THE DOG. 24I cases the characteristic temperature reaction had then passed. From the temperature charts of forty animals injected with tubercuhn, I have found that the maximum reaction occurs between the fourth and eighth hours. In general it is quite distinctive. With doses of 5 to 10 centi- grammes of tuberculin the temperature rises from 1° to 3° C. Tuber- culous cases, however, do occur, especially among animals which are very feeble or affected with generalised lesions, in which the reaction is trifling or nil. Quite recently I saw a Danish boarhound, still in fairly good health, but proved by subsequent post-mortem examination to be distinctly tuberculous, which did not react in the smallest degree to two injections of tuberculin, although the initial temperature was on the first occasion 38° C. (ioo"4° F.), and on the second 38-3° C. (100-9° F.). How does the dog contract tuberculosis ? One fact at least appears certain, viz. that canine tuberculosis is of human origin. The numerous inquiries I have made leave no doubt on this point. Either the animal belonged to a phthisical patient or associated with a tuber- culous person with whom it passed a portion of the day, or it accom- panied its master daily to the wine-shop or eating-house — places where in very many instances the floor is soiled with sputum containing bacilli. In the dog, also, there are two principal avenues of infection, the digestive and the respiratory mucous membranes. At first sight, having regard to the extreme frequency of pulmonary lesions and the diffi- culty of transmitting tuberculosis to the dog by ingestion of virulent material, it seems, as Straus has remarked, that infection occurs often- est by the respiratory passages, in consequence of the dog inhaling infected dust. This is also the opinion I emitted in my work in 1893, but despite the negative results of experiments in which dogs were caused to ingest tuberculous material, despite the common absence of lesions indicating the passage of bacilli from the intestinal mucous membrane, and from the lymphatic glands originating there ; finally, despite the predominance of pulmonary lesions, infection is caused at least as often by the ingestion of virulent material as by the inhalation of infective dust. We know that many dogs have a propensity to lick up human sputa ; some will even go to the spittoons. In 1893 I made the post-mortem examination of a young dog which became tuberculous under the follow- ing circumstances : — Its master, M. V — , living in the Boulevard de Picpus, in Paris, became affected with pulmonary tuberculosis. The doctor who treated him recommended the use of a special recipient for Digitized by Microsoft® 242 CLINICAL VETERINARY MEDICINE AND SURGERY. sputum. In order to guard the dog against distemper Mme. V — , following the advice of some gossip, gave the animal from time to time the contents of the spittoon. This went on for several months. The dog ended by becoming tuberculous. Large lesions in the mesenteric glands and liver showed that infection had occurred through the intestine. Without reference, however, to the source and channel of infection, the dog may become dangerous to man as soon as affected with lesions from which contagious material is externally discharged. A tubercu- lous dog which lives in or enters rooms inhabited by its master may there distribute such discharge. If it plays with, is petted, or looked after by children, this discharge may come in contact with their clothes, or even with their faces. Pet dogs may even infect the sleeping apart- ments or beds of their owners. In 1894 I was several times consulted by Mme. C — , living in the Rue Favart, at Paris, concerning a little terrier which for a long time had appeared thin, and at intervals had shown cough and nasal discharge. The dog was very closely watched, and without doubt had contracted tuberculosis in one of the watering-places in the south of France where Mme. C — annually resorted. I informed her that the dog was probably tuberculous, and suggested the necessary precautions to take, but only after some time would she consent to send it away. Though ill for a whole year the animal had passed most of its time in Mme. C — 's living room, and all its nights in her sleeping apartment. The post-mortem examination of this dog showed, in addi- tion to other lesions, cavernous spaces in both pulmonary lobes and a tuberculous ulcer in the larynx. My case-books contain a number of instances of this kind. I will only relate the most recent. On the 13th October last a dog, which the owner, a working man, thought pure-bred and of great value, was killed when in the last stage of emaciation. Its existence had been passed in two rooms, inhabited by this man, his wife, a three-year-old child, and the dog. The dog had been ill for five months, had had frequent attacks of coughing, discharge from the nose, and vomiting. It had not left the house except on the day when it was brought to Alfort. On /osi-;«07'/(;;« examination we found generalised tuberculous lesions ; both lungs were full of tubercles, and in part destroyed by cavernous spaces. You have noted that many tuberculous dogs show no discharge, or onl)' a trifling running from the nose, and in the majority of those which do discharge the material is only seen at certain times. But Digitized by Microsoft® TUBERCULOSIS IN THE DOG. 243 other secretions may disseminate contagion. Thus in animals with pulmonary tuberculosis the faeces are more or less charged with bacilli derived from the muco-pus ejected from the bronchi into the pharynx, and afterwards swallowed. Several cases have been recorded showing that dogs with lesions of the kidneys or of the prostate also spread the virus by means of the urine. I published the first in 1897. It was that of a dog with generalised tuberculosis. The kidneys were crammed with tubercles which had almost entirely destroyed the cortical layer. The prostate was ten times its normal size, and its right lobe contained a cavernous space. On compressing the gland, after having incised the urethra, greyish pus, rich in bacilli, was seen to escape from its excretory ducts. Large numbers of bacilli were also present in the urine contained in the bladder. These renal and prostatic lesions were relatively old. For several months, therefore, the animal had been spreading tuber- culous virus by means of the urine. In one of our next lectures I shall speak of external forms of tuberculosis in the dog and cat, and shall show that these animals may become the subjects of tuberculous ulcers of the skin, hitherto mistaken for harmless lesions. Digitized by Microsoft® XXXIII.— TUBERCULOSIS IN THE CAT. Very much less has been written on the history of tuberculosis in the cat than in the dog. The cases hitherto reported are very scanty. I have only found thirty-one in special publications, either French or foreign, and the majority only mention lesions seen on post-mortem examination. Among these are comprised the twenty-two cases seen by Jensen while searching for tuberculosis among cats killed at the Veterinary School of Copenhagen during the thirteen months from November, i88g, to January, 1891, and the three cases previously collected by Bang, and published in Jensen's article. To these I can add ten other cases seen in the consulting clinique ; in most cases the animals were given up by their owners, and either died of tuberculosis or were destroyed. This makes, therefore, a grand total of forty-one observations. I have analysed these cases in order to show the relative frequence of the local lesions. The results are as follows : — Changes in the lungs, 29 cases ; in the bronchial and mediastinal glands, 10 ; in the pleura, 3 ; in the trachea and nasal cavities, i ; in the pericardium and heart, 1 ; in the intestine, 4 ; in the mesenteric lymphatic glands, 22 ; in the liver, 5 ; spleen, 4 ; peritoneum (mesentery and epiploon), 5 ; kidneys, 8 ; testicles, i ; uterus, i ; submaxillary and cervical lymphatic glands> 2 ; muscles, i ; articulations, 2. Pleurisy was seen in 4 cases, and pericarditis in 2. Four animals showed tuberculous wounds. On comparing these figures with' those referring to similar lesions in the dog analogies are seen, but also notable differences. In both species the lung is the most frequently affected organ. In the cat lesions of the intestine, mesenteric lymphatic glands, and spleen are commoner than in the dog, while lesions of the liver and serous membranes, ascites, pleurisy, and pericarditis are rarer. Nevertheless it must be borne in mind that in a considerable number of cases the animals were killed, and the post-mortem examination only revealed Digitized by Microsoft® TUBERCULOSIS IN THE CAT. 245 recent lesions. Could a large number of cases of advanced tuberculosis in both species be compared, the differences would probably be less marked. The macroscopic and microscopic characters of tuberculous lesions Fig. 21. — Tuberculous pneumonia. Section through the right lung showing cavernous spaces. Fig. 22. — Tuberculosis of the tracheo-bronchial and mediastinal glands. in the cat are very similar to those in the dog. The lungs show recent greyish granulations of homogeneous consistence, tubercles with softened purulent centres, yellowish-grey areas formed of agglomerations of tubercle, and more rarely diffuse chronic pneumonia with formation of Digitized by Microsoft® 246 CLINICAL VETERINARY MEDICINE AND SURGERY. ■cavernous spaces (Fig. 21). In some cases only one or two large lesions may exist ; in others both lobes are crammed with granules. Secondary lesions may also be seen^ such as those of bronchitis and peribronchitis, broncho-pneumonia, bronchiectasis, emphysema, or pulmonary cedema. The tracheo-bronchial glands, which are almost always affected in •cases of pulmonary tuberculosis of any age, usually show moderate enlargement, appearing as a collection of little hardened masses the size of a pea, haricot bean, or almond. As in the dog, they may, however, become of large size, forming an ovoid or irregular mass surrounding the terminal portion of the trachea, the origin of the bronchi, the large vessels at the base of the heart, and the nerves traversing this region (Fig. 22) ; on section their tissue appears greyish or marbled with black lines, and dotted over with whitish, hard or softened caseous tubercles. They may undergo cystic transformation : the centre is then occupied by a cavity filled with greyish or slightly lactescent liquid. In the majority of cases of pulmonary tuberculosis the visceral layer of the pleura is thickened, injected, and covered with false membranes opposite the seat of the pulmonary disease centres. Some- times the costal and diaphragmatic portions of the pleura are covered with granulations ; sometimes the mediastinum and its lymphatic glands show change. Finally, one or both of the pleural sacs and the pericardium may contain a varying quantity of serous or purulent liquid. Intestinal tuberculosis is characterised by ulcerations of varying extent, depth, and number, which sometimes perforate the bowel. The mesenteric lymphatic glands are very commonly diseased. Opposite the CEecum they are usually confluent, forming yellowish bosselated masses, with caseous or purulent centres. The liver often contains a very large number of fine granules, isolated or massed together. Until now the voluminous cystic new growths occasionally seen in the dog have not been described in the cat. The spleen is simply enlarged or nodular on the surface ; sections through its tissue show granulations and tubercles, the largest scarcely exceeding a pea in size. In tuber- culosis of the kidney the external surface of the organ and the surface of sections sometimes show fine granulations, sometimes tubercles, or even greyish-white tuberculous areas, with cystic or purulent centres. Lesions of chronic nephritis are not uncommon. Bang claims to have seen a case of primary tuberculosis of the right kidney. As tuberculosis of the organs of generation is very rare I shall merely mention the case of primary tuberculosis of the uterus seen by Jensen in a female cat, and recorded by him as an example of infection per coitum — tuberculosis Digitized by Microsoft® TUBERCULOSIS IN THE CAT. 247 of the testicle having been met with in the cat. Tuberculosis of the peritoneum is even less common than that of the pleura. The parietal layer is usually free ; the lesions are limited to the epiploon and mesentery, which appear thickened and dotted over with fine granules. The peritoneal sac may contain more or less abundant, clear or purulent serosity, either poor or moderately rich in bacilli. External tuberculous lesions, with and without ulceration, have several times been noted. I described two cases in a preceding lecture. The paths of infection are multiple, but the two principal are the digestive and respiratory mucous membranes. In most cases the bacilli enter the organism through the intestinal mucous membrane. In this way cats which ingest offal, milk, or other material derived from tuberculous animals, food infected by a tuber- culous patient, or purulent sputum, may become infected. Nevertheless cats may also contract tuberculosis by living in rooms in which the atmosphere is charged with tuberculous dust. We know that in all species infection occurs readily through the respiratory mucous mem- brane. Passage of bacilli through other mucous membranes, and through the skin, is exceptional. Contrary to the most widely held opinion, and to what one would be led to believe from the conditions of life and habits of the cat, tuber- culosis in this animal is most frequently of human origin. In more than three fourths of the cases where the probable method of contagion could be traced, infection from man appeared indicated. The animals belonged to tuberculous subjects or lived in intimacy with them. In this connection the following interesting observation was made to me by my colleague, M. Darras, a veterinary surgeon in Paris : " Mme. X — , concierge, had for four years owned a family of six cats, all of them superb, vigorous animals, in very good health. Towards the end of 1894 these animals began to grow thin and cough. The oldest one soon died. The post-mortem examination, made at Alfort, showed that death had resulted from tuberculosis. Both the thoracic and abdominal organs were affected. Shortly afterwards a female kitten, which had become very thin, showed multiple disease of lymphatic glands ; the glands in the neck were especially large. It died at the end of a month. Post-mortem examination showed no intestinal or pulmonary lesion, but the mesenteric glands were enlarged, and the spleen (which wus of great size) displayed very numerous granulations. No bacteriological examination was made. At the end of six months two other cats which had fallen away in condition. Digitized by Microsoft® 240 CLINICAL VETERINARY MEDICINE AND SURGERY. although continuing to feed well, began to cough and to rapidly pine away. On my advice the worst case was killed. It showed abdominal tuberculosis, and bacteriological examination revealed the presence of bacilli in the lesions. The other, which was much troubled with cough, died two months later. On autopsy tuberculous lesions were found in the abdominal organs and lung. Finally one of the survivors showed symptoms which caused me to suspect it of tuberculosis. " All the cats had enjoyed good health before the arrival in the house of a family containing several consumptives. The symptoms they showed, and the diagnosis given by several doctors, left no doubt as to the nature of the disease from which they were suffering. The members of this family (who were very fond of animals) used to allow Mme. X — 's cats into their rooms, and were in the habit of giving them the remains of their meals. In this way the animals probably became infected." Contagion by tuberculous animals and their products appears less, common than the preceding. In rural districts, where tuberculous cows are common, cats which live or pass the greater part of their time in the byre, and which consume milk from these animals, are exposed to infection. But in Paris (as in all large towns and their neighbourhoods) the cat is very rarely infected by animal products. Since 1892 I have bred thirty or more cats, feeding them on bread, a little chopped horse-flesh, but principally on raw milk from the Alfort cowsheds, the neighbouring localities, and the various parts of Paris. In most cases the feeding on raw milk was continued for five to six months, and in some for more than a year. None became tuberculous, and none showed any tuberculous lesion on post-mortem examination. Digitized by Microsoft® XXXIV.— HEMOGLOBINURIA (AZOTURIA) IN THE HORSE. The day before yesterday we made a post-mortem examination of an eight-year-old stallion which had died after an illness of three days' duration. It was in good, even plethoric condition, and had been attacked while at work and apparently in full health, showing in a few minutes paralysis of the hind quarters and a number of extremely grave symptoms. The animal had for some years been regularly working for a firm of carters in Paris. On the ist and 2nd January it had been left in the stable, which was badly ventilated. The morning of the 3rd January was cold, and after a quarter of an hour's work at a quiet trot the horse slackened his pace, sweated profusely over the hind quarters, showed weakness of the hind limbs, and while the driver (who thought the animal was suffering from colic) was wondering what he ought to do, the horse fell down in the shafts. ,It was unharnessed and helped up. It took a few steps, dragging the left hind limb along the ground, and again fell. It was then put into an ambulance to be taken back to the stable. A veterinary surgeon who was called in bled it, applied stimulant applications, and afterwards sent it to the School. On its arrival we in vain attempted to place it on its legs. It had to be let down on the straw of the hospital theatre, where it lay struggling violently. The mucous membranes were injected, the circulation and respiration very rapid ; the pulse 80 ; respirations 30 ; rectal temperature 39° C. (i02'2° F.). The muscles of the croup and left quarter were swollen and hard, and the subcutaneous connective tissue covering them appeared infiltrated. On passing the catheter about a quart of brownish urine was drawn off. The body was smartly rubbed, and ten centigrammes of eserine sulphate hypodermically injected, producing several evacuations. The animal was then covered up. It received, milk and mashes, to which were added three and a half ounces of bicarbonate of soda. During the evening, in order to quiet it, I further prescribed'a hypodermic injection of morphine and chloral enemata. Digitized by Microsoft® 250 CLINICAL VETERINARY MEDICINE AND SURGERY. Next day, and the day following, the animal was several times lifted, but was unable to remain standing ; it was therefore placed on a deep bed of straw and turned over morning and evening ; food and drink were frequently offered ; the urine was drawn off by catheter, and the rectum from time to time emptied. In spite of all our care the symptoms became aggravated. On the evening of the third day great excitement set in ; the mucous membranes were cyanosed, the body covered with sweat, the respirations very rapid and embarrassed ; the pulse rapid, small, and thready, and the tempe- rature rose to 40'3° C. (i04'5° F.). Death occurred during the night. On post-mortem examination you were struck by the change in the muscular tissue. The muscles of the croup, quarter, buttock, and sublumbar region were swollen, discoloured, yellowish, infiltrated, and at points ecchymosed. The longissimus dorsi, pectoral muscles, and the extensors of the forearm showed similar though less marked changes. Both kidneys were slightly enlarged. On section the cortical layer appeared hyperasmic, infiltrated, and hsemorrhagic ; the medullary layer, where in contact with the cortex, was injected, but towards the pelvis was of a yellowish tint. The bladder contained a little blackish urine. The nervous centres showed no important lesions, though the spinal cord was slightly congested, especially opposite the commencement of the cauda equina. The intestine was hyperaemic at places; the liver large and the colour of a dead leaf; the spleen swollen, deformed by several rounded enlargements, below which its tissue was softened and haemorrhagic ; the left lung hypo- statically congested and infiltrated ; the myocardium discoloured and yellowish ; the endocardium marked with a few ecchymoses ; the blood uncoagulated, blackish, and slightly gummy. But these latter are accessory lesions, and, moreover, inconstant. Last week you saw an eight-year-old gelding belonging to a market gardener of Maisons-Alfort recover from the same disease. Like the preceding case, this horse had been kept in the stable for two days, and after breakfast on the 27th December was harnessed to draw some vegetables to Paris. The weather was cold, the thermometer marking 6 degrees below zero C. (22° F.). The horse walked from Maisons- Alfort to Alfort, about one and a quarter miles. In passing over Charenton bridge it relaxed its speed, and suddenly went lame on the off hind leg. A little further on it stopped, apparently suffering from slight colic. The driver let it rest for a few minutes, rubbed the abdo- men with a wisp of straw, and then as the pain diminished resumed his journey. Digitized by Microsoft® HEMOGLOBINURIA (aZOTURIa) IN THE HORSE. 25 1 Two hundred yards further on the horse fell' down. Being imme- diately taken out of harness it was able to rise. After a few minutes' rest it was brought to the School, where it arrived bathed in sweat, with an anxious appearance about the face, and the off hind limb par- tially paralysed. It almost immediately passed a little thick, viscous, coffee-coloured urine. Although the body and hind quarters were smartly rubbed, paralysis of the hind limbs quickly increased. The animal lay down, its respiration became rapid and tremulous, the pulse accelerated and strong ; temperature sg'i^C. (i02'3° F.). Eight centi- grammes of eserine sulphate were injected subcutaneously in the neck ; the animal was warmly covered up, and given a lukewarm draught con- taining bicarbonate of soda. During the evening it took some mash, milk, and a little hay. It also received nearly gi ounces of bicarbonate of soda. Next morning we found it in a fairly satisfactory state. There was little excitement, and the face appeared more natural. The respira- tions were from i6 to 20, the pulse 60 to 70 per minute, temperature 38"g° C. (102° F.). It was turned over twice during the day. As on the previous day, it took a little hay, some milk, and mashes, to which considerable quantities of bicarbonate of soda had been added. The rectum was cleared outj and the urine drawn off. This treatment was continued for the next two days. The general condition seemed to improve, but the animal was still unable to stand. On visiting it on the morning of the fourth day it was found able to stand, and was therefore kept up for a few minutes by passing strong bars of wood under the chest, while the body and hind limbs were rubbed. With assistance it was moved into a box and placed in slings. Improvement followed rapidly, and in a few days the horse was able to leave hospital completely recovered. From the symptoms and lesions just described you will recognise a disease which was at first known under the titles of enzootic paraplegia, congestion of the cord, then by the names of haemoglobinsemia, or hsemoglobinuria a frigore, the latter distinctions being derived from human medicine, where they were applied to a disease which had some characters in common with hemo- globinuria of the horse. Kussner called the disease paroxysmal haemo- globinuria, and Mesnet hasmoglobinuria a frigore. To-day I wish to go beyond a mere sketch of the clinical appear- ances, and to speak more fully of this disease, which has recently been the subject of interesting researches. For a long time the conditions in which hemoglobinuria usually Digitized by Microsoft® 252 CLINICAL VETERINARY MEDICINE AND SURGERY. appears have been recognised. One cause — the action of which is certain — has been indicated by almost all authors, viz. cold. It is scarcely astonishing, then, that cases of hsemoglobinuria should be particularly frequent during the winter, towards the end of autumn, and in spring. Nevertheless it may also be seen at other seasons pro- vided the temperature suddenly falls, or if other causes intervene. In general the disease is favoured by a plethoric state of body and by rest. It may certainly affect animals in thin or moderate condition which work every day, not even resting on Sundays ; but this is rare. It more particularly attacks fat animals kept in ill-ventilated stables, and which have rested for one or more days while receiving their ordinary working rations. Should an animal thus prepared be taken out or worked during cold weather, hsemoglobinuria may suddenly appear. Indeed, it is not even necessary that the animal should be taken out or directly exposed to cold ; sudden lowering of temperature in the stable resulting in a chill is sufficient. Some years agio we had a horse affected in this way in stable No. 5. It first showed symptoms of colic, and the real nature of the disease was not recognised until a little later, when dark-coloured urine was passed. Horses of all breeds, classes, and ages are subject to haemoglobinuria, though it seems par- ticularly to affect heavy animals of plethoric temperament, which con- sume large quantities of oats, and animals during the most vigorous years of life. This explains both the appearance of the larger number of cases of hsemoglobinuria during the morning hours when cold is most felt, and the enzootic character which the disease sometimes appears to assume at times when frost or snow prevent working ; large numbers of animals which have been subjected to the same predisposing influences being attacked almost simultaneously, or during the course of a few days. Hsemoglobinuria has even been regarded as an infectious disease, and the animals affected with it thought to have undergone some change of tissue or blood-plasma, tending to prepare the. way for the supposed pathogenic agent. Experiments made with the object of verifying this idea have not carried it beyond the stage of an hypothesis. Following many others, I vainly attempted to transmit the disease to horses by injecting under the skin and into the veins and peritoneum defi- brinated blood and preparations from the affected organs. The disease is not contagious, and cannot pass from affected to healthy animals. In the rare cases where contagion or external infection have been suspected, the patients which had been simultaneously or successively affected had also been under the same conditions of feed- ing, treatment, and work. Digitized by Microsoft® HEMOGLOBINURIA (aZOTURIa) IN THE HORSE. 253 The symptomatology of hasmoglobinuria is somewhat complex, and this diversity in its clinical appearances has naturally given rise to equal divergence of opinion as to the nature of the disease. Nevertheless certain highly significant signs are never absent. Let us first consider its general characters. As I have said, the disease usually appears during work. Invasion is sudden. At first the animal is more lively than usual in proportion to the length of the pre- ceding rest, but suddenly becomes uneasy, and exhibits visibly increas- ing anxiety or colicky pains ; its pace slackens ; rigors, trembling, and locaHsed or general sweating occur ; respiration is quickened, sometimes groaning, or rather oppressed ; the face appears anxious, the nostrils dilated, the eye brilliant ; at this time, or very soon after, movement becomes difficult. In most cases these primary symptoms occur ten minutes or a quarter of an hour after the animal quits the stable ; in others at the end of a quarter of an hour to one hour, sometimes even later. When the animal is attacked in the stable or while being harnessed, symptoms of excitement, stamping, rapid movement of the flank, and anxiety, followed by sweating, are noted. When the animal is started or walked about in order to ease the colic from which it is supposed to be suffering, it moves with difficulty, as in the preceding case. The interference with movement, one of the two chief symptoms of the disease, is variable in form, localisation, and intensity. Sometimes it appears as generalised or localised stiffness in the hind quarters, like that due to muscular rheumatism ; sometimes it resembles paralysis, usually limited to the hind quarters ; the hind legs seem paralysed, yield under the body-weight, and are only moved with great difficulty, the toe being dragged or the fetlock even coming in contact with the ground. In a number of cases the hind limbs are unequally affected, or only one may be attacked. Some authors claim to have noted that the left hind limb is more often the seat of disease than the right. This, however, is only accidental : of eighteen cases of paralj-sis of a single hind limb which I examined, ten were of the right and eight of the left side. Sometimes, but much more rarely, one or both of the fore-limbs may be affected. The muscles neighbouring or antagonistic to those paralysed may show contraction. To such contraction is due the rigidity of the neck, the stiffness and lifting of the tail, and the pain- ful tension in certain muscles of the abdomen and limbs. Symptoms of paresis, however, predominate, and sometimes increase with alarming rapidity. When the hind quarters are affected para- plegia soon becomes more or less complete ; the animals are unable to stand, appear excited, and vainly struggle to rise. Digitized by Microsoft® 254 CLINICAL VETERINARY MEDICINE AND SURGERY. In the great majority of cases this failure of motor power, whether or neuropathic or myopathic origin, is accompanied by multiple localised inflammation of muscle, evidenced by circumscribed or diffuse swellings. In some a large portion of the muscular system is affected ; in most the myositis is local, affecting either superficial or deep-seated muscles. No region is exempt, though change is most frequent in the muscular tissues of the croup, quarters, buttocks, lumbar region, back, shoulders, neck, and chest. The appearances are as follows : — Swelling of variable extent and size, produced by tumefaction of the muscles, which are felt to be dense, hard, painful, tense, and sometimes a little cedematous ; the skin covering them is warm, sensitive, and adherent ; sensation gradu- ally diminishes, but complete anaesthesia is rare. These localised in- flammations may persist and become accentuated, may gradually diminish and disappear without leaving traces, or may be followed by degenerative changes, producing atrophy of certain of the affected muscles. The second chief symptom of haemoglobinuria is melanuria — blackish or very deep coloration of the urine, — a change due to the presence of a certain quantity of haemoglobin and of methasmoglobin. This symptom, which is almost always constant, corresponds in intensity with that of the disease itself. The urine may exhibit an entire series of intermediate tints between light red and black. Most frequently the first urine passed is brownish or black, like liquid manure, and in fatal cases remains in this condition ; in others it gradually becomes lighter. This urine contains a varying quantity of haemo- globin, and an excess of urea and various other metabolic products. It also shows a considerable proportion of albumen (as high as three drachms to the pint), desquamated epithelial cells, leucocytes, red blood-corpuscles, cylindrical casts, and sometimes a little glucose. It retains the normal alkaline reaction, though this becomes less when the kidneys are diseased. As long as the patient can stand, micturition occurs easily, but when the patient is lying helpless it is generally suppressed. The changes occurring in other bodily organs are less important. I have mentioned colic, with or without the passage of soft faeces, which occurs at the outset ; at a later stage the peristaltic action of the bowel diminishes in frequence and power ; constipation may exist ; defecation is suspended ; the appetite is usually moderate, but thirst excessive. The respiration, which is more or less accelerated during the first minutes of the attack, soon becomes rapid, panting, and in most cases oppressed ; in animals which struggle violently it may rise to 60 or 80 per minute. The circulation is sometimes comparatively Digitized by Microsoft® ha;moglobinuria (azoturia) in the horse. 255 little disturbed, but. struggling causes a steady rise in the pulse ; the latter is at first full and strong, but later becomes feeble, and in cases almost imperceptible. The mucous membranes, particularly the con- junctivae, are injected and purplish. In many patients the temperature remains normal, or only rises a few tenths of a degree ; in twenty out of twenty-five cases Friedberger and Frohner found no fever whatever. Nevertheless the temperature may rise considerably, sometimes more than 2° C. You must understand that the absence of fever in no way justifies one in regarding the disease as benign ; very grave cases, indeed, may remain absolutely without fever. Apart from the loss of power in the hind limbs and the local con- tractions mentioned, other nervous symptoms occur, including paralysis of the tail, rectum, and bladder. When the kidneys become gravely affected, and no longer perform their function of purifying the blood, symptoms of uraemia appear. The most striking are epileptiform con- vulsions, attacks of dyspnoea, and generalised cramp, alternating with periods of coma, and later, profound depression of the bodily forces and gradual sinking of temperature. To this summary of the symptoms which may appear at various stages of hsemoglobinuria I wish to add a few words regarding the two principal clinical divisions of the disease. Considered from the point of view of its development, course, and terminations, we recognise (i) a rapidly progressive form, accompanied by paralytic symptoms ; and (2) a benign form, in which the disease process quickly subsides without producing paralysis. In the paralytic form, which is most common, paralysis of a limb, or of both hind quarters, may be noted within ten minutes, a quarter of an hour, or half an hour after the appearance of the first symptoms. Patients with paraplegia fall to the ground in spite of all their efforts to remain standing, and on attempting to rise are only able to hft the fore-parts of the body ; the hind parts remain powerless. During the first few hours they show signs of excessive excitement ; the skin is damp with sweat, and steams ; the respiration is rapid and panting, the pulse frequent and strong, the conjunctiva purplish. Sometimes these symptoms persist; sometimes they gradually diminish in intensity ; a quiet period occurs, the sweating ceases, the breathing and circulation are less rapid, ; everything points to real improvement. When the issue is likely to prove favourable this calm period con- tinues, and in from twenty-four hours to six or eight days — usually on the second to the fifth day — recovery takes place. Sometimes it occurs as suddenly as the attack. A patient which the evening before was lying helpless is next morning found standing at the manger. Digitized by Microsoft® 256 CLINICAL VETERINARY MEDICINE AND SURGERY. The most frequent after-complications are bedsores, areas of dry gangrene over the most prominent portions of the body, consequent on the animal remaining too long in one position, and localised atrophy of certain groups of muscles, particularly of the crural muscles, conse- quent on myositis or neuritis. Sometimes the hind limbs show a kind of paresis due to myelitis or to spinal meningitis. When the end is likely to prove fatal, the grave earlier phenomena persist with but slight and short remissions, or the improvement is soon followed by a return of the symptoms, which are prolonged until death occurs. The latter is produced either by slow asphyxia, conse- quent on pulmonary congestion, or by uraemia or cardiac syncope. In some cases the course is very rapid, the symptoms extremely alarming from the first ; the animal struggles violently, the chief functions are greatly accelerated, the respiration especially being hurried and accompanied by frequent groaning; the mucous mem- branes become purple and the limbs cold. Before the end of the first day — sometimes after a few hours — death occurs during a violent attack of struggling, or preceded only by a few convulsions. Some years ago we saw these symptoms of acute hsemoglobinuria in a patient which died in ten hours. The benign form, with or without myositis, is characterised only by trifling general disturbance and more or less marked difficulty in move- ment ; the gait is stiff, awkward, and painful ; the limbs are momentarily flexed ; one or another sometimes shows temporary lameness. These symptoms very rapidly diminish and disappear. Resolution is gener- ally announced by the passage of dark urine. Sometimes the urine is scarcely red in colour, or may even appear normal. After recovery a predisposition to fresh attacks remains. In this respect hcemoglobinuria resembles rheumatic affections. One animal may undergo several attacks during a few weeks. M. Lucet mentions a horse which had three, separated by intervals of ten and five days. This recurring character has procured for the disease the name of periodic or intermittent hsemoglobinuria. Digitized by Microsoft® XXXV.— HEMOGLOBINURIA (AZOTURIA) IN THE HORSE (CONCLUSION). The most constant and important anatomical changes in hasmo- globinuria are to be found in the blood and muscles. As a rule the blood is not coagulated, or is diffluent, blackish, and gummy. Even during life it appears to have undergone change ; withdrawn from the jugular \'ein into a suitable vessel it usually coagulates slowly : sometimes the serum is reddish in colour, due to a certain amount of dissolved haemoglobin ; sometimes it contains crystals of hsematoidin. Chemical analysis reveals a high proportion of urea and other metabolic products ; the alkalinity is diminished. On microscopic examination most of the red blood-corpuscles show the usual physiological characters, but some are changed, deformed, and irregular. The majorit}' of the muscles affected with myositis are swollen, pale, whitish, or yellowish white, and more or less infiltrated with serum ; those recently affected are hypersemic. Incisions made parallel with the fibres demonstrate the existence of blood effusions or of ecchymoses. These lesions, regarded by some authors as primary and by others as secondary, are, as I have mentioned, specially marked in the muscles of the hind quarters. As described by M. Arloing in i865, the muscular fibres show, on microscopic examination, the changes peculiar to acute degenerative myositis — cloudy swelling, loss of or diminution' in the clearness of their striation, fragmentation of the fibres, hyaline or granulo-fatty degeneration ; the interstitial tissue often contains masses of red blood-corpuscles. In most cases the kidneys seem affected with parenchymatous nephritis ; they are large, hypersemic, and ecchymosed ; on section the cortical substance appears moderately congested, marked with hsemorrhagic streaks and points ; the medullary substance is reddish j-ellow, and more or less infiltrated. These lesions, however, are sometimes far from pronounced. Under the microscope a granular exudate is seen in the glomeruh and urini- ferous tubules; sometimes the epithehum of the convoluted tubes is much infiltrated with pigment. Without being absolutely constant. Digitized by Microsoft® 258 cMNicAL vj:terinary .medicine and surgery. congestive and hsemorrhagic lesions in the nervous centres, particularly in the lumbar portion of the cord and in certain nerves, notably the femorals, are rarely absent. In addition I should mention the con- gestive lesions in certain portions of the intestinal mucous membrane, the swelling and haemorrhages in the spleen, the fatty degeneration of the liver and other glands, and the hyperaemia of most of the viscera and of the bone marrow. These appearances are in great part consequent on changes in the blood, and on the uraemia which complicates prolonged cases. The pathogeny of hasmoglobinuria is \'ariously interpreted. The most recent work published on this question does not appear to have in any appreciable degree advanced it. In the nervous or medullary theory, accepted by many writers and remarkably well described by M. Trasbot in the Archives Vctcrinaircs, the symptoms noted are referred to congestion of the spinal cord or to myelitis. Unquestionably the cord often shows hypera;mic and hsemorrhagic changes, but it may well be asked whether these are not due to the same causes as the secondary changes in the viscera ; many persons maintain that they are not constant, and certainly they explain neither haemoglobinsemia nor hsemoglobinuria. In two post-mortem examinations made during the last few years the cord appeared to me unchanged on naked-eye examination, and the microscope showed no important lesions.' Authors have at \-arious times traced the disease to congestion of the kidneys or to nephritis. The waste products usually e.xcreted by the kidneys are said to produce general intoxication, changes in the blood-corpuscles, inflammation of muscle, and the train of symptoms which successively appear. M. Lucet, who regards hsemoglobinuria as a disease of renal origin, refers the benign cases to an ephemeral but excessively acute nephritis. But renal changes appear to be always secondary, consecutive to changes in the blood. Lesions in the epithelial cells lining the renal tubules, like enlargement and pigmentation, are said to be caused by the elimination through the kidney of products resulting from destruction of red blood-corpuscles, or the transformation of haemoglobin. Experiments carried out in company with M. Roger have satisfied me that urinary intoxication produced by injecting fresh filtered urine into the horse's jugular produces none of the symptoms * In his treatise on nervous affections in tlie horse, just published, Dexler regards lismoglobinuria as a disease of the cord. He states that the dominant symptoms are those of a medullary affection, and he claims to have found in the anterior horns of the lumbar portion of the cord lesions which explain these symptoms. Digitized by Microsoft® h.+:moglobinuria (azoturia) in the horse. 259 of haemoglobinuria. We likewise found that blood-serum from horses affected with this disease had no special effect in destroying formed blood elements. Injected into the veins of the rabbit, it did not seem more distinctly toxic than normal serum. The theory that hsemoglobinuria is an infectious disease is not new. In France it was advocated by M. Signol, and particularly by M. Arloing. It better accounts for the phenomena occurring during the course of the affection than any other. These are said to result from auto-infection or auto-intoxication, due either to a ferment present in the food or to the abundant formation of metabolic products under the double influence of cold and movement in animals predisposed by long rest in the stable. It is to-day generally allowed that the cause, whatever it may be, produces change in the red blood-corpuscles, destruction of a greater or smaller number, with solution of their haemo- globin in the blood-plasma, thus setting up hsemoglobinuria, from which all the other lesions are said to be derived. Against this theory it is urged that the disease behaves in no wise like an infectious process, that it is not contagious, that all attempts at transmission have failed, that blood removed aseptically during life does not always give a coloured or red serum ; finally, that the metabolic products which, on the theory of auto-intoxication, should exist in large quantities in the blood, are at times only met with in normal proportion. However this may be, the disease certainly offers some resemblance to an infec- tious process, and it would not be surprising if one day this view of its pathology were bacteriologically confirmed. What was known fifteen years ago regarding the pathogeny of tetanus ? that toxi-infectious disease which can never be transmitted, so to speak, directly, and the development of which, like that of hsemoglobinuria, is so favoured by cold. The muscular or rheumatismal theory supported by Frohner com- pares hsemoglobinuria of the horse with parox\'smal hsemoglobinuria a frigore in man. The principal cause of the equine disease is said to be the action of cold ; the essential and primary change degeneration in certain muscles, the colouring material of which is liberated, and to- gether with other substances passes into the blood, accumulates there, produces secondary lesions in the internal organs, and is then elimi- nated by various emunctories, especially by the kidney, whence the deep coloration of the urine and the nephritis. The partisans of this theory lay stress on the fact that grave lesions almost always exist in several groups of muscle, that the sudden action of cold is capable of rapidly producing change and discoloration of muscle ; finally, that the blood of animals affected with hsemoglobinuria contains an excessive propor- Digitized by Microsoft® 26o Ct.INICAI, VETERINARY MEDICINE AND SURGERY. tion of hjemoglobin which might originate from the colouring material of the altered muscles. The results following attempts to produce experimental haemoglo- binuria in no waj- favour the renal theor}^ Hsemoglobinsemia, with or \\-ithout hsemoglobinuria, maj- be produced b}' introducing into the blood substances \\'hich cause destruction of a greater or less number of red blood-corpuscles, and thus set at liberty varj'ing quantities of haemo- globin, capable of conversion into methsemoglobin and many other still unknown metabolic products. If few red blood-corpuscles are destroyed, slight h?emoglobinsemia without hemoglobinuria is produced : haemo- globin is soon broken up by the liver, spleen, and bone marrow. The same result follows, even though destruction is more abundant, provided it occurs graduall}- ; neither haemoglobinuria nor visible changes in the kidne3-s are seen. On the contrary, if it is abundant and rapid, hsemo- globinuria appears, and the kidne)'3 undergo more or less grave change. Hsemoglobinaemia, hjemoglobinuria, and disease of the kidney constitute the three stages of haemoglobinuria experimentally produced. Spontane- ous haemoglobinuria is ver)- probabh' marked by similar stages. What remains to be discovered is the cause or agent which in the spontaneous form sets at libert}' the haemoglobin. The conditions under which the disease appears, the sudden invasion, preliminary colick}- pains, and the multiplicit}- of organs almost imme- diatel}' affected, suggest that it results from toxic infection of intestinal origin, of which the hasmoglobinaemia, haemoglobinuria, and the changes in muscle and in the spinal cord are onh' the principal manifestations. Not onh- does the intestine present a vast cavity for the growth of pathogenic microbes ; it is also a centre of manufacture for toxins. Overfeeding of horses while idle favours the production of intestinal poisons; and it is known that when associated, otherwise relatively harmless germs, like the Bacillus coli communis, the paracoli bacilli, and the streptococci, may produce deadly toxins. In processes of this nature intoxication maj- pla}' an e\'en more important part than infec- tion.* The diagnosis of hemoglobinuria is usually easy. Nevertheless benign cases may at first be mistaken either for intestinal colic or for muscular rheumatism. Others, where the animal is lying down when examined, may suggest traumatic paraplegia or fracture of the vertebral * M. Lignieres found streptococci in the cerebro-spinal fluid of horses dead of haemo- globinuria. This discovery, however, only shows that streptococci, without doubt originating in the intestine, had entered the blood-stream. It remains to be proved that this was not a case of organisms entering the circulation during the death agony. Digitized by Microsoft® H.'EMOGLOHINURIA (aZOTURIa) IN THE HORSE. 261 column ; but the history and red coloration of the urine remove any possible doubt. The atrophy of muscle afterwards seen in different regions, most frequently in the triceps cruralis muscle, can always be traced to hsemoglobinuria. The majority of other changes are of similar origin. In their case also the history constitutes a valuable indication. A few weeks ago you saw a case of atrophy of the extensor muscles of the right forearm. The history enabled us to trace this lesion to an attack of haemoglobinuria which the animal underwent last winter. The prognosis varies considerably according to the degree of acute- ness of the disease, the localities it affects, and the constitution of the patients. Statistics show the mortality to vary between 5 and 70 per ■cent. Plethoric horses which eat large quantities of grain, and par- ticularly of oats, are much more liable to die than animals accustomed to moderate feeding. This seems to me to explain the marked gravity of hsemoglobinuria in town horses, and the series of recoveries reported by veterinary surgeons who practise in country districts. It is also clear that certain authors have mistaken infectious forms of paraplegia which are seen in all countries, and everywhere cause heavy mortality, for hsemoglobinuric paralysis. Benign character of the first symptoms, slow development of the disease, preservation of the standing position, normal or but slightly modified rhythm of the chief functions of the body, and continuance of the evacuations, are signs justifying a favour- able prognosis. On the other hand, sudden invasion, marked accelera- tion of breathing, abundant sweating, high fever, paraplegia, and cessation of the evacuations, leave little ground for hope. I should ■add that in some cases the disease develops insidiously, and that though at first benign it may at any moment be accompanied by paralysis. For this reason a certain reserve should be exercised in speaking of cases which even appear likely to recover. Prognosis is always un- favourable in cases affected with paraplegia. When this persists beyond the third day the issue is generally fatal. Prophylaxis is founded on our knowledge of the aetiology. Avoid, as far as possible, leaving horses too long in the stable ; exercise them for at least a few minutes night and morning on resting days ; always proportion food to the work to be done ; reduce the rations during rest, improve the animal's hygienic surroundings, paying especial attention to securing uniform temperature, sudden changes in which may have particularly injurious effects. I have said that the disease generally appears during work, and is rapidly aggravated by attempts to draw a load even at a walking pace. Digitized by Microsoft® 262 CLINICAL VETERINARY MEDICINE AND SURGERY. As soon, therefore, as the animal is seen to be ill it should be stopped, taken out of the shafts, and removed to a neighbouring stable, or placed in an ambulance and taken home. Arrived there it can be placed in a box, where it should be kept warm and quiet. Animals do better if able to stand, for which reason slinging may prove useful. If, however, the patient is totally incapable of standing even with slings, it should be given a thick bed of straw. The present uncertaint}' regarding the nature of hsemoglobinuria renders treatment hesitating. As in all diseases in which the essential cause is unknown, a large number of methods and innumerable drugs have been recommended. Many are only injurious, but some are of real value. While combating the more marked disease symptoms, the general line of treatment should resemble that prescribed against toxic infections. In the gra^■e form — especially when dyspncea is marked — bleeding may be practised, seven to fourteen pints of blood being removed according to the animal's size. This constitutes a first method of removing the poisons, microbic or cellular. Whether disease be trifling or severe, attempts should be made to secure an action of the bowels by administering a hypodermic injection of 2 to 4 centigrammes of hydrobromate of arecolin, 5 to 10 centigrammes of sulphate of eserine, or 10 to 20 centigrammes of hydrochlorate of pilocarpine. The body and limbs can afterwards be brisklj' rubbed with flannel or with straw wisps. If necessarj- the hj-podermic injection can be repeated on the following da}'s. Lafosse, Colin (de \'assy), Jouquan, and some other veterinarians have recommended continuous refrigeration of the dorso-lumbar region by irrigation, or b}- applying wet cloths frequently moistened with cold water. This is one method of treating the myositis and congestion of the spinal cord. Sometimes excitement is severe. The animal struggles violently, is covered with sweat, and the body is severely bruised by striking against the ground. This excessive excitement should be combated by nar- cotics and anaesthetics. If water is readily taken, laudanum should be added to it ; but if refused, morphine should be subcutaneously injected, or chloral given in a ball. The animal must be frequently turned over and provided with a good bed, both to prevent hypostatic congestion and the formation of bedsores on prominent parts of the body. When appetite is preserved, or when it returns, the animal should be supported on gruel and milk. It may also be given green food, hay, and a small quantity of oats. In addition to the alkaloids already mentioned, internal medication Digitized by Microsoft® H.E.MOGLOBINURIA (aZOTURIA) IX THE HORSE. 263, comprises administration of purgatives and alkaline salts. Having succeeded at the outset in producing one abundant evacuation, the action of the bowel can be sustained bj' repeated doses of sulphate of soda. The fact that the alkalinity of the blood is generally diminished, as in infectious conditions, and in the various processes which lead to destruction of the formed elements of the blood, suggests the use of alkalies. Dickerhoff recommended bicarbonate of soda in daily doses of six to sixteen ounces, divided into several parts and given in the drinking- water ; this dose was afterwards diminished to three or four ounces. The remed}' is simple, cheap, and readily taken by patients, while it undoubtedly has a favourable effect. By rendering the fluids alkaline it increases their bactericidal and antitoxic powers, and by restoring to them what the infection had removed, it assists elimination of toxins, and fortifies the red blood-corpuscles.* Stimulants are now almost abandoned, their action having been found to be highly injurious. Alteratives have no value. When the animal remains recumbent for long periods it must not only be repeatedly turned over, but the rectum and bladder must be emptied. Needless to say, in passing the catheter full antiseptic pre- cautions must be taken to avoid infecting the bladder. During convalescence alkalies should still be continued even after the administration of tonics has been commenced. Bedsores are treated with antiseptic lotions containing sublimate, carbolic acid, or iodine, and with applications of boric ointment. Soon after convalescence is established the animals may return to light work, being guarded, however, against chills which might lead tO' relapse, and be very gradually brought into their usual work. The muscular lesions seen after attacks of hsemoglobinuria seldom prove permanent. The affected muscles sometimes recover their normal size and strength under the iniluence of work. Should atrophy become more marked, however, the parts may be fired, or irritant solu- tions like those of veratrine or chloride of sodium injected over the affected region. The faradic current is worthy of trial. The painful and obstinate lameness which follows paralysis of the triceps cruralis, and forms the commonest complication, may necessi- tate firing of the parts and continued exercise. By persevering in this way the muscle usually regains its power and the lameness disappears. * M. Masoin found that alkaline salts exercise a prophylactic action against intoxications caused by substances which tend to destroy formed blood elements, and produce formation of methcemoglobin. At the same time they exercise a general antitoxic action. Their use is therefore indicated, not only in the curative treatment of hasmoglobinuria, but in its pro- phylaxis in conjunction with other preventive measures, thevalue of which has been recog- nised by observation. Digitized by Microsoft® XXXVI.— DIABETES MELLITUS IN THE DOG. Among dogs brought for advice or left in hospital during the past few months }'ou have seen several diabetic patients ; one affected with diabetes mellitus, the others with simple polyuria or diabetes insipidus. While the second form is usually benign, the other — diabetes mellitus — is a grave affection, \\-hich almost always proves rapidly fatal. Up to the present time it has been but little studied in animals. I have chosen it as the subject of to-day's lecture. Mentioned by Leblanc in theCliniquc Vcterinaire for 1861, and seen in most of the domestic animals, including both ruminants and carni- vorse, diabetes mellitus is unquestionably a rare disease, though the chief reason that veterinary publications contain so few recorded cases is less connected with the rarit}- of the disease than ^\•ith the fact that examination of the urine is habitually neglected, and hence the disease escapes observation. During the past few years the recorded cases of diabetes mellitus in the dog ha\e increased. Frohner at the Veterinary School of Berlin, and Schindelka at that of Vienna, have noticed several. Eber, who was specially entrusted with the clinique for small animals at the Berlin School, has made researches on the fre- quence of diabetes mellitus in the dog. Within two years about 20,000 patients were brought for examination or treated in the hospital, among which Eber noted twelve grave cases marked by well-defined clini- cal symptoms, that is about one diabetic patient among 2000 animals. The disease is, howe\er, certainly more common than these statistics would seem to indicate ; trifling and recent or obscure attacks of diabetes, unaccompanied by very evident disturbance, either fail to attract attention or remain unrecognised. I will shortly describe our last case of this kind. During the first week of May a person living in the Avenue Kleber, at Paris, brought a five-year-old bitch which had been ill for three months. Although she regularly ate her food with good appetite this bitch was distinctly thin. She drank often and copiously, sometimes vomited after having lapped a large quantity of water ; and finally she Digitized by Microsoft® DlAJiETES MELLITUS IN THK DOC. 265 micturated frequently and in large quantities. J^I. Almy examined her carefully, and finding no signs of any organic disease which would ex- plain the symptoms, suspected diabetes. The urine was analysed by M. Lesage, and found to contain 5'25 grammes of sugar per lOO. The owner refused to leave the patient in hospital. As often happens, the special interest we showed in her aroused the suspicions of the owner, who feared that his animal would be made the subject of experi- ment. I will give a summary of the cases published by Eber in 1897 in the M onatslu'fte fiir Tliicrheilkunde. Case i. — A seven and a half-year-old water-spaniel. For six months had suffered from disturbance of vision, marked thirst, and excessive appetite. Condition on Examination. — Moderately nourished; conjunctiva rose-red ; pulse regular, of normal force, eighty per minute ; respiration normal ; appetite good ; abdomen swollen over the hypochondriac region ; margins of the liver perceptible two finger-breadths from the last ribs; double cataract; temperature 38-8° C (ioi-8° F.) ; polyuria; urine light yellow, pale, exhaling an odour of acetone, acid ; specific gravity roj^2 ; contained 7 per cent, of glucose. Treatment. — Meat diet. Three small doses of tincture of valerian daily. Died on the sixth day in a state of collapse. Case 2. — Cross-bred nine-year-old water-spaniel. Same history as the first patient. -Condition on E.xamination. — Very marked wasting ; both lenses opalescent; margin of the liver perceptible behind the costal carti- lages ; urine pale yellow, acid ; specific gravity 1-040 ; contained 6-5 per cent, of glucose. Returned a month later. Despite careful dieting wasting had in- creased ; urine contained 7 per cent, of glacose. Case 3. — Eleven-year-old Basset hound. Same history as in the preceding cases. Condition on Examination.— Wasting ; opalescence of both lenses ; enlarged liver; urine clear, pale yellow, acid; specific gravity 1-036; contained 7 per cent, of glucose. Patient was not afterwards seen. Case 4.— Ten-year-old Basset bitch. Severe thirst. Three weeks ago both lenses became opalescent. Condition on Examination.— Moderately well nourished; double Digitized by Microsoft® 266 CLINICAL VETERINARY MEDICINE ANII SURGERY. cataract ; liver enlarged ; urine light yellow, transparent, acid ; density i'036 ; contained 8 per cent, of glucose. Case 5. — Nine-year-old poodle. Usual history. Condition on Examination. — Somewhat frequent coughing ; chronic bronchitis ; double cataract ; no enlargement of the liver ; urine cloudy, clay-coloured, bearing in suspension little yellowish-grey flocculi ; specific gravit}- i'024, acid, contained a little albumen ; no bile pig- ments ; 2'6 per cent. 'of glucose. On microscopic examination of the urine numerous epithelial cells, a few very granular cylindrical casts, some red blood-corpuscles, and leucocytes were discovered. Case was not afterwards seen. Case 6. — Ten-j-ear-old pug. Left in hospital. No history. En- larged liver and cataract. The urine contained a large proportion of glucose. No quantitati\'e analysis made. Case 7. — Twehe-year-old water-spaniel. Usual history. Blindness had been complete for a week. Condition on Examination. — Bilateral cataract ; lenses of a yellowish colour ; liver enlarged ; deafness ; impaired sense of smell ; urine pale 3'ellow, acid, specific gravity i"042 ; contained 2"5 per cent, of glucose. Treatment. — Careful diet and administration of bicarbonate of soda. Brought back four months later to be operated on for cataract. At this date the urine was albuminous, but only contained traces of sugar ; heart normal. After operation on one eye the animal fell into a comatose condition, and died four days later. Case 8. — Nine-year-old pug. Polyuria; excessive thirst ; wasting- ^'ision impaired for the past six \\eeks. Condition on Examination. — Opacity of both lenses; enlargement of the abdomen, resembling abdominal dropsy. The liver extended more than a hand's breadth beyond the last ribs ; weakness and wasting ; urine light yellow, slightly albuminous, slightl}' acid, specific gravity i"03i ; contained 9*4 per cent, of glucose. Case 9. — Nine-year-old terrier. Usual history. General Condition. — Badly nourished; diffuse cloudiness of both lenses ; enlarged liver ; urine straw-coloured, slightly turbid, and acid, density l'039 ; contained a little albumen and mucin in addition to 8 per cent, of glucose. Digitized by Microsoft® DIAliETES MELLITUS IN THE DOC. 267 Case io. — Six-year-old pug. Had fallen away in condition, and ex- hibited cough for a month. Appetite great and thirst acute. No dis- turbance of vision. General condition bad. Slight diffuse cloudiness of both lenses; liver enlarged ; urine light yellow, acid, with an intense smell of ace- tone, density 1-044, contained 7 per cent, of glucose; saliva alkahne ; little albumen. Case ii. — Twelve-year-old Pomeranian bitch. For the previous four months had appeared depressed and tired ; appetite had fallen off during the last few days ; thirst very severe ; polyuria ; animal's skin exhaled a foetid smell. No visual disturbance. Moderately nourished. Trifling opacity of both lenses. The li\'er was not swollen ; urine pale, trans- parent, acid, and gave off an intense odour of acetone, densit}- i'033, contained traces of albumen, and 8 per cent, of glucose ; saliva alkaline. Case 12. — Eight-year-old Basset bitch. Intense thirst ; polyuria and general wasting. Appetite nevertheless good. Condition on Examination. — Slight opacity of both lenses; wasting; enormous enlargement of the liver ; urine clear, slightly yellowish, in- odorous, alkaline, density i"028, contained traces of albumen and 5 per cent, of glucose ; saliva alkaline. In five diabetic patients examined after death, Eber found degene- rative changes in the liver. In one the pancreas was atrophied ; in three it showed a few greyish nodules, the nature of which was not determined. In man, in whom the aetiology of diabetes has been carefully studied,, the principal causes are said to be improper or excessive food, abuse of sugary and starchy materials, sedentary life or insufficient physical exercise, gout ; finally, advanced age. The disease is oftenest seen be- tween thirty and seventy years of age, but may also occur before maturity, during adolescence, or even in infancy. In the dog diabetes is almost always confined to animals of fairl}- advanced age. It is exceptional during the first half of life. Of Eber's twelve patients, nine were more than eight years old. The influence of special conditions of life is at least as marked as that of age. Almost all cases are in animals freely fed, leading idle lives, or in pam- pered pet dogs. Many of these are very affectionate and greatl}- attached to their owners ; they become dull, ill-tempered, and Digitized by Microsoft® 368 CLINK Al. VETERINARY MEDICINE AND SURGERY. snappish, and although the history always fails to record the fact, it may be that excitement and emotional disturbance play a certain part in developing the disease. AI. Gibier succeeded in pro- ducing transitorj' glycosuria in a bitch by means of psychic excita- tion. This bitch, which was four years old, and of a ver}' affectionate, nervous, and jealous disposition, lived free in the laboratory with other animals of its own species. Its urine, examined for a period of several days, gave no reaction. Shut up in a cage the bitch appeared greatly ■excited. The urine retained its normal character for three days, but on the fourth contained 5"55 grammes of sugar per litre. The glyco- suria persisted during the entire period the animal was shut up, but disappeared the day after she was set at liberty. Sex appears to have no influence in the aetiology ; cases are as numerous in males as in females. Among Eber's twelve patients were six dogs and six bitches. Diabetes in the dog at first develops insidiously, and for a consider- able period may produce no marked disturbance. In a number of cases it exists for months before attracting attention. As in our patient, the disease is not remarked until the three principal symptoms, polyuria, poh'dipsia (excessive thirst), and wasting, are all developed. Micturition is frequent and abundant. Certain patients pass one or e\-en two quarts of urine per day. Pet dogs which become diabetic are greatly inconvenienced, and micturate on the carpets or cushions of the rooms where they are confined. The urine is usually limpid, pale, or light yellow, not infrequently albuminous, occasionally slightly turbid, of an average specific gravity of i"030 to i"040. It sometimes contains as much as lo per cent, of sugar. In a twelve-year-old bitch seen by Penberthy the proportion was io'62 per cent. As soon as the urine contains from j to 4 grammes of glucose per litre it acquires a sweetish, sugary taste. Another important symptom is the insatiable thirst which troubles the patients. As a consequence of the polyuria thirst is constant, though more marked at certain times than at others, being especially acute during the night. The mouth is dry, and the saliva tends to become acid, so that the gums are often inflamed, and the buccal ca\'ity exhales a disagreeable smell. To the polyuria and polydipsia — the two principal symptoms of diabetes -are added weakness and wasting, which usually become rapidly aggravated. Without being absolutely constant, emaciation is common, sometimes appears early, and is the more striking inas- much as appetite is preserved, or may even be excessive. Of Eber's t\vcl\-e patients ten showed rapid wasting. Enlargement rif the liver is Digitized by Microsoft® l)lAHl':Tf:S MEl.LITUS IN THK DOG. 269, also noted in almost all cases. Usuall}' very marked, it produces deformity of the abdomen almost simulating ascites, a condition from \vhich it is differentiated by palpation. Some subjects show digesti\'e disturbance, particularly vomiting and constipation, alternating with attacks of diarrhoea. Cutaneous complications hke erythema, furunculosis, or gangrene are occasionally seen, as are diseases of the respiratory passages, bronchitis, or pneumonia with a tendency to gangrene and tuberculosis. They are, however, distinctly rare. Disease of the eye, on the other hand, is very frequent. Three fourths of the dogs affected with diabetes suffer during the course of the disease from bilateral cataract,, which often produces complete blindness in a few weeks. Deafness, loss of smell, paralysis, and comatose or apoplectiform attacks may also occur. In diabetic dogs examined after death changes have been found in the liver and pancreas. In most cases the li\'er ^\■as greatly enlarged, hypersemic, and undergoing fatty degeneration ; in some cirrhosis was also seen, but the seat of the sclerosing process has not been clearly described ; in a few cases mention has been made of atrophic changes in the pancreas. At the post-mortem examination of a bitch affected with wasting diabetes, Lienaux found the liver undergoing fatty degeneration, and the pancreas atrophied. The bitch examined by Penberthy showed similar lesions of the liver and pancreas. I shall onl}' say a few words on the pathogeny of diabetes. During the course of the present century, but especially after the discoveries of Bernard, and more particularly during the last twent}- years, this question has greatly interested savants and experimenters. For a long time the conditions necessary to the appearance of sugar in the urine have been known. Being indispensable to nutrition, sugar exists nor- mally in the blood and tissues. The arterial blood of the dog contains about 1-30 grammes, and the venous blood about go centigrammes per one thousand grammes. Manufactured by the liver at the expense of its glycogen, the sugar found in the blood is variously utilised by the organism : one portion is burned up, another is assimilated by the tissues. In health the proportion remains practically the same, but this physiological condition may be disturbed, either by excessive production of sugar, or by diminution in its consumption by the tissues: in either case hyperglycsemia exists, the necessary precedent to the appearance of sugar in the urine—?', e. glycosuria. The latter condition occurs as soon as the blood contains more than 3 grammes Digitized by Microsoft® 270 CLINICAL VETERINARY MEDICINE AND SURGERY. of sugar per thousand ; in certain diabetic patients tiie proportion rises to 5 or 6 per thousand. But an animal whose urine contains sugar is not necessarily a diabetic subject. The temporary presence of sugar in the urine — transitory glycosuria — is, in fact, a symptom common to ^-arious morbid states, to certain brain diseases, to auto-intoxications and infections. What particularly characterises diabetes is the constancy or permanency of the condition. Temporary glycosuria or diabetes can be experimentally produced by injuring the floor of the fourth ventricle below the origin of the pneumogastrics, by adminis- tration of various chemical substances, and by extirpation of the pancreas. I shall not trouble you with the theories of diabetes. At the present time they number almost thirty. The majority are based on supposed disturbance in the glycogenic function of the liver, or on failure of the tissues to destroy the sugar present in the blood, due to disturbance in assimilation. M. Bouchard regards diabetes as a disease due to retarded nutrition. It results from nutritive disturbance primarily characterised by failure or partial inability of tissue elements to consume the sugar. MM. Chauveau and Kaufmann consider that variations in the proportion of sugar contained in the blood depend rather on hepatic production than on disturbance in consumption, and that production of sugar by the liver is regulated by the nervous system, the pancreas exercising a kind of retarding function and moderating the activity of the hepatic cells. According to the rapidity of its development diabetes is described either as acute or chronic. Other forms have been distinguished, depending on whether the patients preserve their condition or undergo wasting. Some authors refer wasting diabetes to lesions of the pancreas, but in the dog it appears only to be an advanced stage of the tirst form ; wasting, in fact, is always very marked, though lesions of the pancreas are rare. AVe also recognise traumatic diabetes, most frequently a result of injury to the cranium. The progress of diabetes mellitus in the dog is usually rapid. Some patients may live for several months ; under appropriate treatment the glycosuria diminishes, but improvement is only temporary. Sooner or later the symptoms become suddenly aggravated, and most animals die in a state of coma. Diabetes in the dog is very apt to escape diagnosis. It may be suspected from the history, from one or other of the principal sym- ptoms, such as the excessive urination, thirst, and appetite; and in certain cases also from the clinical signs — wasting, cataract formation, Digitized by Microsoft® DIABETES MELUTUS IN THE DOG. 271 and enlargement of the liver. Detection of sugar in the urine confirms the diagnosis. Fehhng's solution, prepared so that one cubic centi- metre is reduced by 5 grammes of glucose, forms an easy and rapid means of discovering glycosuria. You know the method of employing it ; 3 or 4 cubic centimetres of the solution are poured into a test-tube and brought to boiling-point (it should remain blue and perfectly limpid) ; the urine is afterwards filtered and slowly added, being allowed to run down the side of the tube so as to form a separate layer above the solution. If it contains a considerable quantity of sugar the surface of contact will first show a greenish layer, which successively becomes yellow and red. In performing quantitative analysis it should be borne in mind that the urine of diabetic dogs contains a variable proportion of uric acid, and of other little known bodies which, like sugar, reduce Fehling's solution. The cure of saccharine diabetes in the dog is undoubtedly possible, but up to the present no case has been reported. All the patients have died, the majority in a very short time. The cases said to have been cured really refer to diabetes insipidus. In slight or recent attacks treatment may prolong life for a varying time. The animals should not be excited. The majority should not be taken into hospital, or separated from their owners. The food should be free of starchy and sugary materials, and is best confined principally to meat, light soup containing green vegetables or cabbage, milk, and combinations of these foods. The animal should be allowed whatever liquid it requires. Exercise must be given, but fatigue avoided. Medical treatment comprises alkalies, particularly bicarbonate of soda, and when wasting is marked, preparations of arsenic or valerian. It must also be remembered that diabetic patients are particularly predisposed to infections. Only urgent operations should be under- taken and the strictest aseptic precautions observed. In the comatose stage drastic purgatives, large doses of bicarbonate of soda, and hypo- dermic injections of ether and caffeine probably offer the greatest chance of improvement. Digitized by Microsoft® XXXVII.— EXOPHTHALMIC GOITRE. At the beginning of the present week I specially retained in hospital a horse showing certain curious symptoms, to which I drew your parti- cular attention. The animal was about fifteen years old, and had been its present owner's possession for five months. Until the last few days it had enjoyed good health and done regular work. We were informed that it then left a part of its food, that the faeces became small in quantity and hard, and that the animal seemed less active at work. In this patient we immediatel}- noted a two-lobed swelling formed by enlargement of the thyroid gland, and situated opposite the origin of the trachea ; the left lobe was larger than the right. Both lobes were soft, elastic, resistent, slightly fluctuating, moveable under the skin, and somewhat adherent to the deeper seated tissues. The mouth was dry, but there was no dental disturbance. Palpation of the abdomen was not painful, and no signs of obstruction of the intestine could be detected. There ^^■as no tachycardia (rapid action of the heart), no palpitation, no intermittency ; in fact, no other trouble. The respiratory move- ments were not accelerated. The temperature hardl}' registered 38'5^ C. (ioi'3° F.). Having noted these points you saw that I examined the eyes in order to judge of their size and prominence. In the letter sent me "slightly pronounced abnormal prominence of both eyes" was mentioned. In point of fact there was no ^•isible exophthalmia. Although the animal showed goitre and a cardiac murmur its want of appetite was due entireh' to enteritis. It was certainly not suffering from exophthalmic goitre. Nevertheless, since I have brought the question before you, I shall not allow it to pass without describing to you in what exophthalmic goitre consists. In human medicine, for rather more than half a century, there has been described under the titles of exophthalmic goitre, Graves' disease, and Basedow's disease a morbid condition, the exact nature of which is still little understood, but \\hich is clearl}' distinguished by three Digitized by Microsoft® EXOPHTHALMIC GOITRE. 273 principal symptoms— palpitation of the heart, goitre, and exoph- thalmia. This disease had hardly been discovered when its essential characteristics were identified and well described in England by Graves, and in Germany by Basedow. Trousseau gives a masterly sketch in the second volume of his Cliniques Medicales de VHotd-Dieu. Since that time it has been the subject, both in France and abroad, of many observations and interesting researches. The first cases of exophthalmic goitre in animals were only announced in 1888. At this date the Russian veterinary surgeon Jewsejenko described two, one in a mare and the other in a bitch. The first \yas that of a four-year-old thoroughbred mare which, when fatigued after racing, exhibited grave disturbance, at first referred to brain disease. For a fortnight she showed weakness, dulness, loss of appetite, excessive thirst, slight acceleration of breathing, rapid action of the heart, palpitation, strong pulse, hypertrophy of the thyroid gland, injection of the conjunctivae, and slight infiltration of the eyelids. Suddenly, on the sixth day, exophthalmia became very marked. The globes of both eyes were fixed, and the eyelids could not be closed. The lobes of the thyroid gland showed pulsation, and continued to increase in size. The temperature rose to 40° C. (104° F.). The patient died of exhaustion at the end of a month. No post-mortem examination was made. The second case was that of a seven-year-old bitch, which was reported as having once suffered from an epileptiform seizure while being exercised in hot weather. Psychic disturbance, agoraphobia (fear of open spaces), and symptoms of great irritability persisted, and were later succeeded by rapid action of the heart, palpitation, hyper- trophy of the thyroid gland, and finally exophthalmia. The globes of the eyes projected prominently, preventing closure of the eyelids. An ulcer developed on the cornea of the left eye, and afterwards perforated the membrane. After the appearance of the above, four new cases of exophthalmic goitre were published — two in the horse, one in the cow, and one in the dog.* This is the only information we possess regarding this singular disease. It is certainly rare in animals, though the paucity of reported cases is certainly in some degree due to the attention of veterinary surgeons not having-been called to it. ' A second case of exophthalmic goitre in the cow was published in 1898 by Gehrig in the Deutsche Thierarztliche Wochenschrift ; and a third in the horse, in 1899, '^1 '^'ss in the Reciieil de Medecine VHirinaire. Digitized by Microsoft® 274 CLINICAL VETERINARY MEDICINE AND SURGERY. In man the disease is usually announced by palpitation, which occurs suddenly after a physical or moral shock, accident, violent emotion, fright, or exhausting work, though the onset may be insidious, and aggravation gradual. The heart-beats are sudden, and so violent as to be visible over a large surface of the chest or even over the whole body. On auscultation the normal heart-sounds are magni- fied, and have a metallic ring, or are accompanied by murmurs, the position and intensity of which vary, but are most commonly soft and systolic. The radial pulse is generally feeble, sometimes arhyth- mic ; in certain cases it cannot be counted owing to its frequency ; on the other hand, it may also preserve its normal character for a long time. The carotids beat strongly, showing bounding movements, resembling that " dancing of the arteries " seen in certain heart dis- eases. Auscultation with the stethoscope sometimes detects soft or rough murmurs. The superficial veins, those of the limbs, and the jugulars more especially are large and distended. Both jugulars show strong pulsation. Hypertrophy of the thyroid gland is sometimes uniform, extending equally to both lobes ; sometimes it is more pronounced in one than in the other. Goitre seldom appears rapidly. In most cases the gland gradually increases in size, remaining somewhat elastic, soft, and moveable under the skin. It is very vascular, and on auscultation sometimes reveals an arterial murmur isochronous with the beating of the heart. In time it may undergo hardening. Exophthalmia — that is, excessive prominence of the globes of the eyes — is usually equally marked in both eyes. It may even develop sufficiently to prevent the eyelids closing, or to threaten displacement of the eyes ; this accident has indeed been seen. In other cases dis- placement may be very slight, or fail to occur. In addition to undue prominence of the eye rupture of the cornea is sometimes seen ; the animal's gaze becomes fixed, tears escape over the face, and the sclerotic is hypersemic. The pupil is usually normal ; sometimes, how- ever, it is dilated or contracted. In most patients the chambers of the eye remain intact and vision is unaffected, but some show dilatation of the retinal vessels, myopia, or presbyopia. To these three symptoms must be added trembling, an almost always constant sign, which is no less important than the preceding. This trembling is sometimes limited to the limbs, in the upper parts of which it is particularly marked. Sometimes it is general, all the muscles showing fibrillary movements. Various secondary disturbances are seen. Appetite is lost ; diges- tion is bad ; attacks of diarrhoea occur ; bodily condition and strength Digitized by Microsoft® EXOPHTHALMIC GOITRE. 275 diminish. In some patients there may be cough, oppression, and anxiety ; in others the skin is warm, dry, and affected with obstinate pruritus-; abscesses may develop in the subcutaneous connective tissue in different regions. Other troubles of cerebro-medullar origin may also be present : at first there is insomnia, in consequence of over- excitement of the brain ; at a later stage there may be change in character and unusual irritability or depression. Polyuria, albuminuria, and glycosuria are frequent. Basedow's disease is not invariably characterised by all the appear- ances I have just mentioned. In some instances even the triad of sym- ptoms which are usually so suggestive fail to appear. In the obscure forms enlargement of the thyroid and prominence of the globes of the eyes are little pronounced, or absent ; in one variety goitre is little marked, and abnormal projection of the eyes altogether wanting ; in another there is marked hypertrophy of the thyroids, and exophthalmia is scarcely noticeable ; in others again only tachycardia and trembling movements are seen. Cardiac disturbance is constant ; it constitutes the first and predominant symptom of the disease. In by far the greatest number of cases exophthalmic goitre is a chronic affection. Its development is slow, interrupted by paroxysms in which palpitation and hypertrophy of the thyroid are particularly well marked. At the very outset development may be acute ; the disease may appear suddenly, and almost immediately be accompanied by palpitation, hypertrophy of the thyroid, and exophthalmia ; but its after progress is slow. Rapidly progressive cases are rare. After continuing for a period varying between a few months and ten, twelve, or fifteen years, the disease may terminate in recovery, or prove fatal. Death sometimes results from cerebral haemorrhage, sometimes from exhaustion, usually preceded by intractable diarrhoea, or from intercurrent infectious disease. The post-mortem examination of persons who have died of exoph- thalmic goitre does not always show lesions in the more important organs sufficiently explaining death. The heart is normal, dilated, or hypertrophied ; in the last case hypertrophy may either be total, or limited to the left ventricle. The valves are normal or thickened ; sometimes the calibre of the carotids is increased. The thyroid arteries are dilated and sinuous. The thyroid gland is enveloped in a layer of connective tissue, penetrated in all directions by large venous channels ; its tissue varies in consistence and colour, but is usually of a deep tint, very vascular, and in exceptional cases fibrous or sclerosed. Digitized by Microsoft® 276 CLINICAL VETERINARY MEDICINE AND SURGERY. Even the ophthalmic artery is often dilated. The membranes of the eye, particularly the choroid and retina, are hyperaemic ; the retinal arteries and veins have been found dilated, the retina infiltrated with blood and pigmented, the choroid strongly injected. Other lesions maj' exist in the principal viscera. The stomach, intestine, liver, spleen, kidneys, and brain are sometimes hyperasmic. In many cases hypertrophic cirrhosis has been noted ; in others renal lesions, similar to those of Bright's disease. Such lesions, however, are of secondary importance, for in most cases the viscera show nothing special. Exophthalmic goitre is characterised by very special features, and forms a well-defined condition. But what is its nature ? One theory regards it as a disease of nutrition, a cachexia. In the obstinate and persistent form, in that which kills, the blood at length undergoes change, nutrition languishes, anaemia sets in, and becomes more or less rapidly accentuated. In the case I related nutrition was evidently affected, wasting and visible weakness were extreme ; cedema had occurred in the lower parts of the body, diarrhoea was permanent, and finally, numerous purulent centres developed in the subcutaneous connective tissue of different regions. In this form death generally occurs from progress of the cachexia, though the nutritive change is only an effect and not a cause of the disease. It is not seen in trifling cases which develop slowly, remain stationary, or diminish. The disease itself is therefore not a cachexia. Many persons still regard the disease as of nervous origin, and consider it principally due to causes acting on the brain, such as severe nervous excitement, depressing circumstances, or violent emotion. Physiology, thej' say, has shown that local congestions may be caused by purely nervous impulses. The congestive phenomena occurring in the thyroid gland and in the eyes are said to result from " nervous paroxysms," which, through the medium of the sympathetic, provoke disturbance of circulation. They thus claim to prove that the three main symptoms result from one cause, that is to say, from primary disturbance in the brain. They describe the disease as a " cerebro- meduUary disease,* a congestive neurosis, which progresses by paroxysms." At the present day the tendency is to regard it as an auto-intoxica- tion, produced by excessive activity or functional disturbance of the thyroid gland itself. Certain symptoms, or even the entire group of symptoms, peculiar to exophthalmic goitre can easily be produced in animals by injecting certain toxic substances. M. Bouchard has Digitized by Microsoft® EXOPHTHALMIC GOITRE. 277 shown, for example, that exophthalmia may be determined by injecting injurious substances excreted by the kidney. MM. Ballet and Enriquez exhibited at the Society Medicale des Hopitaux a dog in which the symptoms of exophthalmic goitre had been produced by long-continued feeding on extract of thyroid gland. Toxic principles poured into, or retained in the blood in excessive quantity act on the nervous centres, and thus excite the complex disturbance recognised as exophthalmic goitre. When clearly marked and accompanied by the essential symptoms exophthalmic goitre cannot be mistaken for any other disease. No other produces excessive prominence of the eyes, enlargement of the thyroid gland, palpitation, and trembling movements. Nevertheless in ill-defined or incomplete cases mistakes are easy. Even in man the disease has sometimes been mistaken for slowly developing typhoid fever, or for tuberculosis. Until recently its occurrence in animals was not recognised ; it formed one of that group of unnamed diseases the nature of which can only be discovered by clinical and anatomico- pathological investigations. When recent it may be mistaken for true palpitation, for " diaphragmatic chorea," or for heart disease. But simple cardiac palpitation and spasm of the diaphragm are usually temporary affections ; and even when they persist for a certain time they at least diminish in intensity after a few days, while the other symptoms of exophthalmic goitre fail to appear. Similarly in true heart disease there is neither enlargement of the thyroid, protrusion of the eyeballs, nor trembling. The prognosis is grave. In most cases, as I have said, the disease steadily progresses, and leads to death after a varying period ; in others it may become arrested. Sometimes it disappears almost completely ; sometimes cure is incomplete, enlargement of the thyroid and ex- ophthalmia persisting in a modified degree. Treatment includes administration of drugs and surgical interven- tion. Patients should receive nourishing food, should live in the open air, and be rested or very moderately exercised. Electricity, especially in the form of the continuous current, has been recommended, the terminals being applied on either side of the heart. Hydrotherapy also has its supporters. Medication is chiefly symptomatic, and com- prises the administration of iodine, iodides, bromides, digitahs, valerian, and arsenic. A new method of treatment, which has been attended with improvement, and even with cure in some unlooked-for cases, ■consists in administering thyroid extract, or tabellas of iodothyrin. Encouraging results have also followed surgical intervention in Digitized by Microsoft® 278 CLINICAL VETERINARY MEDICINE AND SURGERY. connection with the thyroid gland and resection of the cervical sym- pathetic. I have made this short incursion into the domain of the other medicine in order to draw your attention to a disease which has scarcely been observed in animals, cases of which, however, if closely studied and carefully reported, would be of great interest from the point of view of comparative pathology. Digitized by Microsoft® XXXVIII.— ECZEMA IN THE DOG. Of all domestic animals the dog most frequently suffers from skin diseases. Dogs so affected are received into hospital at all times of the year, and a day never passes without your seeing a certain number in the clinique. The study of these diseases has been greatly neglected. Until a comparatively recent time, although the microscope had become a common instrument, the number of practitioners who used it to con- firm their diagnosis of cutaneous disease in the dog was distinctly small. The progress made in the field of human dermatology induced M. Megnin and some other veterinary surgeons to make a special study of diseases of the skin in domestic animals. At the present day the majority of such diseases in the dog are well recognised, and diagnosis is usually easy. Eczema, which was first separated from the various forms of mange, then from the dermatomycoses and the several varieties of dermatitis, still comprises a number of diseases, dissimilar as regards their appear- ance and course, but which will undoubtedly be differentiated later. At the present moment the word eczema cannot well be applied to a simple morbid condition, but refers to a group of dermatoses, of acute or chronic course, differing as to s3'mptoms and lesions, usually re- bellious to treatment, apt to return, and usually seen in combination with a special diathesic condition. Clinically, eczema appears as an eruptive dermatitis, commonest in animals with the above-mentioned predisposition, directly produced by external or internal causes, sustained by pruritus and the consequent scratching or rubbing, variable in character, development, and gravity. According to the degree of intensity it has been divided into acute and chronic forms. In many cases the former is only the first stage of a process which afterwards develops slowly, producing obstinate and often permanent lesions. It affects animals of all breeds and ages, seems almost equally Digitized by Microsoft® 2 So CLINICAL VETERINARY MEDICINE AND SURGERY. frequent in both sexes, but is particularly common during the second half of life. Apart from the eruption of distemper, young dogs seldom show more than ephemeral vesicular outbreaks quite different from the eczema of aged animals. The disease does not attack all regions with equal frequence, appearing to have a preference for the upper parts of the body like the head, neck, back, loins, and croup, and for the point of the elbow, groin, scrotum, tail, and interdigital spaces. When chronic and of old standing it may be more or less generalised. Then it is usually exceedingly rebellious about the back, elbows, hocks, in the ear, and at the extremity of the tail. At the beginning of any summary of the conditions favourable to the outbreak of eczema must be mentioned that important idea that eczematous eruptions are often subordinate to a constitutional condi- tion or diathesis ; in the case of young dogs to a lymphatic tempera- ment, in adults and the aged to a gouty diathesis, to obesity, and sometimes to diabetes. This general condition largely determines the occurrence of the disease, and demands special treatment : in certain subjects it produces disturbance in the functions of the stomach, intestine, and liver, mal-assimilation accompanied by auto-intoxica- tion ; conditions which favour the development of eczema, render it liable to appear under the influence of trifling causes, and may even constitute the primary factor. Many animals with rebellious eczema are also affected with chronic bronchitis, emphysema, or asthma ; and eczematous attacks not infrequently alternate with certain affections of the digestive or respiratory apparatus. Feeding also plays a part in the development of eczema : depending on the conditions under which the animal lives, attacks may be produced either by an exclusively vegetable or exclusively meat diet. Eczematous eruptions are generally preceded by cutaneous irrita- tion of variable character and intensity. They may be caused by clipping, repeated rubbing, pressure of the collar, the action of alka- line or acid solutions, or by external parasites affecting the parts which most commonly become diseased. Want of cleanliness and accumula- tion of dust or sebaceous secretions on the surface may readily bring about outbreaks. In certaia cases, on the other hand, they may result from excessive use of soap and warm or cold water. During the summer they are not infrequently produced by the action of the sun's rays on the skin. The part played by the circulatory and nervous apparatus in the genesis of eczema is still obscure. In dogs the symmetrical, slowly developing eruptions, apparently of nervous origin, are rare. Digitized by Microsoft® ECZEMA IN THE DOG. 28 1 Heredity exercises an unquestionable iniiuence. It depends on the transmission of a tendency to changes in the bodily fluids, or to general nutritive disturbance. Bacteriology had scarcely been raised to the rank of a science before attempts were made to found a parasitic theory of eczema. Eczematous patches exhibit a complex flora of micrococci and bacteria, whose role in the pathogeny of outbreaks is still undeter- mined. In point of fact, organisms may be found as abundantly, and in as great variety, on the healthy skin of neighbouring parts. Never- theless the microbes which multiply on eczematous spots are not without influence on the course and changes of the disease. They aggravate acute eczema, and partly contribute to the obstinacy of chronic forms. Nowadays the tendency appears to be in favour of admitting that human vesicular eczema results from the action of various cocci which occur massed in twos, fours, or larger numbers, and which either occupy the intercellular spaces, or are included within the cells forming the vesicle ; to these Unna has given the name of morococci. In impetigo, a disease now regarded as contagious and inoculable, pyogenic microbes, especially the Staphylococcus pyogenes albiis and aureus, appear to be the true agents of transmission. Whether it succeed to certain suppurating skin lesions or originate in trifling superficial solutions of continuity in the skin, this form essen- tially consists in infection of the papillary layer, and is characterised by pustulation, followed by more abundant secretion than that of ordinary eczema. But further research is necessary to determine the part played by microbes in the pathogeny of eczema. The chief causes of eczematous disease in the dog are cutaneous irritation, disturbed nutrition, improper feeding, and abnormal condi- tions of life, ^tiologically these skin diseases may be divided into two groups, under the titles of essential and symptomatic eczema. Essential eczema is directly induced by external irritation of any given portion of the skin. In dogs with fine skin it may be caused by mechanical, thermic, or chemical agencies ; by rubbing or repeated pressure ; by solar irritation ; and by the action on the skin of any of a large number of topical irritants. It soon disappears, without spreading. It appears to have no hold on the organism, and does not return unless the causes which have produced it are repeated. The pathogeny of symptomatic eczema is dominated by some internal causes, either of constitutional, alimentary, or nervous origin. Various changes in the body fluids resulting from previous morbid conditions, or from mal-assimilation, may produce it. Sometimes these internal influences are alone the cause ; sometimes, while giving Digitized by Microsoft® 282 CLINICAL VETERINARY MEDICINE AND SURGERY. rise to an excessively irritable condition of the skin, they are seconded by direct irritation, such as pressure, friction, or the action of cold or heat. What are the clinical anatomical characters of acute eczema ? The eruption appears in the form of little red spots, varying in size between that of a lentil and a pea, very closely massed together, and sometimes almost confluent. These hypersemic patches increase in size, their centres become thickened and prominent, and fresh patches form ; this stage constitutes papular eczema. When all parts of the diseased surface are inflamed and red the eczema is termed erythe- matous. In this case there is severe pruritus, which provokes incessant scratching. In some rare cases the papules disappear, the epidermis desquamates, and the congestion of the skin vanishes ; but almost always a little drop of serous fluid collects above the papule, which is then transformed into a vesicle ; the eczema has become vesicular. Almost as soon as formed the phlyctenae are ruptured in consequence of scratching ; resorption of the contents of vesicles is quite exceptional. The diseased surface is then more or less denuded of hair, the epidermis destroyed, and the papillary layer inflamed ; the exuded liquid is first serous, afterwards purulent ; it soon forms a viscous layer which exhales an offensive smell : at this stage the eczema is known as moist or secreting. Common eczema rubrum is only a variety of moist eczema characterised by marked redness of the skin, which is deprived of its epidermal covering. At this stage, which persists for some days, animals are usually brought for advice. Over the eczematous patch the hair is glued together by transuded liquid ; in long-haired dogs it forms a felted mass covered with a pseudo-membranous exudate ; the papillary layer is inflamed, swollen, red, finely granular, and extremely sensitive. The least touch produces pain ; quiet animals avoid examination, others may threaten to bite. On carefully examining the skin around the discharging patch, vesicles of recent formation may be seen. By for- mation of such vesicles in concentric zones the eczema spreads from the spot where it originated to adjacent parts. Having arrived at full development it may persist with these characters for three to six days, sometimes longer, after which the stages of recovery commence. But this regular course is not infrequently disturbed by various accidents which impart a special character to the cutaneous lesions. When inflammation is aggravated by rubbing, it may affect the deeper layers of the skin, which granulate, crack, or become wrinkled. In ordinary cases the liquid transuded by the papillary layer becomes Digitized by Microsoft® ECZEMA IN THE DOG. 283 converted into greyish or yellowish crusts, sometimes tinted brown by admixture of extravasated blood ; the eczema has become crustaceous. In some animals the superficial layer of the skin is infiUrated with pyogenic microbes and covered with yellowish crusts, beneath which suppuration continues; these crusts presently become lifted and cracked across, allowing the pus to exude ; the eczema is then known as impeti- gmous. Sometimes suppuration is scarcely apparent ; the crusts at first formed remain adherent, then dry up and fall away. In either case, once the crusts are shed the skin is seen to be still slightly swollen, reddish, and the seat of more or less abundant desquamation ; the eczema has become squamous. Finally, if recovery occur, the swelling, hyperaemia, and exfoliation disappear. In a short time the dermis resumes its normal condition, and hair commences to grow. We may summarise the successive stages of acute eczema as follows : — Redness and swelling of the skin ; papules ; vesicles, which may or may not become transformed into pustules and rupture ; dis- charge ; crusts ; desquamation. Development always follows a certain order, but in reality no skin disease offers more diversified appearances ; a series of eruptive attacks may occur at very short intervals ; sometimes the symptoms characteristic of these different stages are all present in one patient, and even confined within a very narrow area ; a dis- charging patch may be surrounded by vesicles, papules, or red areas ; the eruption may be localised, disseminated, or almost generalised, while secondary lesions not infrequently accompany those just men- tioned. The acute pruritus seen during eruption causes continual rubbing or scratching, sometimes leading to severe cutaneous inflam- mation and more or less extensive destruction of the papillary layer. If exposed and excoriated, the lymphatic vessels opening on the diseased surfaces, and the groups of lymphatic glands in which they terminate, may become inflamed. In generalised eczema — and by this term I wish you to understand not an eruption simultaneously affecting the entire skin, but the existence of disseminated, isolated, or partially confluent centres, vary- ing in age and characters, on the body, head, and limbs, — in this form, I say, one may see febrile symptoms and loss of appetite, the exacerba- tions coinciding with fresh extensions, and finally complications due to visceral lesions. An erythematous affection occurs, which in France is known under the name of rotige (red), but which has no connection with sarcoptic or follicular mange. It is, in fact, a form of eczema. The eruption affects parts where the skin is fine and almost bare, or where hair is scanty, especially the elbow, groin^ and inner surface of the upper parts of the Digitized by Microsoft® 284 CLINICAL VETERINARY MEDICINE AND SURGERY. limbs, sometimes even the lower surfaces of the thorax and abdomen. It is principally seen in young or adult animals, but the suggestion that it specially affects certain breeds is erroneous ; all are subject to it. It is characterised by reddening of the skin and acute itching ; where the hair is white the skin shows a reddish tint. On the inflamed skin little vesicles develop, which rupture, and are sometimes followed by superficial ulceration and trifling discharge. In the more obstinate cases a series of vesicular eruptions may occur ; the layers of the skin become swollen and covered with a layer of thickened epidermis marked by crusts and folds. Cases occur where this erythema, though at first localised, gradually extends along the sides of the thorax and abdomen behind, along the perinseum as far as the anus ; anteriorly along the lower surface of the neck as high as the head. In most patients the inflammation is particularly acute in the folds of skin around the elbow and groin, where the two surfaces of skin in contact become excoriated, and sometimes discharge rather abundantly. Apart from the common form of eczema, accidental cases occur of what Unna described in man ten years ago as seborrhceic eczema, characterised by a special inflammatory condition of the skin, epi- dermis, and sebaceous and sudoriparous glands, and by depilation of regular, sharply defined surfaces which gradually extend, and some- times heal at the centre. This seborrhoea is dry, squamous, or crus- taceous. As a rule the orifices of the sebaceous glands are obliterated in consequence of excessive growth of the epidermis, the glands them- selves being hypertrophied and the capillary follicles atrophied. Attacks of eczema have, as I said, a well-marked predilection for certain regions, though they may be found everywhere ; no portion of the skin is exempt. Some present special characters due to their position, such as eruptions on the eyelids, ear, scrotum, and inter- digital skin. Eczema of the eyelids causes marked swelling, depilation, acute itching, and conjunctivitis, with rather abundant discharge, which sometimes glues together the lids. That of the ear produces an offensive discharge, and gives rise, like the preceding, to acute pain, expressed by continual movement of the parts ; sometimes the skin of the external auditory meatus is much swollen, and the conduit itself obstructed. Eczema of the scrotum is remarkable on account of the swelling and very acute hypersesthesia of the inflamed surface, and the abundance of the discharge. That of the plantar region and inter- digital space produces lameness ; sometimes it is followed by sup- purating dermatitis of the paw, which may become complicated with sinus formation difficult to cure. Many cases of eczema at present under treatment in hospital are Digitized by Microsoft® ECZEMA IN THE DOG. 285 localised on the body, neck, and ear. In one the upper surface of the neck, shoulders, and back presents a large inflamed patch partially denuded of hair, and almost entirely covered with a viscous, yellowish, purulent material ; the skin is thickened, infiltrated, and shows trans- verse folds ; the periphery of this patch is sharply circumscribed by a deep red sinuous line, outside which is a narrow hyperamic zone. In another the lower surface of the neck is the seat of an eczematous zone offering nearly the same characters. A third showed a few days ago a discharging and very painful area on the back. The process has now arrived at the period of desiccation ; the skin is covered with thin crusts, is no longer so sensitive, and is hardly swollen. In a poodle affected with double otitis externa, marked by abundant discharge and great sensitiveness, the integument lining the external ear is still swollen and red, but the discharge has greatly diminished, is no longer offensive, and the itching has disappeared. Another case shows auricular eczema complicated with othasmatoma (oedema of the flap of the ear) ; the incessant shaking of the ears has caused separation of the skin from the subjacent tissues, and the formation of a cyst prominent on both surfaces of the flap of the ear. Histological study of the lesions of acute eczema shows that the process is generally limited to the superficial layer of the dermis. The rete mucosum is the seat of oedematous inflammation, and of a more or less abundant immigration of lymphatic cells ; the epidermis is swollen and softened by the exuded serosity, vesicles form, and the epidermis becomes detached or exfoliated. The vesicles develop be- tween the rete mucosum and the stratum corneum ; they contain a serous liquid, leucocytes, large polynuclear epithelial cells, and micro- cocci. The more intense the inflammation, the greater the amount of exudate and the more abundant the infiltration of leucocytes. The inflammatory changes extend to the entire thickness of the corium, in which purulent centres may develop, partial destruction of tissue occur, and portions of the papillary layer be lost in consequence of external irritation. To sum up, acute simple eczema is an exu- dative inflammation affecting the dermis and epidermis, and producing lesions comparable to those of a superficial catarrh of the skin. Digitized by Microsoft® XXXIX.— ECZEMA IN THE DOG (CONCLUSION). Chronic eczema, which is very common in old dogs, succeeds to acute attacks ; or may develop as a primary condition, and then pre- sents the characters of the squamous form. It also most frequently affects the upper regions of the body ; in some patients it is confined to the limbs, and more particularly to the elbows and hocks. It may continue in the dry stage indefinitely, though, as pruritus is generally severe, certain spots are apt to become irritated by scratching or rubbing, and moist discharging areas develop in consequence. For this reason most animals with old-standing eczema show recent areas alongside others of much older standing. The affected surfaces in chronic eczema present an appearance resembling lichen ; the hair is shed, or the sparse covering left is rigid and patchy ; the skin is thickened, dry, and squamous, often has a granular or verrucous appearance in consequence of hypertrophy of the papilla;, and is usually deeper in colour than that of neighbouring parts. The process produces hardening (sclerosis) of the skin, and leads to hyperplastic and atrophic changes ; the cells of the dermis, the glands, and the capillary follicles gradually undergo change, and may partially disappear. In spite of exfoliation of the superficial layers of the epi- dermis this portion of the skin remains of considerable thickness. As in the acute form, circumscribed patches are sometimes seen which remain obstinate, and very rebellious to treatment. In the dorso-lumbar region eczema often extends over very large spaces, and in old-standing cases produces excessive thickening and folding of the skin. In the limbs the disease affects the elbows, hocks, and digital region ; in some animals it ends by producing suppurative dermatitis, marked by the formation of numerous little abscesses containing blood- stained pus, and offering almost the same appearance as follicular mange. Eczema of the tail sometimes extends to the greater part of this region, or appears as a large number of small disseminated areas, but is most frequently localised at the extremity, the skin covering which is inflamed and swollen, and its superficial layer ulcerated, whence the Digitized by Microsoft® ECZEMA IN THE DOG. 287 name "cancer of the tail;" the remaining hairs at this point are stiff, dry, and fragile, and the end of the tail is often indurated for a distance of an mch or more. The diseased parts are often bitten or otherwise injured, causing bleeding and acute recurrences of inflammation ; in this way the disease may be prolonged for months. In exceptional cases eczema may produce marked thickening of the epidermis cover- ing the caudal extremity, and the growth of little confluent horny patches. Chronic eczematous inflammation of the auditory meatus produces thickening of the lining membrane, sometimes ulceration or hypertrophy of the papillae, and vegetations which obstruct the passage. The symptoms of eczema are sufficiently characteristic in most cases to permit of diagnosis solely by clinical examination. If there is any doubt, it becomes necessary to carefully examine all the affected parts, their appearance and character frequently allowing of an opinion being given without recourse to microscopic examination. Eczema can always be differentiated from the eruption seen during distemper, from favus and tinea tonsurans, and from various traumatic lesions of the skin ; but certain forms may be mistaken for sarcoptic, and others for follicular mange. We recently saw a dog which showed a patch of impetiginous eczema on the neck, closely resembling follicular mange, and eczematous areas often simulate recent sarcoptic mange. In these cases the question can only be decided by microscopic examination of material obtained by scraping the diseased surfaces with a scalpel. The prognosis of eczema is more serious than that of other skin diseases of the dog, except follicular mange and suppurating derma- titis. It is not particularly difficult to temporarily cure animals, but the disease frequently reappears after a varying interval. Although all forms of eczema are not equally grave, the majority imply the existence of a constitutional condition which dominates the appearance of disease. The prognosis is more favourable in acute than in chronic eczema, and in localised than in the more or less generalised forms. Eruptions on the ear, foot, and tail are difficult to completely cure in certain anirhals, especially in those beyond middle age. Various com- plications are possible. Thus eczema of the ear may be accompanied by ulceration of the base of the conchal cartilage — auricular canker ; by othsematoma, by abscess formation at the base of the ear in consequence of rubbing, and later by deafness ; eczema of the eyelid is sometimes complicated by entropion, or even by ulcerative keratitis ; and eczema of the scrotum may be followed by orchitis due to rubbing, by which the animal seeks to allay pruritus. Whatever the seat of Digitized by Microsoft® 258 CLINICAL VETERINARY MEDICINE AND SURGERY. the eruption, intra- or hypo-dermic abscesses and loss of substance of the skin aggravate the eczema and leave cicatrices. Finally,, the animal's mode of life plays a certain part ; in lapdogs eczema is more rebellious, and relapses more frequent than in others. The treatment of eczema is complex. Many practitioners confine themselves to local treatment, but in most patients durable results can only be obtained by internal medication, and change in the method of feeding. The local treatment of acute eczema is best commenced as follows: — The hair should be clipped from the diseased surface, and if the eczema is extensive and generalised the animal should be shaved ; the skin is next washed with soap and water, or with warm boric solution, dried carefully, and afterwards protected as far as possible from irritation ; in pet dogs the rug usually may require to be removed, and in no case should a collar be used if an area of eczema is developed on the skin of the neck. In moist eczema, once the diseased surfaces are cleansed and dis- infected the best local treatment usually consists in topical dressing with powders, with which the parts are dusted two or three times per day. Among such are starch, talc, subnitrate of bismuth, oxide of zinc, or a mixture of these substances. In pet dogs these powders may be slightly perfumed, and rice powder substituted for starch. If the skin irritation is very acute, warm lotions containing chloral hydrate, or 3 to 6 per cent, bicarbonate of soda solution ; or, again, very dilute alcohol, with the addition of i per cent, of carbolic acid, may be used ; and the parts afterwards dressed with a preparation of glycerine, or an ointment containing the same proportion of carbolic acid. In the limbs, and other regions which the animal can reach, eczema is often kept up and aggravated by licking. The diseased surface must then be protected with a cotton-wool dressing. Slight cauterisation of the inflamed surface has sometimes been practised, for which purpose either 10 per cent, nitric acid or 5 to 6 per cent, nitrate of silver solution may be used. The spots are swabbed with one of these preparations by means of a brush. This produces a superficial eschar, and leads to the formation of a thin protective crust, under which the skin dries and the epidermis is renewed. In acute eczema especially, lotions and repeated baths are incon- venient ; water irritates the skin, keeps up or even increases the inflammation, and may produce fresh eruptions. In impetiginous eczema the pus collected under the crust may be gently squeezed out, the crusts themselves removed with small tampons Digitized by Microsoft® ECZEMA IN THE DOG. 289 of cotton wool, and an antiseptic dressing applied. One may also use with advantage 5 per cent, aqueous solution of carbolic acid or of formalin ; pure glycerine, or glycerine containing a trifling proportion of iodine ; zinc ointment ; vaseline, or lanoline. The three latter can either be used alone or with the addition of small quantities of talc, oxide of zinc, boric acid, salicylic acid, or resorcin. The following are useful formulas : (I) li Vaselme . Wax Oxide of zinc . (2) R Vasehne or lanoline Oxide of zinc . (3) R Vaseline . Talc . Oxide of zinc . (4) B Vaseline . Oxide of zinc . Salicylic acid . Resorcin . 100 parts 20 J? 20 >y Equ al parts 100 parts. 50 >) 50 ?j 100 parts. 50 ) J 5 J> In the squamous forms of eczema tar and creolin are the applica- tions commonly used. The tar may be applied either dissolved in alcohol or mixed with green soap. (i) R Tar ...... 100 parts. (2) (3) Alcohol . Tar and green soap Creolin Green soap Alcohol 50 „ Equal parts. 50 parts. 50 „ 25 „ The chosen preparation is applied in a thin layer to the diseased parts ; crusts form and crack, and can be removed at the end of a week. The appearance of the skin indicates whether a second applica- tion is necessary. When the skin is moist these preparations are inferior to powder dressings. The seborrhoeic form is treated by the application of glycerine of starch and oil of cade in equal parts ; by ointments or glycerina con- taining 5 per cent. pyrogalHc acid, 5 to 10 per cent, salicylic acid, or 10 per cent, of sulphur. In treating chronic eczema the chief points consist in softening and detaching the crusts or scales, disinfecting the diseased surfaces, and protecting the hypersemic skin from irritation. The crusts are softened and cleared away by applications of vaseline, and by washing Digitized by Microsoft® 290 CLINICAL VETERINARY MEDICINE AND SURGERY. with Castile or glycerine soap. The skin is afterwards dressed with a warm solution of bicarbonate of soda, or better still with one of the liniments just mentioned in speaking of squamous eczema. The parts are occasionally washed with soap and boiled water, to which has been added i to 2 per cent, of creolin, or with the solution of bicarbonate of soda. Many other preparations, and certain new drugs like ichthyol, anthrarobin, chrysarobin, and pyoctanin, have been recommended during the last few years, but are in nowise superior to the applications usually employed. Internal medication is useless against eczema resulting from purely local causes, but in practice it is impossible to clinically distinguish between such attacks and those of constitutional origin ; when the disease is chronic and rebellious internal medication is always indi- cated. In eczema there is no unique general treatment, and no drug can la\' claim to the character of a specific. Neither alkaline nor arsenical preparations suit all cases. Although the former are valuable at various stages of the disease, they are particularly useful in fat or obese dogs ; bicarbonate of soda may be given in the food in doses of 15 to 90 grains per day. Purgatives are useful in acute eczema ; under their influence the cutaneous patches dry more readil}'. Arsenical preparations, especiall}' Fowler's solution, are valuable in the chronic forms. Fowler's solution is given in doses of i to 6 drops per day. Mineral waters like \'ichy, Evian, or La Bourboule, may be prescribed, especially for pet dogs, and can be given pure or mixed with milk. Sublimed sulphur in daily doses of 15 to 30 grains, cod-liver oil and iron salts also have their use. Finally, it must be borne in mind that hygiene, diet, and healthy surroundings have an unquestionable influence on the development of eczema. Depending on its constitution or bodily condition, the patient should either be confined to light nourishment, to meat, boiled milk, or to various preparations of milk, or may receive a mixed diet. In general the number of meals should not be diminished, but the total daily nourishment should be cut down. If the patient is fat it must be reduced to a minimum diet. Pastry, etc., should be forbidden. Animals leading a confined life should receive regular exercise. In the dog good hygiene and carefully regulated diet often have at least as much effect on the course of eczematous attacks as an}? drug. Many of our patients are under unfavourable conditions for complete cure, so that when their condition can only be improved it is usually better to return them home, arrangements being made for steady exercise, open-air life as far as possible, carefully regulated diet, and ever\- week or two internal treatment. Digitized by Microsoft® XL.— ECZEMA IN THE HORSE. A FEW days ago you saw in the clinique a horse with recent skin disease, indicated by symptoms resembling those of granular dermatitis. This peculiar appearance had struck the veterinary surgeon who sent the animal to me. He pointed it out, and suggested that the disease resembled the " heat spots " seen during warm weather. On examining the patient we found three swollen patches covered with yellowish-grey broken crusts, from between which a sticky, serous fluid escaped. One of these patches, situated between the elbows, was oval in shape and a little larger than a man's hand ; another on the near fore-leg was limited to the external surface of the canon-bone and fetlock ; jthe third, in a similar situation on the off hind leg, was rather larger in size. I will give a summary of the clinical history of this animal. Bay brown, seven-year-old gelding, of lymphatic character, brought for examination and left for treatment on the 6th March. Being attacked with bronchitis towards the middle of last January, this animal was rested for nearly three weeks. Since convalescence it has worked little. The skin affection originated about a fortnight ago. Three patches, from which the hair fell away and discharge occurred, successively appeared, one on the near fore-limb, one on the off hind, and one on the chest. State on Examination. — The patches are situated as follows:— The first on the outer surface of the fetlock and pastern of the near fore- limb ; the second between the elbows ; the third on the antero-external surface of the right hock. The latter has the most striking appearance. At the present moment almost its entire surface is denuded of hair and discharging. At certain points the exudate is serous and trifling in amount ; at others there are little erosions covered with a thin, sticky, yellowish layer formed of dry exudate ; when exposed the dermis is of a more or less bright red, and appears finely punctated. In other places, Digitized by Microsoft® 292 CLINICAL VETERINARY MEDICINE AND SURGERY. where inflammation is more intense, granulations have developed, rising a few millimetres above the level of the skin, and secreting a sero- sanguinolent liquid, which, together with the epidermal cells, etc., forms a material gluing together the hairs surrounding the patch. The patch itself is encircled by a band of skin covered with vesicles resulting from a fresh attack. Sensation is not specially acute at any point, but there is intense pruritus, which the animal betrays by biting or continually rubbing the parts. Despite the use of a cradle it still attempts to bite, and has several times rubbed the diseased spots, causing them to bleed. There is no lameness. The patch on the near fore-limb is less bare than the preceding ; its upper part is becoming dry, but its lower still discharges. At first sight the disease recalls horse-pox, or a recent attack of grease, but the offen- sive odour and the vegetations characteristic of the latter are absent. Examined more closely, this surface shows the same characters as the patch on the right hock. There is a certain degree of itching and of local swelling, but no lameness. The third patch occupies the entire space between the elbows and the upper internal surface of both fore-limbs. It is covered with pale yellow, thin, sticky crusts, while the skin is swollen, infiltrated, and shows a series of broad folds separated by depressions in which secre- tion is abundant. Like the two others, this patch is the seat of extreme pruritus. The continuous movement of the limbs keeps up acute inflammation. The general condition is good. The principal functions are normal. The characters of the patches, the presence of isolated vesicles around them, their almost simultaneous appearance in several separate spots, and their mode of development, leave little doubt as to the dia- gnosis. The negative result of inoculation with the exudate clearly shows the condition to be moist eczema. Treatment consisted in clipping away the hair from around the patches on the limbs, disinfecting the surfaces with warm creolin solution, drying, and applying a powder composed of four parts starch and one part oxide of zinc ; finally, administering internally sulphate and bicarbonate of soda. Considerable improvement was noted from the third day. The patch on the near fore-limb discharged less, except under the pastern, where in consequence of movement the granulations had been torn through. In the off hind limb the disease had extended to the lower portion of the canon-bone and fetlock, developing with great rapidity ; eruption, vesiculation, and rupture of the vesicles occurring in twenty- four to forty-eight hours. The patch between the elbows was much Digitized by Microsoft® ECZEMA IN THE HORSE. 293 less swollen ; the crusts were thinner, and on being removed revealed a rose-coloured granulating surface. On the 13th improvement continued. The diseased surfaces on the fore and hind limbs were almost completely dry, and in a fair way to heal. Nevertheless around the flexures of the pastern and hock the continued movement had resulted in formation of superficial cracks. These were dressed with boric vaseline. On the 15th these two patches were entirely healed, and the third discharged less abundantly. On the 2oth the surface between the elbows had become dry. The foregoing gives an exact idea of the characters of the skin lesions in our patient. Certainly they in no way resemble those of granular dermatitis. Apart from the fact that this disease neither appears nor returns at the present time of year, the superficial lesions that you saw had not the essential characters of this parasitic der- matitis ; the skin was only moderately swollen, the diseased surfaces were only granular at certain points in consequence of mechanical irritation, and the pruritus rapidly diminished. Nor was the disease like urticaria or any form of mange, which usually occupies positions and shows symptoms entirely differing from those we noted. As to horse-pox, the cutaneous lesions of which often simulate acute eczema, we eliminated it by the negative results attending inoculation of several horses. The disease was a simple eczematous eruption, the most striking features of which were its position and the small extent of the affected surfaces. During two of our preceding lectures I devoted considerable atten- tion to the stages of development and different forms of eczema in the dog. To-day I wish to speak of the same disease in the horse, in which, however, it is much less common than in the dog. The forms seen include acute and chronic, sometimes generalised, sometimes con- fined to certain regions. The disease is usually more or less generahsed. A discrete papular eruption appears, accompanied by itching; the points soon become more numerous, the itching increases, and the papules are converted into vesicles and burst spontaneously, or are ruptured by rubbing. Where the skin is fine the eruption is often vesicular from the first. The contents of the blisters spread over the skin, glue together the hairs into little tufts, and afterwards dry, forming small yellowish or greyish crusts, sometimes deeper tinted on account of the blood Digitized by Microsoft® 294 CLINICAL VETERINARY MEDICINE AND SURGERY. present. Trifling suppuration occurs, raising and detaching the crusts, which carry with them a portion of the hairs covering the skin at that point, and thus produce the bare surfaces seen during the final stage of the eruption. The crusts having fallen suppuration ceases, the dermis again becomes covered with a thin dry layer, under which the epidermis re-forms, and the skin gradually resumes its normal ap- pearance. Some weeks ago you saw in an eight-year-old cart-horse a remark- able outbreak of generalised eczema. The skin of the trunk was dotted over with small greyish circular crusts a few millimetres in thickness, over which the hairs were glued together in tufts. The disease had appeared about ten or twelve days before. This horse first showed loss of appetite and depression, followed by the sudden eruption of vesicles over a wide surface. When brought here we noted nothing abnormal save the cutaneous disease ; neither the animal's general health nor the various functions were in the smallest degree disturbed ; not even the mucous membranes showed anything unusual. Successive attacks of an acute or subacute character may develop, a fresh eruption occurring before the disappearance of the preceding, so that lesions of varying age are often associated and combined, forming a complex polymorphic clinical picture. In some cases the skin finally becomes almost entirely covered with crusts. Instead of thus extending, eczema may be limited to certain regions. It is commonest in those exposed to mechanical irritation, like the head, withers, front of the shoulders, back, croup, and girth, where the different portions of the harness exercise pressure and continual friction; behind the elbow, or in the groin, where the folds of skin, which are frequently covered with sweat, produce mutual friction during movement ; on the flexion surfaces of the joints of limbs, especially the lower joints, where the skin forms folds and is ex- posed to the action of wet or mud, or is covered with scurf, dust, or manure ; on surfaces covered with long hair, such as the upper margin of the neck and tail (parts specially affected by parasites, like lice and trichodectes), and at points where the skin is kept moist, or is not cleaned. Circumscribed eczematous patches show the same features as the generalised form. Once the vesicles rupture, the skin, as in exudative dermatitis, is seen to be swollen and discharging, while the margins of the inflamed areas still exhibit a few vesicles. Instead of terminating in recovery eczema may assume the chronic form. The skin becomes thickened, wrinkled, irregular, and squamous ; sometimes it is covered with thick crusts, or shows superficial cracks. Digitized by Microsoft® ECZEMA IN THE HORSE. 295 This chronic eczema produces permanent changes in the skin. The chief consists in more or less abundant cellular infiltration of the corium, especially around the folds ; dilatation of the lymph vessels ; hyper- trophy of the papillse ; and sometimes a fibrous change in the dermis, with atrophy of the glands and hair follicles. The changes, in fact, are those of sclerosis. Eczema especially tends to become chronic in parts irritated by harness and in the flexures of the knee, hock, and phalangeal joints. For a long time all transverse cracks in the skin over the flexures of joints were wrongly considered simple accidents, due to physical, chemical, or thermic causes. Undoubtedly many cases are due exclusively to local influences — during cold weather to the action of snow, mud, or water ; but the transverse cracks which develop in these regions and prove so obstinate (mallenders and sallenders) are often eczematous in character. Their astiology is dominated and their persistence and chronic character explained by some peculiarity in the animal's constitution. Last month you saw in the external clinique a seven-year-old Norman horse which had been ineffectually treated for nearly a year for numerous comparatively superficial cracks under both front pasterns. The choice of applications had certainly not always been happy. Previous to coming here the parts had been dressed with an ointment containing lard, which had formed a layer of decomposing irritant material, contributing in no small measure to the continuance of the disease. We prescribed local antiseptic treatment and internal medication. The horse returned here a few days ago, and you saw that already great improvement had occurred. I have collected a number of similar cases in which success appeared due, in part at least, to internal treatment, a fact which shows how far these attacks are dependent on the general state of health, or on some disturbance of nutrition. In the horse cases of essential as well as of symptomatic eczema are seen, but almost all obstinate attacks depend on some disturbance in the general health. As I said before in speaking of canine eczema, it is probable that microbes living on the skin, or at least some of them, play a part in pro- ducing certain forms of eczema, though even in " grease " this part is at present ill-defined. In the horse certain eczematoid diseases of the foot and lower parts of the limbs are remarkable both for their clinical appearance and obstinate character. Chronic exudative and hypertrophic dermatitis of the pastern — vulgarly known as "grease" — is characterised by a dis- Digitized by Microsoft® 296 CLINICAL VETERINARY MEDICINE AND SURGERY. charge, by staring of the hair, and by verrucous growths due to hyper- trophy of the papillary layer. Chronic vegetating dermatitis of the foot — canker — produces similar hypertrophic changes in the horn- secreting structures of the sole, principally in the velvety tissue, at the same time destroying a greater or less area of the horny sole. Chronic dermatitis of the coronet — inflammation of the perioplic ring — pro- duces disturbance in the secretion of periople and increases and hardens the superficial layers of skin around the coronet. Whilst the latter disease is principally seen in plethoric or nervous patients, the two former (whose development is favoured by the local action of moisture and of urine, etc.) are almost always confined to lymphatic animals, and may be regarded as special morbid conditions having a distant connection with the usual forms of eczema. The prognosis of the various forms of eczema, in the horse is favourable. In the acute forms recovery is easy and almost always rapid. The chronic forms generally yield to suitable local and general treatment. Mallenders and sallenders, which may also involve lame- ness, are the most obstinate complications. In acute eczema the first indication is to thoroughly cleanse and protect the diseased surfaces from irritation. If secretion is abundant, absorbent powders, like simple starch powder, or starch powder with the addition of a little bismuth or oxide of zinc, may be used. Gly- cerine, iodine-glycerine, more or less strong antiseptic solutions, and a large number of ointments have also been successfully employed. The good results obtained from all these agents are easy to explain, inasmuch as we know that in acute eczema recovery occurs spontane- ously in a period seldom exceeding three weeks to a month. Where itching is very severe, ointments or glycerina containing i per cent, of carbolic acid, or analgesic preparations like solutions of cocain may be tried, though the latter require frequent application. If the attack is prolonged or recurrent, internal treatment becomes necessary. Arsenious acid, Fowler's solution, alkalies, or even iodide of potassium may be used. In certain cases the diet requires to be changed. In chronic eczema the diseased surfaces must first be cleansed, either with water alone or with soap and water, and the process repeated sufficiently often to keep the skin perfectly clean. After drying, the parts may be dressed with vaseline, containing carbolic acid or creolin, or with one of the liniments recommended for the dog. Occasionally it is very useful to apply a surgical dressing for several Digitized by Microsoft® ECZEMA IN THE HORSE. 297 days, in order to protect the diseased skin from irritation. This method is particularly valuable when animals affected with eczema about the lower parts of the limbs are obliged to work in wet weather or on muddy roads. Internal medication comprises alkalies and arsenical preparations, which may be given alternately for periods of a fortnight ; bicarbonate of soda in daily doses of one to two ounces, followed by arsenious acid in daily doses of seven to fifteen grains. Between the two courses treatment should be suspended for intervals of one week. Chronic vegetating dermatitis of the pastern (grease) is treated by cleansing the skin with warm antiseptic solutions, and applying astrin- gents or slightly caustic preparations daily, or at intervals of several days. Villate's solution, 5 to 6 per cent, solution of sulphate of copper, 2 per cent, solution of chromic acid, and "2 to '3 per cent, watery or alcoholic solutions of sublimate, or of formalin, appear to give the best results. Chronic dermatitis of the coronet is dealt with by applications of tar, of tar and vaseline, or of slightly caustic solutions, and by thin- ning the wall of the hoof opposite the diseased spot. Vegetating dermatitis of the foot — canker— necessitates exposure of the entire invaded surface of the sensitive sole and excision of the vegetations. The parts are then dressed with antiseptics, astringents, or caustics, care being taken, however, not to destroy the dermis and subjacent tissues, In these forms of dermatitis it is also well to administer some pre- paration of arsenic. The drug is given for periods of a fortnight, treatment remitted for a week and again continued. In this way arsenic may be employed for long periods. Digitized by Microsoft® PART III. CLINICAL CASES. I.— HEAD AND SPINAL CORD. \.— CRANIUM, BRAIN, AND SPINAL CORD. SUPERNUMERARY TOOTH IN THE TEMPORAL REGION— OPERATION- SUPPURATING MEDIAN OTITIS. I. Three-year-old gelding, left in hospital 23rd January, 1897. About two months previously a gradually increasing swelling had appeared at the base of the left ear. On the 20th January a long streak of pus was seen running over the face. A veterinary surgeon who was consulted spoke of operation, and recommended the animal being sent to Alfort. Condition on Entry. — A hard swelling, as large as a hen's egg, and of bony consistence, was seen a little in front- of the base of the left ear. On the anterior surface of the scutiform cartilage was a sinuous orifice, which discharged considerable quantities of greyish pus. Diagnosis. — Supernumerary tooth (dental ectopia). Treatment. — On the 25th January the animal was cast by means of Daviau's table. After clipping away the hair and preparing the parts the sinus was explored, and found to be about 4 inches in depth, and to terminate over a dental prominence. The skin was incised for a length of 35- inches over the swelling, parallel with the long axis of the head. The margins of the wound were drawn apart, and the super- numerary tooth exposed by a second slight incision. The tooth, which was fixed in the temporal bone over the origin of the zygomatic pro- cess, could not be removed with the strong dental forceps used. It was therefore left in position. The wound was cleansed and a plug of iodoform gauze applied, over which the lips of the wound were reunited by a few sutures. The tampon was removed next day. During the next few days the cavity was washed out with an anti- septic night and morning. At the owner's request a further operation was undertaken on the 2nd February. The animal having been cast the tooth was again freely exposed, Digitized by Microsoft® SUPPURATING MEDIAN OTITIS. 299 though a fresh incision was not necessary. The wound having been dis- infected a groove was cautiously excavated around the tooth by means of a gouge and hammer, and unsuccessful attempts made to loosen it. As, however, the tooth was very deeply implanted, and extraction might possibly have caused injury to the brain, the operation was stopped. The wound was cleansed and plugged with iodoform gauze, the skin brought together with a couple of sutures, and the horse allowed to rise. Although every precaution had been observed the animal showed grave symptoms. The head was held pendent, a little inclined to the left ; movement was very difficult ; the fore-limbs were planted wide apart, and yielded on movement, allowing the animal to fall on its knees. It at once rose, but was unsteady on its legs. A deep bed of straw having been spread around it, the patient lay down. It rose in half an hour, and was then placed in its box. During the evening it took some sloppy food. Next day it was found standing but greatly depressed ; the head was held low and still inchned to the left ; the fore-limbs were planted widely apart. The animal was led out and moved a few steps ; the gait was slow, uncertain, and vacillating. At certain moments rolling of the eyes occurred. The wound was washed and plugged with iodoform gauze. On returning to its box the animal attempted to eat. It took some sloppy food and a little hay. At first we suspected intra-cranial haemorrhage, but as the circulation and respiration became more rapid, and the temperature rose to 40-3° C. (104-5° F.),* we concluded that the mechanical injury was complicated with meningo-encephalitis. Affu- sions of cold boric solution were made to the head, the wound was washed with 2 per cent, creolin solution, iodide of potassium was given, and the food confined to mashes and milk. On the 4th February the respiration was rapid and short, 36 per minute; temperature 39-8° C. The pulse was very small and un- countable. On the 5th the respiration was still rapid and the pulse feeble. The animal was sleepy, had no appetite, and only seemed able to masticate its hay. Although held very low the head was less inclined to the left, and movement was less painful. Temperature 39-4° C. Treatment as before. The evening temperature rose to 41° C. ^ On the 6th the condition remained the same ; temperature 40 C. Next day there was slight improvement ; temperature 39-6° to 39-9° C. Respiration was less rapid; appetite fair; difficulty existed in swallowing. ,. , ■ j -ru On the 8th the general condition was a little improved, the patient left the corner of the box in which it had been standing, moved about with some freedom, and ate its oats and mash. Hay and straw were slowly chewed, the food dropped out of the mouth and again picked up ; occasionally a little was swallowed, but with * As the Centigrade scale is now largely used, and the constant addition of the Fahren- heit temperature would prove very cumbrous in these clinical records, I have prmted in the Appendix a comparative chart showing the exact equivalent on the Fahrenheit scale of any ^iven Centigrade temperature. To this readers are kindly referred.— J no. A. W. D. Digitized by Microsoft® 300 CLINICAL VETERINARY MEDICINE AND SURGERY. great difficulty. The eyelids were swollen, the eyes discharging, the mucous membranes injected, the pulse 48, respirations 24, tem- perature 39'5° C. That evening the animal was greatly depressed; it even left its mash. Pulse 60 ; respirations 20 ; temperature 40*2° C. From the gth to the 12th the condition became aggravated, and the comatose symptoms more marked. The temperature varied be- tween 40° and 41° C. Death occurred during the night between the 1 2th and 13th February. Autopsy. — The lung contained several metastatic abscesses as large as a hazel-nut, and a considerable number of smaller sized gangrenous spots. The guttural pouches were full of a liquid grumous pus. On saw- ing through the mesial line of the cranium its internal surface appeared healthy, and the meninges of the brain were only slightly injected. The left ear showed deep-seated suppurative otitis ; the middle ear was full of foetid pus. In spite of the precautions taken during operation the petrous temporal bone had been fractured and the wound infected. Pus collected from the ear and from the pulmonary abscesses contained streptococci. The tooth passed obliquely downwards and slightly backwards through the entire thickness of the temporal bone. [An interesting article on dentigerous cysts will be found in The Veterinarian for 1899, p. 309.] TUMOUR OF THE RIGHT HEMISPHERE OF THE BRAIN. 2. A five-year-old entire horse, brought for examination on the i8th August, 1896. For some time past this horse had shown signs of " immobilite " (ventricular dropsy of the brain). It became useless for work, no longer obeying the rein and stumbling over obstacles in the road. On first examining the animal we were struck by its peculiar attitude. The head and neck were stiff; the neck was slightly concave on the right side ; the head was inclined downwards and towards the left. At rest the animal appeared unsteady on the limbs of the near side. When alone in its box it brought the legs closely together, half flexing the fore-limbs as though about to lie down ; then it began to turn towards the right in an ever-decreasing circle until it pivoted on the hind limbs ; finally it swayed and fell on the right side. It showed great difficulty in rising, and had to be assisted. The hind limbs appeared almost helpless. If the fore-limbs were crossed the animal remained in this position, like a horse with " immobilite." It was quite unable to walk in a straight line, but continually turned towards the right, and could not be made to trot, though it was able to back with ease. The lumbar region was excessively sensitive, and pressure over it caused the animal to fall. Vision was abolished in the right eye ; the eyelids were mobile ; the pupil was dilated ; the various media of the eye showed no disturbance. Examined with the ophthalmoscope, the papilla appeared markedly hypersmic ; the vascular strise were very visible, especially towards the margins. Hearing seemed less acute than normal. Digitized by Microsoft® TUMOUR OF THE RIGHT HEMISPHERE OF THE BRAIN. 30I The lips and tongue were not paralysed. Mastication and de- glutition were normal, and the appetite was perfectly good. General sensation was diminished, except in the region of the head and limbs. The animal was moderately nourished. Temperature 37"5° C. ; pulse 56 ; respirations 14. During the few days the horse was under observation the S3'mptoms remained without notable change ; there was no vertigo or excitement. On the evening before the animal was slaughtered it fell on the right side, and was unable to rise again. Autopsy. — The lesions were confined to the brain, the surface of \\'hich, however, showed nothing abnormal. On the inner surface of the right hemisphere, in the white substance, was a large softened area occupying almost all the upper part of the ventricle ; it measured 3j- inches from front to back, about 2 inches transversely, and about I to I of an inch in thickness, depending on the spot measured. It was not clearly circumscribed, and penetrated in various directions into the grey substance. Throughout its entire extent the nervous sub- stance was of a reddish-grey tint, resembled jelly, and of semi-liquid consistence ; the surface of sections showed a few small hsemorrhagic spots. Studied after hardening in chromic acid, the morbid tissue seemed formed of cells with large nuclei and a small amount of protoplasm, isolated or united in little groups, and provided with long processes forming a kind of reticulum, the meshes of which contained round- cells. The growth was, therefore, not produced by degeneration, as we had at first supposed, but was a true tumour, the particular form being that known as glioma. TUMOUR OF THE RIGHT HEMISPHERE OF THE BRAIN. 3. A seven-year-old greyhound bitch, left in hospital 7th October, 1893. Like most of such animals, this bitch was very irritable. As testified by her own owner, in whose possession she had always been, her health had until the commencement of 1892 been uniformly good. At that time a tumour had been discovered in the mammary gland, and had been removed by a veterinary surgeon. The operation wound healed rapidly. During October another tumour appeared in the gland, and in July, 1893, was removed. The wound closed rapidly. Some weeks later the animal showed a hoarse, dry cough, which occurred in prolonged attacks, and was followed by attempts at vomiting : the attacks became progressively more frequent. The patient soon lost breath when walking, and was regarded as asthmatic. During August and September she was taken to the sea-side by her owner. There, we were told, her condition improved, until one da}- during a walk in the country she came too near a cow, and began to run, yelping loudly ; suddenly she stopped, her limbs became stiff, she fell senseless, and remained in that condition for twenty minutes. Although no trace of injury could be seen on the surface of the body, it was thought that she had been kicked. Having been taken home, she Digitized by Microsoft® 302 CLINICAL VETERINARY MEDICINE AND SURGERY. several times during the evening showed signs of violent excitement. Next day she had regained her usual condition. A fortnight later fresh attacks occurred without any evident cause. When they came on, the patient, if standing, was taken with cramp ; the fore-limbs were stretched out to their fullest extent, then the hind limbs collapsed ; the animal fell towards the left and remained pros- trate, the entire body trembling; sometimes she howled as though in pain. During these attacks, which lasted from ten minutes to a quarter of an hour, the head was strongly inclined to the left. Towards the end of September the disease became aggravated ; the appetite, which had previously been good, gradually diminished, the animal remaining for whole days without taking food. She no longer barked ; urine and fasces were passed in her kennel. During the night she often seemed subject to great excitement. Nevertheless on certain days the disturbance was much less marked. One morning she was walked nearly two miles without showing unsteadiness, without stopping, and without any apparent disturbance of movement. Such was the history given when the animal was brought here. She was left in hospital. The symptoms noted on the first exami- nation were as follows : — The face was dull and expressionless ; the animal reeled on her limbs ; movements were slow and irregular ; the fore-limbs showed irregular contractions ; the head was extended on the neck, and inclined towards the ground or to the left ; the back was arched. Sometimes the animal walked in circles towards the right ; at times the hind limbs collapsed, the animal fell towards the left, and had great difficulty in rising. The respiration was painful and catch- ing, the circulation slightly accelerated. Examination of the head revealed nothing particular except inequality of the pupils, the left being larger than the right. Sensation was normal. Temperature 39-5° to 39-8" C. During the first few days the patient still ate a considerable portion of her food. Twelve grains of iodide of potash were given daily. After a short time she would only take a few spoonfuls of milk. She remained lying quietly in her kennel, occasionally lifting her head and whining. Death occurred on the 14th October. Autopsy. — The lungs showed numerous tumours, the majority the size of a hazel-nut, but some as large as a walnut. These were whitish in colour, sharply delimited, and consisted of a friable tissue, generally light in colour, though reddish in places. Some contained a central cavity filled with liquid. The external appearance of the brain was at first sight normal. On more attentive examination a greyish area, which showed up clearly against the neighbouring parts, was noted in the anterior half of the right hemisphere. On incising this part a little greyish liquid exuded. An ovoid tumour, measuring one inch and a quarter from before back- wards and three quarters of an inch across, had developed in the wall of the hemisphere. Its periphery was sharply defined, and its centre had undergone transformation into a cyst ; its tissue appeared reddish g'^^y- . . r ■ No new growth of any kind was found in the neighbourhood of the scars resulting from removal of the mammary tumours. Digitized by Microsoft® TUMOUR OF THE CEREBELLUM. 303 The tumours of the lung and brain showed the histological cha- racters of sarcoma. They were exclusively formed of small cells, the greater number rounded and flattened at certain points by mutual pressure. All showed a strongly marked nucleus and vessels of em- bryonic character. TUMOUR OF THE CEREBELLUM. 4. Ten-year-old chestnut mare, sent to Alfort on the 13th March, 1897, by M. Laurent, veterinary surgeon, at Bar-le-Duc. History. — The disease from which this mare was suffering dated from September, 1896. It had not developed in consequence of violence. Nothing noteworthy was known as to the animal's previous history. Disturbance in movement was the first symptom noticed ; the gait was irregular, vacillating, and at certain times rolling. The animal was unable to walk in a straight line, but turned to the right or left ; movement was not co-ordinated, the limbs were excessively extended, and most frequently flung outwards. At the least excitement the animal lifted its head high and started back. If harnessed with ano- ther horse it could still be used in the carriage. On returning to the stable it did not appear unwell, and began to eat. These first symptoms gradually became aggravated. During the later period the animal, if approached in the stable, hung back, appeared terrified, rolled about on its legs, then stopped suddenly, with the hind legs thrust far under the body. Left to itself it gradually reassumed the normal position, lifted its head, and re- mained still. If loosened from the manger and forced backwards it pivoted on the hind legs. There was great difficulty in bringing it out of the stable. At first it refused to walk, then it made a few steps, but seemed about to fall. During these movements the head was extended and carried towards the right. Circulation and respiration were normal. A blister was applied to the vertebral column from the withers to the tail ; cold douches to the back of the head were prescribed, and sulphate of strychnine was given internally. The patient had great difficulty in walking from the station at Maisons-Alfort to the College. Placed in a box it lay down on the right side. Breathing was very rapid and difficult. Motor power appeared to be preserved ; there were frequent movements of the neck and limbs. Sensation was diminished : on pricking the skin in different parts of the body no reaction resulted. Temperature 397° C. The animal was assisted into a standing position and made a few uncertain steps, but showed generalised trembling movements and soon fell. At the end of a few hours the respirations were 64, the pulse 80 per minute. The conjunctiva was cyanotic. Death occurred during the night. Autopsy. — No change could be detected in the thoracic or abdo- minal viscera, or in the spinal cord and brain, nor did the exterior of the cerebellum show anything abnormal. But on incising the latter we found in the lower portion of the vermiform process, and right lobe Digitized by Microsoft® 304 CLINICAL VETERINARY MEDICINE AND SURGERY. of the cerebellum, a tumour, the size of a small nut, developed particu- larly in the white substance, from which it was clearly differentiated by its greyish colour and firmer consistence. Its right portion assisted in forming the roof of the fourth ventricle. The growth had not invaded the peduncles of the cerebellum. Histologically examined after hardening in chromic acid, this tumour presented in some respects the characters of glioma, but its predominant features were those of embryonic sarcoma. TUMOUR OF THE BRAIN IN THE HORSE. 5. A well-nourished sixteen-year-old cart-horse. History. — Had always appeared nervous. Six months before death was seen to carry the head inclined towards the left and the poll towards the right, as though the ear were diseased and the animal dreaded it being touched. When pushed sharply away from near side appeared about to fall, and indeed did sometimes fall. Had formerly been used for ploughing, but was latterly unable to walk steadily in the furrow. Had always been able to back, though latterly had difficulty in controlling hind limbs. Could lie down and rise without assistance. Urine and faeces were passed normally. Appetite good. Walked three miles to slaughterer's yard. Autopsy showed brain to be normal except for presence of irregular grey body, about the size of half a walnut, between the cerebellum and medulla on left side. This body was partially blended with plexus choroides of fourth ventricle, was somewhat soft and greasy in consist- ence, and seemed on microscopic examination almost entirely formed of crystals of cholesterin. The cerebellum and medulla were slightly depressed for reception of the mass. Messrs. T. and W. Fletcher's case, Journ. Conip. Path, and Therap., 1891, p. 261. BRAIN DISEASE— TUMOUR IN NEIGHBOURHOOD OF CEREBELLUM AND MEDULLA. 6. A Light Cavalry horse, seen 2nd August, 1886. No record of any previous brain disease. State on Examination. — This animal staggered as if drunk, crossed its legs, its eyes had a vacant stare, the extremities were cold, mucous membranes pale, pulse rather small, 46, respiration and temperature normal. Slight improvement during succeeding days. On the loth symptoms returned as before ; the horse fell when picking up some hay from the floor, and was lifted with difficulty. On the 14th constant twitching of e3^elids and hypersesthesia of limbs ; no improvement followed administration of atropine, which was substituted for strychnine previously given. By the 24th the animal had become extremely nervous and fright- ened at the slightest sound ; if startled it would twitch and quiver all over for some minutes, nearly falling in consequence ; the lips and eyelids continued to tremble markedly for a long time afterwards ; if Digitized by Microsoft® CEREBRAL HEMORRHAGE IN THE HORSE. 30s moved while limbs were trembling, it would blunder across its box, and if avoiding a fall would stand with the legs spread wide apart like props. Course variable until 20th September, when aggravation occurred. Killed on 23rd. Autopsy. — Foramen lacerum basis cranii of right side almost double size of left. Adherent to the pia mater, lying behind the cerebellum and between it and the medulla, was an elongated, nodular, firm tumour, constricted at its centre, and studded with numerous glistening particles of cholesterin. Tumour bright red or pink on section, and very vascular, but showed no recent haemorrhage and no degeneration or calcareous deposit. Pia mater congested throughout, especially behind the cerebellum. Brain normal. Veterinary Captain Rutherford's case, Journ. Conip. Path, and Therap., 1893, p. 72. Fig. 23. — Position at rest. CEREBRAL HEMORRHAGE IN THE HORSE. 7. Eleven-year-old bay gelding, 16-3 hands, seen February 5th, i5 ^ History.— li&d shown " staggers " on day previous to exammation, and been taken home. The head was carried to one side (see Fig. 23) ; u Digitized by Microsoft® 306 CLINICAL VETERINARY MEDICINE AND SURGERY. the animal seemed weak in its hind quarters, and threatened to fall if urged beyond a slow walk. State on Examinatiott.—Fulse 36, respiration 16, temperature ioo-i-° F. The neck was turned to the right side, it rotated on the head, and the chin was directed towards the middle line. Slight paralysis of muscles of right side ; lip and nose turned towards the right ; right nostril more dilated than left, especially when horse was excited. The skin of right nostril was more sensitive to pin pricks than that of left. The right eye was turned downwards,^ inwards, and forwards, was sensitive to light, and the fundus appeared normal. The left was turned upwards and outwards, the cornea appeared unduly convex and the whole eye prominent, the pupil was widely dilated, the retina was insensitive to light, the eye was immoveable and did not follow the light, and the membrana nictitans projected some distance over it. There was slight ptosis. The eyes v\'ere held in asymmetrical posi- tions ; the right seemed less under control than the left. Slight noises Fig. 24. — Brain seen from left side. Cerebellar tumour shown lighter shaded. seemed more alarming on left than on right side. The left ear was moved freely. The hind limbs were moved with difficulty, the toes dragging along the ground; when turning the horse almost fell down. Noises, etc., especially on the left side, greatly aggravated the symptoms. The neck was then jerked away to the right, the head twisted on the neck until its sides were almost horizontal, the squinting increased, and the animal staggered, lifted and put down its feet spasmodically, and seemed about to fall. Diagnosis. — Brain lesion. On account of sudden onset and extensive area involved is apparently due to haemorrhage ; the symptoms shown point to injury in the fourth ventricle, slightly to one side of middle line and almost directly over corpora quadrigemina. Improvement was slow, and owing to the uncertainty of cure the animal was destroyed by intra-tracheal injection of one ounce of prussic acid. Death only occurred after seven or eight minutes. Autopsy showed no important lesions in the thorax or abdomen. Digitized by Microsoft® CEREBRAL INJURY AND CHEYNE-STOKES RESPIRATION IN A HORSE. 307 On examining the brain a tumour the size of a hen's egg was found on the left lobe of the cerebellum (see Fig. 24), extending from the extreme outer margin of the left lobe to a point considerably beyond the middle line. It resembled in shape a peg-top; the point was thrust under the right lobe of the cerebellum ; the body had replaced a large part of the left lobe of the cerebellum. In substance it was moderately firm, nodulated and encapsuled. Microscopical examination showed it to be a glioma. On cutting through the central line of the cerebellum a small haemorrhage was found at the base above the fourth ventricle. On dividing the brain by successive slices another haemorrhage was j4^ i^JCem.m^nfit^e' ^A^'a. Fig. 25.- -Vertical section through brain about half an inch to the right of the middle line. found at the point indicated in the figure, about half an inch from the median commissure and in the right side; Haemorrhage was slight, but the brain showed many small pink spots in this neighbourhood. ]^ote. — The inability to co-ordinate movement was probably due to the haemorrhage at the base of the cerebellum, the facial lesions to the cerebral haemorrhage. The part played by the tumour appeared to be secondary, as the growth had existed for a long time previously without producing symptoms. Mr. Jno. A. W. Dollar's case, Veterinarian, 1896, p. 393. CEREBRAL INJURY AND CHEYNE-STOKES RESPIRATION IN A HORSE. 8. A four-year-old brown gelding. History. — When hunting, came down at a fence and pitched on its head ; for the rest of the day it did not jump as well as usual. Coming home its action seemed exaggerated, the fore-legs being thrown out- wards. It stopped as though to stale, but did not succeed ; it then seemed to stagger and go wide behind. From this time it was led. On arrival in the stable it was amaurotic, and stood with the head against the wall. . . State on Examination. — Seemed in some abdominal pam ; lay on the Digitized by Microsoft® 3o8 CLINICAL VETERINARY MEDICINE AND SURGERY. near side, bathed in perspiration, and struggled violently and inces- santly. The pupil was dilated, pulse about 60. No hardness of gluteal muscles. One hour after hypodermic injection of morphia was sufficiently quiet for the catheter to be passed ; urine moderate in quantity and normal in colour. Diagnosis. — Brain injury, due either to fracture or blood-clot. Two hours after first examination the breathing began to assume the Cheyne-Stokes character ; for about twelve seconds respiration was suspended, the pulse meanwhile becoming slower and weaker, all movements of limbs suspended, and the animal appearing in a deep sleep ; pulse about 70. This interval was followed by a feeble inspira- tion, followed by others of increasingly greater force, the sixth being the deepest and most marked. With each the pulse increased in frequency and force, as did movements of the limbs. The third period was marked by decline in amplitude of respirations until the sixth, which was almost imperceptible ; the pulse decreased in strength, the number falling to 70, and all movements gradually ceasing. The second and third periods occupied twelve seconds. The number of respirations in each period afterwards lessened, though still occupying the same time. The apnoeal periods increased in duration to nearly twenty seconds. Movement of the fore-limb ceased, and the hind limb moved but slightly. Six and a half hours after first examination the respiration assumed the form of a single deep gasp, followed by a deep expiration and one or more shallow movements with a long apnoeal period. Death occurred seven hours after first examination. Post-mortem Examination. — All internal organs healthy ; some bruising on the frontal bone. A large blood-clot at the base of the medulla, on the right side, just over origin of the pneumogastric nerve. The whole of the pia mater was much injected. Mr. F. W. Evans' case, Journ. Conip. Path, and Therap,, 1895, p. 83- TUMOUR OF THE VERTEBRAL COLUMN. 9. Nine-year-old sheep-dog. Entered hospital on the 17th May, 1894. A fortnight previously this dog, whose health had always been good, showed difficulty in walking, especially in moving the hind limbs, a difficulty which rapidly increased. One morning the animal was found paralysed in the hind limbs. State on Examination. — Paralysis of the hind limbs was complete. If the animal was forced to move the legs were dragged along the ground. Sensation was not abolished, pricks with a pin causing struggling. Respiration and circulation were normal, appetite was good, and no difficulty in defecation or micturition had been noted. Temperature 37'8° C. Rectal exploration threw no light on the case, and, in fact, nothing could be detected to account for the paralysis. Treatrhent consisted in administering iodide of potassium in doses of 15 to . 30 grains per day. Milk diet. No improvement. Death occurred on the 31st May. Digitized by Microsoft® CANCER OF THE LOWER EYELID AND GLOBE OF THE EYE, 309 Autopsy.— On the body of the first lumbar vertebra was found a hard spherical tumour, the size of an egg, measuring two and a quarter inches trom before backwards, and two inches across. It chiefly occu- pied the right part of the vertebra, the transverse process of which it entirely surrounded, and was formed of two lobes, one developed on the right surface of the body of the vertebra, the other (which covered the inferior surface from one transverse process to the other) extended beyond the left transverse process, above which on the vertebra a large osteophyte was visible. The upper lobe of this tumour was in contact with the last dorsal vertebra, which it had thrust backward and some- what to one side. Its lower lobe covered a portion of the lower surface of the second lumbar vertebra. On exposing the spinal cord in the lumbo-sacral region the cha- FlG. 26. — Sarcoma of the vertebral column. racters and relationships of the tumour could be clearly made out. It formed in the spinal canal a distinctly marked prominence about one and a quarter inches in length, above which the spinal cord was com- pressed and reduced to half its normal thickness. Its consistence varied according to the point chosen : the part within the neural canal was relatively soft, yielded to pressure, and was easily divided with the point of the bistoury, but towards the centre the appearances were those of bony tissue. On microscopic examination the tumour appeared formed of fusiform cells and tracts of osteoid tissue, pierced with branching cavities provided with canaliculi, and offering the appearance of osteo- blasts. B.—£Yi: AND EAR. CANCER OF THE LOWER EYELID AND GLOBE OF THE EYE. 10. Eleven-year-old gelding. Entered hospital on the i8th July, 1898. Four months before the eyelids of the right eye were found to be glued together each morning by muco-pus. A veterinary surgeon who was consulted thought this due to simple conjunctivitis, and prescribed boric acid potions. The discharge continued, the lower eyehd becam& thickened, vegetations developed on the conjunctiva, thrusting aside the eyelid and soon extending beyond the free margin . Digitized by Microsoft® 310 CLINICAL VETERINARY MEDICINE AND SURGERY, The patient was first brought for examination in June, and was then regarded as suffering from granular conjunctivitis. The vegeta- tions were removed with scissors, and the parts curetted. At this time the eye was still intact. A i per 2000 sublimate solution was prescribed as a collyrium. The parts did not heal. Further vegetations developed and rapidly increased in size. When the horse was left in hospital a reddish, flattened, trans- versely elongated tumour, somewhat resembling a strawberry, projected from between the eyelids. The upper lid remained soft and moveable ; the lower, from which the tumour sprang, was everted. The globe of the eye was partly covered by the new growth, and to some extent pushed back into its cavity. The right side of the face was denuded of hair, and soiled by a purulent discharge. Operation. — Once the animal was cast it was discovered that the tumour had invaded the globe of the eye. The cornea was opaque and perforated at two points. It therefore became necessary to remove the whole of the eye and a part of the lower eyelid, preserving as far as possible the skin covering the latter. The orbital cavity was cleared out and filled with gauze, and the eyelids were brought together with three sutures. This dressing was removed next day, and treatment was afterwards confined to antiseptic injections. The tumour was the size of a walnut, elongated in its transverse diameter, slightly flattened, rounded on the surface, and of firm con- sistence. The surface of sections appeared dry, but pressure caused filaments or little grains to exude, which were exclusively formed of epithelial cells. The histological appearance of the tumour showed it to be an epithelioma of the pavement epithelium type. It was formed of a connective-tissue stroma and of epithelial cells disposed in lobules, which were massed closely together or united by tracts of the same character. The animal left on the ist March, but was brought back two months later for the application of an artificial eye of hardened India rubber. The tumour did not return. MALIGNANT CARCINOMATOUS INTRA-ORBITAL GROWTH WITH DESTRUCTION OF THE EYE IN A COW. II. A well-bred shorthorn cow; first seen March 20th, 1893. History. — Two years before the animal had suffered from " chaff in the eye," followed lay a cold. Nothing was done. State on Examination. — The right eye was totally destroyed and its place occupied by a fungoid mass, which protruded two inches beyond the palpebral fissure. The surface of this mass was covered by a scab, on removing which the tumour appeared formed of broken-down tissue and new capillary vessels. Despite antiseptic treatment the growth continued, and attained enormous dimensions. In June it was removed, and the wound dressed Digitized by Microsoft® TRAUMATIC CATARACT. 3" with saturated solution of zinc sulphate. Improvement was only tem- porary ; in a few weeks the eyelids and surrounding subcutaneous tissue became involved. During the succeeding weeks masses of extremely fcetid new growth were several times removed. Owing to continued spread of the growth the animal was at length killed. A utopsy. — The orbit was occupied by a foul, stinking mass of broken- up tissue of a dirty brown colour, the eyelids were enormously thick- ened, and the eyelashes replaced by a border of cicatricial tissue. The extruding mass measured five and a half inches in diameter, and the surrounding swelling about nine inches. Beneath the skin was a layer several inches thick of repulsively smelling necrosed new growth, presenting the characters of carcinoma. The cranial bones were absolutely healthy ; the growth appeared to have originated either in the eyeball itself or from the peri-orbitale. No visceral metastasis or septic infection was noted on post-mortem, and the cow's continued good health until a fortnight before slaughter contra-indicated such a condition. Microscopical examination confirmed the diagnosis of carcinoma. Mr. Breakall's case, described by Prof. McFadyean, Journ. Comp. Path, and Therap., 1893, p. 365. TRAUMATIC CATARACT. 12. Four-year-old English terrier. Brought for examination on the 29th July, 1897. Two days before this animal while playing had torn the right eye on a piece of iron wire projecting from a grating. The wound was treated with dilute acetate of lead lotion. At the time of our examination the eye was closed, weeping, and very sensitive. After applying cocaine we were able to estimate the gravity of the injury. The cornea was perforated a little below its centre by a narrow opening, from which escaped aqueous humour. The margins of this opening were fairly regular, and slightly swollen. In the lower portion of the anterior chamber was a reddish hsemor- rhagic deposit, but no foreign body was present. Treatment. — Careful disinfection of the cornea, conjunctiva, and eyelids by warm creolin solutions, and frequent instillation into the eye of a warm solution composed as follows : Creolin 50 minims. Boiled water . . . . i pint. The patient was brought back each week. The extravasated blood in the anterior chamber gradually became reabsorbed. In spite of considerable granulation around the margins of the perforation in the cornea healing occurred rapidly, and without acute complications. The opacity of the cornea and wound gradually diminished^and finally completely disappeared ; but, in proportion as the cornea grew clearer, we were able to detect another change in the deeper portion of the eye, viz. the formation of a cataract. This change proceeded rapidly. Three months after its appearance vision on this side was destroyed. By the following May there only remained a very trifling depression Digitized by Microsoft® 312 CLINICAL VETERINARY MEDICINE AND SURGERY. in the cornea, and even here the parts were as transparent as other portions of the eye. CATARACT— OPERATION. 13. Six-year-old poodle affected with double cataract. Left in hospital i6th April, 1898. The first signs of disease in the eye had occurred two years before. The lens of each eye gradually became opaque, though that of the left eye was more rapidly affected than the right. State on Entry. — The lens of the left eye was completely opaque. On the whitish ground formed by the lens a few striae, arranged in the shape of a star, could be seen, and towards the centre several little greyish spots. The right lens was opaque throughout, but the opacity was a little less marked and more uniform than in the left lens. Vision was completely abolished. In unfamiliar spots the animal continually ran against obstacles. Treatment. — We were asked to operate, and decided to deal first with the left eye. For three days the eye was prepared by bathing with warm solutions of 3 per cent, boric acid, and with i in 3000 sublimate. On the 19th the animal was an^sthetised with atropomorphine and chloroform. The operation chosen was that in which the lens is depressed, and was performed by the usual method. Trifling haemor- rhage occurred under the conjunctiva at the point of puncture, and a little blood also passed into the anterior chamber of the eye. During the night the eye was several times fomented with wadding saturated in warm boric solution. The animal's kennel was covered so as to keep it in semi-darkness. The patient readily took milk and a little meat. The same treatment was continued during the following days.: a little opacity appeared in the ajnterior chamber, but in a week it had entirely disappeared, together with the effused blood and the ecchy- mosis under the conjunctiva. Even at this stage there, was marked improvement. The dog saw sufficiently to choose its path and avoid obstacles. It had no difficulty or hesitation in entering its kennel, whilst previous to operation- it always struck against the step in front. Remark. — The observations of Berlin, Moller, Randolph, and Contejean show that' in the dog accommodation is soon restored. In practice it is well to restrict operation to discission for soft cataracts, and to depression for others. Without doubt these methods are very inferior to extraction, but they have the -double advantage of being less dangerous and capable of performance by most practitioners. SYMBIOTIC ACARIASIS AND ECZEMA OF THE EAR. 14. Six-year-old Havanese bitch, entered hospital. 30th December, 1898. . History. — During April, 1898, this bitch, which lived in its owner's rooms, suddenly presented a concourse of symptoms apparently due to Digitized by Microsoft® SYMBIOTIC ACARIASIS AND ECZEMA OF THE EAR. 3 13 some nervous affection. In addition to restlessness, loss of appetite, and depression, it showed at varying intervals paroxysms of trembling and slight rigidity of the body muscles. These symptoms gradually became more marked. One morning the patient was seen to turn in circles to the right, the head inclined towards the same side and slightly depressed. A specialist who was consulted regarded the symptoms as due to a brain lesion. He prescribed friction with antimonial ointment over the upper part of the neck and base of the brain. This treatment giving no result he passed a seton behind the head. In spite of the suppuration produced by leaving the seton in position for a month the disturbance persisted. Towards the end of August the animal one evening had an epileptiform attack, the head being markedly turned towards the right, and the animal falling on the same side. Three weeks before entering hospital it had another more violent attack, and again fell on the right side. Bromide of potassium was -prescribed. On the 29th December a further epileptiform attack occurred similar to the preceding. On the evening of- the next day the bitch was sent to the School. State on Examination. — The patient held the head inclined towards the right side, was depressed, and took no notice of what passed around it. Although it had suffered from these attacks for several months it was still in fairly good condition. There was no rigidity of muscle and no interference with movement. At times the animal shook its ears and scratched them with the hind limbs. It had scarcely been placed in a kennel before it was taken with a fit. It fell forwards, the head being turned towards the right side, its long axis inclined downwards and towards the left, the right temporo-auricular region resting on the straw ; howled loudly, and made convulsive circular movements from left to right around the head, which acted as a pivot. ^ This attack lasted for three minutes. The animal rose, remained stupid for a few moments, and then resumed its former appearance. During the night it ate some fragments of meat given by hand. Five minutes later it was seized with nausea. and vomiting attacks. At next day's visit I made inquiries as to the animal's history. Examining the interior of the ears I noted at the entrance to the auditory meatus an abundant deposit of brownish wax, which I directed to be microscopically examined, with the result that it was found to contain numerous symbiotes (Synibiotes ecatidatiis, var. cams). Treatment. — Washing out of the ears with soap, cleansing of the external meatus, drying with wadding, injection of i per cent, solution 'of sulphide of potash, and light friction around the base of the ear, so as to favour the penetration of the liquid, drying of the entrance to the .meatus and application of a few drops of balsam of Peru. The injection of sulphide of potash solution and the after application of Peruvian balsam were repeated every day until the 15th January. On the 6th the patient was less depressed ; it took a little nourish- ment. The inner surface of the fore-limbs showed an eczematous eruption, accompanied by severe itching. After clipping away the hair Digitized by Microsoft® 314 CLINICAL VETERINARY MEDICINE AND SURGERY. the diseased skin was disinfected with warm creoHn solution and powdered with starch. On the 8th the disturbance due to the acari was markedly dimin- ished, but the two eczematous patches on the inner surface of the fore- limbs were transformed into wounds, which the animal incessantly licked and gnawed. The discharging surfaces were disinfected and a cotton-wool dressing applied, covering the limbs as high as the shoulder. Next morning the dressings were found torn. Fresh ones were applied, which were left undisturbed for three days, when they were renewed. After the 15th the animal showed no further epileptiform symptoms nor digestive trouble. On the 20th the wound on the left leg was dry ; a portion of that on the right was still moist, but by the 27th it had healed. On the 3rd February the animal was cured both of the acariasis and of the eczema. Remark. — Acariasis of the ear — the pseudo-epilepsy seen in packs — occurs with some frequency in dogs kept in living rooms. Seldom a year passes without our seeing cases. In that just described the method of contagion remained doubtful. According to the owner's statement the animal was very carefully looked after and never came near other dogs. C.—A^OSE AND NASAL CAVITIES. NECROSIS OF THE NASAL SEPTUM. 15. Seven-year-old entire horse. Entered hospital 2gth October, 1894. Two months before the animal had received a kick on the forehead. The part became swollen, respiration difficult and noisy, and discharge occurred from both nostrils. Siate on Entry. — -The passage of air through the nose was obstructed ; even at a distance a roaring sound could be heard. The face was deformed ; over the lower portion of the nasal bones, and extending as far as their extremity, was a swelling which was painful on pressure and equally marked on either side of the median line. Both nostrils discharged a little purulent liquid. On the septum, near the entrance to the nasal cavities, and on either side, was a narrow wound with hardened reddish margins, forming the entrance to a sinus about three inches deep. Higher up — towards the roof of the cavity and on the septum — could be distinguished an oval prominence, elongated in the direction of the long axis of the head, formed by separation of the mucous membrane from the subjacent tissues. Pressure with the finger caused a discharge of greyish pus from the sinus. The submaxillary glands were swollen and hard, the condition being rather more marked on the right than on the left side. Diagnosis. — Partial necrosis of the nasal septum. As the animal was useless for work, on account of the difficulty in breathing, we were asked to perform tracheotomy. Digitized by Microsoft® NECROSIS OF THE CARTILAGE OF THE LEFT NOSTRIL. 3 1 J Treatment. — The nasal bone was trephined over the most prominent portion of the swelhng and along the median line, disclosing a fragment of necrotic tissue on the cartilaginous septum. The opening was enlarged, the edges rounded off, and the necrosed cartilage removed by curetting. The wound thus produced was washed out with carbolic solution, and its margins touched with tincture of iodine. A gauze drain was passed into each of the nasal cavities. During the next few days the wound was cleansed night and morning with I per cent, creolin solution, and the drains occasionally renewed. Treatment ceased on the ist December. The animal returned to work. Cure became complete after a time. Respiration was only slightly interfered with, the diminution in size of the nasal cavities opposite the old necrotic centre being trifling. NECROSIS OF THE CARTILAGE OF THE LEFT NOSTRIL, 16. A nine-year-old gelding brought for examination on the 20th October, 1895, with the following history : About two months ago the animal, while in the same stable, had been bitten on the nose by another horse. Treated with carbolic lotion the cutaneous wound Fig. 27. — Necrosis of the nasal cartilage. healed rapidly, but the inner part of the nose became swollen and a more or less abundant discharge continued. State on Examination — A little purulent discharge ran from the lower portion of the left nostril. The inner wing of the nostril throughout its entire extent — but especially towards its upper part — Digitized by Microsoft® 3l6 CLINICAL VETERINARY MEDICINE AND SURGERY. was swollen and indurated. On examining the nasal cavity the swell- ing was seen to be limited to the anterior portion, that is the part corresponding to the cartilaginous plate. The skin covering this, and a narrow layer of the pituitary membrane, were swollen, thickened, and somewhat prominent. At the margin between the middle and upper thirds of the upper wing of the nostril appeared a fungous, reddish, soft mass of granulations, from which pus discharged when the lower part of the swollen nostril was pressed with the finger. The left submaxillary gland contained a somewhat hard swelling the size of a small nut, moveable under the skin, but adherent to the deeper seated tissues. In the right nasal cavity the pituitary mem- brane was neither swollen nor injected, and the internal wing of the nostril was of normal flexibility. Having cast the animal on the right side probing revealed the presence under the granulations of an open sinus about one and a quarter inches in depth, running obliquely downwards and inwards. This sinus was laid open throughout its entire extent, and the walls swabbed with tincture of iodine, by means of a probe covered with wadding. The patient, which continued to work, was only dressed very irregularly. In consequence it became necessary to expose the parts a second time. The swelling of the nostril and suppuration greatly diminished, but recovery was not complete until after four months. Remarks. — Necrosis of the nasal cartilage marked by muco-purulent discharge and enlargement of the submaxillary gland of the correspond- ing side, may at first awaken suspicion of glanders. Differential diagnosis, however, is easy without recourse to mallein. On examining the nasal cavity the inner wing of the nostril shows a hard, circum- scribed swelling, which usually occupies the entire extent of the wing ; arid a fistula, whence on pressure over the swollen area greyish, ill- formed pus, sometimes streaked with blood, escapes. The swollen parts are often rough, prominent, or folded. Fig. 27 shows the appearances in a case brought for examination during September last as suspected of glanders. The inner wing of the right nostril showed throughout its entire extent a considerable, sharply circumscribed, rounded swelling, most extensive below, where it was irregular and exhibited several narrow folds. From its posterior border projected a mass of soft, bleeding granulations, which masked the sinuous tract. SEBACEOUS CYSTS IN THE FALSE NOSTRILS. 17. A seven-year-old mare, left in hospital ist February, 1898. Was suffering from sebaceous cysts of the false nostrils, which first appeared several years before. By their progressive growth these tumours had finally interfered with breathing ; the mare soon lost breath, and made a snorting noise during work. In September, 1897, the swellings were punctured, their contents evacuated, and the interior washed with an antiseptic solution, but they soon formed again. On entering hospital this mare showed in each false nostril, an inch or two from the external opening of the nose, a spherical, yielding, Digitized by Microsoft® CHRONIC INFLAMMATION AND NECROSIS OF POSTERIOR TURBINATED BONE. 317 non-fluctuating, cool, painless swelling ; the right was rather larger than the left and the si^e of a hen's egg. On the 2nd February, after washing and disinfecting the skin the cysts were punctured with a trocar, giving exit to a greyish, thick, granular material. The cavities were injected with pure tincture of iodine, and after manipulation the excess of injected fluid was removed. On the following days the parts showed inflammatory swelling, par- ticularly on the left side. On the 15th February the left cyst had almost completely disappeared, but the right had resumed its former dimensions. Ablation was therefore decided on. On the i8th February the mare was cast on Daviau's table. The parts having been prepared, two curved incisions were made enclosing an elliptical piece of skin, three quarters of an inch wide at the centre, which was removed, together with the wall of the cyst. The deep portion of the latter had to be left, dissection being a delicate matter, and the animal struggling violently. The interior was swabbed out with a tampon saturated with 10 per cent, chloride of zinc solution. The margins of the wound were brought together over a drainage-tube. During the following days weak warm carbolic solution was injected. On the sixth day the drainage-tube was removed, and the parts treated as an open wound. A week later complete healing had occurred. CHRONIC INFLAMMATION AND NECROSIS OF THE POSTERIOR (MAXILLARY) TURBINATED BONE. 18. Four-year-old mare, suffering from a tumour of the left nasal cavity. History. — Seven or eight months ago the left side of the animal's face showed a swelling, which gradually increased ; discharge occurred from the left nostril ; some time later breathing became disturbed and snoring, and during movement a loud nasal roaring sound was pro- duced. M. Audebert, veterinary surgeon at Vailly (Cher), who diagnosed the existence of a tumour in the left nasal cavity, sent the animal to me on the 5th February, 1899. State on Examination. — Animal moderately well nourished. The left side of the face showed a diffuse, rather prominent, hard swelling, slightly painful on percussion. From the left nostril a greyish, muco- purulent discharge continually escaped. On examining the entrance to the nostril nothing abnormal could be seen, but a short distance within a swelling could be felt which appeared formed by the enlarged maxillary turbinated bone. The submaxillary glands were slightly swollen. Breathing was markedly embarrassed. At a walk the mare made a loud roaring sound. Treatment. — Ablation of the tumour. On the 9th February the patient was cast on the right side. The parts having been prepared, an incision an inch and a half in length was made over the left false nostril in the angle formed by the nasal and premaxillary bones. A portion of the swelling could then be examined with the finger, but extraction by this orifice appeared impossible. Digitized by Microsoft® 3l8 CLINICAL VETERINARY MEDICINE AND SURGERY. The left nasal cavity was therefore trephined, an incision about three quarters of an inch long being made opposite the centre of the nasal bone ; at each end two circular trephine openings were made, and the intervening portion of osseous tissue removed with scissors. It then became evident that the anterior part of the maxillary tur- binated bone was markedly hypertrophied. On being trephined the inferior maxillary sinus was found healthy. The anterior part of the diseased turbinated bone was first removed with strong forceps through the lower opening, the remainder being excised through the nasal opening. The nasal cavity and sinus were plugged with gauze. The mare was returned to her box. Temperature 38"6° C. For about half an hour blood dripped from the left nostril. All the extirpated portion of the turbinated bone was inflamed, thickened, and violet in colour ; it measured four inches in length and two to two and a quarter inches in diameter. Its upper half was hard and for the most part ossified. Towards the centre it appeared necrotic, and contained a cavity filled with caseous pus ; the lower portion formed a kind of ovoid tumour measuring two inches in length and an inch and a half in diameter, firm and homogeneous in consistence, and of a whitish-red tint on section. In the lower portion of the turbinated bone the histological characters were those of inflammatory hypertrophy, with numerous small osseous tracts dispersed through the newly-formed fibrous tissue. On the loth the tampons were removed, and the nasal cavity washed out with warm boric solution, which brought away clots and a few fragments of necrotic tissue. General condition and appetite excellent. Temperature 38'5° C. The nasal cavity was left open. During the night it was washed out with boric solution. On the nth the expired air had the smell peculiar to caries. The boric injections were alternated with creolin solution. Temperature 38-4° C. From the 12th to the i6th similar treatment. Discharge remained somewhat free. The submaxillary glands increased in size. Tem- perature normal. On the 17th the pus was less abundant and less foetid. The warm creolin solution was continued. On the two following days the patient showed symptoms pointing to mechanical pneumonia. The temperature was 40*2° C. ; the respi- ration 48 per minute, whilst the pulse was only 44. On the 20th discharge was less abundant, and the general condition had greatly improved. On the 2ist all unfavourable symptoms had disappeared. From the 22nd to the 27th the injections were continued ; suppura- tion was trifling. The opening in the maxillary sinus had entirely closed: that in the nasal bone was still open, but had greatly con- tracted. The discharge from the nostril had considerably diminished. From the 28th February to the 5th March treatment continued the same. The opening in the nasal bone had then nearly closed. Discharge was very trifling. Expiration and inspiration were normal, and scarcely any interference with inspiration could be detected. Digitized by Microsoft® TUMOURS IN THE NASAL CAVITIES. 319 On the 6th March the mare, which was on the way to complete recovery, was returned home. TUMOURS IN THE NASAL CAVITIES. 19. Five-year-old terrier dog. Left in hospital on the 14th March, 1896. About two months before deformity of the face had been noticed. On the right cheek, almost midway between the eye and point of the nose, was a circumscribed, slightly painful swelling. A muco-purulent discharge, streaked with blood, ran from the right nostril. Mastica- tion seemed difficult ; the dog ate slowly, and frequently attempted to scratch the nose. The swelling gradually became more marked. State on Entry. — The right side of the face showed a swelling as large as an egg, apparently developed in the superior maxillary bone ; over its centre the bone was destroyed, and throughout the rest of its extent the external table appeared elevated. The tumour extended above as high as the eye, which however appeared unaffected ; posteriorly as far as the lower maxilla ; it had invaded the mouth and destroyed the right side of the hard palate ; several loose molars were surrounded by the new growth. The buccal portion of the tumour was in most places fairly firm, but showed local ulcerations. Atttopsy. — With the exception of its ends the right superior maxilla was almost destroyed. The tumour extended about one eighth of an inch above the level of the bone. After sawing through the centre of the head the nasal septum was seen to be thrust towards the left by the _growth, which had destroyed the mucous membrane and turbinated bones, and had completely filled the right nasal cavity. Within the mouth it extended backwards as far as the base of the cranium ; the anterior portion of the zygomatic and palatine bones and the body of the superior maxilla, together with the right half of the hard palate, were destroyed. Four molars (the crowns of which retained their white colour) were only held in position by the new growth. The anterior wall of the orbital cavity had disappeared, and the fibrous membrane hning it had been thrust back, though it remained intact. The buccal and maxillary portions of the tumour were somewhat firm ; the remainder was soft and friable. It was of an epithehal nature, formed of a connective-tissue stroma containing irregular cavities filled with small polyhedral cells. At certain points these cells tended to assume a cylindrical form, and to run at right angles to the stroma. In certain alveoli the central cells were large, contained no nuclei, and were arranged in epidermal nests. 20. Four-year-old sheep-dog. Brought for examination on the 15th December, 1892. Had been ill for eight months. The first symptoms consisted of difficulty in breathing, frequent sneezing attacks, and discharge from both nostrils. The animal scratched the nose with its paw, as if attempting to remove some foreign body from the nostrils. Though Digitized by Microsoft® 320 CLINICAL VETERINARY MEDICINE AND SURGERY. previously fond of the water and a very good swimmer, it now avoided entering or soon returned, breathing with difficulty and through the mouth. The face gradually became deformed, the anterior wall of the nasal cavities projected, especially on the left side, the skin became ulce- rated over the swelling, and the tumour finally appeared externally. When the dog was brought here a blood-stained discharge ran from both nostrils. The nasal cavities were obstructed. Over the middle of the nose was a projecting, reddish, bleeding tumour, which had perforated the bones and was surrounded by a swollen depilated zone. Autopsy. — Both nasal cavities were entirely filled by the .tumour, which was adherent over a large surface to the mucous membrane covering the floor of these cavities, whence it appeared to have originated. It had destroyed the nasal septum and the turbinated bones. Below it had advanced close to the nostrils ; posteriorly it appeared bilobed, the lower portion being attached to the side of the palate, the upper portion extending towards the entrance to the sinuses, which were filled with ill-smelling pus. The tumour was greyish, and in places somewhat reddish in colour. ~'i.-' / fe?'. ' ;.-^ f*-' Fig. 28. — Sarcoma of the nose. Its tissue was very soft and friable, and contained large numbers of vessels. In the posterior lobe of the left lung was a tumour the size of a hazel-nut, projecting slightly above the surface. Its tissue was friable and reddish, resembling that of the new growth in the nose. On microscopical examination this tumour appeared almost entirely formed of round-cells and of vessels ; the cells were of small size and contained a strongly-marked nucleus, but little protoplasm ; in places a fine reticulated stroma could be distinguished. Most of the sections showed throughout their extent the histological characters of encepha- loid sarcoma. Digitized by Microsoft® TUMOURS IN THE NASAL CAVITIES. 32 1 21. Five-year-old bull-dog. Brought for examination on the 7th January, 1893. Had been ill for ten months. At first the passage of air through the nose seemed obstructed ; the animal sneezed, showed discharge, and continually scratched the nose, the base of which gradually be- came swollen. Ulcers next formed at two points, discharged a sticky, greenish pus, and gradually increased in size, the exposed tissues projecting prominently and forming mushroom-like growths. The end of the nose became twisted towards the left. A considerable swelling, more marked on the right than on the left, appeared between the eyes over the region of the sinuses, and on opening the mouth the hard palate was seen to be affected, the mucous membrane being perforated in two places. A utopsy. — The tumour filled the nasal cavities and three fourths of the frontal sinuses. The palatine plate of the superior maxilla and the body of the palatine bone were destroyed for a distance of one and a half inches in the longitudinal and three quarters of an inch in the trans- verse direction. At the back, between the sphenoid and pterygoid and the wing of the palatine bones, the tumour formed a thick, transverse prominence which projected into the pharynx. On either side of the median line of the face, the nasal bone, the upper portion of the maxilla, and the internal surface of the frontal bone were destroyed. At certain points the bony tissue enclosing this area was penetrated by the new growth. In others, however, the two were simply in juxtaposition. The nasal septum was almost entirely destroyed. In front only a fragment three quarters of an inch in length and one sixteenth of an inch in depth remained, fixed to the intermaxillary bone, and behind a sickle-shaped piece attached to the vomer and ethmoid. The turbinated bones were also destroyed, the only vestiges remaining being composed of little parchment-like lamellae surrounded by the tumour. The ethmoid cells were only represented by fragments of their base. The tumour had originated in the pituitary membrane lining the floor of the nasal cavities. Thence it had extended towards the base of these cavities, next into the sinuses, whence it spread to neighbouring tissues, radiating in all directions, and perforating the bony partition separating the nose from the mouth and the mucous membrane of the palate. The tissue of this tumour was greyish, very friable, and contained numerous small vessels. Histologically it showed the same characters as that of the tumour in Case 15. It was, in fact, a round-celled sarcoma. 22. A five-year-old spaniel, which had been ill for six months. Brought for examination on the 13th February, 1894. Difficulty in breathing was the first symptom noted, followed soon afterwards by double-sided purulent discharge, sometimes streaked with blood, and swelling of the nose, particularly towards the left lower part. This swelling rapidly increased. During the early part of Feb- ruary the disease made rapid progress. The swelling extended to the X Digitized by Microsoft® 32 2 CLINICAL VETERINARY MEDICINE AND SURGERY. entire nasal region, towards the centre of which a second sinus opened, and suppuration became abundant. On examining the patient symptoms were seen analogous to those noted in the preceding case, except that deformity of the hard palate and nasal lesions were more marked on the left than on the right side. Autopsy. — The left nasal cavity was completely obstructed by the tumour, the posterior portion of which extended as far as the entrance to the pharynx and into the sinuses. The nasal bone, upper portion of the maxilla, and internal table of the frontal bone were at points thinned and perforated. The nasal septum and ethmoid cells were partially destroyed. In the left cavity the tumour had not advanced so far posteriorly and upwardly. As in Case i6, the new growth appeared to have started in the mucous membrane of the lower wall of the nasal fossa. On section the tumour appeared whitish-grey and fairly vascular. Microscopical examination showed it to consist of sarcomatous and mucous tissue (myxo-sarcoma). 23. Three-year-old setter, brought for examination on the 6th August, 1894. A year before the animal had been attacked with sneezing fits, which became more and more frequent. Greyish muco-pus, occasionally streaked with blood, ran from the nose. Some months later the face began to swell, and gradually became more deformed. Finally, the skin ulcerated over the most prominent part of the swelling. For a fortnight previous to entry blood-stained pus escaped in considerable quantities by the wound at this point. When brought here the animal was very thin and appeared in severe pain. The deformity of the face and the existence in this region of a sinuous wound discharging greyish pus clearly pointed to the nature of the affection. On the examiner attempting to touch the wound the animal threatened to bite. The nasal cavities were completely obstructed, and breathing was carried on through the mouth. Post-mortem Examination. — On being opened along the middle line the nasal cavities were found entirely filled with the tumour. The sinuses were invaded ; one portion of the septum, together with the turbinated bones and ethmoid cells, had disappeared. In front the tumour extended to the nostrils, behind to the pharynx. The sinuses contained sticky, greyish, offensive pus. This tumour, like the two preceding, appears to have originated from the pituitary membrane lining the floor of the nasal cavities. The macroscopic and microscopic characters were similar to those of the new growth in Case 17. Remarks. — The majority of tumours of the nasal cavities in the dog are myxomatous polypi, which tend to undergo conversion into sarco- mata. When recent they can be removed through an incision in the nasal bone and a permanent cure effected, but, as a general rule, disease has made such progress before the patients are submitted to examina- tion that intervention is entirely useless. Digitized by Microsoft® PURULENT INFLAMMATION OF THE SINUSES. 323 PURULENT INFLAMMATION OF THE SINUSES- MEN INGO-ENCEPHALITIS. 24. Seven-year-old mare, affected with double-sided purulent inflammation of the sinuses. Left in hospital on the 2nd January, 1899. The left inferior maxillary and frontal sinuses had been trephined, despite which the affection of the sinuses became complicated with brain disease. The mare was sent to the School on the evening of the 2nd January, and had travelled a distance of five miles at a walking pace. State on Examination.— The trephine openings in the left frontal and inferior maxillary sinuses were still open ; their margins were soiled with pus, and from both nostrils escaped a purulent ill-smelling dis- charge, more abundant on the left than on the right side. The left submaxillary gland was swollen, lobulated, and the size of a small nut. When placed in a box the mare appeared exceedingly depressed. The eyelids were swollen and half closed, and vision was interfered with, principally on the right side. During the night the animal took only a little mash. Next morning the condition was more serious. Prostration was even more marked than on the preceding evening. The mare moved with great reluctance ; the gait was slow and uncertain, movements were irregular, and the limbs became flexed at every step. When returned to its box the animal suddenly showed alarming symptoms without any apparent cause ; it rolled about, recovered itself, and leaned against the wall with the front limbs crossed. In about ten minutes it made a few more uncertain steps, again dropped back against the wall and fell heavily, stretching itself on the left side, and showing great excitement, which was succeeded by a period of coma. At this time the temperature was 39*2° C. ; respirations 22 ; pulse 78 per minute. For some hours phases of excitement alternated with periods of coma. During the former the animal sometimes lay on its chest, the front of the head pressed on the ground ; sometimes completely on its side, the head and limbs being constantly in motion. Treatment. — Hypodermic injection of morphine and chloral ene- mata. During the afternoon the coma was only interrupted by passing fits of excitement. Respiration and circulation became more and more rapid, the temperature rose to 39'8° C. The animal died during the night. Autopsy.— The abdominal viscera showed nothing abnormal. The right lung, however, contained two small centres resulting from chronic pneumonia. The head was detached from the body and sawn through longitu- dinally near the middle Hne. On examining the sinuses the mucous membrane was found inflamed, thickened, and covered with yellowish- grey putrid pus. In the antero-inferior part of the cranium the meninges were inflamed, infiltrated, thickened, and bathed in a sero-purulent exudate. Digitized by Microsoft® 324 CLINICAL VETERINARY MEDICINE AND SURGERY. The corresponding surface of the brain was injected and covered with a similar iluid, in which streptococci were discovered on bacteriological examination. Both guttural pouches were inflamed, that of the left side being full of blood-stained offensive pus. V>.—LIPS.—CHEEK.~-JA WS.^MO UTH.—PHAR YNX. PSEUDO-CANCROID OF THE LIP. 25. Four-year-old female cat, brought for examination on the 2ist April, 1894. Had been ill for a j'ear. On the centre of the free border of the upper lip this cat had shown a little flattened, hard tumour, which afterwards became ulcerated. The wound gradually extended on either side as far as the labial commissures, and above to the nostrils. It was of a regular, concave shape. The base exhibited a thin indurated layer. The surface was reddish or greyish in colour, accord- ing to the point chosen. On examining it more closely the red areas were seen to be regular, moveable, and to resemble cicatrices ; whilst the greyish points were formed by little crusts covering shallow depres- sions, apparently caused by extension of the lesion. The ulcer was sharply defined, and the skin marginating it covered with hair. Where it joined the mucous membrane there was neither swelling nor induration. The incisor and both canine teeth were exposed. On either side of the upper part of the neck were two hard inflamed lymphatic glands the size of large peas. A particularly interesting feature was the existence at the base of the dewclaw of each front foot of an ulcerated wound showing the same appearances as that on the upper lip, and only extending to the papillary layer of the skin. The greater portion of the surface was rose-red, though greyish points could be seen similar to those on the ulcer of the lip. The wound on the right paw measured a little more than three quarters of an inch in length, and about three eighths of an inch in width. It was crescent-shaped, and surrounded the paw. That on the left paw was slightly smaller, but situated at exactly the same point. These two ulcers occupied the part which cats are in the habit of licking with the tongue when cleaning themselves. They were evi- dently developed by auto-inoculation, in consequence of repeated con- tact between the skin and the labial ulcer. The patient was not left in hospital. We prescribed dressing the ulcers with a 20 per cent, solution of iodine. The animal was not brought back. 26. Six-year-old male cat, left in hospital on the 20th May, 1895. Two years before had suffered from an ulcer of the lip. Recovery occurred spontaneously after some months. On the 15th April, how- ever, a new ulcer was noted. Digitized by Microsoft® PSEUDO-CANCROID OF THE LIP. 325 This growth, situated on the upper lip, slightly to the right of the middle line, was about a quarter of an inch in length, and one eighth inch in depth, its margin appearing as though cleanly punched out ; its base was slightly hardened, and its surface covered with a thin, greyish, dry, adherent crust. The right submaxillary gland was slightly swollen. Treatment. — The parts were dressed daily with a 4 per cent, solution of chlorate of potash, and every third or fourth day were swabbed with a 10 per cent, solution of methylene blue (methylene blue, ten parts ; alcohol, fifty parts; glycerine, fifty parts). The animal was very gentle, and made no opposition to the dress- ing. By the beginning of June the slight induration about the base of the ulcer had disappeared, the extremities and the cutaneous and mucous margins were seen to be healing, while the submaxillary glands were less hard. Treatment was^stopped on the 15th Jun«. Ten days later recovery was complete, except for the notch produced by ulceration. 27. Two-year-old female cat, brought for examination on the 19th April, 1896. Was suffering from ulcer of the lip. This ulcer had developed on the right side of the upper lip, causing a crescent-shaped loss of sub- stance, about three eighths of an inch in depth at its centre, and extending as far as the right labial commissure. It was very sharply defined, its base a little indurated, but not painful on pressure ; the surface was greyish in colour, and marginated by a narrow, pale red line ; examined more closely it appeared stippled with a large number of minute depressions. On examining the jaw the right submaxillary gland was found inflamed and multilobular. Treatment consisted in dressing the ulcer with methylene blue. This animal was not brought back. 28. Three-year-old female cat, left in hospital 4th September, 1897. •Suffering from labial ulcer. In October, 1896, it had been brought here on account of a similar lesion, which, however, healed in a few weeks. On examination a large superficial ulcer was seen covering all the left side of the upper lip ; the lower lip of the same side close to the commissure was also invaded over a surface three eighths of an inch in length. Treatment. — Daily application of methylene blue solution. Up to the loth there was no change, but during the following days fine granulations appeared. On the 30th the ulcer had healed. Remarks. — In the dog the lips, especially the upper, are sometimes the seat of ulcers of an apparently cancroid nature which, however, are not in reality due to new growths but probably to lesions resembling labial ulcer in the cat. Digitized by Microsoft® 326 CLINICAL VETERINARY MEDICINE AND SURGERY. In a four-year-old watch-dog, which showed an ulcer about one and a half inches in length near the centre of the upper lip with inflamma- tion of a lymphatic gland in the neck, the base and margins of the wound were hardened, and the microscopical characters of the lesion were found to be as follows : — On section of a fragment removed from the ulcer and cut perpendicularly to the surface no epithelial new formation could be detected. At a certain point in these sections the cells were necrotic and could not be stained with carmine, though cells in the neighbouring (healthy) parts absorbed it readily, PAPILLARY SARCOMA OF THE CHEEK. 29. Six-year-old entire horse, left in hospital on the 30th December, If ^ The disease first appeared as a kind of wart growing from behind the left labial commissure. Other tumours soon appeared and covered a considerable surface. State on Examination. — The tumour occupied the greater portion of the cheek. It extended backwards from the commissure of the lips to within about four inches of the ramus of the lower jaw, upwards as high as the forehead, and downwards into the intermaxillary space. According to the point inspected its thickness varied between three quarters of an inch and two inches. It was sharply defined at its periphery, where it met the healthy skin, and was formed of two dis- tinct masses separated by a narrow depression running parallel to the lower row of teeth, and somewhat obliquely from behind forwards and downwards. The shape of both masses was irregular ; their surface rounded and bleeding. The interspace was filled with foetid pus. The submaxillary gland was slightly swollen, hard, insensitive, and adherent to the deeper structures, but not to the skin. The sheath also showed warty growths, the largest the size of a hen's egg. Treatment. — On the 31st December the horse was cast on Daviau's table, the tumour removed with the knife, and the base carefully curetted. Haemorrhage was checked by the cautery. On section the morbid tissue was greyish, firm, and contained little fluid. Histologically it resembled fasciculated sarcoma. It was com- posed of large fus-iform cells containing one or several nuclei, and grouped in bundles running in various directions. During the next few days the eschar became detached. The wound was afterwards touched with dilute tincture of iodine and covered with tannin. On the 12th January, when the animal left hospital, the greater portion of the wound was healed. When seen again two months later the cicatrix was flat, and there had been no return. FRACTURE OF THE LOWER JAW. 30. Eight-month-old poodle, left in hospital i6th April, 1892. Whilst playing in the stable it was kicked, and on being examined Digitized by Microsoft® OSTITIS OF THE INFERIOR MAXILLA— NECROSIS— (SEQUESTRUM). 327 thejaw wasseentobe pendent and blood to be running from the mouth. It was immediately brought to the School for treatment. State on Examination. — The mouth was open, and discharged blood- stained saliya. Manipulation caused pain, shown by the animal yelping. Slight movement of the lower jaw produced crepitation ; the bone was fractured through its neck. The left branch was also fractured under the masseter muscle. The jaw was swollen and very painful, and traumatic fever pronounced. The pulse was 120 ; respira- tions 34 ; and temperature 39-8° C. Treatment. — A dressing formed of layers of linen smeared with pitch was applied. This bandage covered the whole of the lower jaw, and a few turns were passed behind the nape of the neck. The fractured bone was also kept in position by a band of tarlatan rolled round the jaws and neck, several of the turns crossing under the larynx. The patient was spoon-fed with liquid food. The mouth was washed out with boric lotion. The dressing had to be readjusted several times, and as the animal continually tried to remove it a muzzle was used. On the loth May the bandage was removed. The maxilla had united, and the fragments were solidly fixed together. The dog was fed with bread and chopped meat (without bone). On the 15th it was able to take its usual food. The lower jaw was slightly deformed by the presence of a callus, but showed no abnormal tenderness. OSTITIS OF THE INFERIOR MAXILLA— NECROSIS— (SEQUESTRUM). 31. Six-year-old gelding, left in hospital on the 26th October, 1897. Disease had been caused by the bit. The mucous membrane of the mouth had been seen to be wounded, and the lower margin of the maxilla swollen. The injury was first treated by firing, but the swelling increased. An operation was afterwards performed, but gave unsatis- factory results, a fistula remaining. Six weeks later, as the animal was difficult to handle, it was sent here. The outer margin of the left branch of the inferior maxilla, opposite the bars, exhibited a bony tumour the size of a hen's egg, the centre of which was pierced by a fistula about two inches in depth. In the cavity of the mouth could be seen the cicatrix left by the incision made two months before on first operating. On the 29th October the horse was cast on Daviau's table. The fistula was enlarged with a gouge, revealing a sequestrum as large as a hazel-nut in the depth of the bone. The inferior wall of the cavity containing it being very thick and hard, we decided to operate through the mouth. The jaws were opened with a gag, and the tush and corner tooth of the corresponding side removed. Through the opening thus made the sequestrum was easily removed. The margins of the wound were lightly cauterised, and the wound itself plugged with gauze through the cutaneous orifice. Each day the dressing was renewed and the wound washed out with dilute iodine solution. Recovery occurred in three weeks. Digitized by Microsoft® 328 CLINICAL VETERINARY MEDICINE AND SURGERY. CANCER OF THE INFERIOR MAXILLA. 32. A ten-year-old gelding sent to Alfort on the gth June, 1897, by M. Candelot, Veterinary Surgeon at Viarmes (Seine-et-Oise). Five weeks before, during the early part of May, a swelling as large as a hen's egg was seen to have formed under the jaw. A veterinary surgeon who was consulted regarded it as a cold abscess, applied a blister, and a few days afterwards fired it in four places. A week later Fig. 29. — Cancer of the inferior maxilla. this swelling had become five times its original size, and another had developed on the lower surface of the cheek which soon ulcerated and became fistulous. The disease grew rapidly aggravated, without, how- ever, producing general disturbance. The animal preserved its appetite and showed no difficulty in mastication. On entering hospital it was still in good condition. The lower Digitized by Microsoft® CANCER OF THE INFERIOR MAXILLA. 329 portion of the right cheek, the jaw, and the intermaxillary space were occupied by a large new growth, the outer part of which was ulcerated, fungous, and bleeding. Owing to the animal rubbing the parts the chest, shoulders, and forearms were covered with pus and blood. The tumour in the intermaxillary space was only of metastatic origin. It covered 8 inches in length and 10 in width, and its centre projected about 5 inches. It was very hard, bosselated, and adherent to the skin, but moveable in relation to the jaw and the tongue. The tumour on the face occupied the lower portion of the cheek, from the middle third of the masseter to the chin. In front it extended beyond the zygomatic ridge ; behind it projected 3 inches to 3^ inches above the general surface, and was in contact with the tumour in the intermaxillary space. It was somewhat sharply defined, showed a peripheral zone covered with skin, to which it was adherent, and a central ulcerated, vegetating, cauliflower-like centre 4 inches across, in Fig. 30. — Internal surface of the right branch of the maxilla. the depths of which probing revealed softened, crepitant bone. The masseter was distinctly atrophied. On examining the buccal cavity (which was offensive) the tumour was found to have perforated the inner table of the maxilla and the mucous membrane, and filled up the depression between the gums and tongue, forming an elongated reddish mass, which covered the first molars. The characters of this new growth, but especially its point of origin in the maxilla, and its prompt extension to the lymphatic glands and tissues of the cheek and mouth, indicated its epithelial character. Histological examination of a fragment removed from the margin of the ulcer on the face proved it to be an epithelioma of the lobulated pavement variety. The animal was left in hospital as a subject for clinical study. No surgical treatment was possible, and none was attempted. The cancer Digitized by Microsoft® 330 CLINICAL VETERINARY MEDICINE AND SURGERY. made rapid progress, as shown by wasting, loss of appetite, and pale- ness of the mucous membrane. Death occurred on the 23rd June. Post-mortein Examination. — General wasting. No growths in the viscera. The head having been sawn through along the middle line, the left branch of the lower maxilla opposite the first molars appeared destroj-ed throughout its entire depth. Around this area of destruction the branch of the maxilla was swollen, enlarged, its two layers thrust widely apart, and its tissue softened. The, first and third molars had fallen from their alveoli ; the second, surrounded by granulating tissue, was quite loose. The tumour in the intermaxillary space weighed 4 lbs. 6 oz. The buccal and facial portions of the other new growth, which occupied the entire depth of the maxilla and extended beyond its margins, weighed nearly 5 lbs. 6 oz. This case is remarkable for the rapidity with which the cancer de\eloped. In two months it destroyed the central portion of the right branch of the lower maxilla, produced great disturbance, and caused troubles ending in general decline and death. DENTAL CARIES. 33. Five-year-old mare affected with caries of the second left upper molar. Entered hospital on the loth November, i8g6. For some time this animal had been noticed to eat very slowly. It masticated oats badly, ate hay with difficulty, and seemed to prefer mashes and easily masticated food. It had also been observed that considerable quantities of foetid saliva mixed with food material ran from the mouth, and that the left side of the face exhibited a swelling, painful on pressure. Condition on Entry. — The left side of the face in front of the small maxillary sinus exhibited a diffuse, slightly painful swelling. Large quantities of viscous stinking saliva, mixed with food material, ran from the mouth. A greenish muco-purulent discharge escaped from both nostrils, but especially from the left. The submaxillary gland appeared as a small, hard, indolent swelling, not adherent to the base of the tongue. The mouth was offensive. Opposite the second molar was a depression in the line of teeth, around which food had accumu- lated. The gum and inner surface of the cheek were inflamed. At exercise the animal produced a peculiar abnormal sound during respiration, pointing to deformity of the left nasal cavity, a condition verified by e.xploration with Gunther's catheter. Diagnosis. — Caries of the second left molar, with swelling of the floor of the corresponding nasal cavity. Treatment. — Removal of the tooth by punching. On the nth November the mare was cast on the right side, and the jaws having been widely opened by a gag, a V-shaped incision was made over the root of the tooth, the subjacent tissues reflected, and the maxilla trephined, giving exit to a quantity of grumous fcetid pus mixed with food. After cleansing the cavity the punch was applied to the root of the tooth, which was displaced by a few gentle blows, an assistant mean- Digitized by Microsoft® DENTAL FISTULA. 33 1 while controlling the progress of operation by passing one hand into the animal's mouth. The tooth having been removed the opening was cleansed with warm carbolic solution, and plugged with gauze. That evening the temperature was normal. Next day the dressing was renewed. The animal ate freely and seemed to have suffered little from the operation. Temperature 39-2° C. Discharge was less abundant, but breathing was still noisy. The same treatment was continued on the following days. The wound showed no special feature. On the i8th discharge had ceased. The external wound was clean, and there were no splinters or necrosis. Treatment was continued until the 25th. Swelling of the face had gradually diminished, the alveolar cavity rapidly filled up, and the abnormal breathing disappeared. DENTAL FISTULA, 34. Eight-year-old entire horse suffering from dental fistula.. Brought for examination on the 19th January, 1899. History. — The disease had first appeared nearly two years before. At that time the horse showed a slowly increasing enlargement over the anterior portion of the left upper maxilla, which was several times unsuccessfully blistered and once punctured. On the last occasion pus escaped, but the enlargement continued and the wound became fistulous. Condition on Examination. — Opposite the roots of the second and third molars, and at its junction with the cheek, the left side of the face showed a swelling measuring three and a quarter inches in diameter, the centre of which was pierced by a fistula discharging greyish, putrid pus. A probe entered for a distance of one and a half inches, and at that point appeared to be checked by contact with the root of a molar tooth. External manipulation of the parts produced little pain, but the introduction of a probe into the fistulous tract caused the animal to struggle violently. The left line of molars showed nothing abnormal, no caries or tumour, no fistula or gingivitis ; and the buccal cavity was perfectly sweet. The long duration of disease, the fistula formation and other attributes of the swelling, the character of the pus, and the absence of lesions within the mouth pointed to the existence of alveolitis confined to the space around the root of the tooth, or of caries of this root. Treatment. — On the 21st January the animal was cast on the right side by means of Daviau's table ; the maxilla trephined over the root of the second molar (which was found to be separated from its alveolus and the point of origin of the fistula) and the tooth punched out with the usual precautions. After operation the wound was cleansed and the alveolar cavity plugged with cotton wool surrounded by layers of gauze. Digitized by Microsoft® 332 CLINICAL VETERINARY MEDICINE AND SURGERY. The root of the tooth when examined was found to be carious ; the anterior portion had been destroyed, and the tooth itself penetrated by a deep narrow fistula, into which a wire penetrated to within about three eighths of an inch of the grinding surface ; the table itself, how- ever, was intact. No exact information could be obtained as to the cause of this dental fistula. It was probably produced by injury to the maxilla opposite the second molar, leading first to ostitis, then to formation of a necrotic area, followed by alveolitis and caries of the root of the tooth. There being no spare room in hospital the horse was placed at livery near the College. During the following few days it was brought to the external clinique. Every morning the dressing was renewed ; the alveolar wound was exposed, cleansed, and again plugged. At the end of a week a small necrotic area was noted in the maxilla in front of the trephine opening. It was swabbed with tincture of iodine, and the little necrotic patch soon separated. From the beginning of the second week the dressing was only renewed each second day. The external wound and that of the alveolus gradually closed. On the ist March they had become reduced to a narrow channel from which only a little pus escaped ; and in the mouth the breach had almost entirely closed. At this date the animal was returned to work, recovery being assured. 35. A five-year-old water-spaniel left in hospital on the 17th August, 1898. For nearly a year this animal had shown at the base of the lower eyelid, slightly in front of and below the eye, a fistulous wound dis- charging foetid, greyish, sometimes blood-stained pus, which had irritated the skin of the cheek and produced a bare patch. It had been unsuccessfully treated by antiseptic injections, and by exposure and cauterisation. During the previous few months the patient had fallen away in condition. On exploration the fistula was found to terminate over the root of the last molar, around which the gum was inflamed and retracted. Under proper control the molar was extracted with dental forceps. It was partially carious. The alveolus, however, showed no necrosis, and was disinfected with iodine solution, and plugged with cotton wool. During the four following days the dressing was renewed daily. Afterwards the cavity was washed out night and morning with warm boric solution. On the 30th the fistula on the face had closed, and the alveolar opening to a great extent filled up. Next day the animal returned home. 36. A three-year-old cat, with dental fistula opening on the right side of the lower jaw. Brought for examination on the 31st March, 18 ' Digitized by Microsoft® SECTION OF THE TONGUE. 333 The fistula had been in existence for about eight months. The owner stated that it had followed a rat bite. It opened on the right side of the lower lip, and was masked by the surrounding hair ; the track was narrow, its opening level with the skin, and its margins not indurated. A fine stilette introduced into the wound was checked by contact with a necrotic fragment of bone. The animal having been fixed on the table, and the jaws opened by means of two pieces of tape, the gum was seen to be swollen, red, and retracted opposite the right canine tooth, the base of which exhibited a thick deposit of tartar. The tooth was removed, and the vvound and fistulous tract cleansed with a 30 per cent, solution of tincture of iodine. In ten days the cutaneous and buccal wounds had healed. SECTION OF THE TONGUE. 37. A four-year-old Arab horse, brought from Marseilles to Paris in a horse-box, in which it was fastened by means of a rope passed through the mouth. When receiving the horse the owner noticed that the loop of rope was soiled with blood. On attempting to examine the mouth the animal struggled violently, but the tongue was seen to exhibit a trans- verse wound extending over its entire width, slightly in front of the first molars. The patient was brought to the school three days afterwards. The angles of the mouth were soiled with blood-stained saliva; the lower lip and chin showed a semicircular superficial wound, produced like that of the tongue by pressure of the rope. In order to examine the oral cavity a twitch had to be applied. On opening the mouth a foetid odour was observed. The left side of the free portion of the tongue appeared slightly swollen and red ; the right was greenish in colour and gangrenous. At that time, however, the two parts were still in perfect continuity throughout their entire extent, though the line of demarcation could be clearly seen. It extended exactly through the centre of the tongue, except in front where it curved towards the right, attaining the free margin about an inch from the central line. This line of demarcation, though superficial in the left half of the tongue, extended throughout the greater part of the thickness of the right half. The inequality in depth explained the persistence of cir- culation in the left half of the organ and the gangrene of the right. The animal was fed on liquid food, like milk, gruel, and mash, the mouth being frequently washed out with cold fluids. On the animal's return ten days later, the gangrenous portion of the tongue was seen to have become separated and lost. The entire surface of the wound was granulating. The contraction which resulted was most marked in the direction of the thickness of the tongue, the free extremity of which was only drawn slightly towards the right ; there was no subsequent trouble either in prehension or mastication. Digitized by Microsoft® 334 CLINICAL VETERINARY MEDICINE AND SURGERY. 38. and, as mouth. The A Norman mare, brought from Caen to Paris in a horse-box, in the preceding case, tied up with a rope passed through the tongue had been divided transversely throughout the greater part of its depth, a Httle in front of the first molars. The bars, inner surface of the lips, and labial com- missures were severely injured. The rope had rubbed away the hair and injured the skin about the chin, and had entirely cut through the lower lip of either side towards its free margin. The animal was fed with gruel, and the buccal cavity frequently washed out with cold water. At the end of forty-eight hours the anterior portion of the tongue had become gangrenous. It separated six days later. The stump healed rapidly, and the animal was returned to ordinary work. At first it had difficulty in prehension, but soon became capable of consuming its ordinary food consisting of oats and hay. When seen two months after the accident it was in good condition. The lingual cicatrix was flexible and fairly regular, although the tongue itself was drawn slightly to one side. The stump extended about two inches below the first molars. Opposite it the de- pression normally existing between the gums and lips had disappeared, the two structures having become adherent. Despite the mutilation, there was no difficulty in grasping or masticating food. Fig. 31. FOREIGN BODY IN THE MOUTH. 39. A one-year-old Bordeaux dog brought to the School on the 30th November, 1898, during the after- noon, by a lady who was only able to give vague infor- mation. She said that the animal had not eaten any- thing for several days, that saliva dribbled from the mouth, and that a veterinary surgeon who had examined , it prescribed treatment which proved unsuccessful, q ^n This dog was bright and did not appear in pain. From the corners of the mouth a viscous foetid saliva streaked with blood escaped in considerable quantities. The animal would not take solid food, but was able to swallow warm milk given by spoonfuls. On examining it next day, I suspected the presence of a foreign body in the mouth or pharynx and ordered these cavities to be examined. The dog was placed on the operating table and the mouth widely opened by means of a speculum. With the exception of abundant secretions of saliva nothing abnormal could at first be dis- covered. The odour, however, was excessively offensive. Several Digitized by Microsoft® CHRONIC PHARYNGITIS. 335 molars of darker colour than the others attracted attention, but there was no caries, or inflammation of the gums, and some other cause had to be sought. On pressing down the tongue with a spatula and moving it from side to side a cord was noticed in the space between the tongue and gumSj the centre portion surrounding the base of the tongue, and the ends traversing the pharynx and entering the oesophagus. It was seized with the fingers and removed. The appearance it presented is shown by Fig. 31. This cord measured 13 inches, the loop alone being about 8 inches in length. Its free end formed an irregular mass the size of a man's little finger, in which were entangled some fragments of shavings. The loop had slipped under the tongue, and been caught on the frsenum linguae, the free portion passing backwards and entering the pharynx. It could not be swallowed, and could only have been expelled by vomiting, which, however, did not seem to have occurred. Scarcely had the cord been removed than the animal began to eat. On returning to its kennel it soon cleared out its feeding trough. In spite of the stomatitis which had occurred, recovery followed promptly, and the animal was able to return home on the 3rd December. CHRONIC PHARYNGITIS— DOUBLE HYOVERTEBROTOMY (OPENING OF THE GUTTURAL POUCHES). 40. A fifteen-year-old gelding. Entered hospital on the 30th June, 1896. Had been left at Alfort to be treated for pharyngitis in December, 1895, and been removed before complete recovery. A slight discharge from both nostrils had continued, and after some time increased in quantity. On returning to hospital this horse was in rather thin condition ; appetite was normal, but swallowing difficult. A muco-purulent discharge containing fragments of food ran from both nostrils, and part of the drinking water, which was at first mixed with muco-pus, returned by the same channel. Violent attacks of coughing occasionally occurred. The throat was neither painful nor swollen. The parotid region appeared normal. It was difficult to produce coughing by pressing on the larynx. The submaxillary glands contained two small hard multilobular masses. The chief functions were regular. The lungs revealed nothing abnormal. On the 4th July the guttural pouch of either side was opened and a mass of gauze saturated with dilute tincture of iodine was passed to act as a drain. Up to the 25th July antiseptic injections were made daily and fresh strips of gauze saturated with iodine solution were passed. After that time drainage was stopped. The discharge and difficulty in swallowing gradually diminished. On the 28th the animal was almost completely cured, and returned home. Trifling disturbance remained for a time, but finally dis- appeared. Digitized by Microsoft® 336 CLINICAL VETERINARY MEDICINE AND SURGERY. COLD ABSCESS IN THE RETRO-PHARYNGEAL GLANDS. 41. A five-year-old mare, left in hospital the nth June, 1897. History. — About three months before the stableman had noticed in the submaxillary and laryngeal regions a swelling, which extended on either side over the parotid. Though at first little marked, this swelling gradually increased. A little whitish, mucous, inodorous discharge, which appeared oftenest during work and when the animal began to swallow liquids, ran from the nostrils. Deglutition was difficult, and the mare ate and drank slowly. No useful information could be obtained as to the animal's ante- cedents. We simply learned that it was of American origin, and had been bought four months before. State on Examination. — In spite of the difficulty in eating, the mare was in good condition. The swelling of the throat and parotid regions was considerable, was hard, resistent, without fluctuation, and almost painless on pressure. The head was held extended. The submaxillary gland was slightly swollen, the swelling being ill- defined and rather cedematous towards its periphery. From time to time, and especially when the animal drank, a whitish, inodorous dis- charge ran from both nostrils, though rather more abundantly from the left, although the swelling appeared equal on either side of the throat. Treatment. — After a week of observation the upper part of the right guttural pouch was opened and a counter opening made in the usual way. No pus escaped, but a drainage-tube was nevertheless intro- duced. A similar operation was performed on the other side with like result. The animal was left at liberty in a box. During the afternoon it appeared dull and hardly touched food. The guttural pouches were washed out with a warm solution of iodine and iodide of potassium. On the following days the parotid regions increased in size and became very tender. Mastication and deglutition appeared painful, and there was difficulty in flexing the neck. The temperature only rose a few tenths of a degree. Each morning the drainage-tubes were replaced. The patient was fed on gruel and milk. On the 22nd creamy pus escaped by the drainage-tubes ; the swelling decreased, especially on the left side ; difficulty in swallowing was less marked ; discharge ceased ; and the extension of the head and stiffness about the neck diminished. During the following week the swelling due to operation lessened in the upper half of the parotid region, but persisted in the lower. Imme- diately above the origin of the trachea a swelling formed, and steadily became more clearly circumscribed, giving the impression of a deep- seated cold abscess or of a tumour. During the first week of July these local symptoms remained unchanged. Further operation was decided on. On the gth the mare was cast on Daviau's table. The head was firmly fixed in a position of extension, and the skin covering Viborg's triangle washed, shaved, and disinfected. A cutaneous incision about 6 inches in length was then made immediately above and parallel to Digitized by Microsoft® COLD AlisCliSS IN THK RETRO-PHARVNGEAL (iLANDS. 337 the external maxillary vein. By careful dissection the skin, subcu- taneous fascia, parotid gland, and subjacent aponeurosis were reflected. On passing the finger behind the left guttural pouch a large, rounded, uniform, resistent swelling, without the least fluctuation, was detected. For the moment it was doubtful whether this represented a new growth or a cold abscess in the retro-pharyngeal glands. The end of a grooved director was introduced, guided by the left index finger, and was pushed in the direction of the centre of the swelling. It appeared to enter, and some whitish laudable pus escaped. The tract was enlarged, and about a pint of similar pus evacuated. The abscess cavity was washed out, a rubber drainage-tube inserted and fixed to the skin, and the animal allowed to rise. On entering the stable it at once began to eat some oats, which it swallowed without difficulty. The swelling about the throat had almost entirely disappeared, and the head and neck were moved freely. During the evening and following days the abscess cavity was washed out with antiseptic solutions. Suppuration was trifling. On the 14th the drainage-tube was removed. On the 20th the guttural region had resumed its ordinary appearance, except for the cicatrix of the operation wound. Respiration was unaffected, and appeared normal at all paces. Digitized by Microsoft® II.— NECK. WOUND OF THE NECK. 42. A nine-year-old gelding suffering from a wound in the region of the neck, left in hospital the i8th November, 1898. On the i6th November when out for exercise this horse had reared up when passing close to a man carrying a scythe, and the cutting edge of the implement had entered the neck, producing a large wound (Fig. 32). State on entering Hospital. — The patient was brought to hospital Fig. 32. two days after the accident. On the left side of the neck was a wound about twelve inches in length, running obliquely forwards and down- wards, extending from the upper border of the neck to within an inch and a half of the jugular furrow. Its anterior extremity was almost in contact with the lower jaw. Above, it passed across the upper margin of the neck, and for a further distance of three inches over the right Digitized by Microsoft® POLL-EVIL. 339 side. The tissues covering the upper part of the neck were completely, and the ligamentum nuchse partially divided, especially on the left side. Towards its centre the wound was six inches broad and three to three and a half inches deep. Opposite the line of the vertebrse it was two and a half inches in depth, and extended through the muscular tis- sues. The upper part was somewhat shallower. The greater portion of both surfaces of the wound was covered with dried exudate, and the deeper portions contained masses of blood-clot. The animal was depressed and feverish ; it only ate a portion of its food ; the tempera- ture was 39'5° C. Treatment. — Thorough disinfection of the wound with a warm one per thousand solution of sublimate, insertion of deep-seated sutures, and application of moist antiseptic compresses. November 20th. — The wound had become clean. Some fragments of dead tissue had been shed. Suppuration was trifling. Temperature 39-2° C. During the following days the wound granulated over its entire surface. The muscular layers became united. The depressions filled up and suppuration remained slight. In spite of the extent and depth of the wound the neck was easily moved in all directions. The appetite was good, and the temperature normal. On the 5th December the use of moist compresses was discontinued, the wound being simply washed out night and morning with an anti- septic solution. On the 20th it had almost filled up ; the margins were nearly in contact, and at the widest part were only separated by a distance of an inch and a quarter. POLL-EVIL. 43. Fifteen-year-old gelding, sent to the School from the Pasteur Institute on the 27th February, i8g8. It had first been treated at the infirmary of the Institute for an open sinus on the left side of the head. Carbolic and sublimate injections had proved unsuccessful. On the 28th the horse was cast on the right side. The sinus, which opened almost on the median line, extended obliquely downwards and backwards parallel to the ligamentum nuchse, and was about six inches in depth. Treatment.— The sinus was exposed and a counter-opening formed. A gauze drain was inserted, and the parts washed out night and morn- ing with 30 per cent, tincture of iodine, and with Villate's solution. A prophylactic injection of antitetanic serum was given. Though continued until the 15th March this treatment by drainage and injections produced no improvement. Operation for poll-evil was then decided on. The animal was cast on the table, and the cordiform portion of the ligamentum nuchse removed up to the point where it becomes inserted into the occipital bone, the latter being scraped. The wound was cleansed with warm sublimate solution, powdered with iodoform, and Digitized by Microsoft® 34° CLINICAL VETERINARY MEHICINE AND SURGERY'. covered with compresses of iodoform gauze, over which was appUed a compress dressing of cotton wool kept in position by three bandages. On the second day after operation the dressing was removed and the wound washed out with warm subHmate solution. A fresh gauze and cotton-wool dressing was applied. The dressings were changed every second day until the 3rd Ma}', when the wound was granulating throughout. SINUS OF THE NECK. 44. Eight-j-ear-old gelding, left in hospital the 27th August, 1898. For the previous three weeks this horse had shown a diffuse, very tender swelling in the upper part of the neck, the centre of the swelling being occupied by a large partially detached slough, which appeared to extend deeply towards the ligamentum nuchas. Treatment. — The greater part of the dead tissue was excised. Two incisions in the shape of a cross were made, one in the axis of the neck, the other transverse to it ; and in addition a counter-opening was made on the right side, in which a strip of gauze was placed to act as a drainage-tube. Night and morning the wound was disinfected, the margins powdered with bicarbonate of soda, and the parts covered with compresses saturated with warm 5 per cent, bicarbonate of soda solu- tion. Thistreatment was continued for a week. Suppuration remained abundant, and the swelling large and painful. From the 5th September the parts were dressed with a weak solution of formalin and a mixture of calomel and iodoform. This treatment proved very successful. The wound soon assumed a better appearance. The pus became thicker and less abundant, while the parts lost their extreme sensibility. On the 30th September the necrotic portions of the ligament had separated, and the entire surface of the wound was actively granulating. The neighbourhood of the wound still remained ver}- sensiti\'e in conse- quence of irritation of the skin. MOIST GANGRENE IN THE NECK REGION. 45. A thirteen-year-old entire horse, left in hospital 28th April, 1893- . . This animal had been injured a little in front of the withers by the collar. The neighbourhood of the wound and the upper margin and sides of the neck became much swollen. A veterinary surgeon punctured the swelling on both sides with a pointed firing-iron, but tumefaction increased during the following days. State on Examination. — Depression ; loss of appetite ; anxious appearance of the face ; mucous membranes cyanotic ; respiration and circulation rapid ; temperature 39'6° C. The whole of the neck was enormously swollen ; sloughing had occurred in the upper half, and the lower was cedematous. At the centre of the upper margin was a sinus into which almost half a litre of liquid could be injected. On the right side the necrotic parts were beginning to separate. Digitized by Microsoft® PHLEBITIS OF THE JUGULAR VEIN. 34I Treatment. — Attempts were made to check the extension of gangrene on the left side of the neck by applying about thirty deep punctures with the firing iron, into which was injected 30 per cent, tincture of iodine containing iodide of potassium. The parts were sprayed with carbolic solution. Alcohol, carbolic acid, and bicarbonate of soda were given internally. The evening temperature was 40^2^ C. April 30th. — The general condition had improved. The mucous membranes were less injected ; the pulse and respiration less frequent. The animal took a part of its food. The general symptoms were no longer alarming. Separation of the dead parts had begun on the left side. The eschar measured fourteen inches in length and varied between four and seven inches in breadth. The parts were sprayed with carbolic solution three times daily and covered with a thick com- press saturated in one per thousand solution of sublimate. May 3rd. — Improvement was progressive. Appetite had returned, and each day delimitation was more marked. May 6th. — The eschar not yet being completely delimited, the grer.ter portion was excised. A mass weighing nearly six pounds was removed. In front a gangrenous patch about four inches in length remained. To prevent necrosis extending in the funicular portion of the ligament cervical desmotomy (division of the cordiform portion of the ligamentum nuchse) was performed. Antiseptic treatment was continued. May gth. — The remaining necrotic patch was excised. It weighed a little more than two pounds. May loth to 27th. — The wound became clean, and granulated actively. The loss of tissue was gradually replaced. Up to the loth June a sinuous tract remained, originating from a necrotic fragment of the ligamentum nuchse. The animal left hospital on the 15th June. The wound was granu- lating throughout, and recovery was certain. PHLEBITIS OF THE JUGULAR VEIN. 46. Five-year-old entire horse, left in hospital on the 30th Dc; cember, 1896. The animal had been bled, and in consequence a large thrombus had formed. • , 1 • From the site of the operation wound up to the parotid the jugular furrow was swollen, hot, cedematous, and painful. The wound was sinuous, and a director could be passed into the vein. The sinus was laid open for a long distance m the axis of the vessel ; its walls were curetted, disinfected with strong carbolic solu- tion and tincture of iodine, and plugged with iodoform gauze. During the succeeding days the dressing was renewed daily, the wound cleansed by spraying with carbohc solution, and dusted with calomel. Suppuration was trifling, and healing regular. On the 8th January a little perivenous abscess, which had de- veloped about an inch above the wound, was punctured. The cavity was cleansed and treated with antiseptic injections. Cure was complete in a fortnight. Digitized by Microsoft® 342 CLINICAL VETERINARV MEDICINE AND SURGERY. 47. A seven-vear-old in-foal mare, left in hospital i8th F^ebruary, 1897. About six weeks before the animal had been bled from the left jugular. Phlebitis resulted, and was treated by laying open the parts and cleansing with disinfectant lotions. Recover)- appeared to be taking place when the parotid region became inflamed. On examining the animal on the nth February we discovered a subparotid abscess developed between the middle and upper thirds of the gland. It was punctured and washed out with 30 per cent, iodine solution. The condition becoming aggravated, the animal was left in hospital on the i8th Februar}-. State on Entry. — The entire left parotid region was greatly swollen and very painful. The swelling extended from the wound in the vein to the temporo-maxillary region and back of the neck, passing round the base of the ear. The subparotid abscess communicated with the wound in the vein. The animal discharged from the left nostril. It refused part of its food. Treatment. — Drainage of the ^-ein and injection of the sinus with 30 per cent, solution of iodine and iodide of potassium. On the 19th Februarj- two small abscesses had developed above the first, and were opened. They contained little pus. On the 22nd two more abscesses were opened ; one, of considerable size, had developed behind the parotid, the other near the base of. the ear. The cavities were cleansed, and the sinus irrigated with iodine solution. A fragment of the gland tissue was removed. When feeding saliva escaped by the parotid wounds. On the 25th a deep-seated abscess opened in the pharynx, and pus escaped by the nostrils. On the 28th another parotid abscess was opened, and a counter- opening made in \'iborg's triangle. From this time onwards improvement was steady. On the 17th March drainage of the vein was stopped. A week later the wounds had healed. The parotid region and upper part of the jugular furrow remained slightly swollen, but the swelling soon afterwards disappeared. 48. Six-year-old mare, left in hospital on the nth January, 1897. A month before the animal had suffered from strangles, and had been bled from the left jugular. The patient was brought in an ambulance, and was so thin and feeble as to require support when walking. Scarcely any weight was borne on the near hind limb. On being placed in a box it soon fell into a comatose state, remaining quite still, the eyes half closed, the head depressed, the limbs brought together under the bod} ; from time to time the animal was obliged to lean for support against the wall. The mouth was hot and dr}- ; the conjunctiva yellowish in colour; the pulse 80, small and thready ; respirations 22 ; temperature 39'5° C. The hair had been removed from the left parotid region by the action of vesicants. In the upper part of the jugular furrow was a warm, slightly painful swelling, extending over the parotid, and show- Digitized by Microsoft® PHLEBITIS OF THE JUGULAR VEIN. 343 ing a sinuous wound which discharged blood-streaked pus. Another wound existed about the centre of the parotid region. In the oedematous tissue filKng the left side of the submaxillary space, a large, irregular, slightly sensitive swelling formed by the submaxillary gland could be felt. A large swelling covered the region of the sternum and extended beyond the ensiform cartilage. The left haunch was atrophied ; the right showed a cool, slightly painful swelling, speciall)- marked over the region of the coxo-femoral joint. The left hock was swollen, denuded of hair by blistering ; and exhibited on the lower and inner surface a small wound discharging whitish pus. Nothing abnormal could be detected on percussing and auscultating the chest. Rectal exploration failed to discover signs of intra-pelvic abscess. Treatment. — The wounds were washed with antiseptics, creolin being used in the fistulous portion of the jugular; and warm creolin enemata were administered during the evening. Milk, hay tea, brandy, and bicarbonate of soda were given internally. The patient readily took gruel. Next daj' the animal seemed less depressed. The local symptoms remained unchanged. Discharge of pus was facilitated by inserting drainage-tubes in the fistulous portion of the vein. The swelling under the chest showed fluctuation, and on being opened discharged a pint of pus ; it was washed out and disinfected several times during the day. The swelling in the co.xo-femoral region was stationary. In order to prepare for operation the hair was shaved and the skin disinfected over an area the size of a man's hand, but explorator\' puncture was deferred, as the position of the abscess was uncertain. The internal treatment was continued. The evening temperature was 40"5° C. On the 13th there was little improvement though the vein sup- purated less than on the previous day. In order to check extension towards the base of the jugular a few deep punctures were made with the firing-iron in the upper part of the. parotid region. Antiseptic injections into the fistulous vein and into the purulent cavity beneath the sternum were continued. Temperature 40° C. Internal treatment continued. Evening temperature 40"3° C. Respirations 20. On the 14th January temperature 40"6° C ; respirations 26. No striking change except a diminution in size of the swelling in the coxo- femoral region. During the evening the mare lay down and groaned a good deal. She received an enema containing chloral. Temperature 40"5° C. Died during the night. Autopsy. — The peritoneum, ecchymosed in places, contained a little yellowish serous fluid. The liver, spleen, and kidneys were congested. In the depths of the right haunch was a collection of pus surrounding the hip-joint. The left pulmonary lobe contained about fifteen little purulent centres; the pericardium about one pint of yellowish serous fluid. The myocardium showed no lesions, though the endocardium exhibited a few ecch}-moses. Digitized by Microsoft® 344 CLINICAL VETERINARY MEDICINE ANIJ SURGERY. On dissecting the parotid region phlebitis was seen to have extended a considerable distance beyond the parotid fistula. The subzygomatic and internal maxillary veins had become affected. On dividing the head along the middle line the meninges appeared inflamed, thickened, and bathed in a purulent exudate, in which bacteriological examination revealed the presence of st'repto- and staphylococci. EXTEXSIVE LACERATED WOUND IN NECK OF HORSE; OF THE TRACHEA; RECOVERY. RUPTURE 49- Light van horse, seen 23rd July, i8(;,__ History. — Had been struck about the middle of the neck by the pole of a two-horse van (see Fig. 33). State on Examination. — The animal showed two wounds in the neck and one in the pectoral region. The largest was on the off side of the Fig. 2^. — The larger wound is shown white; the position of the smaller is indicated by the arrow; the pole head is shown within lines. neck, about midway between the angle of the jaw and point of the shoulder. A large irregular fragment of skin about three and a half inches in either direction had been entirely torn away, and on insert- ing the finger into the wound two channels could be detected, one Digitized by Microsoft® FOREKiN BODY IN THE QCSOPHACUH. 345 about three and a half inches in length passing downwards and back- wards, following the direction of the levator humeri muscle ; the other upwards and forwards, and towards the opposite (nearj side of the neck. As the finger penetrated more deeply the rough broken edges of a tracheal ring could be felt, and during inspiration and ex- piration air rushed in or was forced out, producing a loud bubbling sound. The tissues were extensively bruised, and the skin torn away from subjacent structures for a considerable distance. The wound on the near side of the neck was three to four inches below the angle of the jaw, and measured two and a half inches by half an inch. It communi- cated with that of the opposite side by a channel running downwards and backwards, so that by standing in front of the animal and gently passing the foreirngers in from either side they could be caused to meet just in front of the trachea. Treatment. — The wounds were thoroughly explored and cleansed, care being taken to avoid the use of much fluid which might have passed into the trachea. To facilitate the freest possible drainage no stitches were inserted. The parts were cautiously injected three times daily with 5 per cent. " Sanitas " solution, care being taken to reach the bottom, and the neighbourhood of the wounds was carefully cleansed. Low diet. On the 24th July the wounds and surrounding parts were greatly swollen, but discharge was not offensive. Until the 29th the wounds and neighbouring parts were much swollen, but on that date swelling began to subside. There was slight fever and rather high pulse rate for the first few days, but this soon subsided. Appetite was preserved throughout. On the 8th August both wounds had closed and were granulating freely. A week later the horse returned to work. A year afterwards the horse showed very slight traces of the accident, and breathing was normal. Mr. Jno. A. W. Dollar's case, Veterinarian, 1S96, p. 672. FOREIGN BODY IN THE (ESOPHAGUS. 50. A seven-year-old entire horse, left in hospital on the i8th February, 1897. When being taken out of harness this horse passed near a heap of shced carrots, and picking up a few pieces hastily swallowed them. Almost immediately it showed grave disturbance, violent excitement, efforts to swallow, and abundant salivation. It was brought to hospital during the evening. The animal made continued attempts to swallow. A little saliva ran from the mouth ; the head was slightly extended on the neck ; respiration was increased, and cough frequent. In the jugular furrow a little below the larynx was a well-defined swelling. Palpation left no doubt as to the nature of the condition, viz. obstruction of the oesophagus. . . The animal was cast on the table and chloroform administered. The jaws were opened with a gag, and the first portion of the oesophagus examined. No foreign body could be detected. Taxis was employed, Digitized by Microsoft® 346 CLINICAL VETERINARY MEDICINE AND SURGERY. and the probang passed without success. As the obstruction might probably become softened in a short time further surgical intervention was deferred. The animal was allowed to rise, and placed in a box from which the litter had been removed, in order to prevent it attempting to eat, thus introducing material into the trachea. A hypodermic injection of pilocarpine and eserine was given. For half to three quarters of an hour salivation was very abundant, and swallowing efforts ver}' frequent ; then the symptoms suddenly dis- appeared ; the foreign body had passed onwards into the stomach. The point at which it had been arrested remained sensitive for some days, but there was no subsequent difficulty in swallowing. 51. Two-year-old sheep-dog, left in hospital on the 2nd January, 1899. This animal was in the habit of fetching and carrying, and was fond of playing with objects given it for this purpose. During the last few days of December it had appeared verj- dull, had refused to eat, and shown swelling of the throat. Condition on Entry. — The dog was dull, held the head depressed, and refused food. The guttural region showed a hard, cool, insensitive swelling, the size of a small egg, without local fluctuation. This was first regarded as a cold abscess in course of formation. On the two following days there was no local change. The animal refused all food, and had to be spoon-fed with milk. On the 5th January the hair covering the centre of the swelling was glued together bj* pus, and the skin seen to be penetrated by a small opening. To evacuate the contents of the abscess slight pressure was exercised over the swelling on either side of the wound, when the end of a fragment of knitting-needle, two and a half inches in length and covered with sanguinolent pus, was seen to be projecting. The fistula having been laid open a director was passed nearly two inches in a direction almost perpendicular to the surface of the region. The wound in the oesophagus healed. When the animal drank, no liquid escaped b}- the fistula. As often happens when sharp objects are swallowed by dogs, this needle had become implanted in the walls of the pharynx or com- mencement of the oesophagus, had passed through them under the influence of the swallowing movements to which it gave rise, and become implanted in the tissues of the neck, where it had produced the above-mentioned swelling ; and had finally attained the skin, causing ulceration. The next day, in spite of the needle having been removed, the animal appeared dull, moved slowly, and refused food. Milk diet was therefore continued. On the 7th the condition was the same, and the bowels were con- stipated. No faeces were passed. An ounce of castor oil was given, and warm water enemas administered. During the day some dry, earthy fasces, streaked with blood, were voided. On the 8th the warm water enemas were continued. Suddenly the Digitized by Microsoft® SURGICAL TREATMENT OF CHRONIC ROARING — HEMIPLE(UA LARVNGIS. 347 animal made violent expulsixe efforts, and passed bj' the anus a ball of worsted. Bj' the evening it was bright, and ate some of its ordinar}- food. During the following days improvement increased, the animal became brighter, and appetite returned. On the loth the swelling about the neck had disappeared, and only a narrow fistula remained, discharging a trifling amount of serous pus. The wound had closed on the 15th, when the animal left hospital. FCETID PURULENT ABSCESS IK THE NECK OF A CAT CAUSED BY A NEEDLE. 52. Subject. — A five-year-old male tabby cat. History. — Had suffered from catarrhal fever in April, 1892. For a fortnight before examination had appeared restless and in pain, appetite was capricious, and at times there was slight vomiting ; the right side of the neck from the jaw to the shoulder became swollen. State on Examination (on September 3rd, 1892). — The swelling in neck was painful and fluctuating, and had commenced to -point. Treatment. — The abscess was opened an inch below seat of pointing to afford freer drainage ; about six ounces of foetid pus escaped. The cavity was irrigated with weak creolin solution, and the parts covered with a sublimate cotton-wool dressing. Until September 6th appetite and general condition improved, the abscess cavity diminished, and healthy granulations formed. On September 7th the animal appeared worse, and on the 8th was again brought for inspection. A piece of grey worsted three inches in length was removed from the cavity, and on search a needle was dis- covered to the right of the splenius muscle ; its eye was uppermost, level with the superior border of the muscle, and about two inches distant from the head ; the needle was inclined obliquely from above downwards and forwards towards the pharynx ; it was two inches in length, and black in colour. Evidently it had penetrated from the mouth. The patient died on the loth September. Autopsy. — The pleural cavities contained eight ounces of offensive hsemorrhagic purulent exudate, in which floated a few flakes of lymph ; this exudate formed a jelly after a few minutes. The pleura pulmonalis showed a few flakes of slightly adherent lymph ; the mediastinal pleura was inflamed, thickened, and friable. The centre of the right lung was consolidated. Petechiae were visible on the epi- cardium. With the exception of a cheesy gland near the inferior ligament of the liver the abdominal viscera were heahhy. No tubercle bacilli were found on microscopical examination. Mr. H. Gray's case, Journ. Comp. Path, and Thernp., 1892, p. 3S1. SURGICAL TREATMENT OF CHRONIC ROARING— HEMIPLEGIA LARYNGIS. 53. A seven-3'ear-old Norman mare belonging to M. M — , 232, Faubourg St. Honor6, Paris, affected with intense chronic roaring. Digitized by Microsoft® 348 CLINICAL VETERINARY MEDICINE AND SURGERY. This animal came to a standstill after trotting loo yards. Left in hospital the i6th September, 1895. Exercised in the riding school on the morning after arrival it almost immediately began to roar loudly. Respiration soon became painful, and dyspnoea so marked as to prevent it continuing. Operation was performed on the i8th. The animal was placed on its back, the head firmly fixed in a position of extension. The region of the larynx ha\ing been prepared by clipping away the hair, and shaving and disinfecting the skin, the skin and subcutaneous muscular layers were incised from opposite the body of the thyroid as far as the second tracheal ring. After checking haemorrhage I opened the larynx in the median line, dividing the crico-thyroid ligament, cricoid cartilage, crico-tracheal ligament, anjd first ring of the trachea. The larynx was then widely opened, and the left arytsenoid seen to be completely paralj'sed. It remained motionless during both periods of respiration, whilst the right moved to the normal extent. Having introduced into the trachea a cannula padded with gauze I excised the left arytsenoid by the method described in the preceding portion of the present work (p. 31). With cutting forceps I also removed the greater portion of the fragment of cartilage left by the bistoury opposite the crico- arytcenoid articulation. Two rectangular tampons of gauze were arranged side by side in the larynx, and three interrupted silk sutures inserted to bring together the muscular layers and to fix the tampons. The skin was also sutured and covered with a layer of collodion. On rising the mare was placed in a box without litter. No food was given. The evening temperature was 38"8° C. Next morning two of the sutures were cut and removed. The dressing and the cannula were changed. After cleansing the wound with tampons of wadding held in forceps the skin and muscular layers of each lip were sutured together. The patient received and ate its ordinary allowance of food. Swallowing was somewhat difficult, especially in the case of fibrous food. Portions of the latter and cf the drinking-water escaped from the laryngeal wound. Temperature, morning, 38'6° C. ; evening, 38"g° C. During the next three days difficulty in swallowing persisted ; a little of the drinking-water escaped by the wound. Temperature, morning, 38"5° C. ; evening, 39*3° C. Particular care was taken in cleansing the external wound. After the 23rd the difficulty in swallowing diminished. The wound granulated over the entire surface. From the 24th to the 30th nothing particular occurred. The wound suppurated slightly, and gradually contracted. Neither food nor liquid passed through it. Temperature, morning, 37"9° C. ; even- ing, ■38'3° C. From the 28th 2 to 2I drachms of iodide of potassium were given daily in the drinking-water. During the first week of October the animal showed signs of sore throat, including discharge from both nostrils and cough. This, how- ever, diminished, and during the following week disappeared. On the i6th October the external wound had closed. On the 20th and 22nd the mare was exercised at a trot in the.riding Digitized by Microsoft® SURGICAI, TREATMENT OF CHRONIC ROARING — HEMIPLEGIA LARYNGIS. 349 school. There was still a slight abnormal sound during inspiration, but the dyspnoea and difficulty in breathing, which had been so marked before operation, had disappeared. The animal was returned to M. M — on the 28th October, and went to work during the early part of November. It worked in a brougham without interruption and without showing any diificulty with breathing. Eighteen months later the owner made the following statement : " Since leaving the school the mare has worked every day. For the first three weeks breathing was still a little noisy, but during the course of December this trouble disappeared, and since then I ha\'e never heard any roaring, even in heavy work." 54. An eight-j-ear-old Anglo-Norman horse belonging to M. M — , 232, Faubourg St. Honore, Paris, left in hospital 13th June, 1896. Had commenced to roar about a year before. The difficulty in breathing gradually increased. At the time of entry the horse was incapable of trottingwork. Tested in the riding school it roared very loudly in a few minutes. On the 15th June it was operated on under chloroform, and the left arytaenoid cartilage removed. A small fragment of the articular angle was left. Dressing was carried out as in the first subject. Two hours after operation the temperature was 39"3^ C, and in the evening 39"6° C. No food was given for the first twenty-four hours. Next morning the dressing and cannula were removed. The skin and muscular tissues of each lip were sutured together. On returning to its box the horse drank a bucket of water placed on the ground and began to eat. It consumed all its food, though swallowing was a little painful ; the meal was interrupted by attacks of coughing, and water, oats, and fragments of hay were discharged through the wound. In the intervals the horse appeared a little dull and depressed. Tempera- ture, morning 39"i° C, evening 39"4° C. After-treatment simply consisted in cleansing the external wound night and morning. On the 17th the depression seen on the previous evening had dis- appeared. Temperature 38*4° C. Inspiration was difficult and noisy. The margins of the wound were drawn apart. When eating a little water and food escaped from the orifice. During the following days the difficulty in swallowing diminished, respiration became quiet, and the temperature fell to normal. On the 22nd the muscular sutures were removed. Neither food nor drinking-water passed by the wound. The lips were granulating over their entire surface. Iodide of potassium was then commenced. The wound gradually contracted. By the nth July the larynx had closed. On the 17th the wound was entirely healed. On the i8th and 19th the horse was trotted in the riding school. At the end of five or six minutes the inspiratory sound became marked, but was very different both in character and intensity from that noted before operation. During the first week of August the animal returned to work in a brougham, work for which its roaring had previously unfitted it. Digitized by Microsoft® 35° CLINICAL VETERINARY MEDICINE AND SURGERY. In September, 1897, M. M — sent me the following report: " Since operation the horse has worked very well. In warm weather the roaring sound still occurs, but to a very trifling extent, and does not prevent the horse being perfectly ' workable.' " 55. A ten-year-old Dutch mare, belonging to M. S — , 6, Rue Dieu, Paris, affected with chronic roaring, which appeared to have developed after bronchitis. Left in hospital 20th October, 1895. The roaring was noticed when the animal first returned to work after illness, and gradually became more marked despite internal treat- ment. The animal could still be worked, but respiration was difficult, and dyspnoea continually appeared imminent. Trotted in the riding school the mare roared loudly. By con- tinuing for a few minutes longer dyspnoea was produced ; the flank movements were very rapid, the nostrils widely dilated ; inspiration was painful, and the appearance of the face anxious. Nothing abnormal was found on examining the nasal cavities, larynx, and trachea. Operation on the 22nd October. The parts having been prepared the lower surface of the larynx and the first tracheal ring were incised. On dilating the wound paralysis of the left arytsenoid was detected. The cartilage was removed, the parts dressed with gauze, double muscular and cutaneous sutures inserted, and the animal was placed in a box without litter. The evening temperature was 38'7° C. Next day the dressing and cannula were removed ; the muscular layers were united to the skin on each side by three interrupted sutures. Litter was again provided. Food and drink were given as usual after operation. Temperature, morning 38*3° C, evening 38-5° c. During the following days a portion of the drinking-water and fragments of food mixed with saliva returned through the nostrils and operation wound. Feeding was interrupted by attacks of coughing. Temperature, morning 38*2° C, evening 38'9° C. On the ist November the difficulty in swallowing had disappeared. The laryngeal wound was covered with granulations and reduced in length to one half. Neither food nor liquid escaped by it. Adminis- tration of iodide of potassium was commenced. On the 15th the wound had closed. The animal left hospital on the 24th November. Result. — At the commencement of December the mare returned to work. A little whistling was then noticed at a trot. By June, 1896, this had disappeared even at the fastest paces. Nothing more than rather loud respiration could be detected. There was no roaring sound, nor was the respiration in any wise impeded. 56. A nine-year-old Hungarian horse, belonging to M. S — , 6, Rue Dieu, Paris, suffering from chronic roaring. Left in hospital 24th September, 1896. Had been in M. S — 's possession for five months. The roaring varied in intensity from time to time. Occasionally there was cough- ing and slight whitish, frothy discharge from both nostrils. M. S — Digitized by Microsoft® SURGICAL TREATMENT OF CHRONIC ROARING — HEMIPLEGIA LARYNGIS. 35 1 declared that the animal could not work at a trot, and on leaving it with us insisted on my at once performing the same operation on it as was practised on his other horse. External examination of the larynx and trachea revealed nothing abnormal. After a few minutes' trotting the horse produced a roaring sound, which rapidly became aggravated. This test was repeated each morning for the following three days. On each occasion whistling occurred after a couple of minutes, and soon became very loud, while dyspnoea threatened. Operation on the 28th under chloroform anaesthesia. The larynx was opened and paralysis of the left arytsenoid detected. I removed the cartilage, leaving a small fragment of the articular angle in the depths. The intra-laryngeal wound was not sutured. A gauze dress- ing was inserted and fixed in position by two sutures passed through the skin and muscle. The sutures also served to steady the cannula. The animal did not rise until ten minutes after the hobbles had been removed. It was then returned to its box and kept without food for twenty-four hours. Morning temperature 38° C. ; evening tempera- ture 38-4° C. Next day the sutures were cut, the dressing and cannula removed, and the superficial wound cleansed. The skin and muscular layers of each lip were united by three interrupted sutures. To facilitate breath- ing the lips of the wound were kept widely open for some days. The patient was placed on ordinary diet, which it ate with good appetite. A little saliva, water, and food escaped by the wound. Temperature, morning 38'8° C, 'evening 39'5° C. During the following days treatment was confined to cleansing the external wound night and morning with fragments of wadding held in dressing forceps. From the 7th October food and liquid ceased to escape by the larynx. From the loth to the 30th 2 to 2j drachms of iodide of potassium were given daily in the drinking-water. On the 23rd the superficial wound had completely healed. On the 28th the horse was trotted and galloped in the riding school. At the end of ten minutes at a trot, and of five minutes at a gallop, slight abnormal breathing sounds were still audible. M. S — kept this horse for work. He reported on the 21st January, 1899: " During the months following its return to work the horse was able to make long and rapid journeys without showing more than slightly noisy breathing. On starting out it coughed and discharged a Httle whitish mucus from the nose for the first mile. Even at the present time there is a slight discharge on commencing work, but once the animal warms to its work respiration becomes normal, even at a rapid trot. In harness this horse has made continuous journeys of fifteen miles without being distressed, and has often made the double journey, amounting in all to thirty miles, with a rest of one hour half- way. In the saddle it roars a little at rapid paces, but the sound ceases when the horse has galloped rapidly for some distance or after it has jumped. It is perfectly useful for all kinds of work." Digitized by Microsoft® 35^ CLINICAl, VLTJiRINARV MEUICINK AND KURGERY. 57. A six-year-old Anglo-Norman horse, left in hospital 24th January, 1895. In March, 1894, this horse had suffered from pneumonia. On return- ing to work towards the end of the following month it had shown difficulty in breathing, which was noisy. During the hot weather the roaring increased and the animal underwent various treatment, but without improvement. It was finally sent to Alfort to be operated on. Nothing abnormal was detected on exploring the nostrils and nasal cavities, or on externally examining the larynx and trachea. At a slow trot the horse roared after five minutes. When pushed it almost immediately began to whistle loudly, producing a noise audible from a considerable distance ; respiration became painful, the nostrils dilated, and the animal, though in very good condition, was obliged to slacken its pace. Having been prepared for several days and submitted to two further tests, which gave results similar to the first, the horse was subjected to operation on the 28th January under chloroform. The larj-nx having been opened, the left arytsenoid was seen to be paralysed. The cartilage was removed, onl}' a very small fragment of the articular angle being left, and at the same time the vocal cord was excised. The mucous membrane was not sutured. The parts were dressed with gauze, and sutures passed through the muscles fixing the gauze and cannula in position. The skin was separately sutured. The animal was kept without food throughout the day. After-treat- ment was similar to that in the preceding case. From the second to the fifth day the temperature oscillated between 39° C. and 397° C. Up to the loth February saliva, drinking-water, and fragments of food passed into the larynx. After the latter date the external wound healed rapidly. On the 8th administration of iodide of potassium had been commenced. On the 17th Februarj' the wound was closed. When exercised in the riding school on the ist, 3rd, and 5th of March, the horse roared much more loudl}- than before operation. It left hospital on the 7th March. Some days afterwards tracheo- tomy became necessary. 58. Four-year-old Norman horse suffering from severe roaring, which prevented its being used. Left in hospital on the 31st August, 1898. When ridden in the riding school a roaring sound was produced in a few minutes, and rapidly grew more marked. On the 5 th September operation was performed ; the left aryttenoid cartilage and internal wall of the corresponding ventricle of the larynx were removed. Dressing and after-treatment were similar to those in the preceding cases. Next day the morning temperature was 39"i° C. ; evening tempera- ture 59"8° C. On the 7th the temperature again became normal. Until the nth a little Hquid and fragments of food passed through the laryngeal wound. After the 12th, i^ to 3 drachms of potassium iodide were given daily in the water. Trifling discharge occurred from both nostrils. Digitized by Microsoft® SURGICAL TREATMENT OF CHRONIC ROARING — HEMIPLEtllA LARVNGIS. 353 On the 22nd the external wound had closed. Discharge still continued, but gradually diminished during the succeeding few days, and disappeared a week later. On the 5th October exercise was commenced, a quarter of an hour's walk being given every morning. During the first few days the horse was seized with violent fits of coughing on leaving the stable. On the 7th it was exercised in the riding school. Roaring occurred after a few minutes' exercise. Two days later it was again tried at a trot ; in three minutes the test had to be given up, so severe was the roaring. During the night of the 3rd November the respiration suddenly became extremely difficult and asphyxia threatened. Tracheotomy was therefore performed. Some days later the larynx was reopened. The seat of operation was occupied by a contracting cicatrix, extending the entire depth of the larynx. Remark. — I could relate a number of cases showing the value of arytffinoidectomy, and the failure of other methods of operation. I have chosen the most characteristic. Two horses belonging to one owner, M. M — , treated by ablation of the arytsenoid, were both cured. Two horses also belonging to one owner, M. S — , and treated in the same way, were also quite cured. The true value of those other operations which have been so greatly vaunted is shown by the results of Cases 50 and 51. With them one may rely on ensuring the greatest possible chance of failure. Digitized by Microsoft® III.— THORAX. FISTULOUS WITHERS. 59- A ten-year-old Irish mare, sent for examination on the 30th January, i8gg. For several years this mare had been exclusively used for saddle work. Towards the end of December, i8g8, a hasmatoma developed on the withers, was punctured on either side at its lowest point, the cavity injected with antiseptic liquids, and the surface repeatedly blistered. The wound on the right side closed in three weeks, but that on the left suppurated and became sinuous. The pus, which had difficulty in escaping, macerated the supra- spinous ligament, which became necrotic. State on Examination. The right side of the withers was marked by a cicatrix ; the left, especially towards its posterior part, exhibited a diffuse, very tender swelling, pierced about an inch from the highest point of the dorsal spinous processes by a sinuous wound into which a probe penetrated for a distance of nearly four inches. Blood-stained pus ran from the opening. The sinuous tract ran obliquely forwards and slightly upwards, appearing to end over the portion of the supra-spinous ligament covering the fifth dorsal vertebra. Treatment.- — On the 30th January the sinus was laid open parallel to the line of the superior spinous process for a distance of four inches, exposing the necrotic portion of the ligament, which was excised with the bistoury and curette. The wound was cleansed, the margins were touched with tincture of iodine, the parts powdered with iodoform, the edges brought together by three sutures, and covered with layers of iodoform gauze fixed in position with collodion. The dressing was renewed every second day until the loth February, at which time the back portion of the wound was granulating, though a fresh necrotic point had developed in front. On the nth February the animal was cast and the anterior angle of the wound laid open, when the cartilaginous disc covering the superior spinous process and a part of the supra-spinous ligament were seen to be necrotic. With the help of the bistoury and curette the dead structures were removed. The wound was washed with one per thousand sublimate solution and dressed with tannoform. During the following days suppuration was trifling, and hopes of cure were entertained. After a period of real improvement a fresh complication occurred : at the commencement of March the liga- Digitized by Microsoft® FISTULOUS WITHERS. 355 mentous tissue covering the sides of the superior spinous process of the third dorsal vertebra became necrotic. The mare was left in hospital on the 5th March. At that date the dead tissue was removed. The dressings used were 3 per cent, creolin, tincture of iodine, iodoform, and iodoform gauze. On the 1 2th March the skin was seen to have become separated over the median line in front of the superior spinous process of the third dorsal vertebra, where a smooth spot appeared. Treatment was continued until the 28th March without much improvement. At that Fig. 34. date marked swelling appeared in front of the wound, pointing to recurrence of necrosis in the supra-spinous ligament. We determined not to operate further, but to continue the antiseptic treatment. From the ist to the 15th April the wound did not show the slightest improvement. Towards the back for a distance of about six inches it was healing, but the separation of the skin and the swelling around the anterior angle caused us to fear that necrosis was extending in the supra-spinous ligament. Digitized by Microsoft® 3S6 CLINICAL VETERINARY MEDICINE AND SURGERY. From the 15th to the 30th treatment consisted in applying to the necrotic parts a mixture of sulphate of iron and sulphate of copper, and in spraying the parts daily with creolin, followed by application of a dressing saturated with traumatol. Under the influence of the spraj^ and of the traumatol, especially of the former, suppuration diminished, and swelling became confined to the right side. It surrounded an opening, at the base of which a necrotic fragment of the ligament could still be seen. The parts were again opened, allowing the spray to play directly on the necrotic point, which was cauterised with a mixture of the sulphates of iron f§7!\ ■■ ■ r, Fig. 35. and copper. Under the action of the 2 per cent, creolin and i per cent, lysol spray the eschar separated in a few days. The wound finally granulated throughout, and healing became assured. During the following days suppuration was trifling. Both wounds (Figs. 34 and 35) made regular progress towards cicatrisation. Remark. — Antiseptic treatment, when thoroughly carried out, often gives good results in the treatment of fistulous withers, and in fistula of the neck and poll ; but even when supplemented bj? removal of necrotic fragments of the supra-spinous ligament and the cartilaginous layer covering the superior spinous processes, recovery is frequentlj- slow and uncertain. Sometimes necrosis has extended beyond the limits of the tissue removed, especially in front ; sometimes the sup- puration which accompanies large operative wcunds itself causes recurrence. In the case just mentioned, despite excision and the observance of ordinary antiseptic methods, necrosis twice recurred in Digitized by Microsoft® FRACTURE OF THE FIRST RIB IN THE HORSE. 357 front of the wound within the substance of the supra-spinous ligament. It was iinally arrested and the wound rendered healthy by warm anti- septic spraying, which has the advantage over lotions and irrigations of penetrating the dead tissue and destroying the infectious agents in the depths. ABSCESS IN THE LEFT COSTAL REGION— NECROSIS OF THE LAST RIB. 60. Eleven-year-old gelding, left in hospital 6th June, 1896. A year before this horse had shown on the left surface of the chest over the last ribs a large swelling, which finally suppurated. The wound resulting from opening the abscess became sinuous. The animal having been cast on the 5th May for castration, the veterinary surgeon who operated took advantage of the occasion to explore the tract. The parts were afterwards irrigated with carbolic solution, but refused to heal. State on Examination.. — On the left side of the chest, over the centre of the last rib, was a sharply-defined swelling, the centre of which was pierced by a sinuous tract running obliquely inwards and forwards. A probe penetrated for a distance of four inches. The horse having been cast, the sinus was laid open in the axis of the last rib, a portion of which was then seen to be necrotic. It was resected. On passing the finger into the wound the two ends could be felt about one inch apart. After antiseptic irrigation of the wound a rubber drainage-tube was introduced and fixed to the skin by sutures. During the following days the wound was cleansed and injected with a solution of iodine varying in strength between 20 and 30 per cent. Suppuration was trifling. On the 15th the rubber tube was removed ; the iodine injections, however, were continued. The wound was daily plugged with gauze. The surrounding tissues showed little swelling. On the 25th the deep portions of the operative wound had to a large extent filled up. The plugging was discontinued. From this date treatment simply consisted in washing out the wound. A week later the animal was returned to work. By the end of July the wound had healed, and the trifling swelling which remained was quite painless. FRACTURE OF THE FIRST RIB IN THE HORSE. 61. Eight-year-old well-bred chestnut mare. History. — Had been worked for three hours in a victoria ; returned home with great difficulty and exceedingly lame in the off fore-leg. State on Examination. — The near fore-heel showed signs of a recent overreach. The animal was in great pain, and supported the weight of the body mainly on the hind legs ; the off fore-leg was flexed, the knee and fetlock bent, and the outside of the toe just touched the ground. The elbow was lower than normal, but was not unusually " dropped." Digitized by Microsoft® 358 CLINICAL VETERINARY MEDICINE AND SURGERY. By forcing the knee backwards, and thus straightening the leg, the animal was enabled to take one step with the sound limb ; but imme- diately the knee of the injured limb became in the least degree bent the leg collapsed, and the animal nearly fell. Progress was facilitated by pulling forward the lame leg as far as possible, and then pressing on the knee until a step had been taken with the sound leg. The most marked symptoms were absolute inability to advance the leg, and great difficulty in keeping it perpendicular. No fracture of any of the leg bones could be distinguished. Crepitus was entirely absent. Diagnosis. — Fractured first rib. Prognosis. — Unfavourable so far as useful recovery was concerned. Treatment. — Slinging and rest. During the three weeks and three days the animal was kept the limb was always flexed and turned slightly inwards, so that the outside toe of the foot became worn. Post-mortem examination showed fractured first rib (see Fig. 36) ; the surrounding muscles were not lace- rated or ruptured. Only a small provisional callus had formed. The broken and overlapped pieces of bone were freely moveable, and not (as might appear from inspection of the figure) rigidly fixed together. Mr. H. G. Rogers' case, Veterinarian^ 1894, p. 78. Fig. 36. MYOMA OF THE (ESOPHAGUS. f 'S^^«^ 62. A fifteen-year-old gelding, brought for examina- tion on the 4th January, 1895. A fortnight before a considerable swelling had been noticed in the lower portion of the jugular furrow, which the owner thought due to collar pressure. During the following days the animal began to roar as soon as put to work. The respiration became very rapid and gasping, so that asphyxia appeared imminent. When swallowing the food passed slowly through the swollen region and showed a tendency to stop. At certain times a part of the liquid taken was rejected through the nostrils. On trotting the animal almost immediately began to roar, and the swelling in the jugular region increased, dilating and contracting synchronously with the respiratory movements. Diagnosis. — Tumour developed around and compressing the ceso- phagus and trachea, or the nerves in this region. The lesion being principally thoracic no useful intervention seemed possible, and the animal was slaughtered. Autopsy. — In the lower third of the neck the oesophagus was dilated. Its thoracic portion was very large, firm, and hard, forming a kind of elongated, fusiform tumour, eighteen inches in length and ten in Digitized by Microsoft® CHRONIC ENDOCARDITIS. 359 diameter, weighing over twenty-six pounds. This tumour had deve- loped at the expense of the muscular coat. Sections appeared greyish in colour, and exuded a milky pus. The lumen of the oesophagus, which was partly obstructed by masses of food, was greatest opposite the centre of the swelling, and gradually diminished towards the extremities ; near the cardia it was reduced to very small dimensions. In the centre of the swelling the wall of the tube was four inches in thickness. The anterior portion of this growth had compressed and flattened the bronchi and the last rings of the trachea, greatly diminishing their calibre. Microscopic examination of the sweUing showed it to be a myoma of unstriped muscle — leiomyoma. CHRONIC ENDOCARDITIS. 63. A six-year-old entire horse, bought at Beauce on the 14th February, 1897, and brought to the School for examination on the 20th. The day after its arrival in Paris the animal had appeared dull and tired. It was left in the stable. It only ate a small part of its food. A veterinary surgeon who was called in at first regarded the case as one of pneumonia, and prescribed external application of mustard, and internally a mixture, the principal constituents of which were tartar emetic and iodide of potassium. During the next four days the animal was not markedly worse, but the symptoms persisted. At the first glance this animal appeared as though suffering from some pulmonary disease. It was rather stiff and sleepy, carried the head low with the eyes half closed ; the conjunctiva was moderately injected and slightly infiltrated. The flank movements were more rapid than usual, the respirations 22 per minute, and expiration was double ; the pulse was 60, small and irregular. We auscultated the chest, commencing on the right side. The vesicular murmur was very feeble, and in certain parts of the lower half of the lung was almost imperceptible ; some borborygmus was noted ; the heart-beats were especially noticeable, being unequal and irregular in rhythm. This at once led us to examine the heart. We noted a strong systolic murmur without particular timbre, which covered the systolic sound and continued during the short pause. Furthermore, the contractions were of irregular strength, and every three, four, or five pulsations were followed by a pause, equal in length to an entire cardiac cycle. Auscultation of the left lobe of the lung revealed diminished vesicular murmur in the lower half. Diagnosis offered no difficulty. Evidently this horse was suffering from old-standing mitral insufficiency, complicated at that moment with pulmonary congestion. The animal was rested for a week. When brought back on the 28th February the secondary troubles noted on the former examination had disappeared. Externally the animal appeared in good health. The respirations were only 14 per minute. On questioning the seller it was learned that this horse had suffered from strangles in October, 1895. A month after recovery it was used Digitized by Microsoft® 360 CLINICAL VETERINARY MEDICINE AND SURGERY. for farm work, and had never shown any disturbance which could have aroused suspicion of heart disease (?). It had never had any internal disease other than strangles. 64. Sixteen-year-old gelding, brought for examination on the 27th March, 1897. Was in heavy work. Between the previous December and the commencement of March it had been very hard worked. A month before its appetite was noticed to decline, and its condition to suffer, while the limbs became greatly enlarged. The horse was rested for about a fortnight. On returning to work it suffered from some re- spiratory disturbance, and was therefore brought for e.xamination. The hind limbs were oedematous, and almost half as large again as normal. In addition to symptoms of acute bronchitis we noted very strong pulsation in the carotid and subzygomatic arteries. On auscultating the heart the first sound was heard to be feeble and double ; the second was obscured by a murmur which continued throughout the long pause, — that is, by a murmur due to aortic insuf- ficiency. All the accessible arteries exhibited strong pulsation. The carotid and the subzygomatic visibly rose at each beat of the heart. Treatment. — Administration of iodide of potassium in daily doses of 2i drachms for the first two weeks in each month. The horse still remained capable of work until the commencement of August. Shortly afterwards, however, it had to be slaughtered. Autopsy. — Lesions of fibrous myocarditis. The aortic sigmoid valves were thickened, wrinkled, and their faces irregular. The right side of the anterior small valve near the corpus Arantii presented a narrow perforation ; the lower surface of the left side, close to the free border, was occupied by a vegetation as large as a hempseed. There was marked insufficiency, a large space existing between the valves when approximated. The anterior lobe of the right lung contained a patch of chronic pneumonia. 65. A fifteen-year-old gelding, brought to the School on the 5th June, 1898, to be used as a subject in the practical surgery class. The animal was thin, emphysematous, and a crib-biter. On aus- cultating the heart a strong musical murmur, covering the second sound and the long pause, was heard over a large surface. The first heart-sound was diminished. There was no arterial "dancing." The pulse was of practically normal volume. At the autopsy the heart was found to exhibit sclerosing myocar- ditis of both ventricles and changes in the aortic sigmoid valves, which were slightly thickened and showed several small indurated vegetations. Although the right and left valves were perforated parallel to their free border insufficiency was trifling. This case shows once more that a strong murmur due to insufficiency does not necessarily imply large valvular lesions. The character of the pulse was explained by the very trifling hiatus, and by the lesions of the myocardium. Digitized by Microsoft® MYOCARDITIS— CARDIAC INTERMITTENCY. 361 MYOCARDITIS— CARDIAC INTERMITTENCY. 66. Twelve-year-old gelding, left in hospital 29th April, 1896. This horse had worked daily in a brougham for several years, and had done good service. During the months preceding entry, however, It had been dull in the stable, and for a considerable time had refused part of Its food. At work it was " soft," and carried its head low, and sweated readily. State on Examination. — Auscultation of the heart revealed intermit- tency ; the first heart-sound was of a " rolling " character, and was regarded as systolic. The pulse was full, strong, and numbered 40 per minute. After a few minutes' trotting the heart-beats became violent; the first sound was prolonged, and the second double. Certain peculiar symptoms had been noted, which appeared due to brain mischief. The animal was almost always depressed and somno- lent. Sometimes it walked in circles round its box, sometimes it suddenly stopped while eating. If the front legs were crossed it remained as placed for some moments. It was timid and very irritable, being frightened by the shghtest movement ; when ridden it would often stop in front of any object, such as a piece of paper, and refused to proceed. The urine contained only traces of albumen. There were no ocular lesions. Diagnosis. — Chronic myocarditis, probably complicated by chronic disease of the brain, dropsy of the lateral ventricle, or tumour in the choroid plexus. On the 30th April, on auscultating the heart, intermittencies were noted lasting for a complete cardiac cycle, and repeated after every three or four beats. One and a half drachms of iodide of potassium were given in the drinking-water, and the dose progressively increased to 2-h drachms. The animal's condition became aggravated. The intermittency grew longer and more frequent. On being informed that his horse was suffering from an incurable disease the owner had it slaughtered. Autopsy. — The heart was larger than normal, the left ventricle being especially hypertrophied. The walls of the auricles had undergone hardening. The right ventricle also showed patches of sclerosis. There were no valvular lesions. The right kidney was smaller than the left. Its surface showed slight projections and depressions, and its capsule was more adherent than normal. Sections exhibited all the appearances of chronic atrophic nephritis. There was no hydrocephalus. The plexus choroides was greatly thickened, oedematous, and contained small cholesteatomata. 67. A ten-year-old entire horse, left in hospital 23rd December, 1896. Three years before it had suffered from purpura hsemorrhagica. After recovering it had always worked well and had shown no other internal disease. During the last few months the animal had appeared weak, soon lost breath, and on returning to the stable at once lay Digitized by Microsoft® 362 CLINICAL VETERINARY MEDICINE AND SURGERY. down. A veterinary surgeon, who was called in, was struck by the slowness and irregularity of the pulse. He prescribed nux vomica and digitalis. This treatment producing no improvement the animal was sent here. Condition on Entry. — The conjunctiva was pale ; the pulse was feeble, irregular, and intermittent ; there was no venous pulse. On auscultating the heart pauses were noted after every third or fourth pulsation. They lasted for a period equal to one or two complete heart cycles. Furthermore, the first beat of the heart was double. Treatment. — Iodide of potassium in daily doses of 2^ drachms. Appetite was preserved, and the animal ate freely. On the i6th December examination of the heart and pulse revealed no change. After a few moments' trotting the heart-beats became accelerated and violent, and the pauses, which at rest had occurred after every third or fourth pulsation, were deferred for much longer intervals. Their duration still equalled that of a complete heart cycle. The first pulsation which followed an intermittence was stronger than the others. The pulse was small and feeble, contrasting with the violence of the heart-beats. After some minutes' rest the intermittency resumed its previous fre- quence. During the next few days the condition remained stationary. The animal left hospital on the gth January. Treatment had pro- duced no improvement, but the owner was advised to continue it for fourteen days each month. 68. A three-year-old mare, brought for examination on the 14th December, 1895. The animal had been bought a week before at a cab sale. In work it rapidly lost breath, slackened its pace, and stopped, showing signs of violent dyspnoea. The neck was extended ; the face appeared anxious ; respiration was very rapid, and the flank movements were short and irregular. At the first examination, made after a period of rest, breathing was regular. There was no double flank movement and no check during expiration. The cough was not like that of broken wind. The pulse was irregular, a series of three or four normal pulsations being followed by a feeble beat. On auscultating the heart no murmur and no change in the sounds could be detected, but the rhythm was not quite regular, three or four normal beats being followed by a slower and feebler con- traction. After a few minutes' trotting the heart beat violently and irregularly ; the second sound was diminished and almost lost, but the irregularity of the pulse was less marked. At the end of about two minutes pauses could be detected approximately equal in duration to two cardiac cycles ; these were followed by two slow, and afterwards by four or five rapid contractions ; beats then succeeded in increasingly rapid succes- sion until the next pause. The pulse showed some want of rhythm. At the end of ten minutes intermittency had disappeared, and all that could be detected was irregularity in the strength of the cardiac con- tractions and pulse. Digitized by Microsoft® MYOCARDITIS — CARDIAC INTERJUTTENCV. 363 On again exercising the horse the same peculiarities were noted. The mtermittency recurred two or three minutes after exercise was stopped, and again disappeared some minutes later. 69. A ten-year-old gelding, brought for examination on the i6th January, i8g6. Had been in the hands of the same owner during four years, doing regular work delivering parcels, sometimes at a walk, sometimes at a trot. Had been healthy for that period. Both at work and in the stable this horse coughed rather frequently. A month before examina- tion It began rapidly to lose breath, and to cough more than usual. The patient was emphysematous. It showed a distinctly double flank movement, and had a short, dry, paroxysmal cough. Ausculta- tion of the lungs revealed sibilant rales and a dry crepitant sound. On auscultating the heart, every fourth or fifth contraction was followed by a pause equal in length to two cardiac cycles. The pulse showed similar characters. This intermittency disappeared during exercise, but returned after a few minutes' rest. Iodide of potassium and arsenical preparations were prescribed, to be continued for a week and interrupted for a similar period. 70. A seven-year-old entire horse, left in hospital 31st July, 1897. Three weeks before had been attacked with pneumonia, which had not been detected until in an advanced stage, and had left troubles regarded as due to heart disease. On entry the animal's general condition was satisfactory. There were no visible signs of disease. Respiration was normal. The pulse was rapid, small, and intermittent. On auscultating the heart the first sound was double, the second diminished, and pauses occurred after every sixth or eighth normal contraction, each pause lasting as long as a complete heart cycle. Treatment. — Iodide of potassium in 2 ^-drachm doses daily, gradu- ally increased by the end of a week to 4 drachms. During the following days intermittency persisted with the same characters. After the loth August the pauses occurred at longer and less regular intervals. On the 20th August, when the animal left hospital, they only occurred after every fifteenth to twentieth pulsation. 71. A six-year-old gelding, left in hospital 7th December, 1897. Had been worked very hard. Three days before, when sweating freely, had been exposed to rain for more than an hour. That evening the animal refused food. A veterinary surgeon who examined it prescribed treatment. The animal was brought here on the morning of the succeeding day. The temperature was then 40"5'^ C, the con- junctiva yellow, the eyes half closed ; the nostrils discharged a little rusty-coloured mucus ; the lower third of the chest was dull, the right side revealed moist crepitation ; the pulse was large and strong, 56 per minute ; respirations were 22 per minute. Diagnosis. — Pneumonia. Digitized by Microsoft® 364 CLINICAL VETERINARY MEDICINE AND SURGERY. Treatment. — Bleeding, sinapisms, 5 ounces of alcohol, mashes and milk. Next day the temperature was 39*9° C, respirations 30, pulse 63. The animal was depressed and sleepy. Nevertheless it took milk and hay tea, to which alcohol had been added. On the 9th a tubal murmur could be heard on the right side. The heart-beats were violent and audible on either side. Temperature 40*7° C, pulse 64, respirations 32. Sulphate and bicarbonate of soda were further prescribed. On the loth and nth the animal was more depressed ; it could scarcely stand, and appeared as though suffering from laminitis in the fore-feet. On the 12th these signs of weakness and of congestion about the feet had disappeared. The pneumonia was undergoing resolution. A moist crepitant rale could be heard. Temperature 38"5° C. On the 13th the heart became intermittent, pauses occurring after series of four to twelve contractions. All treatment was stopped. On the 14th intermittency was more frequent. Of five pauses, four usually occurred after a regular series of four pulsations, the fifth after an irregular series of two to eight. On the i6th the pauses were less numerous. They became less and less frequent until the animal left hospital. [An interesting contribution to the study of heart disease in the horse, by Professor Stockman, appears in the Journal of Comparative Pathology and Therapeutics for 1894, p. 138.] HYDATID CYST OF THE HEART. J 2. An eight-year-old Percheron gelding, which had died suddenly during work on the 9th August, 1893. The autopsy was incomplete, but the heart was sent to us as it exhibited peculiar changes. It was of large size, and towards the centre of the left ventricular wall showed a swelling as large as a turkey's egg, yellowish white in colour, the surface marked — especially towards the periphery — with fine vascular branchings. The swelling was uniform, fluctuating, and thin-walled. Incision gave exit to a serous liquid containing in suspension a few whitish flocculi. Though for the most part smooth, the wall of the cyst was irregular in places, marked with slight depressions and promi- nences. Microscopic examination of a scraping from the internal surface showed scolices and numerous hooks. The wall was formed of two distinct membranes somewhat loosely united : the external, forming the hydatid membrane or cuticle, exhibited a number of caseating and calcified patches ; the internal, or germinal membrane, was greyish in colour, thin, and very delicate. The cyst measured three inches and a half in greatest length, and two inches and three quarters to three inches in diameter. It pro- jected above the surface of the ventricle to the extent of more than an inch. Two thirds of the thickness of the wall of the ventricle were destroyed, so that the muscular tissue, which should have been nearly Digitized by Microsoft® FOREIGN BODY IN THE PERICARDIUM. 365 two inches in thickness opposite the centre of the swelling, was reduced to about half an inch. INTRA-MURAL CARDIAC ABSCES.S IN A COW. 73. History. — About a year previous to death the animal had suffered from " foul in the foot " with fever ; the foot had not perfectly healed until after three months. A week before death, which occurred very suddenly, the cow had shown trifling symptoms. It had not been treated. Post-mortem examination showed all the internal organs except the heart to be healthy. Projecting from the ventricular septum into the right ventricle was an eminence the shape of an English cottage loaf, measuring three inches in diameter by two in depth from its summit to the level of the ventricular surface of the septum. The endocardium had become softened and entirely removed from its salient parts by the current of blood, and was replaced by several layers of coagulated lymph. On incising this fluctuating swelling, thick, creamy, odourless pus escaped, leaving a very large cavity in the substance of the septum, which, however, was intact on the side of the left ventricle. There was slight hypertrophy, but the walls of the heart and the valves were otherwise healthy. Note. — Professor Walley regarded the abscess as pysemic in origin, and consequent on the above-mentioned attack of " foul in the foot." Death was probably due to syncope. Prof. Walley's case, Journ. Contp. Path, and Therap., 1894, p. 65. FOREIGN BODY IN THE PERICARDIUM— INTRA-PERICARDIAL HEMORRHAGE. 74. On the 6th June, 1892, a cowkeeper in the neighbourhood brought us the body of a cow which had died during the night, without having previously shown any signs of grave disease. Post-mortem examination proved that the animal had died from intra- pericardial haemorrhage produced by a fragment of iron wire. This fragment, starting from the reticulum, had pierced its anterior wall, passed through the diaphragm, penetrated the pericardium, and at- tained the heart opposite the posterior vascular furrow, an inch or two from the point, the sharp extremity as usual being in front. The foreign body having, as commonly happens, produced chronic inflammatory lesions in the tissues traversed, there is some room for doubting the extreme suddenness of death and the absence of more or less grave premonitory disturbance, either of continued or intermittent character, during the days preceding the end. Questioned on this point, the owner gave the following very precise information : — " I purchased this cow on the 22nd January last. Apart from a trifling ailment lasting for a few hours, which she showed soon after arrival, her soundness never appeared doubtful. One thing, how- ever, struck me. Although she showed excellent appetite this beast never grew fat, but this I attributed to the fact that she was a very good milker. On the evening before the day of death I passed through Digitized by Microsoft® 366 CLINICAL VETERINARY MEDICINE AND SURGERY. the stable as usual about ten o'clock, and she then seemed to me to be ruminating like the others. At any rate I noticed nothing remarkable, and at six o'clock next morning she gave the same quantity of milk as on the preceding days. Next morning she was found dead. As to the swallowing of some sharp body, or the cause of death itself, the expla- nation is as follows : — At the beginning of February I received from Brittany some hay in bales fastened with iron wire. A fragment of this wire must have fallen into the food given to this animal and have been swallowed." As none of this hay had been used after the first week of March, the fragment of wire had remained for about three months in the stomach and in the tissues it had traversed before producing fatal results. RUPTURE OF THE RIGHT VENTRICLE IN THE HORSE. 75. A five-year-old well-nourished brown cart gelding, 16.2 hands high. History. — Had recently been purchased and only worked for a fort- night. On the 1st July, i8g6, had made a long journey involving much hill climbing ; arrived at its destination, the animal had to draw and back through new-made ground. It suddenly plunged, fell, gave a few convulsive struggles, and died. xiutopsy. — The right side of the thoracic wall was wounded over the ninth rib by the broken shaft, but the chest cavity was not pene- trated. Abdominal organs healthy. Right lung hypostatically con- gested, but lungs otherwise normal. The pericardium was distended with blood. On cautiously incising it and examining the heart three ruptures were found in the wall of the right ventricle ; the first, about two and a half inches in length, situated almost centrally in the wall of the ventricle, was irregularly funnel-shaped, being large externally, and tapering down to an aperture about three quarters of an inch across, communicating with the interior of the ventricle. The muscular fibres were not shredded, but showed a comparatively " short " frac- ture. The second wound resembled the first, was two inches from the apex of the heart, about three quarters of an inch in length, and communicated with the ventricle by a mere point. The third was about one eighth inch across and a quarter of an inch in depth ; it lay half an inch from the apex of the heart, but did not communicate with the ventricle. Measured at their thinnest points the thickness of the walls of the various heart cavities was as follows : — Right auricle five sixteenths of an inch ; left auricle (close to junction with ventricle) two inches ; right ventricle five eighths of an inch ; left ventricle (near auricle) two and three eighths inches ; near apex of heart one and a quarter inches ; septum one and seven eighths inches. Mr. Jno. A, W. Dollar's case, Veterinarian, 1896, p. 670. RUPTURE OF THE PULMONARY ARTERY. 76. A two-year-old Irish setter, bought when five weeks old. At the age of ten months had suffered from severe distemper, but had completely recovered, and afterwards enjoyed good health. Digitized by Microsoft® RUPTURE OF THE PULMONARY ARTERY. 367 About three in the afternoon of the 2nd March, 1895, it was playing with another dog in front of its master's house, when suddenly it began running as though mad, leaped upwards several times, and fell dead. Poisoning being suspected, the cadaver was sent to the College. Autopsy.— 'Extreme pallor of the visible mucous membranes. The spleen was large, and of the lilac tint common in lymphadenoma. The liver had undergone a certain degree of hypertrophy. Lungs normal. The pericardium was considerably distended with blood. The organs about the base of the heart, the large vessels originating there, and the trachea, were covered with a layer of coagu- lated blood, infiltrated between the layers of the mediastinum. On opening the pericardium a little red blood escaped. The cavity contained a thick clot moulded on the heart. Over the origin of the great arterial vessels the visceral layer presented a rupture about three eighths of an inch in length. ■ The heart was carefully examined, but neither ventricles, auricles, nor valves showed anything abnormal. The external surface of the pulmonary artery was covered with a thick clot. On removing this we detected on the right surface of the vessel, about three eighths of an inch from the base of the heart, two transverse ruptures, one measuring a quarter of an inch, the other one eighth of an inch in length. Opposite these tears the artery was ex- tremely thin, and showed several little atheromatous points. Escaping by these ruptures the blood had spread around the large vessels, thrust apart the layers of the mediastinum, lifted the visceral layer of the pericardium, which became ruptured under the pressure, and then by accumulating in the pericardial sac produced cardiac syncope and death. Digitized by Microsoft® IV.— ABDOMEN AND TAIL. NECROSIS OF APONEUROTIC TISSUES IN THE FLANK. 77. A t\veIve-3^ear-oId gelding, left in hospital, the 5th February, Two months before this horse had suffered from colic and intestinal indigestion, for which the caecum was punctured. During the follow- ing days a warm, painful, oedematous swelling developed around the wound, but nevertheless the horse continued to work for some time. As the wound became sinuous, suppurated freely, and resisted treat- ment by antiseptic injections, the animal was sent to Alfort. The centre of the right flank displayed a granulating wound, nearly an inch in diameter, surrounded by induration which extended as far as the last rib. The pus was abundant, liquid, and offensive. Diagnosis. — Necrosis of aponeurotic tissues in the flank. The horse was cast on the table. The sinus was found to be about six inches in length, penetrated deeph', and ended in a large blind pouch. It was exposed, a counter-opening made at the lowest point, and a rubber drainage-tube inserted. The sinus was frequently washed out with creolin and sublimate solution. By the 20th February swelling and suppuration had markedly diminished, and the animal seemed in a fair way to recovery. A week later, however, swelling extended below the lower wound, from which pus escaped freely. Fresh operation was decided on. On probing the lower wound a sinus, four inches in length, was found running obliquely downwards and slightly backwards, along the last rib. A counter-opening was made, and this second sinus drained like the former. The injections were continued, though the liquids used and the degree of concentration were varied. Among others, carbolic acid, sublimate, chloride of zinc, Villate's solution, and tincture of iodine were tried. A 20 to 30 per cent, solution of tincture of iodine and iodide of potassium was found most useful. Recovery was not complete until towards the 15th June, though had the animal not been used in a carriage it might long before have been returned to work. Remark. — Although the disease was remarkably obstinate we did not think it advisable to perform a radical operation, as this would have necessitated too great destruction of tissue and would not have been without danger, on account of the depth to which the sinus extended into the abdominal wall. We therefore preferred to confinf ourselves to counter-openings, drainage, and antiseptic injections. Digitized by Microsoft® HERNI/E. 369 HERNIA. 78. A cart stallion brought to the external dinique on the 14th June, 1898. A few hours before, when working in a dray, one of the arms of the windlass * had penetrated the left flank. A large cedematous swelling was visible in the left flank opposite the stifle. On manipulation, the abdominal tunic was discovered to be ruptured, and slightly above this rupture the muscles were torn through. In order to confirm the diagnosis (of ventral hernia) the parts were explored per rectum. Four to five inches in front of the inguinal ring was a tear about six inches long in the abdominal wall, .running obliquely forwards and outwards. During the afternoon the animal was cast on the right side and chloroformed ; the left hind leg was abducted, as in operation for strangulated inguinal hernia. After disinfecting the parts, M. Almy made an incision about six inches in length through the skin, in an oblique direction backwards and inwards, exposing a loop of slightly congested small intestine. This having been reduced, the muscles and aponeuroses forming the abdominal wall were seen to be irregularly torn, the several layers being ruptured in different directions. The muscular tissues were brought together with a line of silk sutures, which, however, were very difficult to insert on account of the condition of the tissues. A second row of silk sutures, crossing the former in an oblique direction, was inserted in the aponeurotic portion ; lastly, the skin was brought together. A cotton-wool dressing was applied. After removal of the hobbles the patient remained recumbent, not rising until the end of a couple of hours. Food was confined to gruel and milk. The evening temperature was 38"8° C, respirations 16, pulse 50. During the three following days the temperature oscillated between 38*8° C. and 39'7° C. A considerable cedematous swelling developed around the wound. Between the 17th and 20th the temperature rose to 39° C, some- times even to 39'5° C, and the respirations became more frequent — 45 to 50 per minute. On the 20th the wound, after cleansing, was bright red, and almost entirely covered with granulations. A few small fragments of the aponeurosis, which had become loose, were excised. Some of the deep sutures were removed, the parts were dusted with iodoform, and a gauze dressing applied. Fever continued distinctly high, respiration was rapid and shallow. From the 22nd to the 25th general disturbance diminished. The patient consumed all its food. On the 30th June it left hospital in a fair way to recovery. When again seen on the 9th July the wound had healed, and the swelling disappeared ; the hernia was cured. * In France carts used for carrying casks are provided with a windlass for tightening the ropes by which the load is secured. — Jno. A. W. D. A A Digitized by Microsoft® 37° CLINICAL VETERINARY MEDICINE AND SURGERY. 79. A five-year-old entire horse, brought to the school on the 5th March, 1895. Since the previous night it had suffered from cohc. Examination of the upper inguinal rings left no doubt as to the origin of the abdominal pain, which was due to acute left-sided inguinal hernia. The animal having been cast and suitably secured was anaesthetised with ether, the scrotum was disinfected, and operation performed. On enucleating the cord, the deep tissues (cremasteric fascia and tunica vaginalis) were found torn through externally for a distance of three to three and a half inches. Having incised the vaginal sheath along the lower margin of the testicle, strangulation was seen to have taken place at the hernial ring, which was situated opposite the external inguinal ring at a much lower point than usual. The hernial swelling was composed of two parts. The first, above the hernial ring, was rather larger than a man's fist, formed by a portion of intestine which had thrust aside the vaginal tunic and drawn the peritoneum through the internal inguinal ring, the anterior margin of which was torn. In the other part, situated below the hernial ring, the intestine had already undergone grave change, was blackish in colour, and in imminent danger of becoming gangrenous. It was rinsed with boiled salt solution. After enlarging the hernial ring by incision in an outward direction reduction was easy. A little hesitation was felt as to the best method of fixing the clamps, but it was finally decided, after torsion of the vaginal sheath, to apply them to the cord and skin. This method was preferred, firstly, as insuring against further protrusion of intestine, rendered possible by tearing of the vaginal sheath, and favoured by patency of the inguinal ring ; and secondly, as favouring adhesion of the skin to the cord below the ring, and thus ensuring formation of a solid fibrous cicatrix. The operative wound progressed favourably, but the herniated portion of the intestine became gangrenous, and death occurred on the sixth day. It is easy to explain the symptoms shown by this case. The hernia presented two conditions of different age and character. The internal inguinal ring had been abnormally large before strangulation ; the peritoneum surrounding it had yielded under the continual tension, and a loop of intestine had become extruded, forming a hernial swelling in the depth of the groin. This swelling afterwards became compli- cated with acute inguinal hernia. Tearing of the vaginal sheath probably resulted from the repeated manipulation to which the scrotum had been subjected before operation. 80. A five-year-old setter bitch, left in hospital 15th March, 1893. This animal had long suffered from inguinal hernia, which, however, had gradually increased in size during the preceding months. On entry it was incommoded by the swelling, and sometimes appeared in pain. The swelling occupied the left inguinal region, and was the size of a man's fist. Though tense when the animal was standing, it imme- diately diminished and became flaccid when the animal was placed in the dorsal position and taxis performed. It was perfectly reducible. Digitized by Microsoft® HERNIvli. 371 For three days the patient was placed on milk diet and received one third grain of calomel daily. Operation. — On the 9th March the bitch was secured in the dorsal position. Anaesthetics were not given. The skin covering the swelling and surrounding parts was washed with soap, shaved, and rinsed with alcohol and sublimate solution. The flanks and abdomen were covered with aseptic compresses. An incision about three and a half inches in length was then made through the skin in the long axis of the swelling, running in a slightly oblique direction backwards and inwards. The sac was enucleated with the fingers, care being taken not to tear it. By methodical compression over the exposed part of the sac the contained organs were gradually returned to the abdomen. The hernial opening, formed by the enlarged inguinal ring, was oval in form ; it measured about three quarters of an inch in its longer diameter and three eighths of an inch across. The sac was twisted under slight tension, ligatured with silk as close as possible to the inguinal ring, and the free part removed about one sixth of an inch below the ligature. After slightly curetting the margins of the inguinal opening the lips were touched with strong carbolic solution and brought together with two silk ligatures. The wound was cleansed with tampons of cotton wool, powdered with iodoform, and the skin brought together with interrupted sutures. When dried the sutures were covered with a layer of iodoform collodion. The inguinal region was surrounded with a gauze compress and enveloped in a thick layer of cotton wool put in place by a bandage. No bad results followed. During the succeeding night and next two days the animal was fed on milk and meat. The temperature never exceeded 39*4° C. On the nth March the dressing was removed. The margins of the wound were slightly swollen ; there was no suppuration. On the i6th the wound had healed to a very large extent ; its centre, and about one and a quarter inches of its lips, discharged a little sero- sanguinolent fluid. It was cleansed with carbolic solution and the cutaneous sutures removed. The parts were swabbed with a cotton- wool tampon saturated in alcohol, a new dressing of cotton wool was applied and left in position until the 20th. At that date the centre portion of the wound had healed. The animal left on the 25th. Remarks. — Operation for acute inguinal hernia in the bitch is some- times difficult owing either to adhesion between the herniated organs and the sac, or to the presence of a foetus in one of the (herniated) uterine horns. When one of the herniated organs is adherent to the sac the latter is incised, the adhesion broken down, the hernia reduced, and operation concluded as usual. When, however, epiploon alone is contained in the sac the latter is either ligatured with catgut and excised, or traction i S ^9 ii5 k n 1l 12 t. 1 111. 2 ■> 5^-3 \h h 5 L 6 i ■P Chart IV, the morning the quinine produced a depression of seven tenths of a degree two hours after administration, followed by a rise ; in the evening a depression of five tenths in two hours, succeeded by a return to the previous height at the third hour (Chart 4). On the 25th the general condition was good. Respirations 29, pulse 68, temperature 40-2" C. Marked tubal murmur. The heart- Digitized by Microsoft® 484 CLINICAL VETERINARY MEDICINE AND SURGERY. beats were unequal and the pulse feeble. Quinine was discontinued, and i^ drachms of digitalis given in electuary. On the 26th the general state was similar to that of the previous evening. The temperature began to fall. Respirations 26, pulse 72, temperature 397° C. The heart's action was more regular, the pulse larger and stronger. On the 27th the general condition was still better than on the preceding days. Respirations 24, pulse 60, temperature 38"5° C. The murmur remained ; dulness was stationar3^ On the 28th the general condition was excellent. Respirations 20, pulse 52, temperature 38'2° C. The cough had become easier and more frequent. There was some dulness on percussion, and the crepi- tant rale peculiar to resolution had returned. During the following days the last troubles disappeared. The animal left hospital entirely cured on the 7th January. 182. A twelve-year-old entire horse, entered hospital January 26th, 1899. Had come from a stable in which contagious pneumonia was rife, four animals having been affected and two having died. On the evening of the 25th, after a hard day's work, this animal had refused its food, breathing had become rapid, and the animal had shown slight shivering fits. Brought to the College next day. State on Examination. — The animal was depressed, and took no notice of what passed around it. The gait was careless, the limbs r- '■ - y \ / 'V / \ ^ y /' / / 10 '^B ^11 I'f ^_ 1 k I ii % '^z \^ t s t 6 Ii Chart V. dragged along the ground. The skin was warm, the conjunctiva injected, the pulse 70, feeble and soft, the respirations 20, and the tem- perature 40° C. Pressure on the larynx produced a deep cough ; a little brownish discharge ran from the nostrils. On percussion the thorax was normally resonant. Auscultation detected exaggerated vesicular murmur throughout the depth of both pulmonary lobes. Treatment. — Mustard applications to the lower portion of the chest ; internal administration of 3I ounces of sodium bicarbonate, 5 drachms sulphate of quinine in two doses, and 35- fluid ounces of alcohol. At II a.m. on the 25th January the temperature was 40° C. Two Digitized by Microsoft® PNEUMONIA. 485 and a half drachms of quinine sulphate were given in electuary. At 11.30 the temperature was 40*3° C, at midday 40*5° C, at i o clock 40*8° C, at 2 o'clock 40"3° C. In three hours the temperature had risen i"2° C. Concurrently with this rise in temperature excitement had been shown during the first two hours. There was anxiety, trembling, marked acceleration of breathing, and excessive dilatation of the nostrils. After the first two hours the temperature gradually decreased. At 3 o'clock it became 40*9° C. The second dose of electuary was given. During the following hour the temperature continued to fall. At 3.30 it was 40*5° C, at 4 p.m. 39"5° C. From 4 p.m. until 6 p.m. it rose three tenths of a degree (Chart 5). Next day the general condition was stationary, the disease taking its usual course. Temperature 39*9° C. ; respiration 18; pulse 60. The pulse was small ; the conjunctiva remained injected. On aus- cultation the respiratory murmur was markedly diminished in the lower part of the right lung, which was also dull on percussion. Over the upper part of this lobe, and the whole of the left lung, the vesi- ~- -^ ~~ _— ^ ~ j 39° ~ ~ / ^^ ~ / \ — H -^ ^ ■■A \ ""■ K-^ \ ~^ ^ \ ^ ^ ~~ \ / ~ ^ \ / 1 ? 5id|ic 12! h. 12 li _ i_ J b k^^ \l Iv _5 li J X 2> Chart VI. cular murmur was exaggerated. The cough was rough, deep, and sometimes paroxysmal. An abundant rust-coloured discharge ran from both nostrils. As on the previous days the animal received three and a half ounces of sodium bicarbonate and five drachms of quinine sulphate in two doses. The temperature curve on that day closely resembled the first. The first dose of quinine was followed by a rise in temperature of 1-3° C. in four hours. At three o'clock the temperature was 40-6° C. A second dose of quinine sulphate was given. An hour later the temperature fell to 39-8° C, but the depression was not maintained, for at seven p.m. the temperature marked 40-4° C. (Chart 6). . The excite- ment, rigors, and trembling fits noted on the previous day were re- .peated. - On the 28th the morning temperature was 40-6° C, the pulse 80, and the respirations 25. The pulse was feeble, respiration pamful, and expiration double. The cough still remained frequent and paroxys- mal, and the rust-coloured discharge was somewhat free. Percussion Digitized by Microsoft® 486 CLINICAL VETERINARY MEDICINE AND SURGERY. revealed a zone of dulness in the lower half of the right lung. At this level a moist crepitant rale was heard. The heart's action was some- what weak, and both sounds were diminished. The patient took milk and gruel, but hardly touched oats or hay. Treatment was modified b}^ giving three subcutaneous injections of 80 minims of ether, and i drachm of digitalis, and applying mustard plasters to both legs. The dose of quinine sulphate was reduced to [^ drachms. The temperature at 9 a.m. was 40*4" C. drachms at 10, 40'5 C. ; and at 11, 40"6° C. One and a quarter drachms of quinine were then given. At 11.30 the temperature was 40"o'^ C, at midday 39*8° C, at I p.m. 39'5° C. ; at 2, 393° C. There was no excitement. At 3 p.m. the temperature was 39"8° C. One and .a quarter drachms of quinine were then given. At 3.30 p.m. the temperature was 39"i° C. ; at 4, 39"2° C. During the next sharply. At 5 p.m. it was 40*3° C. ; at £ 40-2° C. (Chart 7). On the 29th the patient was greatly depressed. The fore-limbs were abducted, the head held low and rested on the manger. The animal took ten quarts of milk, but refused other food. Temperature hour the temperature rose 407° C. ; and at 7 p.m. 41? W. 39° "~ "— -'^ / f. -- k— - / y- \ Y \ 1 \ f -._ \ / I ^ N ^ / \ y \ ^ 9 ]i JO u Jl Ml y k _I L 2 if 3 ^i \'* h. S K 6 h J i Chart VII. 40"2° C. ; respiration 30 ; pulse very rapid, and perceptible with diffi- culty. Dyspnoea was intense, and expiration jerky. On the right side dulness was complete over more than half the chest. On aus- cultation a strong tubal murmur could be heard. Treatment. — Bicarbonate of soda, sulphate of quinine, digitalis, in- jections of ether. After the second dose of quinine the temperature fell I degree. On the 30th the general condition was better than on the previous evening. The temperature varied between 39*3° and 40° C. ; the respiration continued rapid and irregular ; the pulmonary dulness and murmur showed no change. Treatment was continued as before. After the first dose of quinine a slight rise in temperature occurred. After the second the temperature fell i'3° C. in an hour, after which it gradually rose again. On the 31st the improvement noted on the previous evening became more marked. Morning temperature 39'5° C; respiration 21; pulse 63. The zone of dulness had diminished. On auscultation Digitized by Microsoft® PNEUMONIA. 487 the tubal murmur was still heard. The pulse became stronger ; the patient was brighter than on the previous days, and ate a little hay. On the 1st February the condition remained stationary. Morning temperature 397° C. ; respiration 20°. The dulness and bronchial murmur remained. There were signs of cardiac weakness. On the 2nd the patient appeared greatly depressed. It was feeble and tottered on its legs, so that it had to lean for support against the side of the stall. Temperature 39"2° C. ; respiration 33 ; pulse very rapid and small. Dulness was limited to the lower third of the chest ; the tubal murmur was weaker. The animal refused all food, including even milk. During the night it lay down on its side. Next day it was found standing up eating some hay. It showed a little opposition when we attempted to auscultate the chest. The zone of dulness was limited to the lower half of the right lung ; above this the crepitant rale peculiar to resolution could be detected. Tempe- rature 38*7° C. ; respiration 15 : pulse 80. On the 4th the temperature was 38'2° C, respiration 12, and pulse 64 ; the pulse still remained feeble. The animal received three injec- tions of eighty minims of ether and one drachm of digitalis in electuary. On the 5th and 6th the temperature and respiration became normal ; the pulse was still 60, but fairly good. The last symptoms disappeared during the following days. On the nth February the animal had recovered. 183. A six-year-old entire horse entered hospital March loth, 1899, after an illness of two days. Had come from a stable in which contagious pneumonia existed. State on Examination. — The animal was depressed, showed rigors, and hung back from the manger. The mouth was hot, the skin cold, and the mucous membranes markedly injected. Respiration 24 ; pulse 75 ; temperature 40-5° C. The cough was strong and dry. There was little discharge. Pressure over the intercostal spaces caused pain. Respiration was irregular, expiration being slow and double. The lower quarter of the right lung was partially dull on percussion, but on auscultation the vesicular murmur was found to have disappeared ; during expiration a few moist crepitant rales could be heard. In the upper part of the right, and over the entire area of the left lung the vesicular murmur was exaggerated. The pulse was feeble ; the heart- sounds were strong and rhythmical, but at varying intervals a pause, equal in duration to a complete heart cycle, was noted. Treatment.— yiustdiid. applications to the chest ; sulphate and bicar- bonate of soda; alcohol. The mustard plaster produced a large swelling within four hours of application. The rectal temperature was 39-8° C. Appetite was preserved ; the patient took several quantities of gruel and 8 quarts of milk. There was no noteworthy change during the evening. Temperature 40-3° C. On the nth the animal was more depressed than on the previous evening. The conjuctiva was deep yellow. Respiration 22 ; pulse 76 ; temperature 40-1° C. Inspiration was short, expiration prolonged and double. The lower part of the right lung was dull, and on ausculta- Digitized by Microsoft® 458 CLINICAL VETERINARY MEDICINE AND SURGERY. tion silent. Above the dull zone the crepitant rale was more marked than on the previous evening. The pulse was scarcely perceptible though the heart-sounds were strong. Four drachms of quinine sulphate in two doses was added to the treatment. The first dose produced a depression of one degree in temperature at the third hour, but two hours later the temperature had returned to its former point. In the evening the quinine produced a similar result. The rectal temperature did not rise beyond 40° C. On the i2th the general condition remained stationary. Respira- tion 26 ; pulse 72 ; temperature 39*9° C. A slight cough occasionally occurred. All the lower part of the right lung up to the level of the point of the elbow had become dull. Above this, crepitation was audible both during inspiration and expiration, but most markedly during inspiration. In the upper part of this lobe and throughout the left lung the vesicular murmur was exaggerated. The character and rhythm of the heart-sounds were modified ; the first sound was strong, the second feeble ; every three or four contractions were followed by a pause, lasting as long as a complete heart cycle. One drachm of digitalis was added to the former treatment. The quinine sulphate produced variations in temperature as on the previous day. On the 13th the patient was prostrate and refused all food. The extremities were cold. Respiration 28; pulse 76; temperature 39"8''C. The zone of dulness was stationary. On auscultation borborygmus was heard far in advance of the diaphragm. Crepitation was increased and a slight tubal murmur could be heard. The cardiac pauses were more frequent, and occurred after every two or three beats. The pulse was feeble and intermittent, in sympathy with the heart, The urine contained 18 grains of albumen per pint. The weather being mild and bright, the animal was led from its stall and fastened in the open air from midday to 3 p.m. On return- ing to the stable it began to eat. The respiration was less rapid and difficult, the pulse good ; the temperature remained at 39'7° C. Sulphate of quinine in similar doses as on the previous day produced no sensible diminution. On the 14th the general condition had improved. The animal took several quantities of gruel, ate its hay, and drank 8 quarts of milk. Respiration 22 ; pulse 72 ; temperature 39"6° C. The condition of the chest remained as on the previous day, though a few crepitant rales were heard at points. The irregularity of the heart continued. Treatment. — Sulphate and bicarbonate of soda were administered, but the alcohol, sulphate of quinine, and digitalis were discontinued. On the 15th improvement was more marked. The animal took note of its surroundings. Respiration 20 ; pulse 68 ; temperature 39"4° C. Respiration was freer, the zone of dulness lower, and moist crepitant rales occurred over a large surface. The cough was loose and paroxysmal, and accompanied by discharge. The cardiac pauses were less frequent and longer than at first. They lasted considerably longer than a cardiac cycle; the second, sound continued feeble, and was sometimes imperceptible. There was no dulness, though still some moist crepitant rales. Digitized by Microsoft® PNEUMONIA. 489 On the i6th improvement became more pronounced. Respiration 10 ; pulse 58 ; temperature 38-9° C. During the following days the last symptoms disappeared, the cardiac mtermittency becoming less and less frequent until it finally disappeared. On the 25th the animal left hospital entirely cured. 184. A seven-year-old mare left in hospital April nth, 1899. Had come from a stable in which contagious pneumonia was raging; affected three days before entry. The animal only ate part of its food, but suffered from a cough. There was no other history. Condition on Entry. — The animal moved stiffly. The eye was re- tracted into the orbit and half covered by the upper lid ; the con- junctiva was hyperaemic and infiltrated ; the extremities were cold. Respiration 36 ; pulse 84 ; temperature 41-1° C. The pulse was fairly strong. The cough was infrequent, and when produced by pressing on the larynx was small, dry, paroxysmal, and inclined to return. There was a somewhat abundant rusty discharge. The lower part of the right lung was dull, and at this point borborygmus, heart-sounds, and some crepitant rales could be heard on auscultation. At the junction of the lower and middle thirds crepitant and mucous rales were audible ; and in the upper part, and over the whole of the left lung, the vesicular murmur was strong. Except that it contracted with unusual suddenness and force, the heart revealed nothing note- worthy. Treatment. — Bleeding, mustard application to the chest, quinine sulphate four drachms, sodium bicarbonate three and a half ounces. Evening temperature 40*6° C. Next day the patient appeared less depressed. Respiration 36; pulse 80 ; temperature 40-5° C. Percussion showed increase in the 2one of dulness, especially in front. On auscultation a slight tubal murmur was heard. Left lung normal. At 9.30 a.m. the thermo- meter marked 40-5° C. Two and a half drachms of quinine sulphate were given in electuary. At 10.30 a.m. and during the next two hours temperature 40-8° C. ; at i p.m. 407° C. ; at 2 p.m. 40'5° C. ; at 3 p.m. 40"2° C. ; at 4 p.m. 40*4° C. The second dose was then given. At 4.30 p.m. temperature 40*6° C. ; at 5 p.m. 407° C. ; at 7 p.m. 40-4° C. ; at 8.30 p.m. 40'2° C. The urine, which was very deep in colour, con- tained eighteen grains of albumen per pint. On the 13th April the general condition was bad. The animal lay on the right side, and was unable to rise without assistance. Respira- tion 36 ; pulse 76 ; temperature 40° C. The conjunctiva still remained deeply injected. The respiration was short and sighing. On per- cussion and auscultation of the chest the physical signs were as on the previous, evening, except that the murmur was somewhat stronger. The heart-sounds were weaker. During the day three subcutaneous injections of two and a half drachms of ether were given ; four drachms of quinine were administered in two doses. At g.30 a.m., before the first dose, the temperature was 40° C. ; at 10 a.m. 40° C. ; at 11 a.m. 39"8° C. ; at midday 39'6° C. ; at i p.m. 39*5° C. ; at 2 p.m. 39*4° C. Digitized by Microsoft® o 490 CLINICAL VETERINARY MEDICINE AND SURGERY. The animal lay down, but rose at the end of an hour. At this time the temperature was 40*3° C. ; at 4 p.m. 40"6° C. The second dose of quinine was given. Temperature at 5 p.m. 40'4° C. ; at 6 p.m. 40-5° C. ; at 8.30 p.m. 40-2° C. On the 14th the general condition remained stationary. Tempera- ture 39'3° C. Respiration was still more rapid and sighing. The pulmonary dulness was unaltered, the tubal murmur strong. The left lobe remained normal. The heart showed signs of weakness and irregular intermittency ; the second sound was diminished, and almost lost at certain moments. The patient took the greater part of its food. One and a quarter drachms of digitalis were added to its medicine. At 9 a.m., the tem- perature being 39'3° C, two drachms of quinine sulphate were given. Temperature at 10 a.m. 38"9° C; at 11 a.m. 38'8° C. ; at midday 38*6° C. ; at I p.m. 39'i° C. ; at 3 p.m. 39'0° C. At 4 p.m. the second dose of two drachms of quinine Vv'as given. At 5.30 p.m. the tempera- ture was 39"i° C. ; at 6 p.m. 39° C. ; at 8 p.m. 39° C. The animal was very weak, and during the day lay down several times. It re- ceived three subcutaneous injections of two and a half drachms of ether. On the 15th it was still greatly depressed. Temperature 39"4'" to 39'8° C. ; respiration 48 ; pulse 76. The lower half of the right lung remained dull on percussion, though to a less degree at certain points. Over the tenth and eleventh ribs, near the (vertical) centre of the chest, was an area of tympanic resonance as large as the palm of a man's hand. On auscultation crepitant rales were heard in the pos- terior portion of the lung, and mucous rales about the centre. The left lung appeared normal on auscultation. The first heart-sound had a metallic ring, the second was dull. The cough was strong and loud. A little whitish discharge ran from the nostrils. One drachm of digi- talis, three and a half ounces of sodium bicarbonate, three and a half fluid ounces of alcohol, and carbolic enemata were given. On the i6th the temperature was 39'4° C. Respiration was less rapid, but continued short and sighing. Crepitant rales were heard in the upper thirds of the right lung, but in the lower third only heart- sounds could be detected. Cough was frequent. During the night the animal lay down on the right side, and showed so much excite- ment that a fatal issue was feared. It was lifted and placed in slings. On the 17th respiration 30; temperature 39'8° C. Crepitation, alternating with localised liquid sounds, was heard over the entire area of the right lung. The heart-beats were scarcely perceptible. The pulse could not be counted. Treatment as on the previous day. The allowance of hay was eaten ; the gruel, etc., refused. The urine still remained albuminous. On the i8th weakness was extreme. Temperature 39'6° C. Aus- cultation of the right lung revealed the same liquid sounds as on the previous day. The animal's hind legs seemed painful. At 9 a.m. it was taken out. It moved with difficulty. The right hind limb was paralysed, the joints yielded, and the limb rested on the fetlock when- ever weight was placed on it. The symptoms resembled those of paralysis of the great sciatic. The patient refused to walk, and leaned Digitized by Microsoft® PNEUMONIA. 491 agamstthe wall. Sensation was lost throughout the affected limb except in the region served by the femoral nerve ; it was intact in the left hmb and in all the other hind parts. At 3 p.m. the animal lay down on the left side, became greatly excited ; respiration was moan- ing, and death occurred during the night. Autopsy. — Muscles pale; mesentery and epiploon congested; liver large, friable, and of pale colour ; spleen and kidneys normal. In the pleural sac was a little yellowish serosity. The right lung had not collapsed, but adhered by its anterior lobe to the costal pleura, and by its postero-inferior part to the mediastinum. It showed lesions of lobular pneumonia. According to the point chosen it appeared black, bluish, deep red, bright red, or greyish in colour, the tints cor- responding to centres of hepatisation, oedema, or emphysema. Palpa- tion revealed dense hepatised areas, separated by yielding tracts of healthy pulmonary tissue. Sections of the upper and posterior parts appeared emphysematous, congested, or oedematous, according to the point chosen ; the middle region showed hepatised areas, purulent centres, and cedema. One of the abscesses contained a fragment of necrotic tissue as large as an orange. Some of the bronchioles were obstructed by fibrinous clots. The left lung was unaffected. The ' n° ^^ -^ - ^^ 1 ^ I \ 40° J. 7 -I i - . \- — nT__ - ^A ^^-1. & 5 ^. J_ , - X 4 : 17:^ ' ^'\ ), .A ^ ^ . A ^V^v K 3- S8° IL 1 1 :*"v' s: 23 30 1 2 3 4 5 6 7 8 3 10 II /2 13 l'^ IS IS 17 18 19 20 Chart VIII. hepatised centres in the right lobe contained large numbers of different bacteria, streptococci and staphylococci predominating. The heart was large, and showed ecchymoses along the vascular furrows, particularly at the base of the ventricles. It was discoloured, the greater part of the left ventricle being stained yellow, but the col- oration was less marked over the right. Sections were deep red, pale red, or yellowish in colour. On laying open the left ventricle the decoloration of the myocardium was very striking ; the muscle appeared greyish yellow, and was dotted with ecchymotic patches under the endocardium and pericardium. Its tissue was infiltrated ; the surface of sections was covered with a viscous exudate. The mitral valves were intact ; the aortic sigmoid valves were thickened and infiltrated, showed a few light red spots at their base, and several little hard. Digitized by Microsoft® 492 CLINICAL VETERINARY MEDICINE AND SURGERY. fibrous patches, which, however, were of earher date than the pulmonary disease. The endocardium and valves of the right side appeared unaffected. The great sciatic nerve of the right side was exposed throughout ; its upper part displayed a few disseminated hsemorrhagic points. The spinal cord appeared normal. Microscopic examination of the cardiac and nervous tissues failed to reveal the presence of microbes, and inoculation of gelatin and agar with scrapings from these tissues produced no growths. Remarks. — In equine pneumonia, quinine sulphate in doses of i-j to 2^ drachms, according to the size of the patient, repeated twice a day, usually causes temporary lowering of temperature. Excessive doses produce excitement and hyperthermia, as in Case 182, where the animal was of medium size, and 2^ drachms was an overdose. 185. A six-year-old entire horse, bought six weeks before, and left in hospital April 2gth, 1899. Had been kept in a stable where out- breaks of pneumonia were frequent. In consequence of an attack of acute enteritis at the commencement of April it had been rested for nearly three weeks. On the 27th April it showed symptoms suggestive of pneumonia, and was sent here two days later. State on Examination. — Seen in its stall, the animal seemed greatly depressed, and hung back from the manger, with its head low and eyes half closed. The conjunctiva was yellowish ; the mouth moist and hot ; the artery tense ; the pulse feeble ; the cough small and paroxysmal. Nothing was noted on auscultation or percussion. Respirations 26, pulse 68, temperature 40'5° C. Treatment. — Mustard was applied to the chest, causing the tempera- ture to fall eight tenths of a degree ; internally, alcohol, bicarbonate of soda, and warm creolin enemata were prescribed, while 8 ounces of normal salt solution were injected subcutaneously. On the 30th the condition was graver ; torpor, loss of appetite, and injection of the visible mucous membranes were noted, and a dark line had developed along the gums. Respirations 35, pulse 75, temperature 40*4° C. On auscultation the vesicular murmur extended over the entire area of both pulmonary lobes. No abnormal sound could be heard. Apart from its rapid action the heart showed nothing particu- lar. The evening temperature was 40'6° C. On the 1st May the general condition remained as on the previous evening. Respirations 32, pulse 75, temperature 30'9° C. The con- junctivas were saffron-yellow ; the pulse feeble ; there was abundant rust-coloured discharge from the nose ; inspiration was oppressed, and expiration sighing. Cough was frequent. On the left side the zone of dulness extended as high as the point of the elbow. On auscultation, crepitation and a slight tubal murmur could be heard. On the right side the lower part of the chest revealed partial dulness, but no abnor- mal sounds. The heart-beats were strong and slightly irregular. The same treatment was continued, but a dose of digitalis was also given. Sixteen ounces of '8 per cent, salt solution were injected. During the following hours the temperature fell a few tenths. In the evening respirations 35, pulse 84, temperature 40-4° C. Digitized by Microsoft® PNEUMONIA. 493. On the 2nd the general condition remained bad, and appetite was entirely lost. There was frequent cough and rust-coloured discharge. The pulse was feeble. Dulness had markedly extended on the left side, and rose to the middle third of the thorax ; on the right a loud tubal murmur was heard during inspiration and expiration. Respira- tion 40 ; pulse 80 ; temperature 397° C. During the afternoon the horse was led out and left in the open air for several hours. Micro- scopical examination of the discharge resulted in several varieties of microbes being found, though two streptococci, one of which stained by Gram's method, predominated. During the evening the heart's action became very rapid, the pulse feeble, the respiration extremely difficult, and the face anxious. Twelve and a half fluid ounces of salt solution and five and a half fluid drachms of ether were injected. The thorax and limbs were rubbed with mustard. At 7 o'clock the tem- perature was 39-4° C. Another subcutaneous injection of ether was given. At 3 o'clock the general condition was similar to that on the previous day. Respiration 44 ; pulse 82 ; temperature 39-4° C. The nasal discharge had ceased ; the conjunctiva was deep red ; the pulse perceptible with difficulty ; dulness had increased on both sides ; there was tympanic resonance on the left. During both stages of respiration and on both sides of the chest a loud tubal murmur could be heard. The cardiac sounds were feeble. The former treatment was continued. Two and a quarter fluid drachms of ether were injected. Night and morning the horse was led out of the stable and left in the open air for several hours, provided the weather was good. The urine did not contain albumen or bile pigments. On the 4th respiration 44 ; pulse 84 ; temperature 39° C. General condition improved. The animal was less depressed, and for the first time after entering hospital fed voluntarily. The tubal murmur and tympanic resonance on the right side persisted. The hind limbs were a little swollen. The same treatment was continued. In the evening respiration 40 ; pulse 80 ; temperature 39"2° C. On the 5th the rapidity of breathing contrasted with the improve- ment in the general symptoms. Respiration 50 ; pulse 88 ; temperature 39"2° C. The dulness and tympanic resonance continued ; the tubal murmur was less marked. Crepitation and loud mucous rales were heard. Small subcutaneous abscesses developed in different regions. The same treatment was continued. In the evening respiration 60; pulse 78 ; temperature 39*3° C. On the 6th the pulmonary symptoms were still marked, but the patient readily took food. The conjunctiva was rose-coloured, the pulse feeble ; the respiration was more regular. Respiration 42 ; pulse 70 ; temperature 38'6° C. On both sides of the chest a tubal murmur and crepitation could be heard. Percussion revealed dulness with areas of tympanic resonance. In the evening respiration 42 ; pulse 70 ; temperature 38*7° C. On the 7th dulness had almost disappeared from the left side. On auscultation crepitant and sibilant rales were still audible. On the right a tubal murmur and crepitation were noted. The heart-beats Digitized by Microsoft® 494 CLINICAL VETERINARY MEDICINE AND SURGERY. were regular and fairly strong, and the pulse was good. Respiration 38 ; pulse 72 ; temperature 38'5° C. On the 8th the general condition was excellent. On auscultation the tubal murmur had disappeared, and diffuse crepitation, together with bronchial rales, was heard on both sides. Respiration 34 ; pulse 74; temperature 39"3° C. Treatment was reduced to administration of sodium sulphate and bicarbonate. On the 13th the respiration was still 26, pulse 74, and temperature a little over 38° C. On the 14th and 15th the breathing diminished in frequency. During the following days the last troubles disappeared. On the i8th the temperature was 38° C. A week after leaving hospital the horse was brought back again suffering from a deep-seated metapneumonic abscess in the withers. The pus contained streptococci. 186. A five-year-old gelding, entered hospital March 15th, i 38° — ~ " "■ H ^ f\ ^ \/ /\ 1 / V, V ^ ^ \ \ 1 1 \ 1 1 1 \t' v. N I-- vf 1 15 /6 n 18 /9 20 2/ 22 2 3 24. Chart IX. For some days it had been dull, had eaten little, and coughed frequently. It had been treated for pulmonary attack during the spring of i8g8. State on Examination. — The animal was stiff, and moved with difficulty ; the conjunctiva was deep yellow ; the breathing and pulse were very rapid ; the cough was strong and loose. Percussion of the thorax failed to reveal dulness. On auscultation some moist crepitant rales were heard in the lower part of the left lung ; the heart-sounds were normal and the pulse was good. The animal ate slowly but consumed all its food. Respiration 25 ; pulse 70; temperature 41° C. Treatment. — Injection into the jugular vein of five and a half fluid drachms of i per cent, iodine solution. At 7 p.m. respiration 27 ; pulse 60 ; temperature 4i'4° C. Next day respiration 27 ; pulse 60 ; temperature 408° C. Partial dulness and crepitant rale in the lower part of the left lung. Nothing on the right side. During the day three intra-venous injections of two Digitized by Microsoft® PNEUMONIA. 495 and a half fluid drachms of the iodine solution were made. The anirnal ate slowly, but consumed its oats and hay. In the evening respiration 32 ; pulse 65 ; temperature 4i'3° C. On the 17th respiration 30 ; pulse 67 ; temperature 40-5° C. In the lower third of the left lung was a zone of dulness limited by a Hne drawn obliquely downwards and backwards. Over this area a trifling tubal murmur, and towards the upper part some crepitation, were heard. The appetite still remained i^ood. The same treatment was continued. In the evening respiration 34 ; pulse 70 ; temperature 41° C. On the i8th respiration 82; pulse 65 ; temperature 40-3° C. The patient was less depressed than on the preceding days. The dull zone was larger, the tubal murmur strong, and there was more crepitation. The heart-beats were feeble but regular. The cough was frequent and strong ; the mucous membranes were slightly injected. Two intra- venous injections of 4 fluid drachms of iodine solution were made. In the evening respiration 37 ; pulse 70 ; temperature 40-4^ C. On the 19th respiration 35 ; pulse 68 ; temperature 40° C. Dulness over the lower half of the left lung ; the tubal murmur remained marked. The heart beat regularly ; the pulse was rather feeble. During the day the breathing became rapid. The animal took note of what occurred around it ; it did not leave any of its food. Same treatment continued. In the evening respiration 50 ; pulse 66 ; temperature 40° C. On the 20th respiration 45 ; pulse 62 ; temperature 39"i° C. The zone of dulness was stationary ; the murmur persisted ; the pulse was small, the conjunctiva slightly yellow ; the appetite was preserved. Same treatment continued. In the evening respiration 35 ; pulse 60 ; temperature 38*9° C. On the 2ist respiration 35 ; pulse 52 ; temperature 38'2° C. The dull zone had diminished in size ; the tubal murmur was weaker ; the crepitant rale indicating resolution had returned ; the pulse had again become large and strong. The animal was exercised for a quarter of an hour. Same treatment continued. In the evening respiration 37 ; pulse 50 ; temperature 38'4° C. On the 22nd respiration 33 ; pulse 43 ; temperature 38'4° C. Dulness had almost disappeared. On auscultation only a slight tubal murmur and a few crepitant rales were noted. Exercised in the sun during the afternoon, the patient was bright and walked with freedom. On returning to its box it ate with good appetite. Same treatment con- tinued. In the evening respiration 34 ; pulse 43 ; temperature 38-3° C. On the 23rd respiration 30 ; pulse 40 ; temperature 38-2° C. There were still a few crepitant rales. No cardiac disturbance. The animal lay down during the day, but rose on the slightest disturbance. The iodine treatment was stopped, and one and a half ounces of sodium bicarbonate were given in the drinking-water. In the evening respiration 30 ; pulse 45 ; temperature 38° C. On the 24th respiration 22 ; pulse 40 ; temperature 38° C. No abnormal sound was heard on auscultation. There were no after complications. Digitized by Microsoft® 496 CLINICAL VETERINARY MEDICINE AND SURGERY. PURPURA HEMORRHAGICA. 187. A six-year-old entire horse, brought for examination on the 5th March, 1897, suffering from a corn in the off fore-foot. The bar and branch of the sole were thinned, the foot reshod, and a tar dressing applied. On the loth March the horse was returned here. For two days before all four limbs had been swollen and cedematous. State on Examination. — The swellings were of considerable size, and extended as high as the elbows and stifles, where they were sharply delimited. The mucous membrane of the nose was covered with petechise. There was no swelling about the face. Walking was difficult, the limbs being carried stiffly and not being flexed. The appetite was good. Temperature 38*4° C. During the previous three years four cases of purpura hsemorrhagica, three of which had ended fatally, had occurred in the stable from which this patient came. Treatment. — Injection into the connective tissue of the neck of three and a half fluid ounces of normal horse serum. During the five following days four to four and a half fluid drachms of this serum were injected in the region of the neck, over the triceps muscles, and into the front of the chest. On the i6th swelling of the fore-limbs had dimiriished ; that of the hind remained as before. There was little fever, the temperature only rising a few tenths of a degree above normal ; appetite was preserved. The treatment was continued. On the 19th the swelling in all four limbs was diminishing. A trifling whitish discharge ran from both nostrils ; it continued for a week. Serum was injected, and one and a half ounces of sodium bicarbonate were administered on alternate days. The animal left hospital on the 31st March, the swelling of the limbs having completely disappeared. 188. A ten-year-old gelding entered hospital December loth, 1897. Had been attacked with paraplegia a month before, and had afterwards suffered from the abdominal forrh of influenza. Still showed traces of bleeding from the jugular and blistering of the dorso-lumbar region. Had been rested since the 25th November. On the 9th December signs of purpura appeared. Was brought to the school on the evening of the next day. State on Examination. — The limbs were swollen as high as the upper third of the forearm and thigh. The left side of the breast and the right of the abdomen showed cedematous patches ; the lower half of the head was swollen ; the nose, face, lips, and cheeks were greatly infiltrated. Blood-stained discharge ran from both nostrils ; the mucous membrane of the nose exhibited blackish ecchymoses, almost everywhere confluent. The respiration was 60 per minute and noisy ; temperature 39*7° C. Treatment. — The swelling about the head was perforated in about thirty spots with the fine needle of the thermo-cautery, allowing a large quantity of reddish serosity to escape. Four and a half fluid Digitized by Microsoft® PURPURA HEMORRHAGICA. 497 ounces of normal horse serum were injected ; six and a half ounces of sodium sulphate and three and a quarter ounces of alcohol were given in the drinking-water. During the night the difficulty in breathing increased, and tracheotomy had to be performed. On the nth the general condition remained stationary. The breathing, however, was easier, and much less rapid than on the pre- vious evening. Temperature 39'o° C. During that and the next day four and a half fluid ounces of normal horse serum were injected in three separate quantities. On the 13th the head and fore-limbs were less swollen ; the oedema- tous patch on the thorax was undergoing absorption ; that on the abdomen remained as large as before, and had extended to the sheath. An oedematous zone of considerable size had developed around the tracheotomy wound. Temperature 39"0° to 39'5° C. The injections of serum were continued. During the three following days the head continued to diminish in size ; the swelling in the limbs remained stationary ; the patch on the neck gravitated towards the breast, and increased ; whilst that on the abdomen advanced beneath the thorax. Temperature 38'5° to 38"8 C. On the 17th the swellings about the front of the body had greatly diminished, as had those on the hind limbs and abdomen. The tracheal tube was removed, and the wound swabbed with 20 per cent, iodine solution. Temperature 39*0° to 39*3° C. Treatment was sup- plemented by the daily administration of two ounces of sodium bicar- bonate. On the 22nd the cedema had almost disappeared at all points; tem- perature 38-0° C. The serum injections were discontinued ; the patient was exercised night and morning. A week later it had entirely recovered. 189. An eight-3'ear-old entire horse, left in hospital December 18th, 1897, to be treated for bronchitis. Double pneumonia afterwards developed ; its onset was insidious, but the real nature of the disease was clearly shown by the moist crepitation and tubal murmur on both sides, and by the dulness of a considerable area of both lungs. The pneumonia commenced on the 8th January. On the 22nd the temperature still varied between 39-0° and 39-6° C. Cough persisted, and was accompanied by a double-sided muco-purulent discharge, in which streptococci and some staphylococci were found on bacterio- logical examination. The appetite was capricious. Percussion revealed dulness over the anterior part of the right lung. On auscul- tation moist rales were heard. A patch of chronic pneumonia was suspected. The principal drugs used were iodide of potassium and oil of turpentine. On the 27th the hind limbs were swollen, and an cedematous patch, as large as a man's hand, appeared on the right side of the abdomen. The Schneiderian membrane showed a few petechiae. Temperature 38-9° C. ; respiration 17 ; pulse 40. . Treatment. —Suhcvtta.neous injection of three and a quarter fluid ounces of normal horse serum. T I Digitized by Microsoft® 498 CLINICAL VETERINARY MEDICINE AND SURGERY. On the 28th the general condition was bad and the appetite poor. The hind limbs showed greater swelling, sharply defined at the upper part. Temperature 40*0° to 39*8° C. ; respiration 23 ; pulse 43. Treat- ment continued. On the 2gth the fore-limbs and the lower part of the head became swollen ; breathing was accompanied by a wheezing sound. Tempera- ture 397° to 40'0° C. ; respiration 18 ; pulse 40. For three days six and a half fluid ounces of serum were injected daily. The condition remained stationary until the ist February. On the 2nd the swelling about the face had diminished ; the respi- ration was free, and the appetite good. Temperature 39"5° to 40'0° C. ; respiration 20 to 24; pulse 45. On the following days the swellings were smaller. The injections were continued. On the 5th the swelling about the face had disappeared ; that on the limbs and abdomen had diminished. One and a half ounces of sodium bicarbonate were given in the drinking-water. On the gth the swellings were almost entirely re-absorbed. Tem- perature 38"4° to 39"3° C. ; respiration 15 ; pulse 42. Only three and a quarter fluid ounces of serum were injected, one and a half ounces of sodium bicarbonate being given daily in the drinking-water. Some necrotic patches of skin sloughed away from the scrotum. On the 17th the horse had fully recovered. TETANUS. 190. A three-year-old entire horse, entered hospital November 4th, 1896. State on Examination. — Various groups of muscles, especially those about the neck, showed tonic contraction ; the head was extended on the neck ; there was slight trismus ; the eyes were partly withdrawn into the orbit, were immobile, and covered by the membrana nictitans ; the tail was held horizontally, and the limbs were stiff. Respiration 30 ; pulse 50 ; temperature 38"5° C. No wound could be discovered on the skin or mucous membranes. The front of the off hind fetlock exhibited a cicatrix resulting from an injury inflicted six months before. All four feet showed a little thrush. Treatment. — The frogs were cleansed ; the median lacunas carefully wiped out, swabbed to the bottom with tincture of iodine, and covered with tar. The patient was placed in a dark box and given three and a half ounces of sodium sulphate, one and a quarter ounces of sodium bi- carbonate, and two and a half drachms of potassium iodide daily in the drinking-water. Enemata containing iodine and chloral were also given. During the next four days the condition remained stationary, the temperature varying between 38° and 38"5° C. On the 9th the hind limbs were slightly less stiff. The enemata produced rather violent expulsive efforts, and were stopped. Digitized by Microsoft® TETANUS. 499 Up to the 15th there was no visible change. Each day the animal ate part of its food. On the i6th the condition was graver. Temperature 39-8° C. ; pulse 52 ; respiration 28. Mechanical pneumonia from passage of food into the trachea was feared. Auscultation and percussion of the chest revealed nothing abnormal. The laryngeal region was slightly painful on pressure. The animal refused most of its food. From the 17th to the 20th, three and a half fluid ounces of alcohol were given daily in the drinking-water, and three antiseptic fumigations made._ The symptoms persisted, and were accompanied by attacks of coughing. On the 2ist there was trifling double-sided muco-purulent dis- charge ; the submaxillary glands were swollen and sensitive ; the temperature 3g"6° C. On the 22nd discharge was more abundant ; the pituitary mem- brane was deep red. The submaxillary swelling had become fluctuat- ing. Temperature 39'5^ C ; respiration 22 ; pulse 56. The abscess was opened, and the cavity irrigated with carbolic solution. Next day the general condition had improved. The neck and head were more freely moved. The animal ate all its food with the exception of a little hay. Temperature 39"2° C ; respiration 28 ; pulse 78. During the next few days the last symptoms of sore throat disappeared, and the tonic contractions became less and less marked. On the 28th there was still slight stiffness of the ears and tail. On the 30th cure was complete. igi. A ten-year-old entire horse, entered hospital February 3rd, 1897. For the previous three weeks a wound caused by the collar had existed on the upper part of the neck. On the 3rd February the animal worked during the whole morning, but towards two o'clock the driver noticed signs of stiffness about the limbs and difficulty in breathing. He took it to a veterinary surgeon, who diagnosed tetanus. The animal was brought to Alfort during the evening. State on Examination. — On its arrival symptoms of tetanus were clearly marked. Walking was difficult, the hind limbs especially being affected. The neck was stiff, the head extended, and the tail elevated. There was slight trismus. Temperature 38*3° C. No other wound except that on the neck could be discovered. Treatment. — The patient was immediately placed in a dark box, and the wound disinfected with 5 per cent, carbolic solution and tincture of iodine. Three and a half ounces of sodium sulphate and one and a half ounces of sodium bicarbonate were given in the drinking-water. Milk ad libitum was allowed. The horse ate all its food, though masti- cation was difficult. Next day the condition had become slightly worse. The breathing, which had previously been normal, was rapid and short. Temperature 38*4° C. The same treatment was continued, but in addition eight ounces of '8 per cent, salt solution were subcutaneously injected. This was repeated during the following days. From the 5th fever ceased. On the 9th slight improvement was noted. Movement was less Digitized by Microsoft® 500 CLINICAL VETERINARY MEDICINE AND SURGERY. difficult ; the neck less stiff; the nostrils less dilated; while respiration was slower and easier. The injections of artificial serum produced considerable struggling, but nevertheless were continued until the 14th. From the 15th to the 25th treatment was reduced to daily adminis- tration of four and a half ounces of sulphate and one and a half ounces of bicarbonate ot soda. Improvement was slow. From the 25th to the 30th injections of artificial serum were re- peated, but they caused such violent struggling that finally they had to be suspended. Treatment was, therefore, again restricted to adding sulphate and bicarbonate of soda to the drinking-water. During the early part of March improvement occurred more rapidly, and by the loth recovery was complete. 192. An eleven-year-old mare, entered hospital October 15th, 1897. On the 25th September had fallen and injured the right forearm and knee. On the 14th October symptoms of tetanus appeared. The animal was brought to the school next morning. There was trifling generalised muscular contraction and slight trismus. Temperature was normal. The animal could still eat. Treatment. — Disinfection of the wound and of the knee and forearm with 3 per cent, creolin solution, followed by tincture of iodine. Eight iiuid ounces of warm i per cent, salt solution were injected into the jugular, five ounces of sulphate, and two ounces of bicarbonate of soda were given in the drinking-water. In addition enemata containing chloral were administered. During, the next two days the condition remained stationary. Respirations 20 ; temperature 38° to 38"4° C. The animal took gruel, hay, and oats. Treatment as before. On the i8th the trismus was a little more pronounced. Tempera- ture 38'2° to 38'5° C. Nine and a half fluid ounces of artificial serum were subcutaneously injected. These injections, together with the internal and local treatment, were continued until the 26th, on which day improvement appeared. As the animal became difficult to approafth the enemata were discontinued. Until the 12th November a daily dose of i to if ounces of sodium bicarbonate was given in the drinking-water, and from time to time 3 to 5 ounces of sodium sulphate. At the date mentioned recover}' was complete. The animal left hospital on the 15th November. 193. A twelve-year-old gelding, entered hospital November 29th,. i8g6. Had been castrated four months previously ; one of the wounds had become sinuous. A week before, the animal's left hind pastern had also been injured by a fragment of glass. On the 29th November the owner noticed that the horse moved with difficulty. The head was extended on the neck, the tail was elevated, and the limbs were stiff. State on Entry. — The patient showed symptoms of acute tetanus. Tonic muscular contraction was intense and generalised ; at rest the limbs were stretched out on either side, and during movement were advanced without being flexed. The tail was lifted ; the head Digitized by Microsoft® TETANUS. 501 markedly extended on the neck ; the ears were directed forwards, and could not be moved ; the membrana nictitans covered part of the globe of the eye. Trismus was very marked. The animal made unsuccessful attempts to swallow its saliva, which dribbled from the mouth in long filarnents. Any excitement caused paroxysms. Temperature 39*3° C. ; respirations 78 ; pulse 85. A wound about two inches in length, with contused margins, was found in the left hind pastern. Treatment. --Disiniection of the wounds with dilute tincture of iodine, immersion of the foot in a -i per cent. subUmate solution, fol- lowed by iodoform dressing of the pastern. The patient was afterwards placed in a dark box and fed with nourishing enemata. At 9 p.m. 75 grains of Behring's dry antitoxin, dissolved in iii fluid drachms of luke- warm sterilised water, were injected into the jugular. The animal was found dead next morning. Autopsy. — Lesions of asphyxia; suppurating scirrhous cord; the base of the left spermatic cord was swollen, as large as a hen's egg, and contained numerous suppurating centres. 194. A four-year-old gelding, castrated on the 27th November, 1896, in the northern suburbs of Paris. The operation was performed by the covered method with clams, and partial antiseptic precautions were taken, During the days following operation the wounds were washed with 'i per cent, sublimate solution three times daily. On the 4th December the clams were removed. Next morning considerable swelling of the genital region appeared, but in a few days again diminished. The wounds suppurated slightly. Until the 20th December nothing unusual was seen. Next morning, however, symptoms of tetanus appeared, and the horse was sent to Alfort. State on Examination. — Generalised tonic contractions ; tail elevated ; head extended and held stiffly ; ears directed forwards ; membrana nictitans covering part of the globe of the eye ; trismus ; respiration rapid, varying between 32 and 36 per minute ; temperature 38° C. Treatment. — The horse was placed in a box. Every care was taken to guard it against the action of light, cold, and noise. The wounds were disinfected. Morphine and chloral were given. During the day and ensuing night the symptoms became aggravated. On the morning of the 21st the skin was covered with sweat. Hypersesthesia was very marked ; opening the door, touching the animal, or making the smallest noise produced paroxysms. Respira- tions 36 ; pulse 46 ; temperature 38"2° C. Seventy-five grains of Behring's dry antitoxin, dissolved in ii^ drachms of lukewarm sterilised water, were injected into the jugular. During the day the patient took milk, and in the evening gruel. Res- pirations 36 ; pulse 48 ; temperature 38*5° C. On the 22nd the condition was more severe. The respirations were 70 to 80 per minute during the attacks. Seventy-five grains of aqueous extract of belladonna and 5 ounces of sodium sulphate of soda were given in the drinking-water. Morphine was subcutaneously injected, and chloral given in enemata. Digitized by Microsoft® S02 CLINICAL VETERINARY MEDICINE AND SURGERY. On the 23rd the contractions and trismus had become still more exaggerated. Swallowing was impossible. The same treatment was continued, but the animal died during the night. Autopsy. —'Lesions of asphyxia. 195. A nine-year-old gelding, entered hospital May 6th, it having shown sj'mptoms of tetanus for t\\'0 days previously. Came from the eastern suburbs of Paris. A month before had fallen and injured its knees. State on E. rami nation. — The legs were stiff and placed farther apart than usual ; the head was extended on the neck. The animal had relatively little difficulty in moving. The face appeared anxious ; the eyes were fixed, the nostrils dilated, the ears drawn together and rigid ; the tail was lifted. The least excitement caused the membrana nictitans to be projected over the eye. Mastication was slow, and appetite diminished ; trismus was little marked. The front of the left knee showed a circular wound the size of a sixpence. Temperature 38'8° to 39"i° C. ; respiration 28 to 30 ; pulse 60 to 66. Treatment. — The animal was placed in a dark box. Milk, gruel, hay, and oats were offered. Bicarbonate of soda was added to the drinking-water. Five and a half fluid drachms of an emulsion pre- pared from the cerebral substance of a dog was subcutaneously in- jected, and two quantities of two and a half and five fluid drachms of I per cent, iodine solution were injected intra-venously. Though con- tinued from the 6th to the 15th May, this treatment appeared to have no effect on the temperature, circulation, respiration, or on the mus- cular contractions. Nevertheless, during the hour following the iodine injections excitement seemed diminished. Next day there was no particular change. The bowels were con- stipated. Passage of urine was frequent and painful. Six and a half ounces of sodium sulphate and four drachms of bicarbonate were added to the drinking-water. On the 7th tension about the neck and trismus were less marked. Swallowing was easier. Temperature 38' 1° to 38'7° C. ; respiration 28 to 32 ; pulse 60 to 66. On the 8th the improvement continued. Temperature 38° to 38"9° C. ; respiration 22 to 30 ; pulse 60 to 62. On the gth condition stationary. The patient moved about its box. The eye was still partly covered by the membrana nictitans. Tem- perature 38° to 38-4° C. ; respiration 25 to 32 ; pulse 60 to 64. From the loth to the i8th May the condition was more satis- factory. The symptoms gradually diminished. Temperature 37'9° to 38'6° C. ; respiration 25 to 28 ; pulse 52 to 60. From the 15th only one daily injection of two and a half drachms of iodine solution was made. On the 19th May the iodine treatment was stopped. The jaws were moved normally. There was only trifling stiffness when moving. Recovery was assured. The animal left hospital on the 24th. Remarks. — None of the drugs, or combination of drugs, yet sug- gested for the treatment of tetanus are of much value. In the horse. Digitized by Microsoft® TETANUS. 503 whatever treatment be adopted, the mortahty is about 70 per cent. I have made experiments as to the benefit of excising the inoculation wound, and of injecting antitoxic serum. In our patient free removal of the margins of the inoculation wound necessitates anaesthesia, with- out which excessive excitement and violent struggling occur. It is of less value than careful disinfection of the wound, provided this can be done without causing pain. It is well known that the first antitoxic serums produced in Ger- many and France were useless in the acute form of tetanus. They have only proved successful in chronic tetanus, a form which in the horse is often followed by recovery under the older forms of treatment. In November, 1896, Professor Dieckerhoff published in the Berliner thierdfztliche W ochenscJirift some clinical cases which appeared to show that a new antitoxin (Behring's dry antitoxin), manufactured in the Sero-therapeutic Institute of Hochst-u.-Main, when subcutaneously or intra-venously injected in doses of seventy-five grains, dissolved in eleven and a quarter drachms of sterilised water, cured the acute form of tetanus. In spite of the high price of the remedy (6s. 31^. per fifteen grains), I procured a sufficient quantity to study the effects. Cases 156 and 157 were treated with an intra-venous injection of seventy-five grains of this antitoxin. The first died twenty-four hours after injec- tion, and the second on the fourth day. In three other horses affected with acute tetanus, treated by subcutaneous injections of an emulsion of nerve substance, and by intra-venous injections of iodine solution, the course of the disease was less rapid than in the two preceding cases, but the final result was the same. The intra-cranial injection of antitoxic serum is still the subject of study. Its efficacy in acute tetanus not having as yet been clearly demonstrated, it cannot be recommended in practice. Digitized by Microsoft® VII.— VARIOUS DISEASES. PARASITIC ANEMIA (IXODES). 196. A nine-year-old setter dog, entered hospital November 24th, 1894. For several months this dog had been covered with ticks. More than 300 could be counted, fixed principally to the ears, the right side of the head, the left shoulder, the chest, and the dorso- lumbar region. The animal was thin and very feeble, showed slight ptyalism, and its mucous membranes were pale. Appetite was good. Temperature 37"8° C. The ticks fixed to the ears and left shoulder were touched with oil of turpentine, and those in the other regions with benzine. At the end of an hour some of the larger which had been touched with benzine began to loosen their hold. An hour later the majority were only attached by the rostrum, and their bodies were blackish ; they were then easily removed with forceps. The large ticks touched with oil of turpentine became detached more slowly. The smaller had all preserved their colour. At the end of four hours all the parasites, whether touched with benzine or with turpentine, remained fixed to the skin only by the end of the rostrum. The patient showed uneasiness and partial paresis of the hind quarters, resulting from absorption of a certain quantity of the agents employed. It was washed, dried, and rubbed, and given a few spoonfuls of strong coffee and milk containing bicarbonate of soda. Some ticks which survived the action of the benzine and turpen- tine were touched with pure carbolic acid. At the end of ten minutes they were easily removed. It is interesting to note that the larger ticks appeared less resistent than the small. ECHINOCOCCOSIS OF THE BRAIN, LUNGS, AND LIVER IN A HORSE. 197. A fifteen-year-old blue roan pony, first seen at 5.30 a.m. on June 3rd, 1895. History. — Was thought to have sustained some injury to its hind quarters, and was unable to rise. On the previous evening it had been a little restless, and seemed rather uncertain on its hind legs, but becoming quieter after the administration of some simple colic medicine it was left for the night. Early next morning the coachman found the pony lying on its off side, sweating a good deal, and unable to rise. It had been lifted by sheer strength, but could not stand. Digitized by Microsoft® ECHINOCOCCOSIS OF THE BRAIN, LUNGS, AND LIVER IN A HORSE. 501; State on Examination. — The animal was still lying on its off side, and appeared fairly comfortable. The pulse was 50, soft, and of good volume ; respirations 16, temperature ioo-|°. The conjunctiva was of a brick-red tint, and the pupil sensitive to'light. The animal was turned over and placed in a position to rise, but in spite of some assistance it made no effort to do so. Examination of the. back and off hind Hmb revealed no injury. There was neither pain nor crepitation, and sensation seemed good in both hind limbs. The statement (elicited by close questioning) that the pony had not been exercised for some days, but had been liberally fed, aroused suspicion of haemoglobinuria, although the lumbar muscles did not show the usual stiffness. The suggestion was afterwards negatived by the urine continuing perfectly normal. As it was important to raise the patient, and allow it, if able, to stand, this was done, but the animal failed to place any weight on the off hind limb, which seemed para- lysed : while the near, though sustaining weight, could not be moved. The united efforts of five men were required to keep the animal on its legs, and therefore after the bed had been renewed and increased it was again let down. Failing any positive evidence to the contrary, and no urine having been found in the blad- der, the case was at this stage treated as azoturia. Stimu- lating applications were made to the loins, and an anodyne draught containing Tr. Opii fl. 5ss, Chloral Hydrate Jj, Spt. Tereb. fl. ^ss, and 01. Lini Oss peated in four hours. By 8 p.m. on the same day (June improvement, but the urine azoturia became untenable. Region of insensibility (shaded). administered, and ordered to be re- having 3rd) there was no particular 3een examined the diagnosis of In the meantime, however, the pupils became insensitive to light, and some difficulty was shown both in breathing and swallowing.. Cerebral injury was therefore suspected, and a dose of aloes and calomel given to unload the bowels. Cold applications were made to the head, and at a later date a blister was applied. At 6 p.m. on June 4th the pony was still unable to rise, and lay with the head and neck fully extended. The pulse was imperceptible either at the submaxillary or radial arteries, and the heart's impulse could not be detected through the chest wall. The respirations were 57. The pupil was fully dilated and completely insensitive to light ; the retinal vessels appeared enlarged, and the bright reflection from the tapetum was dulled by what seemed to be a deposit of lymph. A Digitized by Microsoft® 5o6 CLINICAL VETERINARY MEDICINE AND SURGERY. corneal ulcer, the size of a split bean, had developed in the right eye. The mouth was hot and drj', salivation completely in abeyance. There was moderate bilateral paralysis of both lips, grinding of the jaws, and from time to time a slight muscular spasm appeared to flit over the face. The near hind leg had become affected almost to the same degree as the off, but both still responded to stimuh, such as the prick of a pin, except over the upper part of each quarter in the region shown in the diagram (shaded). For the previous twenty- four hours the animal had shown regularly recurring periods of excite- ment, moving the legs rapidly, as if at full gallop, for a minute or two, and then subsiding into quiet. Latterly the fore-limbs alone had been moved, the hind limbs being partially flexed, and kept either quite still or only moving passively. Pricking the skin of the hind Fig. 66. — Liver with cysts. limbs at any point outside the shaded area produced an exaggerated movement of the panniculus, or in some cases contraction of the limb. That sensation in the hind limb was not entirely destroyed, however, was shown by the fact that a sharp prick also excited contractions in the fore-limbs. There was local sweating under the arms and in the flank. The tail was partially paralysed. The bowels were acting slightly. The kidneys had acted twice on the 3rd, and once on the morning of the 4th. Having regard to the sudden onset, the almost total absence of fever and of delirium, the failure to detect local injury, and the rapid course, the diagnosis was haemorrhage at the base of the brain — an opinion that proved far from correct. The prognosis was necessarily very unfavourable, and, in point of fact, the animal died about g p.m. on the evening of the 4th June. Digitized by Microsoft® ECHINOCOCCOSIS OF THE BRAIN, LUNGS, AND LIVER IN A HORSE. S°7 On post-mortem examination, made the same evening, the intestines, spleen, bladder, and kidneys were apparently normal, though, as would be expected in an old and well-fed animal, there was an unusual accu- mulation of fat around the kidneys and in the omentum and mesentery. Fig. 67. — Liver, showing cysts, laid open. The liver was enlarged, showed signs of fatty degeneration, and its left lobe contained numerous cysts, marked a, h, c, and d in the figure. These only represent a few (Fig. 66). A straw has been inserted in one of the upper cysts which had been opened. To facilitate description Fig. 68. — Right lung, showing cysts. a further figure is given, showing the three larger cysts (a, b, c, and d) laid open (Fig. 67). That marked a was the largest. Its walls were of the consistency of cartilage, measured three eighths of an inch in thickness, and were lined internally with a light greyish, crapy-looking Digitized by Microsoft® 5o8 CLINICAL VETERINARY MEDICINE ANI) SURGERY. membrane. It contained g ounces of a perfectly clear limpid fluid, which escaped under pressure on the sac being incised. Scrapings taken from this were microscopically examined. The appearances will be described later. The second cyst (really consisting of the cavities b and c) was perhaps as large in extent, but contained less fluid. Its walls were calcified, and varied in thickness from a quarter to half an inch. Its lining membrane was yellow, and covered with a slimy muco-purulent fluid, while the bulk of its contents was of a similar semi-purulent character, though thinner than the material adhering to the walls. The third cyst was somewhat smaller, and contained about 5 ounces of fluid. Its walls were some three eighths of an inch in thickness, but in all material respects it resembled a. The central lobe contained another cyst ; the right seemed free. The lungs were emphysematous. They showed in all about thirteen cysts of varying sizes, each having a wall of cartilaginous hardness, containing a clear fluid under pressure, and exhibiting a greyish-white Fig. 6g. — Debris in cyst fluid, showing echi- nococcus spines and buds or daughter cysts. Fig. 70. — Echinococcus scolex, intact. crapy lining. The right lung is that represented (see Fig. 58). The largest cyst, which projected prominently, is marked a ; others are marked b, c, d, and c. A minute particle scraped from the wall of any of these cysts showed the appearance of Fig. 69. Myriads of echinococcus spines, singly and arranged in the characteristic saucer forms, float in the fluid, together with secondary and tertiary cysts in various stages of develop- ment. A secondary cyst, more highly magnified, is shown in Fig. 70. By careful lighting this was seen to be bounded by a thin cell-wall containing apparently a glutinous fluid. At the base was the crown or saucer of echinococcus spines (6), which, on rupture of the investing membrane, break up and float singly in the fluid, producing the appearance shown in the preceding figure. Towards the top were two denser bodies (c), apparently undergoing division, while throughout the rest of the free space were numerous daughter cysts {d) arranged in order. The heart was enlarged, but otherwise normal. Digitized by Microsoft® ECHINOCOCCOSIS OF THE BRAIN, LUNGS, AND LIVER IN A HORSE. 509 On removing the brain the meningeal vessels appeared congested, but it was not until the tissue had been hardened and carefully divided that the most interesting lesion was discovered. Two typical cysts were found : one about the size of a pigeon's egg in the upper part of the cerebellum, rather inchned towards the left side ; the other, some- what smaller, in the cerebrum. In both cases haemorrhage had occurred around the cyst, and had infiltrated the substance of the brain. The cerebellar cyst had a distinct wall about one twentieth of an inch in thickness, was lined by a greyish-white membrane, and con- tained a yellowish caseous material, examination of which showed the usual echinococcus spines. Around the cyst and extending obliquely downwards and forwards towards the fourth ventricle was a well- marked haemorrhage (see Fig. 71). The cyst in the cerebrum appeared of later growth. Its wall was thinner and only perceptible with diffi- culty. It contained a similar material, and was equally surrounded by a hasmorrhagic area, which in this case, however, extended chiefly upwards towards the point where the crucial fissure abuts on the third anterior convolution. Note. — The cysts in the brain and cerebellum were apparently of Fig. 71. — Brain, showing cysts. considerable age, probably not less than two or three years, and pos- sibly much older. That in the cerebellum might have existed for five or six years, and provided its growth were slow have caused no peculiar symptoms. Extensive tracts of the cerebellum can be destro3'ed by malignant growths without interfering with even the most complicated acts ; and it is known that in dogs, large portions of whose cerebellum have' been experimentally removed, function is sometimes completely restored after the lapse of a year or two. It need excite no surprise, therefore, that slowly increasing cysts in this region produced no sym- ptoms caUing for remark. Cysts, however, like tumours, are always surrounded by a network of vessels, the walls of which are generally very thin, and which in an old horse would be liable to rupture. A simple shock, such as that of falling down when asleep, might produce this effect, especially if there were a tendency to brain congestion, as occurs in acute indigestion. (It must be remembered the horse had shown colic the evening before.) Digitized by Microsoft® w 5lO CLINICAL VETERINARY MEDICINE AND SURGERY. Haemorrhage might then have occurred on the left side in and around the motor tract for the hind hmb, finally leading to more and more complete paralysis of the hind limb of the opposite (right) side. Extending still further, it would first produce irritation, and later paralysis of the motor fibres going to the fore-limb, and then of those supplying the face. It is somewhat difficult to understand the partial paralysis of the lips while the fore-limbs still retained their function, but the difficulty does not altogether invalidate the explanation. Mr. Jno. A. W. Dollar's case, Veterinarian, 1895, p. 775. PARESIS OF THE HIND LIMBS (CHOREA), 198. A two-year-old poodle, entered hospital August 22nd, 1897. On the i8th August the animal's walk appeared awkward ; the hind parts rolled from side to side, the hind limbs being in fact partially paralysed. In addition spasms occurred about the face, ear, and shoulder, and discharge from the eye and prepuce had been noted. The owner did not think the dog had suffered from distemper, but the existing symptoms were certainly a consequence of that disease. State on Examination. — The animal was thin. On clinical examina- tion the most striking peculiarity was the weakness of the hind quarters ; during movement the limbs partially collapsed. The muscles of the head — especially the temporal muscles — and those of the ear, shoulder, and forearm were the seat of very marked clonic contractions. Appetite was good, but the animal had a little difficulty in grasping its food. There was no cutaneous eruption, and the chief functions were normal. Treatment. — Administration of 5 grains of potassium iodide ; hypo- dermic injection of '03 grain arseniate of strychnine ; application of the faradic current by means of brass wires passed under the skin of the shoulder and of the base of the tail respectively. The current was continued for three to five minutes. During the first four or five days the hypodermic injection of strych- nine was followed by a period of excitement, and by slight generahsed contractions. At the end of a week the effects became less marked and the contractions feebler. The daily dose was then increased by '004 grain, until a total daily dose of "045 grain was reached. In this dose the action of the strychnine was always well marked, all the anterior portion of the body showing clearly marked hypersesthesia, and the slightest touch producing excessive excitability. Continued for six weeks this treatment gave excellent results. The paralysis of the hind quarters and the clonic contractions gradually diminished. On the 20th September recovery was almost complete. Slight spasms still occurred about the shoulder, but afterwards entirely disappeared. Remark. — In the treatment of paraplegia following distemper the medicines which have given the best results in my hands are potassium iodide, given by the mouth, and arseniate of strychnine injected subcu- taneously. Very small doses are first given, and are gradually increased until the desired effect is obtained. I have also tried this treatment on Digitized by Microsoft® RHEUMATISM. 51I three pure-bred animals affected with chorea, a disease whose nature is still undetermined, but which certainly shows all the characters of chronic myelitis of toxi-infectious origin. It did not produce any appreciable result. At the present time we have in hospital a two-year- old thoroughbred dog affected with this disease, which we have unsuc- cessfully treated for the past three months with subcutaneous injections of cerebral substance and intra-venous injections of iodine. RHEUMATISM. 199. A ten-year-old Danish dog, brought for examination September 30th, 1894. For several years this dog had shown repeated symptoms of rnuscular rheumatism — difficulty in moving, stiffness of the neck, back, and limbs. At certain times it suffered such pain as to howl loudly, especially at night, or when it rose after having remained long in one position. It was in the habit of bathing in a running stream near its owner's house, and the attacks frequently followed these baths. Except for these rheumatic attacks the dog had enjoyed fairly good health. Five or six days before, more serious troubles, however, had been noted. The animal refused food, remained continually lying down, and had frequent attacks of dry cough. If forced to walk, it rolled from side to side, and ended by falling. These troubles continued, though in less degree than at first. When the animal was brought here it showed stiffness in movement, especially of the head and neck ; the neck was tense and rigid, and seemed painful even on slight pressure. The heart revealed a double systolic and diastolic murmur. We prescribed general hygienic treatment, together with internal administration of i|- drachms of sodium bicarbonate and 15 grains of sodium salicylate. During the night and next day the condition remained stationary. On the 2nd October the patient was found dead in its kennel. The owner sent the body to the school for post-mortem examination. Autopsy. — No liquid in the abdominal cavity ; intestines of normal aspect ; gastro-intestinal mucous membrane slightly hypersemic at points ; liver enormous and blackish, with the appearances of " cardiac " liver ; the spleen exhibited several blackish swellings, the largest the size of a nut; both kidneys were reddish, and their surface was marbled ; sections showed lesions of chronic nephritis. The right testicle was the size of a hen's egg, and contained a tumour ; the spermatic cord and the sublumbar lymphatic glands were invaded. The lungs contained numerous little whitish cancerous patches. The pericardium was normal. The heart was very large, marbled with greyish irregular patches, indicating areas of indurative myocarditis. The left heart showed lesions of chronic endocarditis ; the mitral valves were thickened, contracted, fibrous at their base, reddish and vege- tating towards their free margins ; the aortic valves were thickened and contracted. The right heart was less changed, though the ventricle Digitized by Microsoft® 512 CLINICAL VETERINARY MEDICINE AND SURGERY. was dilated ; the lips of the tricuspid valves were thickened and reddish, and their free margins granulating. The cerebro-spinal fluid was abundant. The meninges lining the cranium and covering the brain showed no change ; in the cervical region, however, they showed patches of ossification ; throughout the rest of their extent they appeared normal, as did the cord. The muscles of the neck were hypersemic, infiltrated, and marked \vith a few ecchj-moses. The articulations were unaffected. Toxicological examination discovered no poison in the organs. The tumour in the testicle and those in the lungs were alveolar epitheliomata. This case is interesting for more than one reason. It shows that a case which for years exhibits signs of rheumatism may end by contracting cancer ; it shows lesions of rheumatism and of ossifying pachy- meningitis associated, and leads us to ask whether these latter were not the effect of a localised rheumatic inflammation of the meninges. RHEUMATISM OR PACHYMENINGITIS? 200. " Marquis," a six-year-old dog, left in the surgical laboratory on the 15th January, 1892. The condition from which it was suffering had suddenly appeared two months before. Without apparent cause the animal was attacked with paroxysms of acute pain, during which it whined and sometimes howled loudly. Several attacks occurred during the first day. In spite of treatment being commenced on the second day these attacks returned more or less frequently and violently. The dog had previously been in excellent health, and had always seemed very intelligent, bright, and affectionate. It was fed on cooked meat, which it ate with good appetite. We were informed that it had always shown marked sexual instinct, continually running after females and even males of its own species, and attempting coitus. A preliminary examination only showed somewhat marked double exophthalmia. Left at liberty in the laboratory it repeatedly mani- fested signs of excessive sexual excitement ; the propensitj' to coitus appeared almost permanent during the intervals between attacks. Some- times these occurred suddenly ; sometimes they were preceded by warning symptoms, like dulness, stiffness of the limbs, arching of the back and fixity of attitude, the head being depressed and the nose almost brought in contact with the ground. The attacks, whether or not preceded by preliminary signs, were always very violent. The animal suddenly appeared to be in acute pain. Standing upright, with the head and neck extended, all four limbs stiff, or one of the front limbs flexed — most frequently the left (Fig. 73), — he gave vent for half a minute to a minute to piercing howls, which were followed by pro- longed whimpering. Sometimes several attacks succeeded one another, but the first was always the strongest and most prolonged. At times these attacks could be produced by forcing the animal to move ; some- times b}' simply touching certain regions, which appeared hypersesthetic. To bring them on it was only necessary to place the hand on the Digitized by Microsoft® RHEUMATISM OR PACHYMENINGITIS? 5 13 animars head, neck, or shoulder; to pass it over the back and loins ; or to litt the animal by its front legs. The attacks also occurred if the sense-organs were suddenly stimulated as by opening or closing a door or by letting fall any metallic object. Sometimes they came on without any appreciable cause. They were followed by a prolonged uneasy period. They also occurred during the night : on certain mornings the animal was found depressed, with the appearance of having gone through a series of attacks. During its bad days the patient was not comfortable anywhere. 'irr Fig. 72. — Attitude when quiescent. Whether lying on its bed or sitting up it seemed to suffer extremely. The body showed slight trembling ; the face was anxious ; the eyes even more prominent than usual ; the respiration moaning. When standing upright the back was strongly arched ; the limbs were placed far in advance of their ordinary position ; the body was rocked slightly from behind forwards ; the neck was tense, and the head depressed. The least movement produced cries. If the animal lay down it did so with great precautions. First of all it sat down glowly, extended the front limbs, then rolled gently over on one or other side. On the 29th February, 1892, the attacks were particularly severe. K K Digitized by Microsoft® 514 CLINICAL VETERINARY MEDICINE AND SURGERY. The first was produced by a very trifling blow on the neck. The animal was still standing stiffly, with the back arched and the front hmbs extended, when a second attack was determined by the noise of a metal box falUng on the floor. A few minutes later, when it was about to lie down, still whimpering, a third attack followed without any appreciable external cause. During the night others occurred, but less frequently than at first. . In spite of these frequent crises the animal remained well nourished. During the intervals, and sometimes during several days together, it was bright and cheerful, ate well, and, as stated above, appeared desirous of coitus. Its intelligence was in no way impaired. The temperature was normal ; the sensibility of the skin was not lessened Fig. 73.- -Attitude during an attack. at any point ; the reflexes were preserved ; there was no ocular dis- turbance or apparent disease of the ears. This condition continued without notable change until the 25th March, when recovery occurred. On the 28th March a small bitch in heat was brought into the laboratory. "Marquis," who had to be fastened up to prevent his troubUng her, made a scene at the door ot the room where she was. For hours he ran to and fro m the rooms through which she had passed, searching for her, jumping on tables, and looking through windows; In spite of this prolonged excitement no fit occurred. , . , , <.„„, After being castrated in March, 1894, this dog became eczematous and fat. He continued at liberty in the surgical hospital until May, 1807 Having been taken out one Sunday by the attendant m my hospital, whom he was in the habit of accompanying, he took advan- tage of a crowd to escape, and was never again found. Digitized by Microsoft® SARCOMATOUS DISEASE OF THE LUNG. 515 What was the nature of this disease, which continued for nearly five months producing these painful crises ? Our diagnosis always hesitated between rheumatism and pachymeningitis. I have seen several other patients suffering from similar though less violent and less persistent attacks, due to rheumatism. I incline to think that in this dog a rheumatic localisation had occurred in the meninges and auditory apparatus. The hypothesis of ossifying pachymeningitis is scarcely compatible with the perfect and lasting recovery. SARCOMATOUS DISEASE OF THE LUNG. 201. A fifteen-year-old entire horse, entered hospital June ist, 1897. For two years previously this horse had enjoyed good health. The sides of the chest were marked by hairless patches due to long- previous blistering. On the 25th May the animal experienced a chill and showed some alarming symptoms, regarded as due to broncho- pneumonia. State on Examination. — On the day of entering hospital the patient exhibited evident signs of grave disease ; the mucous membranes were injected and slightly swollen ; the respiration was very rapid (50 per minute) ; cough readily followed pressure on the larynx, and was loud, moist, and inclined to recur ; there was abundant mucous discharge, which contained numerous organisms, among others an encapsuled diplococcus, which stained by Gram's method. Nothing abnormal was noted on percussing the chest. On auscultation the vesicular murmur could be detected over the entire area of both pulmonary lobes. The heart was normal, the pulse accelerated (70 per minute). The appetite was good, the animal ate all its food ; the faeces were normal. Temperature 40-8° C. The cough, discharge, difficulty in respiration, and coloration of the mucous membranes appeared to indicate that the animal was suffering from pneumonia, still localised in the deep parts of one or both lungs. Treatment. — Sulphate of quinine, and sulphate and bicarbonate of soda internally ; fumigations with menthol (produced by adding a tablespoonful of the following mixture to half a bucket of hot water : Menthol .... 10 drachms. Oil of turpentine . . 10 drachms. Alcohol .... i2-i ounces.) From the 2nd to the 14th June little change occurred. The per- sistence of fever, cough, and dyspnoea, and the signs furnished by aus- cultation and percussion, led us to diagnose chronic pneumonia with abscess formation in the lung, or tuberculosis. The funiigations were stopped. Nothing abnormal was found on rectal examination. The discharge contained no tubercle bacilli. The urine was highly charged with deposit and was slightly alkaline, but showed no epithelial casts, or sugar, and very little albumen. The reaction for indican was doubtful. On the 15th June the chest was punctured, with the hope of obtain- ing a little pleural liquid for examination ; nothing escaped. Digitized by Microsoft® 5l6 CLINICAL VETERINARY MEDICINE AND SURGERY. The temperature continuing at 40° C, the animal could not be tested with tuberculin. Until the 25th June the condition slowly grew worse ; wasting and weakness became more marked. Respiration was greatly accelerated and painful. Percussion indicated dulness at several points. On aus- cultation the vesicular murmur was diminished over the entire extent of both lobes, and various abnormal sounds were heard, particularly crepitant rales towards the end of expiration. On the 28th June the animal was slaughtered. Lesions. — The abdominal organs appeared normal, but on opening the chest the surfaces of the lung appeared mammilated and bosse- lated by greyish tumours. Sections exhibited a bright red ground formed by the healthy pulmonary tissue, marked with circular, sharply defined, whitish patches, varying in size between a sixpence and a man's hand, resulting from division of the tumours. The lungs weighed thirty-four pounds. The bronchial glands were only slightly hypertrophied. The pleural cavity and heart were normal. On microscopic examination the tumours showed the characters of round-celled sarcoma ; but bacteriological examination was carried out in order to dispose of the question of tuberculosis. Numerous sections were made, but no bacilli found. Four guinea-pigs were intra- peritoneally injected with an emulsion formed by crushing fragments of the pulmonary tumour in sterilised water. When killed five weeks later they showed neither tuberculous nor sarcomatous lesions. These pulmonary tumours had the same naked-e5'e appearances as the lesions in the sarcomatous form of tuberculosis, from which they conld only be satisfactorily differentiated by bacteriological examina- tion and inoculation. ROUND-CELLED SARCOMA OF THE RIGHT TESTICLE WITH ENORMOUS INTRA-ABDOMINAL TUMOUR IN A HORSE. 202. Sixteen-year-old black cart-horse; a right monorchid. History. — The animal had been in the possession of a carrier for twelve years, was noted for its great endurance, and had never shown signs of illness prior to the last week of December, 1893. State on Examination. — Haggard expression of countenance ; animal stood with fore and hind legs widely abducted, and showed great disinclination to move. Temperature 105° F. ; pulse 65. Appetite fastidious ; bowels costive. On careful search a large tumour was found in the right scrotal sac; it extended to the external abdominal ring, was very firm and non-sensitive. A dose of physic was given, and acted freely. On rectal examination on the following day an enormous abdominal tumour was discovered, occupying the right lumbar region, extending forwards to the right kidney, backwards into the pelvic cavity, and downwards to the iloor of the abdomen. It was firmly attached to the inferior surface of the rectum. Prognosis was unfavourable. From this time onwards the animal became gradually weaker ; the Digitized by Microsoft® MAMMARY ADENOMA IN THE BITCH WITH PULMONARY METASTASIS. 517 right limb from the haunch downwards became greatly swollen, as did the sheath and subcutaneous connective tissue under the abdomen. The horse was killed on the 17th January, the autopsy revealing the above-described tumour, which weighed fifty pounds. There was evidence of chronic peritonitis ; the abdomen contained several gallons of sanguineous fluid; all the abdominal and thoracic organs were healthy. Microscopical examination showed the growth to be a round-celled sarcoma. The testicle was soft and pulpy; all the testicular substance ap- peared to have been destroyed ; the structure of the cord up to the point of junction with the abdominal tumour was normal. The abdo- minal growth was for the most part firm, glistening on section, and here and there showed evidence of hsemorrhagic infiltration. Prof. Walley's case, Jow-n. Comp. Path, and Therap., 1894, p. 66. CARCINOMA OF THE KIDNEY IN A HORSE. 203. An eight-year-old half-bred bay gelding. History. — Four months before examination the animal seemed to be easily fatigued, and had fallen away in condition. When turned out to grass it wasted rapidly, and swellings appeared under the belly, in the sheath and hind limbs. On the right side the asternal ribs were outwardly displaced, apparently by some abdominal growth. Pulse 50, weak ; temperature ioi° F. During the subsequent stages the temperature varied between ioi° and 104° F. Diagnosis. — Enlarged liver. Slaughter was advised, but a delay of some weeks occurred before the advice was put in practice. Post-mortem examination showed the right kidney to be enormously enlarged. It was attached above to the psose muscles, on the right to the abdominal wall, and below to the double colon. Before incision it weighed seventy-nine pounds, and measured four feet six inches in circumference. The left kidney was nearly double its ordinary size, but otherwise normal. Microscopical examination showed that the mass was almost entirely composed of a carcinomatous new growth, with a small amount of stroma and epithelial cells of the spheroidal or glandular type. Mr. G. J. Harvey's case, Journ. Comp. Path, and Therap., 1892, p. 378. MAMMARY ADENOMA IN THE BITCH WITH PULMONARY METASTASIS. 204. A collie bitch suffering from a tumour about the size of a hen's egg in the mammary gland. Removal was not attempted. The patient had been unwell for about a week, but dyspnoea only appeared two or three days before death, and did not become distressing until twenty-four hours before the end. On autopsy both lungs were found to be enlarged, and did not collapse on opening the chest. The surface of the visceral pleura was Digitized by Microsoft® Sl8 CLINICAL VETERINARY MEDICINE AND SURGERY. raised by a multitude of small greyish nodules varying in size from a pea to a hazel-nut. On section these nodules were found throughout the lung sepa- rated by a very small but variable amount of lung tissue. Their consistence was that of a hepatised area in the horse ; the invaded parts were airless and contained no softened centres. The bronchial glands were enlarged and firmer than normal ; some contained black pigmented centres (carbon). 205. A setter bitch with tumour about the size of a man's fist, which was excised. The patient remained dull after operation, but no definite symptoms appeared until the tenth day, when the temperature rose to 105° F., and the respirations became slightly hurried. The temperature gradually rose to 106° F., the symptoms of dyspnoea became more intense, and on the fourteenth day the patient died. The microscopic appearance of the lungs of this animal was practically the same as in Case 204. The nodules, however, were hardly so numerous, nor ^ye^e they as firm ; their consistence was that of a normal testicle. The microscopical appearance was the same in _both cases, and sug- gestive of what may follow from an infecting agent being arrested in the pulmonary capillaries. At various points the spongy tissue was obliterated by very dense collections of oval-shaped cells resembling certain forms of glandular epithelium, but only in a few cases was there an acinal arrangement. Each cellular area was surrounded by a limiting membrane, which was not of the same thickness in every case. In some cases this membrane was the alveolar wall, in others the inter- lobular septum ; in the latter case the interfibrous spaces were invaded and the fibrous tissue cells were proliferating. The majoritj' of the cells had a diameter of 5 ;u ; a few were somewhat larger. The seg- mentation of their nuclei indicated the activity with which they were dividing. In the more open parts the alveolar walls were thickened, and their cavities contained a few catarrhal cells. The new formations in the bronchial glands were identical in structure with those in the lungs. Note. — Adenomata are the commonest malignant neoplasms in the bitch, and their prim^ary seat is usually in the mammary gland. The two cases just described show in how astonishingly short a time the secondary (metastatic) growths may develop ; they give an idea of when symptoms of secondary formation may be expected after operation, or in other words at what date after operation a favourable prognosis may be ventured on. In both cases symptoms of dyspnoea only occurred a few days before death, in Case 205 on the tenth day after that on which we might assume the infecting agent gained the venous stream. During this time the new cells were actively dividing and obliterating the lung tissue, which on the fourteenth day was so far destroyed as to render life impossible. As the primary lesion was in the mammary gland, and the secondary growths in the lungs and bronchial glands, it is probable that the infecting agent travels both by the venous and lymph streams. Prof. Stockman's cases, you-rn. Comp. Path, and Therap., 1895, p. 254. Digitized by Microsoft® INFECTIVE GRANULOMA IN A IIARE. 519 INFECTIVE GRANULOMA IN A MARE. 2o5. Ten-year-old bay cob mare. History.— About the beginning of 1899 the animal showed inconti- nence of urine, \yhich continued for a time without improvement. A local adviser was called in, who prescribed, and the animal seemed to recover somewhat, but symptoms recurred soon afterwards. Naturally the almost continuous urination caused irritation and inflammation of the skin of the thighs, and ultimately developed raw sores. There was also a difficulty experienced in defecation. Gradual atrophy was observed to occur on the right side of the back behind the Fig. 74. — -Malignant granuloma. Mare.- section of stomach, (fin. obj.; camera length iSin.) withers, just underneath the seat of the saddle, for a period of six to eight months before death. At last the owner had the animal slaugh- tered. Post-mortem Examination. — " The animal was in poor condition. The pulmonary pleura was thickened and indurated, while large patches of the lung beneath were firm, very dense to the touch, and almost cartilaginous on section. The growth was in large areas, lying more or less underneath the pleura, and the inferior border of the lung, bronchi, and blood-vessels showed thickening to a great extent, while here and there in the diseased area small caseous nodules were discern- Digitized by Microsoft® 520 CLINICAL VETERINARY MEDICINE AND SURGERY. ible. The thoracic l}'mphatic glands were apparently not affected. The liver contained large whitish fibrous areas scattered throughout its substance, and the diaphragm had attached to its posterior surface a number of yellowish nodules about the size of a pea. The wall of the stomach was very much indurated, being at places about an inch thick from the mucous to the peritoneal surface, and composed of hard, dense, fibrous growth, showing on section here and there small caseous foci, from the size of a pin's head to that of a wheat seed. The internal mucous surface was inflamed, and felt tough. The portion of the organ ■ i -^'UC^ ■■■■*'■ % Fig. 75 —Malignant granuloma. Mare : section of lung showing cirrhosis, periarteritis, peribronchitis, and distended lymph spaces. affected was chiefly the greater curvature. The supra-renal bodies were enlarged. The ovaries were very much enlarged, and of the same dense fibrous consistency as the other organs affected. The walls of the uterus and of the bladder were also thickened and cedematous, the mucous surfaces being inflamed and raw-looking. The bladder con- tained a quantity of blood-coloured fcetid urine and a considerable quantity of calcareous deposit, the mucous membrane being inflamed and haemorrhagic." Specimens of the different organs were preserved in a solution of " formalin." The pathological changes were evidently Digitized by Microsoft® INFFXTIVE GRANULOMA IN A MARE. 52 1 due to the growth of new fibrous tissue, which was of a dense nature, feeling almost like hard india rubber, and of a peculiar dirty yellow colour. Sections were made of various portions of the different organs, and the new growths ascertained to be composed of dense fibrous tissue. The appended photographs show the microscopical appearance of the lung and stomach. At first the case was regarded as due to actinomyces or botryomyces ; but, although sections were stained by every conceiv- able method, Mr. Gilruth failed to demonstrate to his own satisfaction any organism that might be looked upon as the cause of this peculiar condition. The caseous foci, where sections were stained with carbol- fuchsin and decolourised with picric acid, showed a few small points which retained the red stain, but it was doubtful whether these were even parasitic in nature. In the photograph of the lung the intensity of the periarteritis and peribronchitis will be observed, as also the sharp line of demarcation between the fairly healthy and diseased tissue ; and in that of the stomach the spread of the round-cells between the altered gastric glands, with the dense fibrous tissue underneath, will be noted with interest. Mr. J. A. Gilruth's case, Veterinarian, 1900, p. 298. Digitized by Microsoft® PART IV. EXPERIMENTAL AND COMPARATIVE PATHOLOGY. I._A CONTRIBUTION TO THE STUDY OF AVIAN TUBERCULOSIS. (In collaboration ■uiiih MM. Gilbert and Roger, Fello-ws of the Paris Faculty of Medicine, Doctors of Medicine.) I.— HISTORICAL. Numerous memoirs published during the last thirty years have shown that tuberculosis is common in birds. Leisering, Larcher, Paulicki, Ziirn, and certain others have published very interesting cases, but it may fairly be asked whether all were cases of true tuberculosis due to the microbe which Koch discovered in man. This doubt, how- ever, seems to have been removed since Koch, Ribbert, Babes, Cornil, and Megnin found in tuberculous material obtained from fowls a bacillus showing the same staining properties as that found in mammals. MM. Nocard and Roux cultivated this bacillus, and their cultures, submitted to many observers, served for a large number of experi- ments. The identity of the two forms of tuberculosis was freely admitted, — indeed, could scarcely be doubted when innumerable experiments showed that the rabbit could be inoculated with avian tuberculosis, and when several observations appeared to establish the transmissibility of human tuberculosis to birds. In 1873 Bollinger reported that eight pigeons had been contami- nated by eating the expectorations of phthisical patients ; in 1885 he also pubhshed several similar cases. Koch, Nocard, Mollereau, Chelchowsky, de Lemalleree, Durieux, and Cagny all published obser- vations, or experiments, which seemed to place the conveyance of Digitized by Microsoft® AVIAN TUBERCULOSIS. — HISTORICAL. 523 human tuberculosis to fowls beyond question. Nevertheless some contradictory facts arose from time to time. It was recalled that Villemin had not been able to transmit tuberculosis to a cock and a wood-pigeon ; M. H. Martin always failed in attempting to inoculate fowls by intra-peritoneal injection with tuberculous material derived directly from man, or with material which had been passed through the guinea-pig. But the idea of the unicity of avian and human tuberculosis had already struck deep, and M. Martin carefully guarded against the conclusion that fowls are proof against human tuber- culosis ; he only thought his failures due to his having made intra- peritoneal inoculations, or having introduced too small a number of bacilli. Rebutting facts soon began to accumulate. MM. Straus and Wurtz fed six hens and a cock for six to twelve months with phthisical sputum. The animals resisted, and post-mortem examination showed their organs to be perfectly healthy. Riffi and Gotti also declared that the tuberculosis of mammals did not affect the Gallinacese. Rivolta laid stress on the considerable differences between avian and human tuberculosis ; he found that tuberculous products from the fowl did not produce general infection in the guinea-pig, the lesions being confined to an abscess at the point of inoculation. The same results occurred in the rabbit, though in this animal a few tubercles developed in the lungs. The study of tuberculosis in the Gallinaceas was again taken up by Maffucci. This author recognised that avian virus was transmissible to fowls ; that in the rabbit it behaved as Rivolta had stated ; and that in the guinea-pig its action varied according to the point of injection. The animal usually resisted inoculation into the subcutaneous con- nective tissue though it showed a local lesion ; in other cases it died at the end of some months in an extremely emaciated condition, and on post-mortem examination the liver and spleen were found atrophied ; no tubercles were seen, and microscopical examination and cultures revealed no bacilli. After intra-peritoneal inoculation the animals died within a period varying between fourteen days and three months ; if development had been rapid the organs were infiltrated with embrj'onic cells and filled with bacilli ; in more prolonged cases atrophy of the liver and spleen were alone found. Inoculation into the lung pro- duced interstitial inflammation; the bacilh remained localised, and did not invade abdominal viscera ; after intra-venous inoculation guinea- pigs died in fifteen, twenty, or twenty-five days, and on microscopic examination the liver appeared infiltrated with embryonic cells con- taining numerous bacilli. Finally Maffucci showed that mammalian Digitized by Microsoft® 524 CLINICAL VETERINARY MEDICINE AND SURGERY. tuberculosis cannot be transmitted to the Gallinaceae : twenty fowls inoculated under the skin, in the stomach, lung, peritoneum, and veins all resisted. The interesting researches of Rivolta and Maifucci therefore again rendered it doubtful whether tuberculosis is identical m various species of animals. This doubt was shared by Koch, who announced at the Berlin Congress that he had resumed the study of the question, and that in his view the tuberculosis of birds was not in all respects similar to that of mammals. At this time we published a preliminary note on the same subject. Relying on a considerable number of experiments we showed that avian tuberculosis can be transmitted to the Galli- naceae ; that in the rabbit, intra-peritoneal inoculation with avian material produces generalised miliary tuberculosis ; whilst in the guinea-pig it usually produces either no lesion whatever, or only a few little visceral tubercles. In some cases, however, avian, like human tuberculosis, is capable of producing visceral granulations in the guinea-pig. Nevertheless, speaking generally, the avian virus behaves differently in the rabbit and guinea-pig. The latter animal, though very sensitive to mammalian tuberculosis, appears very resistent to the tuberculosis of Gallinaceae. In spite of the differences which we observed between the two viruses we at that time avoided coming to any fixed conclusion as to their nature. Regarding the importance of these differential characters, we said : "The bacilli of human and avian tuberculosis are regarded as two distinct species, or two varieties of one species. At present it is very difficult to settle the question ; study of other microbes has shown that their form, development in various culture media, and powers of resistance and virulence are by no means fixed quantities, and vary under different circumstances. This question may possibly be cleared up when we know how the bacillus of human tuberculosis behaves when inoculated into birds." We therefore undertook researches in this direction, and were led to regard the two bacilli as representing two varieties of one species. During this time M. Nocard had resumed his previous experi- ments. He again attempted to transmit mammalian tuberculosis to the Gallinacese. This time his results were negative, and he concluded that in his first experiments he must accidentally have utilised a number of fowls which had previously suffered from avian tuberculosis. Finally MM. Straus and Gamaleia, in an important memoir, demon- strated in striking fashion the differences between the viruses of the two tuberculoses. Among the new facts contributed by these savants Digitized by Microsoft® AVIAN TUBERCULOSIS. — ^ETIOLOGY. 525 is one of considerable importance, namely, that the dog reacts in an entirely different way to the two viruses. It readily contracts human, but resists avian tuberculosis. The authors were thus led to conclude that the two bacilli are entirely different, and represent two distinct species. On our side we continued the comparative study of the tubercu- losis of birds and mammals. Our research, though prosecuted for the past two years, is far from ended, but we have noted certain facts deserving of publication. On the basis of our own researches, and of others of earlier and later dates, we shall endeavour to set forth the history of avian tuberculosis. II.— ETIOLOGY. Tuberculosis affects the fowl as well as man with remarkable frequency. Of 600 fowls examined after death by Ztirn, 62 were affected ^\■ith tuberculosis. If this result truly reflects the facts tuber- culosis would account for more than 10 per cent, of the mortality in these birds. Pheasants, guinea-fowls, turkeys, peacocks, and pigeons are also, though less frequently, victims of tuberculosis. In order to discover the means by which the disease is introduced into aviaries and poultry farms, we undertook several inquiries and addressed a list of questions to nineteen owners or breeders who had sent us tuberculous birds. Some gave no reply; others useless information. We were only able to collect eight almost complete records of tuberculosis among fowls. In three of these epizootics tuberculosis had clearly been introduced by newly purchased birds. The first outbreak attacked poultry with- out affecting pigeons ; the second was confined to pheasants ; the third to pheasants and poultry without affecting the peacocks. In the five other epizootics the origin of the disease remained obscure. In three, fowls alone were affected; in one, fowls and turkeys ; in the last, pheasants. Of the three epizooties in which fowls were affected one occurred in a new fowl run, which had only been inhabited for eight months ; another in a fowl run occupied for two years ; the last in a run where no new birds had been introduced during the previous five years. The epizootics which attacked pheasants had not been preceded by any importation of birds for a very long series of years. In one of these cases we were able to discover that the person who looked after the fowls coughed and expectorated a greal deal, but examination of his sputum failed to reveal the presence of tubercle Digitized by Microsoft® 526 CLINICAL VETERINARY MEDICINE AND SURGERY. bacilli, and we had every reason to believe that he was affected with chronic bronchitis. In another we learned that at the time of the outbreak the fowls were under the charge of a young woman who after showing cough and expectoration for more than a year, had become thin and was regarded as suffering from tuberculosis. In only one of the attacks were we justified in supposing that the birds had been inoculated by the sputum of a phthisical patient, as in the cases related by Bollinger, Nocard, Mollereau, Chelchowski, de Lemalleree, Durieux, and Cagny. In no case were we led to suspect the ingestion of milk, or meat, from tuberculous animals, as in MM. Guerrin and Baivy's cases. When tuberculosis is imported by new birds, these die first, and the disease afterwards attacks others. The mischief is rarely con- fined to a few, or to one fowl, as, however, happened in one of our cases ; usually it extends successively to a large number ; sometimes it continues for years (four years in one of our cases), and ends by completely clearing the run. The owners of these badly infected fowl runs not infrequently sell the surviving birds, which being thus distributed among healthy subjects communicate the disease to them. The contaminated fowl runs are afterwards cleansed, disinfected, and restocked, but even when they have remained empty for several months the new birds, though at first healthy, soon become ill and die of tuberculosis. Observation of these epizootics leaves no room for questioning the contagious character of tuberculosis in fowls. Contagion occurs through the medium of the intestinal dejections, which in some cases contain very large numbers of bacilli. Being ingested with the food the bacilli pass through the intestine and gain the peritoneum, liver, spleen, and in rare cases other organs. In about half the cases the passage of bacilli through the intestinal wall leaves no trace. Under such circumstances the intestinal contents are probably free of bacilli, and the birds are incapable of transmitting tuberculosis. But in other instances inoculation is marked by the intestine itself becoming tuberculous and ulcerated. The dejections are then rich in bacilli, the distribution of which over the ground explains the propagation of disease. III.— SYMPTOMS AND PATHOLOGICAL ANATOMY. Sympionis. — The signs indicative of tuberculosis in fowls are, during life, usually very vague. The birds become progressively thinner, and Digitized by Microsoft® AVIAN TUBERCULOSIS. — ETIOLOGY. 527 the amount of wasting may be estimated by palpation of the thorax over the breast-bone ; the pectoral muscles fall away and the bone projects prominently. At the same time other phenomena peculiar to wasting may be noted : the comb loses its red colour, and the mucous membranes become pale. The birds die in this condition ; towards the end paralytic symptoms have several times been observed. Under these conditions diagnosis is difficult, but tuberculosis may be suspected because it is the most frequent cause of wasting. Under certain cicumstances, however, the observer may feel more certain of the nature of the disease, viz. when external manifestations occur, such as specific changes in the mucous membranes of the head, in the subcutaneous connective tissue, and in the bones or joints ; in the latter case considerable swellings may occur, especially over the articulations of the wings and feet. Pathological Anatomy. — On post-mortem examination the intestine is found affected in about half the number of cases. The peritoneum is sometimes, and the spleen and liver are almost constantly, the seat of new growths. Tuberculosis of the liver is indicated by the existence on its surface and within its substance of tubercles varying in size between that of fine dust and of a hazel-nut, but usually of about a pea. The super- ficial nodules adhere to Glisson's capsule, beneath which they some- times form slight projections. Whether superficial or deep-seated they are whitish in colour when small, and greyish or yellow when of larger size. Their shape is spherical, conical, or irregular ; and they may be simple or confluent. They increase both the size and weight of the liver in proportion to their extent and number, which latter is usually considerable. The hepatic tissue between the tuberculous nodules is not always unaffected ; on the post-mortem examination of two fowls affected with " spontaneous " * tuberculosis we found in the right hepatic lobe large hjemorrhagic infiltrations; in one the blood had traversed Glisson's capsule and passed into the peritoneal cavity. In two pheasants affected with " spontaneous " tuberculosis, and in four fowls which had been inoculated with avian tuberculosis, we found fibrinous ascites ; in three cases this condition existed independently of any change in the peritoneum, and appeared therefore to have resulted from the hepatic lesions. On the other hand, six cases showed peritoneal tuberculosis without ascites. After the liver the spleen is the organ most frequently invaded. * By the term " spontaneous" tuberculosis is here meant tuberculosis not produced by experimental inoculation.— Jno. A. W. D. Digitized by Microsoft® 528 CLINICAL VETERINARY MEDICINE AND SURGERY. Sometimes its parenchyma is filled with small granulations ; sometimes it contains large tuberculous areas. In all our observations of "spontaneous " tuberculosis the kidneys and lungs remained unaffected. In about half the cases the intestinal mucous membrane showed either small tubercles, or ulcerations of greater or less depth. The latter lesions, which indicate the point of entry of infection, also serve to propagate the disease ; examination of the intestinal contents several times resulted in the discovery of bacilli. We should also mention the occurrence of tuberculous lesions in Fig. 76. — Tuberculosis of the liver (fowl). the subcutaneous connective tissue, in bones, articulations, and peri- articular tissues, a condition which, according to Friedberger and Frohner, is fairly frequent. We saw a remarkable case of tuberculous arthritis of the femoro-tibial articulation. The lesion occurred in a fowl dead of spontaneous tuberculosis, and was extremely rich in bacilli. Tuberculosis of the pheasant and of the fowl are practically indis- tinguishable to the naked eye, but on applying iodine solution the tubercles in the pheasant assume the mahogany coloration charac- teristic of amyloid degeneration. Histology. — Histologically the lesions in the fowl and in the phea- sant vary to a marked extent. This was shown by microscopic exa- Digitized by Microsoft® AVIAN TUBERCULOSIS. — SYMPTOMS AND PATHOLOGICAL ANATOMV. 529 minations carried out principally on the liver, an organ which readily lends itself to a study of this character. In the pheasant the smallest tubercles are formed by a central mass of epithelioid cells surrounded by round cells. In the largest tubercles the centre displays a cavity containing epithelioid cells, either crowded together in large numbers, or few and separate. This cavity, being more or less rounded and usually sharply delimited by a layer of dense connective tissue, might be mistaken for a vessel unless care were taken to examine a series of preparations. It is surrounded by layers of epithelioid cells. The latter are separated from one another by connective tissue attached to that surrounding the central cavity. Finally, the periphery of the tubercles is often surrounded by a layer of round cells. The largest tubercles show two well-defined zones, a central and a peripheral. The internal is chiefly formed by a compact or vacuo- lated connective tissue, the cells of which, however, display no nuclei capable of being stained. Here, again, we find the pseudo-vascular cavity, which only contains shapeless cellular debris and granulations. '' The peripheral zone is composed of masses of epithelioid cells separated by connective tissue, and is surrounded by round cells. Such is the structure of the simple tubercles. At many points these approach, touch, or become mutually fused together, so much so that in the internal zone of the largest tubercles, for example, one generally finds several cavities resembling blood-vessels. The epithelioid cells which enter into the formation of the tubercles are generally provided with a single nucleus ; a certain number, how- ever, possess several, and some, of enormous size and principally situated in the centre of the tubercles, are half surrounded, or even completely surrounded, by nuclei, forming true giant-cells. The connective tissue of the tubercles is coloured brownish red by a watery solution of iodine, and rose-red by methyl violet, thus resem- bling amyloid material. The bacilH in the tubercles stain readily by Ehrlich's or Herman's methods. They are either isolated, or, as has been well figured by MM. Cornil and Megnin, collected in more or less rounded clumps, surrounded by epithelioid cells. Though numerous in the epithelioid "nests," of which the smallest tubercles consist, they are even more common in tubercles of medium size, particularly in their pseudo- vascular spaces, where they often form compact masses. They par- tially or entirely disappear in the internal zone of the largest tubercles. The hepatic tissue between the tubercles shows no alteration, and L L Digitized by Microsoft® 530 CLINICAL VETERINARY MEDICINE AND SURGERY in particular presents neither fatty nor amyloid degeneration, nodular hepatitis, nor cirrhosis. The preceding histological details would appear to suggest that in the pheasant the development and subsequent course of hepatic tuber- culosis is somewhat as follows. A colony of tuberculous bacilli first becomes arrested at some point in the liver, where the bacilli multiply and cause a local reaction, indicated by the production of a nest of epithelioid cells. Around this nest round cells group themselves, and a limiting connective-tissue membrane forms, which on section re- sembles the wall of a blood-vessel. This barrier is insufficient to prevent the spread of the tuberculous process. The bacilli pass it, extend beyond, multiply, and cause the development of fresh nests of epithelioid cells, which become surrounded by fresh fibrous limiting membranes. The bacilli thus gradually progress, exciting an epi- thelioid reaction and further formation of fibrous tissue, which, as we have seen, undergoes amyloid degeneration. When the tubercles attain a certain size the connective tissue in the central parts becomes thickened, the epithelioid cells undergo degeneration, and the bacilli cease to stain, but their periphery presents an active zone extremely rich in bacilli and epithelioid cells, the further growth of which only ceases with the death of the animal. In the fowl the smallest tubercles are formed of a mass of epi- thelioid cells, surrounded by others of a spherical and fusiform outline. The larger show a central necrotic, hyaline portion coloured brown by picro-carmine. Around this hyaline centre is arranged a border of epi- thelioid cells, usually of considerable size, and always containing a large number of nuclei, which stain vividly with carmine. These cells are generally elongated, and more or less cylindrical in shape, and are arranged perpendicularly to the hyaline zone ; they contain nuclei principally collected at that extremity of the cell farthest from the hyaline zone. It might thus seem at first sight as though the hyaline mass were contained within a bile-duct, in the same way that a super- ficial examination might suggest the existence of vascular cavities at the centre of the tubercles in the pheasant. Outside the border formed around the hyaline zone by the above-mentioned epithelioid cells are masses of ordinary epithelioid cells. The extreme periphery of the tubercle is indicated by round and fusiform cells. Certain tubercles of similar size to the preceding are simply formed by masses of epithelioid cells, without the hyaline zone and border of epithelioid cells which distinguish the former. In other tubercles, on the contrary, the central epithelioid mass shows a hyaline zone and a Digitized by Microsoft® AVIAN TUBERCULOSIS. SYMPTOMS AND PATHOLOGICAL ANATOMY. 531 border of epithelioid cells, distinguished from the others by their direction, form, large size, number, and by the position and staining of their nuclei. In some of these tubercles the hyaline zones tend to become, or do in reality become, fused. The largest tubercles, composed of large numbers of epithelioid masses, display a faint indication of a connective-tissue capsule. The hyaline degeneration is then extensive, and replaces the epithelioid cells. Certain of these tubercles resemble old syphilitic gummata, and appear simply formed of an encapsuled hyaline mass. In tuberculosis of the fowl the bacilli stain readily by Ehrlich's method. They are contained in very large numbers in the epithelioid cells, and though usually isolated are sometimes collected in clumps, as in tuberculosis of the pheasant. They are also found in the smallest tubercles formed of a simple mass of epithelioid cells. In the larger tubercles they are more numerous, particularly in the vitreous zone, where they appear of great size and with a tendency to branch : the epithelioid border of the hyaline zone, on the contrary, contains ex- tremely few ; under any circumstances it contains much fewer than the epithelioid masses towards the periphery of these tubercles. The first stage in the tuberculous process in the liver of the fowl, as in that of the pheasant, is therefore marked by the development, in consequence of microbic irritation, of an epithelioid mass, which is surrounded by spherical and fusiform cells. Around this primary mass of epithelioid cells others successively form. The centre of the primary clump of cells undergoes hyaline degeneration, as does that of the later formations ; necrobiosis tends to replace the tuberculous neoplasis, whilst a fibrous barrier develops around the periphery of the tubercle. The tubercle may thus cease to grow, and become com- pletely transformed into an encysted hyaline mass. But this is excep- tional ; whilst the older portions of the tubercles undergo degeneration bacilli escape through the imperfect fibrous barrier which surrounds them and spread into healthy tissue, in which they produce a crop of fresh tubercles. To sum up, although the initial stages of tubercle formation in the liver of the fowl and of the pheasant are identical, later development is marked by notable differences. In the pheasant the tubercle bacillus causes development of epi- thelioid cells ; these soon undergo molecular degeneration and are succeeded by formation of abundant connective tissue, which surrounds pseudo-vascular cavities and undergoes amyloid degeneration. In the fowl the epithelioid cells undergo hyaline necrobiosis, which, Digitized by Microsoft® 532 CLINICAL VETERINARY MEDICINE AND SURGERY. though at first limited to the centre of the tubercle, and producing the appearance of a clear centre surrounded by special epithelioid cells, afterwards extends to the whole of the new growth and tends to en- cystment. The histological appearances of tuberculosis of the liver in the fowl and in the pheasant so greatly differ that at first sight the micro- organisms producing the lesions might be regarded as of different species. This interpretation, however, would be erroneous. We have inoculated from the pheasant to the fowl, and in the liver of the latter have found histological lesions identical with those of spontaneous fowl tuberculosis. Although the production of tubercles, both in the fowl and in the pheasant, is due to the same bacillus, the development of these growths is none the less affected by peculiarities of the host. It is the story once more of the grain and the soil. Not only do the hepatic tubercles in the fowl and pheasant differ from hepatic tubercles in mammals, but they vary to a marked extent between themselves, although developed in such nearly related species. We cannot lay too much stress on this fact, which throws so prominently into relief the pathological peculiari- ties of animals, and which shows how dangerous it is to indulge in general conclusions drawn from experiments on a single species. IV.— EXPERIMENTAL STUDY. Only one method existed of determining the nature of avian tuberculosis, viz. the experimental. Only after having shown how the virus of avian tuberculosis behaves in mammals, and how that of mammals behaves in birds, could we even attack the continually recur- ring problem of the unicity of tuberculosis in various species of animals. We ma}' therefore divide this chapter into two parts, and we shall commence by giving the particulars of experiments made with avian tuberculosis. Part I. — Inoculation Experiments with Tuberculosis of the Gallinacece. To study the effects of the avian virus we directly inoculated from lesions developed in the Gallinaceas and utilised in our experiments a considerable number of birds drawn from different localities, a fact which may be regarded as giving a certain general character to our results, and also explaining some apparently contradictory results which we have observed. We obtained our virulent material from eleven subjects — eight fowls, t\^'0 pheasants, and one guinea-fowl — sent us by different owners and breeders. In all these animals post-mortem examination showed Digitized by Microsoft® AVIAN TUBERCULOSIS. — SYMPTOMS AND PATHOLOGICAL ANATOMY. 533 the existence of tuberculous lesions, and bacteriological examination revealed the presence of the characteristic bacilli. For our inoculations we utilised growths from the liver. Fragments of the viscus were crushed in sterilised water, and the emulsion thus obtained was in- jected into a certain number of animals. Unless otherwise indicated, all inoculations will be understood to have been made into the peri- toneal cavity. Inoculation of Fowls. — That the Gallinacese may be inoculated with avian tuberculosis has been placed beyond doubt by the study of epizo- otics in fowl runs, and by a certain number of experimental researches. We did not therefore undertake numerous experiments on this point. Six fowls were inoculated with spontaneous avian tuberculosis. Two received the virus in the axillary vein ; they fell away in condition, and died at the end of thirty-nine and fifty-three days respectively. The liver and spleen were crammed with tubercles ; in one abundant fibrin- ous ascites and peritoneal granulations were discovered. The four others were inoculated in the abdominal cavity ; they died at the end of from forty-one to ninety-three days. Post-mortem examination revealed the presence of numerous granulations in the liver, spleen, and on the peritoneum ; in two cases the abdominal cavity contained a rather abundant fibrinous liquid. In all these animals histological examina- tion of the liver showed the presence of bacilli and of lesions similar to those found in cases of spontaneous* tuberculosis. On another occasion we attempted to transmit in series these tuberculous products ; the result was negative : the second fowl, killed at the end of 165 days, showed no lesion. This result should, how- ever, be regarded as absolutely accidental, and was probably due to a pecuHar resistance on the part of the animal inoculated. The history of other infectious diseases reveals analogous occurrences. In another case we performed series of inoculations, and were able to transmit tuberculosis in succession to four fowls. Inoculation of Rabbits. — Numerous experiments carried out in France with avian cultures showed that the rabbit is very sensitive to this form of tuberculosis. Intra-peritoneal inoculation produces visceral granu- lations, and intra-venous inoculation has the same effect, provided too large a quantity of virus be not injected, otherwise the animal dies with lesions of the Yersin type. The results of avian inoculation in the rabbit being already fairly well known, we only made a few experiments. Five rabbits were inocu- * As already mentioned, by spontaneous tuberculosis is here meant disease not produced by experimental inoculation.— Jno. A. W. D. Digitized by Microsoft® 534 CLINICAL VETERINARY MEDICINE AND SURGERY. lated in the abdominal cavity v^^ith a few drops of an emulsion prepared from the liver of tuberculous fowls : three of them died between sixty- nine and eighty-seven days after inoculation ; another was killed at the end of io8 days. In these four 3.mma.ls post-mortem examination showed generalised tuberculosis ; the peritoneum, and especially the epiploon, were dotted over with little tuberculous granulations ; the liver and spleen were crammed with them ; the lungs and kidneys, however, con- tained a smaller number. Several times we microscopically examined the invaded organs, which we found contained large numbers of bacilli ; the structure of the tubercles showed nothing special. We must now mention an experiment in which the development of avian tuberculosis showed peculiar features. On the i6th June, i8go, two rabbits were inoculated from the liver of a fowl. One died in sixty-nine days from generalised tuberculosis. The other remained in good health until the 3rd January, i8gi, at which time swelling of the right hock was noted ; some days later the radio-carpal joint of the same side was in turn attacked. On palpation numbers of fungous growths could be detected developed around the joints first invaded ; these soon projected beneath the skin ; at the antero-external part of the carpal region they perforated the skin, and appeared externally as reddish, soft granulations. In order to make certain as to the nature of the articular lesions, we had, before the external appearance of the granulations, punctured the parts aseptically with a Pravaz's syringe, and thus obtained a few drops of liquid con- taining the characteristic bacilli. In spite of the existence of these fungating growths the animal's general health remained excellent, and its condition even improved. On the 5th January the subject weighed 5 lbs. g^- oz. At that time we subcutaneously injected "25 c.c. (that is at the rate of o'l c.c. per kilo, of body-weight) of tuberculin. We had previously satisfied our- selves that a similar or even larger dose produced no disturbance in a normal rabbit. The injection was made at 11 a.m., and the animal seemed to experience no effect throughout the day. At 7 a.m. next morning, however, it was dead. On post-mortem examination the lungs were found engorged with blood ; they contained a few disseminated tuberculous granules. The liver was congested, and contained five or six tubercles; two were also found in the spleen, which was of very large size. The kidneys were enormous and violet in colour : they only contained two or three little granules. Examination of the affected joints showed that the fun- gating growths had invaded the synovial membranes and periarticular tissues. Digitized by Microsoft® AVIAN TUBERCULOSIS. — EXPERIMENTAL STUDY. 535 This case, which we reported to the Societ6 de Biologic, appeared to us interesting for several reasons. It furnished a new example of varying resistance in two animals of the same species inoculated in the same way. It furnished a good type of experimental tuberculous joint- disease. Finally, it showed that animals affected with avian tuberculosis reacted to tuberculin like animals affected with human tuberculosis ; in both cases large doses of tuberculin produce death with intense con- gestive symptoms precisely similar to those just described. To sum up, avian tubercular material, when inoculated into the peri- toneum of the rabbit, generally produces tuberculous granulations ; in most cases all the viscera are affected, and death occurs on an average at the end of eighty days. In some cases, however, the animals remain to all appearance in good health, and when killed astonish the experi- menter by displaying generalised tuberculosis. It will be seen how greatly our results differ from those of Rivolta and Maffucci. These two Italian investigators regard avian tuberculosis as scarcely pathogenic for the rabbit, and as only producing a few very discrete pulmonary granulations. From our experiments it will be seen that the virus, when introduced into the peritoneum, produces general- ised tuberculosis, and, in fact, acts on the rabbit as does mammalian tuberculosis. Inoculation of Guinea-pigs. — The experiments of Rivolta and Maffucci have shown, as we said, the great difficulty of transmitting avian tuber- culosis to guinea-pigs. MM. Cornil and Megnin, who inoculated two guinea-pigs, failed to discover any visceral changes when the animals were killed two months later ; the subjects only showed an abscess containing bacilli in the abdominal wall. They thought that generalisa- tion would have occurred had they waited longer before terminating the experiment. MM. Straus and Gamaleia, after intra-peritoneally inoculating guinea-pigs with avian tuberculosis, found that death occurred in two to four weeks. On post-mortem examination no lesion was found, or the spleen simply appeared rather large and red ; in whatever way the material was introduced, tubercles failed to develop. These observers several times detected bacilli in the viscera, but the organisms had never produced any formation of nodules. Our experiments extended to twenty-four guinea-pigs, which were intra-peritoneally injected with emulsions prepared with material from the livers of tuberculous birds. In several cases we simultaneously injected a few drops under the skin. Digitized by Microsoft® 536 CLINICAL VETERINARY MEDICINE AND SURGERY. In the latter cases the resuks were as follows : — At the point of inoculation a small caseous abscess containing numerous bacilli formed, but healed in a few weeks. Whether or not this local lesion developed, the lymphatic glands in the neighbourhood of the inoculated spot (in this case the inguinal glands) generally became enlarged ; instead of extending and becoming generalised, however, this glandular inflamma- tion, which was especially marked from the eighth to the ninth or twentieth day, retroceded, and ended by disappearing. Most frequently the animals remained in good health, and did not fall away in condition. They showed nothing indicating disease ; a local infection, characterised by the inoculation abscess and by inflammation of lymph-glands, cer- tainly occurred at the time, but these lesions were temporary, and rapidly disappeared. Of twenty-four guinea-pigs inoculated six died spontaneously, one rapidly in r6 days, as in Straus and Gamaleia's experiments ; the others lived for a period varying between 30 and 164 days. The post-mortem examination of these animals was negative, in the sense that examination of the viscera showed no lesion resembling tuber- culosis. We simply add that one guinea-pig showed at the point of inoculation in the peritoneum a small, entirely encysted caseous abscess. The other animals remained in perfect health, and were killed between the iiith and 248th day after inoculation; in nine the results were negative ; there was no appreciable lesion except in one guinea- pig, which showed a little encysted abscess in the peritoneum. In short, of the fifteen guinea-pigs inoculated with avian tuber- culosis which died spontaneously, or were killed, the organs remained absolutely unaffected ; no appreciable lesion was found except in two animals, each of which exhibited a caseous abscess similar to those already discovered by Cornil and Megnin. Six other guinea-pigs were killed like the preceding whilst still in very good bodily condition, but the autopsy showed the presence of tuberculous granulations. The number and the localisation of these, however, differed entirely from what has been noted after inoculation with human tuberculosis ; instead of becoming generalised the lesions were confined to one or two viscera, or to the peritoneum ; in one case the serous membrane was alone affected, five or six miliary granula- tions being found in the perihepatic portion. In addition, infection had extended to the liver and spleen, but careful examination was required to detect it. Each of these viscera contained three or four small granulations, so that the appearance of the organs was hardly modified. In particular the spleen showed none of the hypertrophy generally seen in experimental tuberculosis in rodents. Digitized by Microsoft® AVIAN TUBERCULOSIS. — EXPERIMENTAL STUDY. 537 In two cases the lesions were again very different from those usually observed ; the abdominal organs were normal, the lungs alone con- taining two or three pearly tubercles, the size of millet-seeds, projecting beneath the pleura. Microscopic examination of these lesions revealed bacilli remarkable for their size, which was somewhat greater than that of the human bacillus, and for their more granular appearance. The pulmonary new growths were formed of a mass of epithelioid cells ; giant-cells were absent, and the periphery of the lesions exhibited very few embryonic cells. The hepatic tubercles had a special appearance. In one case the granules were formed of a caseous centre surrounded by a fibrous zone ; in another, a tubercle had been entirely transformed into a fibrous mass ; this was unquestionably a tubercle in course of healing. Histological study, therefore, showed that the lesions produced in guinea-pigs by inoculation with avian tuberculosis tend to become localised and to heal. This tendency towards spontaneous recovery had already been suggested by the course taken by the local tubercle resulting from inoculation and by the glandular inflammation. To sum up, avian tuberculosis behaves quite differently in the rabbit and in the guinea-pig. This fact, which escaped Rivolta and Maffucci, and which we were the first to note, has been confirmed by the researches of different authors, and by the results of further experi- ments which we have carried out. Thus we are led to conclude that avian, unlike human tuberculosis, is more active in the rabbit than in the guinea-pig. In the latter animal it either causes no lesions, or gives rise to a caseous abscess, or finally produces a few rare visceral tubercles, which scarcely interfere with the animal's general health, and tend to undergo fibrous transformation, that is, to heal. But although the results just noted are generally constant, they are subject to certain exceptions. A guinea-pig which had been inoculated with a fragment of liver from a fowl, which again had been inoculated from the liver of a pheasant, died at the end of 103 days. At the autopsy it was found suffering from generalised miliary tuberculosis ; the peritoneum con- tained a certain quantity of serous liquid ; the liver, which weighed if ounces, and the spleen, which weighed 25 drachms, were crammed with tubercles; the lungs also showed granulations. The lesions were/ in fact, similar to those seen after inoculation with human tuber- culosis. From this guinea-pig a second was inoculated. The latter remained Digitized by Microsoft® 538 CLINICAL VETERINARY MEDICINE AND SURGERY. in perfect health ; when killed at the end of 141 days its condition appeared perfectly normal ; post-mortem examination revealed the existence of five or six scattered tubercles in the liver and lungs ; the spleen was healthy. The virus, instead of increasing in virulence, seemed therefore to have become attenuated by passage through two guinea-pigs. To continue the series we inoculated another guinea-pig and a rabbit from the liver of this animal. The guinea-pig died on the logth day, a dozen granulations being found in its liver. The rabbit remained in good health and was killed at the end of 139 days. The cadaver showed numerous granulations remarkable for their localisation ; instead of having invaded the liver and spleen they occupied the lungs, mediastinal lymphatic glands, and kidneys. To test the results of inoculation with this virus, which had behaved in such a peculiar manner, we utilised it to inject a guinea-pig and two fowls. The guinea-pig remained in apparently good health, but on killing it at the end of 169 days we were not a little surprised to find it suffering from generalised tuberculosis ; the lungs, peritoneum, spleen, and liver were filled with granulations ; the liver was the seat of very marked cirrhosis, which rendered its surface bosselated and deeply channelled. The fowls were killed at the end of 169 and 176 days respectively, but the autopsy revealed no appreciable lesion. Thus after passing three times through mammals the avian virus behaved very much like that of human tuberculosis ; it produced tubercle in the guinea-pig but failed to affect the fowl. It might, therefore, be suggested that in this second series accidental inoculation with mammalian tuberculosis had occurred, but such a supposition appears to us inadmissible. Along with the first guinea-pig, which showed generalised tuberculosis, a second had been inoculated ; the same syringe had been employed, and the two guinea-pigs had been placed in the same cage ; now one of these behaved as usual, the other died from generalised tuberculosis. Accidental contamination, moreover, seems to us less probable, as at this time the laboratory con- tained animals inoculated only with avian tuberculosis. The above experiments show that in some cases intra-peritoneal inoculation with avian tuberculosis may produce in the guinea-pig a generaUsed crop of tubercles ; such a result is somewhat rare, but is indisputable, and has, moreover, been confirmed by MM. Courmont and Dor, who have also obtained generalised tuberculosis by ino- culating with avian cultures. To enable the reader to more readily follow our experiments, we give the results below in tabular form. Digitized by Microsoft® AVIAN TUBERCULOSIS. — EXPERIMENTAL STUDY. 539 The tables describe the animals which provided the material for ex- periment ; those in which inoculations were practised, the after history, and the principal results of the autopsy. The asterisks indicate animals which were intra-venously injected. All others were inoculated intra-peritoneally. FOWL I. Tuberculosis of the liver and spleen. November yth, 1889. Fowl.* Died December 30th (53 days afterwards). Tuberculosis of the liver and spleen. I Guinea-pig. Killed June 8th (158 days afterwards). TiDO or three gramtlations in the ' I Fowl. Killed June 15th (165 days afterwards). No lesion. I Guinea-pig. Killed June 15th (165 days afterwards). No lesion. FOWL II. Tuberculosis of the intestine^ liver, and spleen. December 30th, 1889. I Rabbit. Died April 6th, 1890 (97 days afterwards). Generalised tiibercidosis of peritoneum, spleen, liver, kidneys, and lungs. I Rabbit. Killed June 15th (70 days afterwards). No lesion. Fowl. Died February loth, 1890 (41 days afterwards). Ascites, tuberculosis of the peritoneum, liver, and spleen. Guinea-pig. Died February 26th (16 days afterwards). No lesion. FOWL III. Tuberculosis of the liver and spleen. January 25th, 1890. I Guinea-pig. Killed June 15th (140 days afterwards). No lesion. FOWL IV. Tuberculosis of the intestine, liver, spleen, and peritoneum. March i8th, 1890. Rabbit. Died June 2nd (75 days afterwards). Generalised tuberculosis of peritoneum, me- senteric glands, liver, spleen, kidneys, and lungs. Guinea-pig. Killed August 3rd (138 days afterwards). Two or three granulations in the liver and spleen. Digitized by Microsoft® 540 CLINICAL VETERINARY MEDICINE AND SURGERY. FOWL V. Tuberculosis of the liver and spleen. April 17th, 1890. Rabbit. Killed August 3rd (108 days afterwards). Tubercles in the epiploori ; a few granules in the liver and spleen. I Guinea-pig. Killed March 20th, 189 1 (229 days afterwards). No lesion. FOWL VI. Tuberculosis of the liver and spleen. June i6th, 1890. I Guinea-pig. Guinea-pig. Rabbit. Rabbit. Killed October sth Died November 27th Died August 24th Died February 7th, (in days afterwards). (164 days afterwards). (69 days afterwards). 1 891 (236 days after- No lesion. No lesion. Generalised tubercu- wards). losis of peritoneum, White swellings ; some liver, spleen, kidneys, tvtbercles in the liver, ajid lungs. kidneys, and lungs. Rabbit, Guinea-pig. Died November 24th (93 days Died March 20th, 1891 (208 afterwards). days afterwards). Generalised tuberculosis of perito- No lesion, neum, liver, plexira, and lungs. FOWL VII. Tuberculosis of the intestine, peritoneum, liver, and spleen. July 6th, 1890. I I I Fowl. Fowl.* Guinea-pig. Died October yth (93 days Died August 24th (49 days Died November 29th (146 afterwards). afterwards). days afterwards). Tuberculosis of the liver, Ascites ; tuberculosis of the Abscess at the point of inocu- spleen, and peritoneum. liver and spleen. lation. I Fowl. Died November 20th (88 days afterwards). Titberculosis of the liver, spleen, peritojieum , and kidneys. I Fowl. Killed March 20th, 1891 (120 days afterwards). Discrete tubercles in the spleen and peritomeitm. 1 I Fowl. Guinea-pig. Died June 15th (87 days afterwards) Killed July 12th (114 days afterwards). Tuberculosis of the liver, spleen, peritoneum. No lesion, and lungs ; fibrinous ascites. FOWL VIII. TiLbercidosis of the intestine and liver. November 6th, 1890. I _ _ _ I I '^ I . Horse.* Guinea-pig. Guinea-pig. Killed January 7th, 1891 (62 Killed July 2nd, 1891 (248 Died December Sth (32 days days afterwards). days afterwards). afterwards). No lesion. Large hepatic abscess. No lesion. Digitized by Microsoft® AVIAN TUBERCULOSIS. — EXPERIMENTAL STUDY. 541 PHEASANT. Ascites ; tuberculosis of the intestine, liver, and spleen. Deceiriber 14th, 1889. I ^1 ' I Fowl. Fowl. Died January 25th, 1890 (42 days afterwards). Killed February 2nd, 1890 (50 days after- Ascites ; tuberculosis of the peritoneum, wards). liver, and spleen. Tuberculosis of the peritoneum and liver. I I ■*■ Guinea-pig. Guinea-pig, Guinea-pig. Killed June 8th (135 days Died May 9th (103 days Died March 4th (30 days afterwards). afterwards). afterwards). Abscess at point of inocida- Ascites ; generalised tuber- No lesion, tion. culosis (liver, spleen, lungs). I Guinea-pig. Killed September 8th. Five or six granulations in the liver and lungs. Guinea-pig. Rabbit. Died December 25th ([09 days afterwards). Killed January 24th, 1891 (139 days after- A few granulations in the liver. wards). Tuberculosis of the lungs, kidneys, and mesenteric glands. I Guinea-pig. Fowl. Fowl. Killed July 12th (169 days Killed July 12th (169 days Killed July 19th (176 days afterwards). afterwards). afterwards). Generalised tubemdosis (liver No lesion. No lesion. \cirrhotic'\, spleen, peritoneum, and lungs). PHEASANT. Ascites, tuberculosis of intestine, liver, and spleen. December 15th, 1889. 1 Guinea-pig. Killed June 8th, 1890 (165 days afterwards). A few pidvionary tubercles. GUINEA-FOWL. Tuberculosis of the liver and spleen. March 9th, 1890. I Guinea-pig. Guinea-pig. Killed July 20th (121 days afterwards). Killed July 20th (121 days after- A few granulations in the peritoneum, liver, wards). and spleen. Three or four granulations in the I epiploon. I i Guinea-pig. Guinea-pig. Killed February 15th, 1891 (210 days Died November 29th (i29days afterwards). afterwards). No lesion. No lesion. Digitized by Microsoft® 542 CLINICAL VETERINARY MEDICINE AND SURGERY Summary of Inoculation Experiments on the Guinea-pig. — In sum- marising the results obtained by inoculating guinea-pigs with avian tuberculosis the animals may conveniently be classified into four groups : — (i) Those in which the autopsy showed no appreciable lesion ; (2) those in which a caseous abscess was found at the point of inoculation ; (3) those which showed a few visceral tubercles; and (4) those in which the disease became generalised and revealed itself by an outbreak of tubercles sometimes as abundant as when human tuberculous material is used for inoculation. These different results are given in the table hereafter. In each group the animals have been divided into two categories — those which died spontaneously, and those which were killed. In each of these again we have noted how long the animal lived after inoculation. No Lesion. Loc.^L Abscess. Discrete Visceral Tubercu- losis. Generalised Tuberculosis. Animals vihich died. Days. 16 30 37 129 164 Animals killed. Days. Ill 114 140 165 208 210 229 248 Animals which died. Days. 146 Animals killed. Animals which died. Animals killed. Organs affected. Animals which died. Animals killed. Days. 135 Days. Days. 109 j — — 121 — 121 — 138 — 141 — j 158 - : 165 Liver. Peritoneum. Liver and spleen. Id. Liver and lungs. Lungs. Id. Days. 103 Days. 169 5 cases 8 cases I case I case I case 6 cases I case I case 13 case per c 5, or 54 ent. 2 cases or 8 per cent. 7 cases, or 29 per cent. 2 cases, or 8 per cent. Successive Inoculation with Avian and Human Tuberculosis. — We might add to the experiments already described many others consisting of inoculating guinea-pigs with cultures of avian tuberculosis. Certain animals resisted, a fact which enabled us to undertake the study of a fresh problem, viz. whether after such inoculation any modi- fication occurred in the animal's receptivity to human tuberculosis. On the 25th March, 1890, we injected a guinea-pig intra-peritone- ally with a certain quantity of avian culture. On the 19th October, Digitized by Microsoft® AVIAN TUBERCULOSIS. — EXPERIMENTAL STUDY. 543 that is to say, at the end of 200 days, this animal, which had continued in excellent health, was killed. On post-mortem examina- tion two encysted caseous abscesses were found in the epiploon ; one the size of a pea, the other of a small nut. The pus from these abscesses, which contained very large numbers of bacilli, was used for the intra-peritoneal injection of three guinea-pigs and a fowl. The latter remained in good health, and was destroyed on the 9th April, 1891, that is at the end of 172 days. At the site of each injection was a yellowish flattened mass, as large as an almond, formed of fibrous tissue, in the centre of which were seen round and fusiform cells and hyaline masses. Although we were unable to dis- cover bacilli on section, we regarded this growth as tuberculous, and similar in character to the rice-like grains of certain cysts. But even rejecting this interpretation, the fact none the less shows that during their six months' sojourn in the organism of a guinea-pig the bacilli had become incapable of producing an outbreak of tubercle in the fowl. "We cannot help comparing the above result with that obtained by passing the tuberculosis of the pheasant through three mammals. The reader will remember that in this case the virus was greatly modified, and that it became incapable of killing members of the Gallinaceae. Of the three guinea-pigs inoculated simultaneously with the fowl, two died rapidly in sixteen and twenty days, as sometimes occurs after inoculation with avian cultures. Autopsy only revealed a small local lesion at the point of injection. The third bird appeared in good health on the 12th March, i8gi, five months after inoculation ; some drops of an emulsion prepared with the liver of a guinea-pig, which had died from inoculated human tuberculosis, were then injected into the abdominal cavity. The animal died on the 3rd July, i8gi. At the autopsy caseous infiltration of both lungs was noted. The spleen, which measured three inches in length and one and a half inches in breadth, appeared red, and dotted over with white points ; the liver was large, and had a " nutmeg " appearance. Histological examina- tion showed extremely extensive tuberculous infiltration. Here, then, was a guinea-pig which had perfectly resisted inoculation with avian tuberculosis, but had in no sense become immune against human tuberculosis. It died as rapidly as the two control guinea-pigs inoculated simultaneously. With this we may compare another precisely similar experiment. On the 2ist January, 1891, we inoculated two guinea-pigs with a culture of avian tuberculosis ; they remained in good health. One was Digitized by Microsoft® 544 CLINICAL VETERINARY MEDICINE AND SURGERY. injected on the 12th March, the other on the 12th April, with human ^tuberculosis ; the first died on the 2nd July and the second on the 15th. In both we found generalised visceral tuberculosis precisely like that which follows inoculation with human tuberculosis. These experiments may be summed up as follows : — Six guinea-pigs received avian cultures ; two died rapidly, without showing visceral lesions on post-mortem examination ; four resisted, three of which were afterwards inoculated with human tuberculosis. The latter behaved as though previously healthy. Without wishing to draw a final con- clusion from these three experiments we think it allowable to conclude that previous inoculation with avian tuberculosis neither favours nor impedes the development of human tuberculosis. To summarise the facts established in this first portion of our research, we have only to reproduce in their entirety the propositions formulated at the end of our previous note on avian tuberculosis. Tuberculosis of Gallinaceae is transmissible to fowls. Intra-venous or intra-peritoneal inoculation is followed by the development of generalised and rapidly fatal tuberculosis. The rabbit readily contracts avian tuberculosis, at least when bacilli are introduced into the peritoneum ; death follows in two or three months from generalisation of the infection. The guinea-pig, though more sensitive to human tuberculosis than the rabbit, is much more resistant than it to avian tuberculosis. Inoculation rarely produces general infection. In almost all the cases (gi per cent.) either the animals show no lesion of tuberculosis (54 per cent.), or they show, at the point of inoculation, a caseous abscess which persists for a longer or shorter time (8 per cent.) ; or visceral infection occurs (29 per cent.), the tubercles remaining partial and discrete, and tending towards fibrous transformation and recovery. Part 2. — Inoculation of the Gallinacece with Mammalian Tuberculosis. Having shown the manner in which avian tuberculosis behaves when inoculated into animals, it now becomes necessary to approach the converse problem, and to discover if mammalian tuberculosis can be conveyed to birds. We ha^•e already remarked that authors who have studied this question are far from agreeing. Although Bollinger, Koch, and Nocard were able to transmit human tuberculosis to the Gallinaceae, the majority of pathologists have had negative results. Villemin, H. Martin, Straus and Wurtz, Rifii and Gotti, Rivolta, Maffucci, Digitized by Microsoft® AVIAN TUBERCULOSIS. — EXPERIMENTAL STUDY. 545 Straus and Gamaleia were unable to convey mammalian tuberculosis to fowls ; and M. Nocard had no greater success in a fresh series of experiments. We have further pursued the study of this question. We inoculated thirty-nine fowls and a pheasant with tuberculous material obtained from man and from various mammals. Inoculation with Human Tuberculosis. — In most of our experiments we employed pulmonary tuberculous material, choosing recent un- softened centres, so as to obtain a pure lesion and to avoid injecting mixtures of microbes. (i) In the first series of experiments we directly inoculated a guinea- pig and two fowls with human tuberculosis ; the guinea-pig died in twenty-eight days with classical generalised tuberculosis ; a fowl inoculated in the peritoneum was killed at the end of 211 days; its viscera appeared healthy, and inoculation of a fragment of its liver into a guinea-pig produced no appreciable disturbance. The results in the second fowl, which was intra-venously inoculated, were very different. This fowl was killed at the end of forty-two days, when it appeared in perfect health. We were, therefore, exceedingly surprised to find in its liver and spleen a considerable number of extremely minute granula- tions ; they consisted of greyish, semi-transparent tubercles, evidently of recent date. This discovery alone seemed to show that the tuber- culosis was not spontaneous in character ; if the changes had existed prior to our inoculation they would have presented an entirely different aspect. As we before showed, one often finds in such cases large yellowish masses, not a crowd of greyish granulations. But if any doubt remain, it should be dissipated by the results of inoculations made with the liver of this fowl. An emulsion of the liver was injected into the peritoneal cavities of a guinea-pig and a fowl ; the guinea-pig died in seventy-two days of generalised tuberculosis ; the fowl was killed at the end of 207 days, but its organs remained healthy. This experiment appeared to us absolutely conclusive. We were dealing with human tuberculosis, and the bacillus which had in the first fowl produced tuberculous granulations had preserved its specific properties : inoculated into a second fowl it failed to produce tubercles, which would certainly have developed had we been dealing with an accidental avian tuberculosis. This fact alone sufficiently demonstrates that the bacillus of human tuberculosis may sometimes produce visceral granulations in the fowl. As before, we summarise the results of the experiments in tabular form, so that the series of inoculations may more easily be followed. M M Digitized by Microsoft® 546 CLINICAL VETERINARY MEDICINE AND SURGERY. The asterisks indicate animals which were intra-venously injected; the others were inoculated intra-peritoneally. MAN. Piihnonary tuberculosis. August 24th, 1890. I Guinea-pig. Died September 21st (28 days afterwards). Ascites; tuberculosis of the peritoneuvi, liver ^ and spleen. Guinea-pig. Died December 16th (72 days afterwards). Geueralised tuberctdosis {peri- toneum, liver, spleen, and lungs). Fowl.* Killed October 5th (42 days afterwards). Very numerous and very small granulations in the liver and spleen. l_ I Fowl. Killed April 30th (207 days after- wards). No lesion. Fowl. Killed March 24th, 1S91 (211 days afterwards). No lesion. Guinea-pig. Killed July 12th (iio days afterwards). No lesion. (11) Most of the fowls were inoculated with human material, which, however, had been passed through the guinea-pig. Twenty-three fowls were used in these experiments : fifteen received the virus intra-venously; three intra-peritoneally; and five simul- FiG. 77. — Tuberculosis of the liver, produced by inoculation with human virus. taneously in the veins and in the peritoneum. None of these ani- mals died ; all were killed at the end of a period varying between ele\'en and 266 days. On post-mortem examination we only found tuberculous lesions in three fowls. These three belonged to the third series com- Digitized by Microsoft® AVIAN TUBERCULOSIS. — EXPERIMENTAL STUDY. S47 prising five animals which had been simultaneously inoculated in the veins and peritoneum with an emulsion of guinea-pig's liver. The first of these five fowls was killed at the end of eleven days ; its organs were unaffected. The second, killed at the end of twenty-four days, showed no visceral lesion, but the bacilli of human tuberculosis were still present in its liver, for inoculation of a guinea-pig with fragments of the organ produced typical tuberculosis. The third was killed on the thirty-fifth day ; it was rather thin : on post-mortem examination sero-fibrinous ascites was noticed ; the liver was slightly enlarged, and crammed with extremely small tuberculous granulations ; the spleen was also slightly enlarged, but contained no granulations. The fourth, killed on the thirty-eighth day, also showed numerous granulations in the liver and on the mesentery. The fifth was killed at the end of fifty-nine days ; in it the lesions were less marked ; somewhat numerous but small tubercles, practically similar to those seen in the fowl, directly inoculated with human tuberculosis, had developed in the liver. With tuberculous material from the fowl killed at the end of thirty- five days we inoculated another fowl, which remained in good health. It was killed at the end of eighty-six days ; we found ascites and small granulations in the liver and spleen. All these facts are given in the following tables : MAN. Pulmonary tubemdosis. August 24th, 1890. I Guinea-pig. Died September 2ist (28 days afterwards). Ascites ; tuberculosis of the periiojteum, liver, and spleen. I Guinea-pig. Killed October i8th (28 days after- wards). Tuberculosis of the peritoneum, li'ver, and spleen. J \' Fowl.* (Reinoculated March i8th.) Killed July I2th, 1891 (2'" Fowl. Killed March 20th, 1891 (180 days afterwards). No lesion. and 121 days afterwards). No lesion. Fowl. (Reinoculated March 13th.) Killed July 12th, 1891 (266 and 121 days after- wards). No lesion. I Guinea-pig. Killed November 2nd, 1890 (15 days afterwards). Tuberculosis of the peri- toneum, liver, and spleen. Guinea-pig. Died November 28th, 1890 (26 days). A few tubercles in the Fowl.* Killed January 24th, 1 89 1 (83 days). No lesion. I Fowl.* Killed July 12th (252 days). No lesion. Fowl. Killed July 12th (252 days). No lesion. Digitized by Microsoft® 548 CLINICAL VETERINARY MEDICINE AND SURGERY. GUINEA-PIG. Generalised tuberculosis. Killed March 13th, 1891. i I Guinea-pig. Killed May 6th (54 days). Generalised tuberculosis. Fowl." Killed March 24th (11 days). No lesion. I Fowl.* Killed April 6th (24 days). No lesion. Guinea-pig. Died May 25th (19 days). Generalised tuber- culosis. I Fowls. Guinea-pig. Killed July I2th (97 days). Tuberculosis of the liver ^ spleen^ culosis of the and lungs. liver and spleen. Fowl.* Killed April 17th (35 days). Ascites; granu- lations in the liver. I Killed July 12th (86 days). Ascites ; tuber- I Fowl.* Killed April 20th (38 days). Granulations on the perito- neum and in the liver. Fowl.* Killed May nth (59 days). Very small tu- bercles in the liver. I. Killed May 22nd (16 days). II. Killed May 30th (24 days). III. Killed June 7th (31 days). IV. Killed June 15th (39 days). V. Killed June 22nd (46 days). VI. Killed July ist (55 days). VII. Killed July 9th (63 days). VIII. Killed July 17th (71 days). IX. Killed July 19th (73 days). X. Killed July 26th (80 days). XI. Killed Sept. 14th (131 days). XII. _ _ _ No lesion. Of the first five fowls inoculated in this last series, three showed tuberculous lesions on post-mortem examination. When these results were laid before the Societe de Biologic various objections were made, the chief of which are as follows : — ( i) The best evidence of the immunity of fowls against human tuberculosis is to be found in the fact that none died spontaneously ; (2) we were wrong in not using cultures for our inoculations ; (3) we had mistaken for tuberculosis, nodular lesions produced by the injection of emulsified tuberculous material ; (4) we should have experimented on fowls already affected with avian tuber- culosis. To the first objection we reply, that if none of our fowls died spon- taneously it was for the simple and decisive reason that we killed them. To the second, that of the various methods of inoculation with human tuberculosis (direct inoculation, or inoculation with cultures prepared in living animals, or on inert media), we consider that none is superior to the others unless it give better results. To the third, that histological and bacteriological examination clearly proved the tuberculous nature of the lesions noted. Finally, in order to refute the last objection, we shall not shelter ourselves behind the assurance of the person who furnished us with the Digitized by Microsoft® AVIAN TUBERCULOSIS. — EXPERIMENTAL STUDY. 549 animals, that tuberculosis had never occurred in his fowl run, and that during the previous four years no contagious disease had occurred there ; but draw attention to the fact that two fowls killed respec- tively eleven and twenty-four days after inoculation were free of any visible tubercle, whilst the last three fowls, killed thirty-iive, thirty- eight, and fifty-nine days after inoculation, had become tuberculous. In these three fowls the tubercles were small, greyish, and trans- parent, unquestionably recent. On histological examination they were seen to be composed of simple epithelioid nests without trace of degeneration. Our sections showed in an absolutely unanswerable way that the granulations of the fowl inoculated with human tubercu- losis, and killed on the 35th day, were less advanced in their develop- ment than those of the fowl inoculated with avian tuberculosis, which died on the thirty-ninth day. We are, therefore, convinced that the tuberculosis was the result of inoculation. But the fact which seems to us most important is, that human tuberculosis could be transmitted from one fowl to another ; the lesions were well marked, notwithstanding which this animal, like the preced- ing, seemed little affected by the presence of these visceral granula- tions ; it had not lost flesh in the least, and we were exceedinglj' surprised at the result of the post-mortem. Thus, in the same way that avian tuberculosis may, in mammals, produce growths of minute tubercles without interfering with general health, and without causing emaciation, human tuberculosis may in the fowl produce specific lesions, which are very well tolerated. (hi) We have to record a third series of experiments, in which we utilised the caseous magma from a case of tuberculosis of the testicle. It seemed interesting to utilise this local lesion, for a virus attenuated for man might very well be more active for the fowl. With the material from this tuberculous testicle we inoculated four fowls, one pheasant, and two guinea-pigs. The guinea-pigs died from visceral tuberculosis, in fifty-four and fifty-six days respectively. The birds all resisted, and when killed, after an interval varying between 62 and 248 days, their viscera showed no appreciable changes. These results are indicated in the following table. It will be seen that we inoculated a guinea-pig with the liver of a fowl killed at the end of seventy-two days. The result was negative. The bacilli had therefore been destroyed, or changed by their sojourn of two and a half months in the body of the fowl. Digitized by Microsoft® 55° CLINICAL VETERINARY MEDICINE AND SURGERY. MAN. Tuberculosis of the testicle. November 13th, 1890. I Guinea-pig. Died January 6th, 1891 (54 days). Tuberculosis of '^ the spleen. Guinea-pig. Died January Sth (56 days). Tuberculosis of the spleen and liver. Fowl.* Killed Jan- uary 24th (72 days). No lesion. Fowl.* Died April loth (149 days). No lesion. I Fowl. Killed Jan- uary 24th (72 days). No lesion. Fowl. Killed July 19th (248 days). No lesion. Pheasant. Killed January 1 6th (62 days). No lesion. Guinea-pig. Killed July 12th (169 days). No lesion. Summarising the facts noted after inoculating members of the GalHnaceas with human tuberculosis, the results are as follows : Thirty-two fowls were inoculated with tuberculous material derived directly from man, or having passed through other animals ; on post- mortem examination five showed visceral granulations ; in all inocula- tions tuberculosis had been produced, i. e. tuberculosis resulting from human, and not from avian bacilli. Even though objection might be made regarding the second series of experiments, no doubt seems possible concerning the fowl in which the granulations proved inocu- lable to the guinea-pig and to another fowl. In these cases the bacillus had preserved its original characteristics, and the nature of the infection appeared to us absolutely proved. Inoculation with Bovine Tiiherculosis. — We were not content to inoculate with human tuberculosis alone, but utilised tuberculous material from different mammals, and particularly from animals of the bovine species ; such a test appearing more important on account of the doubts which have recently been thrown on the identity of pulmonary tuberculosis in animals and human tuberculosis. Fowls remained unaffected whilst the disease was transmitted to the rabbit, guinea-pig, and cat. COW. Pleural and pulmonary tuberculosis. November 4th, 1889. Guinea-pig. Died Novem- ber 20th (16 days). A fern tubercles on the perito- neum. Guinea-pig. Died Novem- ber 27th (23 days). Tuberculosis of the spleen, liver, and peritonemn. I Guinea-pig. Died Novem- ber 27th (23 days). Tuberculosis of the liver, spleen, and peritoneum. I Rabbit. Died Novem- ber 17th (13 days) . A few tubercles on the perito- neum, and in the liver. Rabbit. Died Novem- ber 29th (25 days). Tuberculosis of the liver, spleen, and peritoneum. Fowl. Killed March 20th, 1890 (136 days). No lesion. Digitized by Microsoft® AVIAN TUBERCULOSIS. — EXPERIMENTAL STUDY. 551 OX. Pleural and pulmonary tuberculosis. November 15th, 1889. I Cat. Died November i6th (31 days). Generalised tuberculosis. I Fowl. Killed August 3rd, 1890 (230 days). No lesion. OX. Pleural and pulmonary tuberculosis, March i8th, 1890. I Fowl. Killed October 12th (208 days). No lesion. Inoculation with Tuberculous Lesions from the Dog, Cat, and Horse. — Finally, we come to the last series of experiments in which material for inoculation was obtained from animals which rarely suffer from tuberculosis. In the first the virus was obtained from a dog with tuberculosis of the lung and pleura. From a pulmonary centre which contained large numbers of bacilli we inoculated two guinea-pigs and two fowls. The fowls resisted, while the guinea-pigs died with all the ordinary sym- ptoms of tuberculosis. In the second the virulent material was obtained from a case of pulmonary tuberculosis in the cat. The inoculation was successful in the guinea-pig, but failed in the fowl. What renders this second series interesting is that the virus appeared pathogenic for the horse, intra- venous inoculation producing death in twenty-four days. On post- mortem both lungs were found affected with miliary tuberculosis, the separate points being extremely small and confluent ; this lesion was of surprising intensity. The bacilli inoculated must have been very virulent, for every one knows that the horse is not specially sensitive to tuberculosis. We therefore supposed that the virus, rendered still more virulent by its passage through the horse, would have developed in the fowl, but in this case again inoculation was unsuccessful, the fowl, on being killed at the end of 135 days, showing no appreciable lesion. DOG. Pulmonary tuberculosis. January 5th, 1891. Guinea-pig. Died February 13th (39 days). Generalised tubercu- losis {liver, spleen, and lungs). 1 1 Guinea-pig. Fowl.* Died February 23rd Killed April i6th (49 days). (loi days). Generalised tubercu- No lesion, losis [liver, spleen, and lungs). Digitized by Microsoft® 1 Fowl. Killed July 19th (195 days). No lesion. 552 CLINICAL VETERINARY MEDICINE AND SURGERY. CAT. Pulmonary tuberculosis. January 20th, 1891. GUINE.\-PIG. Died February and (13 days). A few granulations in the liver. I Horse." Died February 13th (24 days). Miliary tuberculosis of the lungs. I Fowl.* Killed June 28th (159 days). No lesion. I Fowl. Killed June 28th (159 days). No lesion. Summary of the Attempts to inoculate Gallinacecs with Mammalian Tuberculosis. — Forty members of the Gallinacese were inoculated with mammaHan tuberculosis ; none died spontaneously ; all were killed after a varying period. On post-mortem examination tuberculosis was found in five, but in thirty-five no lesion could be detected. The results obtained are indicated in the following table, which summarises all this portion of our experiments. Origin. Man Man Dog Cat {Pulmonary j tuberculosis | {Tuberculosis f of the testicle \ J Pulmonary J \ tuberculosis 1 J Pulmonary J \ tuberculosis \ J Pulmonary f 1 tuberculosis 1 Method of inoculation. Number of animals inoculated. Resu ts. Negative. Positive. Directly After passage through guinea-pig After passage through fowl 2 23 2 I 20 r 3 I Directly 5 5 — Directly After passage through cat . 2 I I — Directly 2 2 — Directly After passage through cat . 2 I 2 I = 40 35 5 Without attempting a comparative study of tuberculosis in the different mammals, we would draw attention to the fact that these experiments, performed with material from bovines, and from the dog, cat, and horse, may be cited in favour of the unicity of tuberculosis. The guinea-pigs and rabbits died in the same way as when inoculated with human tuberculosis. Development has often been very rapid, for bovine tuberculosis killed guinea-pigs in two and three weeks, and canine tuberculosis in five weeks. Persistence of the Fluinan Bacillus in the Organs of Gallinacea. — Our experiments, and those published by other investigators, show Digitized by Microsoft® AVIAN TUBERCULOSIS.- — EXPERIMENTAL STUDY. 553 that mammalian tuberculosis can only be transmitted to birds by special methods. We were therefore led to inquire what becomes of the bacillus when introduced into the bodies of birds. M. Martin first commenced the study of this question. He collected blood from a certain number of fowls which he had intra-peritoneally injected with human tuberculosis, and with it he inoculated guinea- pigs. The results were extremely variable : sometimes blood from fowls inoculated three months before did not appear virulent ; some- times blood from birds inoculated six or even seven months before trans- mitted tuberculosis. We again took up the question, but thought it better to utilise the liver instead of the blood, as the microbes become localised in the viscera. Our experiments gave the following results : — Fragments of liver from a fowl inoculated twenty-four days before transmitted tuberculosis to the guinea-pig ; fragments of the same organ injected into other guinea-pigs seventy-two, eighty-three, and 211 days after the primary inoculation, produced no appreciable result. Thus a month after inoculation with human tuberculosis the bacilli still persisted in the fowl's organism ; at this time they seem to betray their presence by certain morbid reactions ; the fowls often become ill towards the end of the first or commencement of the second month after inoculation; this fact had not escaped M. Martin, two of whose fowls had died on the forty-seventh and forty-eighth day, though the autopsy was negative. Now it was precisely about this time that we noted visceral tuberculosis (as shown in the table below, which gives the results of our experiments). Results. Negative. Positive. 5 S — 7 3 4 27 27 — C Between the nth and 31st days . Animals killed < Between the 3Sth and Spth days ( Between the 62nd and 266th days Total . . • • 39 • 35 + Speaking generally, there was no tuberculosis before the thirty-fifth or after the fifty-ninth day.* The question may therefore arise whether, towards the second month after inoculation, lesions may not be produced, which though in most cases only appreciable on microscopic examination, would nevertheless explain the symptoms shown. Histological examination, carried out in one case, did not support this hypothesis. The liver of * The fowl to which tuberculosis of human origin was transmitted after passage through other fowls forms an exception ; in this case the virus may have undergone modification by passage through the previous birds. Digitized by Microsoft® 554 CLINICAL VETERINARY MEDICINE AND SURGERY. a fowl killed on the thirty-ninth day was steatomatous, but contained no granulations. To sum up, inoculation of members of the Gallinacese with mam- malian tuberculosis seldom proves fatal. In most cases it is well borne ; towards the second month it sometimes excites certain tem- porary disturbance ; finally, in rare cases it produces a crop of tuber- culous granulations in the viscera. v.— SUMMARY AND CONCLUSIONS. Having arrived at the end of our investigation, we think it well to summarise our principal conclusions. It has long been known that the Gallinacese suffer from a disease resembling tuberculosis, characterised by the production of granula- tions and caseous masses of varying size. These lesions especially affect the liver, spleen, and peritoneum. The intestine often shows ulceration ; the intestinal contents then contain bacilli, which serve to transmit disease and explain certain outbreaks. The histological characters of the tubercles differ in the fowl and in the pheasant. In the fowl the tubercle consists of a clump of epi- thelioid cells, the central portion of which has undergone hyaline necro- biosis, and is surrounded by a border of special cells. In the pheasant the lesion is at first formed by nests of epithelioid cells, the central portion of which afterwards disappears in consequence of molecular degeneration ; simultaneously a connective-tissue ring is formed, which undergoes amyloid degeneration, and surrounds cavities resembling blood-vessels. All these growths contain bacilli presenting the same appearance, and behaving to colouring agents in the same way, as those found in the tuberculosis of man and of other mammals. Experiment appeared the only way of determining the connection between tuberculosis of mammals and that of birds. Our research may be divided into two parts. In the first group of experiments we studied the avian virus, and found that it is readily communicated to fowls. Injected into the veins or peritoneal cavity it produces lesions resembling those of spontaneous tuberculosis. When introduced into the abdomen of the rabbit the avian behaves very similarly to the human bacillus, producing a generalised outbreak of granulations in the viscera. In the guinea-pig the results are more variable. We inoculated twenty-seven guinea-pigs intra-peritoneally ; thirteen of these showed Digitized by Microsoft® AVIAN TUBERCULOSIS. — SUMMARY AND OONCLUSIONS. £55 no appreciable lesion ; five showed a caseous abscess at the point of inoculation ; seven a few discrete visceral granulations ; and three generalised miliary tuberculosis. In passing through the organism of mammals, the avian virus be- comes modified and loses its pathogenic properties for the fowl. In a second series of experiments we injected fowls with tuber- culous material derived from man and from different mammals (ox,. dog, cat, and horse). Forty fowls were inoculated, either in the veins or in the peritoneal cavity, or simultaneously in both. None died. In five we found recent very small transparent tubercles ; they were due to the human bacillus, for in one case they could be reinoculated into the guinea-pig, but could not be transmitted to another fowl ; the virus had therefore preserved its original properties. In another case the bacilli became more markedly modified, and the lesions could be re- inoculated from one fowl to another. The cases we have described, and the experiments published by other observers, indisputably prove that profound differences exist be- tween mammalian and avian tuberculosis. On the basis of the results obtained, the following comparison may be established between the two viruses. The avian bacilli are longer and more granular ; they develop- more readily on artificial culture media, and grow at once on glycerine agar. The human bacilli only grow on this medium after having several times been sown on serum. As MM. Straus and Gammeleia have well shown, cultures of the avian bacilli are moist, fatty in appearance, wrinkled, and soft ; those of the human bacilli are dry, scaly or warty, dull and hard. The avian bacillus grows at 43° C, and can resist a temperature of 65° C. ; the human bacillus ceases to grow at 41° C, and dies at 65° C. An avian culture six months old is still living, and can still be re- planted. A human culture loses its power of reproduction in six months (Maffucci). Avian tuberculosis can be transmitted to fowls. It seldom or never produces generalised tuberculosis in the guinea-pig, and cannot be inoculated in the dog. Human tuberculosis can only exceptionally be transmitted to fowls ; it always produces generalised tuberculosis in the guinea-pig, and can readily be conveyed to the dog. Such are the differences between the two viruses, and it must be confessed they are considerable. But are they sufficient to constitute a radical distinction ? and must we regard the two bacilli as belonging to different species ? Digitized by Microsoft® 556 CLINICAL VETERINARY MEDICINE AND SURGERY. On reconsidering the distinctive characters just mentioned we see that they are perhaps less marked than might at first appear. The general characters of the two bacilli are the same, and the reactions they produce in the living organism are similar. In reply to the objection that the histological characters of human tubercle differ from those of tubercle in the Gallinaceas we may point to the still greater difference between the tubercles of the fowl and of the pheasant ; in animals equally sensitive to both viruses, like the rabbit, the histological features of the lesions are identical ; there is the same formation of nodules, the same tendency to caseation. By studying the morphology of the two microbes they are seen to be very similar ; the few differences which have been noted are secon- dary, and equally marked variations are observed on comparing tuber- culous bacilli from different members of the same species ; in man it is not uncommon to find certain bacilli longer and more granular than others. On the other hand, both in avian and in human bacilli the great specific characteristics remain, especially the staining reactions, which appear to us of infinitely greater importance than a morpho- logical detail. Without being absolutely identical, cultures of the two bacilli offer certain analogies ; the human bacillus can grow on glycerine media, and in this respect tends to resemble the avian bacillus ; even though it will not grow immediately, is this character sufficient to establish a fundamental distinction ? Would not a simple variation of race suffice to explain this difference ? We might make similar suggestions regarding the other differential characters, but we hasten to consider those more particularly appro- priate to our investigation — we mean the pathogenic properties. It is certain that different animals do not react in the same way to both viruses; in this connection MM. Straus and Gamaleia lay stress on the following fact which they have discovered : the dog readily contracts human tuberculosis, but is proof against avian tuberculosis. This fact is of considerable interest, but is, nevertheless, in our estima- tion insufficient to establish a specific distinction. Equally marked differences often exist between varieties of the same species ; the anthrax bacillus kills the rabbit, while the first anthrax vaccine is without action on it. To continue our comparison we might remark that from the point of view of form and of cultures there is certainly as much difference between the virulent anthrax bacillus and the attenuated bacillus as between the bacillus of human and of avian tuberculosis. We do not think it advisable to rely on one or two differential characters in attempting to solve this question, but to take into con- Digitized by Microsoft® AVIAN TUBERCULOSIS. — SUMMARY AND CONCLUSIONS. 557 sideration all the characteristics of the two microbes. From this point of view we should bear in mind that a number of facts tend to prove a community of nature between the two viruses. The rabbit, for example, contracts avian as readily as human tuberculosis, at least when inoculated intra-peritoneally. Although the guinea-pig, the test par excellence for human tuberculosis, usually resists the avian disease, it nevertheless sometimes dies with generalised visceral granulations. Conversely the fowl is not absolutely immune against human virus ; on several occasions we have seen tuberculous lesions produced in the fowl, and in one case we were able to prove that the lesions were due to the human bacillus, which had preserved its particular characters. Finally, we have cited in this investigation various results which tend to establish that the two viruses may undergo modification, and even transformation ; in one case human tuberculosis was transmitted from one fowl to another ; in another avian tuberculosis by passage through mammals became exalted in virulence for these animals, but lost its pathogenic properties for the Gallinacese. The results we have obtained, and those reported by other experi- menters, lead us to think that the two bacilli only represent two varieties of the same species. Without doubt these two varieties are very different, and it is impossible to apply to one results obtained with the other. To prevent a recurrence of the confusion which pre- viously obtained, it is, therefore, always necessary to state which virus has been used. But, despite their very important distinguishing charac- ters, a common basis exists on which these two pathogenic agents may be compared and regarded as derived from a single source. The view which we think best agrees with hitherto observed facts is that tuberculosis of mammals and of Gallinacese are essentially one and the same. Digitized by Microsoft® II.— TUBERCULOSIS OF PARROTS— ITS RELATIONS TO HUMAN TUBERCULOSIS. By MM. Cadiot, Gilbert, and Roger. When Koch discovered the bacillus of tuberculosis it was hoped that the old unending dispute between the unicists and the dualists would have ended. It has not been so ; the problem has only been modified. Doubt no longer exists of the unicity of tuberculosis in man, but the unicity of tuberculosis in animals is still disputed. Some authors have attempted to draw a sharp line of demarcation, an absolute distinction, between the pathogenic agent found in mammals and that discovered in birds ; have attempted, in fact, to prove the ■existence of two distinct kinds of tuberculosis, human and avian. The question has more than a theoretical interest, for its solution vitally affects hygiene. Depending on whether the avian bacillus represents a particular variety or species, and is or is not capable of developing in mammals, tuberculous birds 'must be considered dan- gerous or innocent for man. If the avian bacillus has no relation to that of mammals affected birds can be safely utilised for food, or kept in close proximity to man without danger. It is impossible to deny that important differences exist between the tuberculosis of mammals and that of birds. We have shown that the avian bacillus, though very virulent for the rabbit, seldom produces in the guinea-pig more than circumscribed discrete lesions, with a marked tendency to undergo fibrous transformation. Conversely the human bacillus is but slightly dangerous to the Gallinaceae, and its inoculation into birds is seldom followed by the growth of tubercles. But there are exceptions to these rules : in the guinea-pig the avian bacillus sometimes produces visceral lesions of an extremely marked character, which can be transmitted in series. Moreover the Gallinaces are not entirely immune : of eighty-six fowls inoculated with mamma- lian tuberculosis nine showed positive results, i. e. a proportion of about 10 per cent. Although the Gallinaceae show unquestionable resistance, other Digitized by Microsoft® TUBERCULOSIS OB' PARROTS — ITS RELATION TO HUMAN TUBERCULOSIS. 559 birds — the Psittacese (the parrot tribe), — very readily contract human tuberculosis. Observation tends to support this view, and experiment has established it beyond question. The merit of having first drawn attention to the frequency of tuberculosis in parrots, and of having shown that the disease especially affects the skin, mucous membranes, subcutaneous and submucous connective tissues, the articulations and bones, is due to Frohner and his assistant Eberlein. Of 700 parrots brought for examination to the Berlin school 170 were tuberculous, i. e. a proportion of 25 per cent. Eberlein gave a summary of fifty-six of these cases, according to which the principal localisations were as follows : Eye and periocular region . . . . 14 Commissure of the beak . . . . 11 Tongue ........ 9 Larynx ........ 2 Bones and articulations ..... 14 In Eberlein's observations tuberculosis affected the skin and its appendages in twenty-nine cases, i. e. a proportion of 50 per cent. The cases which we have recorded number twenty-seven, and may be divided as follows : Tuberculosis of the skin . . 15 cases, i. e. 55 per cent. Tuberculosis of the mucous mem- brane ..... 6 cases, i. e. 22 per cent. Simultaneous tuberculosis of the skin and mucous membrane . 6 cases, i. e. 22 per cent. On more closely studying the localisation of these lesions we see that they most frequently occur about the head, especiall}- the sides of the face, the periorbital region, and the commissures of the beak. Eberlein considers that the left side is more frequently attacked than the right, without, however, being able to give any reason for this predominance. Finally, it is not uncommon to find several massed or distributed cutaneous centres in the same animal. Studied according to their localisation an analysis of the lesions in our twenty-seven cases proves very similar to that of Eberlein : Cheeks, periorlDital region, and eye . . 12 cases Commissures of the beak . . . . 7 ,, Tongue . • • • • • • ,, Palate . 4 >> Upper hmbs and wings . . . ■ 7 >> Claws ....-•■ 3 I. Cervical, dorsal, and caudal regions . . 5 ,, Digitized by Microsoft® 560 CLINICAL VETERINARY MEDICINE AND SURGERY. In order to convey a better idea of the seat and appearance of the lesions we very briefly summarise these observations. I. Tuberculous Lesions of the Skin and Appendages. Case i. A green parrot bought in April, 1886. In December, 1894, a little greyish, firm, scaly swelling was noted on the right side of the face. It gradually extended to subjacent parts, becoming more prominent. On the 1st January, 1895, this tumour was removed by a veterinary surgeon. A fortnight later it returned. On the 19th January the parrot was brought here. The right side of the face showed a greyish, conical, scaly vegetation, slightly incurved at its extremity. Examination of a scraping from the inflamed skin around the base of the growth revealed numerous bacilli. The tumour was removed, the skin curetted and touched with the thermo-cautery. The parrot was brought back again on the 12th February, 1895. The horny mass had again grown, and another swelling was in course of formation above the former. The same treatment was repeated. On the 2nd March both growths had returned, and a fresh one had appeared between the skin and the upper mandible. Case 2. A parrot, the globe of whose eye was almost entirely covered by the lower eyelid, which formed a fungating swelling the size of a haricot bean ; the central portion was caseous, and contained bacilli. Case 3. A parrot with a tuberculous horny growth developed on the right side of the head immediately behind the buccal commissure. Brought back again a month later it showed other small horny growths close to the first. Case 4. A parrot showing a large horny growth below the lower mandible ; the surface of implantation occupied half the depth of the head ; this horn was pyramidal in shape ; the anterior side measured one and a half inches in length ; it was hard, fragile, and stony in appearance. Two similar growths the size of hemp-seeds existed in front of the left eye. Case 5. A four-year-old parrot, imported from Brazil at the age of three months. For some time this bird, previously very talkative, had appeared dull and quiet. A horny growth, the size of a small hazel-nut, existed on the right cheek, behind the base of the mandible. Digitized by Microsoft® TUBERCULOUS LESIONS OF THE SKIN AND APPENDAGES IN PARROTS. 561 Case 6. A parrot which had shown marked wasting for several months. On the right side of the head was an indurated cutaneous patch the size of a sixpence ; at the lower part of the neck was a horny growth as large as a haricot bean ; on the back a similar but smaller patch ; finally, on the sacrum a fungous, bleeding, ulcerated spot. Examination of these various lesions revealed the existence of numerous bacilli. Case 7. A parrot brought to hospital on the 4th May, 1894. It was thin, dull, and had not talked for several weeks. On the right side of the head, three eighths of an inch from the base of the beak, was a horny growth, conical in shape, covering a surface about three eighths of an inch square. A similar growth existed at the base of the neck. In the lumbar region was a circular, granulating, bleeding wound surrounded by a zone, from which the feathers had fallen.- Case 8. A five-year-old parrot, which for two years had belonged to the woman who brought it. A horny growth had appeared on the left wing, and somewhat later another had developed on the head. Case g. A five-year-old parrot, which had been in its owner's possession for three j^ears, and had been ill for five to six months. The left side of the head behind the eye was the seat of a cylindrical, horny growth, about three eighths of an inch in length, and one sixth of an inch in thickness. Case 10. A parrot which had appeared ill for the previous five to six months. Had been in its owner's possession for two years. On the right side of the neck were two horny tuberculous growths, about" three eighths of an inch in length. In the subcutaneous connective tissue, covering the larynx, were two growths the size of a small hazel- nut. The right wing showed an ulcerated tuberculous patch. Case ii. A parrot which had belonged to the same person for the previous eighteen months. About three months before its appearance here a growth of fibrous consistence which granulated freely, and the centre of which was occupied by caseous material, had appeared on the carpal region of the left wing. Case 12. Parrot ill for about six months. Horny growth on right wing over the humero-radial articulation. Case 13. Parrot affected for the previous two months with an ulcerated tuberculous swelling of the metatarsal region. Case 14. Parrot affected with two swellings the size of hazel-nuts on the lower part of the right claw. The muscles of the claw were atrophied, and the animal could not use the limb. Case 15. Parrot showing a horny tumour of conical form at the base of the tail. This growth, which had only been discovered ten N N Digitized by Microsoft® 562 CLINICAL VETERINARY MEDICINE AND SURGERY. days previously, measured three eighths of an inch in length. It had invaded the anus and caused obstinate constipation. 2. Tuberculous Lesions of the Skin and Mucous Membranes. Case 16. Parrot ill for the previous three months. Two horny growths, one over the throat, the other on the left side of the head. Several small yellowish vegetations on the buccal mucous membrane behind the commissure and on the palate. Case 17. Parrot showing two cutaneous horns on the back opposite the wings ; whitish patches, the size of a lentil, at the base of the tongue and on the left side of the larynx. Case 18. Parrot ill for the previous two years. On either side of the head, opposite the commissures, were small horny growths. On the palate was a conical horny growth, the size of a haricot bean, directed forwards. The end extended beyond the tongue. The base, which was about three eighths of an inch in diameter, was attached to a finely granulating surface. Case 19. Parrot bought eighteen months before. Had shown difficulty in swallowing for the past six months ; was emaciated. Two small tumours existed, one above the upper mandible, the other behind the left commissure, each the size of a pea. A third ulcerated swelling was seen on the palate. The bird died on the 15th March, 1895. No visceral lesions. 3. Tuberculous Lesions of the Mucous Membrane. Case 20. Parrot which for the previous two months had shown several small greyish swellings on the commissures of the beak and on the tongue. These growths had gradually increased in size, become confluent, and ended by forming two flattened tumours of considerable thickness, the outer part of which extended as far as the branches of the lower mandible. The lingual patches having been detached with a director the mucous membrane beneath was seen to be red, thickened, and granulating. Another patch of similar character, but smaller extent, occupied the palate. Case 21. A parrot which had been ill for five months; swallowing very difficult ; extreme wasting during the last month ; tuberculous vegetation on the tongue and hard palate. Case. 22. Parrot affected with a large swelling at the base of the tongue ; great difficulty in deglutition. For five or six months pre- viously the animal had suffered in condition. Case 23. Parrot showing a rounded tuberculous growth the size of a pea on the hard palate. Digitized by Microsoft® TUBERCULOUS VISCERAL LESIONS IN PARROTS. 563 Case 24. Parrot suffering from tuberculous patches on the tongue. 4. Visceral Lesions. Case 25. Parrot which had been ill for the previous eight months. Tuberculous hardened growth on the right side of the head ; tuber- culous, swelling on the left wing ; hardened growth, about three quarters of an inch in length, on the extremity of the rump. Feet deformed ^nd contorted ; the bird had difficulty in holding on its perch. It died a month later. Autopsy. — The liver and spleen were crammed with tuberculous granulations ; both legs showed deep-seated lesions of the bones, articu- lations, periosseous and periarticular tissues. Case 26 (Autopsy). Tuberculosis of the tongue, larynx, lungs, and liver. The lesions were similar to those usually noted in the Gallinaceje. Two tuberculous spots in the muscles of the thigh and leg ; tuberculosis of the tarsal joints ; some cutaneous tubercles. Case 27 (Autopsy). Tuberculosis of the tongue and nasal cavities, lungs and liver ; a tuberculous spot in the muscles of the left foot. The above cases show that the lesions are almost always of so Fig. 78. — Horny growth developed on a tuberculous patch on the cheek (Eberlein-Krampf). special a character as to have rendered it impossible to detect their nature before the introduction of bacteriological methods. These cutaneous manifestations differ entirely from the lesions seen in other animals, and can only be compared to certain forms of verrucous lupus. In general the first sign is furnished by the falling of the feathers. The skin then becomes thickened and verrucous, after which the growths develop and are covered with thick crusts. These hardened Digitized by Microsoft® 564 CLINICAL VETERINARY MEDICINE AND SURGERY. growths may even attain two inches in length, and three eighths to three quarters of an inch in width at their base (Fig. 78). When detached they are seen to have grown from a granular or fungous tissue. Ulceration is not uncommon, and occurs most readily when the diseased part has been exposed to injury, or to repeated rubbing. In some cases the lesion occupies the subcutaneous tissue. It then forms a growth of fibrous consistence, sometimes as large as a cherry. At a later period the centre undergoes softening and is transformed into a caseous magma. Finally, peculiar local growths are sometimes seen, which have caused mistaken diagnosis ; the tubercles develop in certain parts of Fig. 79. the feet, which become deformed and contorted, precisely as in the cases described under the title of " gout in birds." The external lesions may, by their size and position, cause varying functional disturbance. They may cover, or close the eyes (Fig. 79) ; interfere with the movement of the mandibles, and when in the anal region render defaecation difficult ; while those on the feet are usually accompanied by muscular atrophy, and sometimes by paresis. Vegetations resembling the skin lesions may be seen on the buccal mucous membranes; sometimes they are simply hard, white or yellow- ish, slightly prominent patches ; in others conical or rounded tubercles, varying in size between a pea and haricot bean, considerably dimin- Digitized by Microsoft® TUBERCULOUS VISCERAL LESIONS IN PARROTS. 565 ishing the buccal cavity and interfering with deglutition. Despite their development from a mucous membrane, they present a horny appearance ; in only one case have we seen an ulcerated growth on the palate. Visceral growths may develop simultaneously with, or apart from, cutaneous, articular, or buccal lesions. Some may be detected by the symptoms shown during life ; gastro-enteritis, for instance, produces diarrhoea and sometimes passage of blood ; and pulmonary tuberculosis (which Eberlein regards as the commonest visceral locali- sation) causes continual attacks of coughing. In most cases development is extremely slow. The onset being insidious, the disease is often overlooked ; and the large growths seen on examination have often been described as the product of a week or so. When it causes no functional disturbance, and is unaccompanied by visceral lesions, tuberculosis produces little disturbance ; birds may, therefore, continue for a long period to incubate and distribute the bacillus of tuberculosis. Sooner or later, however, they become ill, appear dull and thin, cease to talk, and usually die, extremely emaciated, in six months to a year. Sometimes, however, they survive for a much longer period. We have seen parrots, still in very fair condition, two years after the onset of disease. In spite of their slow development, the cutaneous lesions are diffi- cult to cure. In Eberlein's and in our own experience, extirpation always failed, the growth recurring in a few weeks. It is difficult to exactly estimate the frequency of visceral lesions. Eberlein, who made fifteen post-mortem examinations, gives the follow- ing results : No visceral lesions . Tuberculosis of the lungs ,, of the liver . ,, of the intestine ,, of the muscles ,, of bones and articulations ,, of the heart The same author has several times detected tubercle bacilli in the liver, even when there were no visible granulations. He justly lays stress on the frequency of pulmonary lesions, which, on the other hand, are very rare in the Gallinaceae. In most of the cases we have seen the birds were kept ahve by their owners ; in only seven were we able to carry out post-mortem Digitized by Microsoft® ■ 7 cases. ■ 4 j> • 4 )j • 3 jj . I case. 2 cases. . I case. 566 CLINICAL VETERINARY MEDICINE AND SURGERY. examinations. In three of these (Cases 25, 26, and 27) we found visceral tuberculosis in the form of little miliary granulations scattered through the liver, spleen, and lungs. In these three cases we also noted tuberculous points in the bones, articulations, and muscles. By histological examination of one of these cases we discovered that the tubercles in the liver of the parrot resemble human tubercles, and differ from those of the fowl and pheasant. They consist of central giant-cells, round or fusiform, peripheral cells, and epithelioid intermediate cells (Fig. 80). The giant-cells contained a very large number of nuclei, which are usually distributed throughout the cell, or occupy the centre, but not the periphery, thus differing in appearance from the ordinary giant-cell in human tuberculosis. In these centres, and especiall}' in their giant-cells, bacilli appear very numerous. What is the origin of tuberculosis in parrots ? This is the most interesting question both from the theoretical and practical' point of view. One can hardly believe that in the majority of cases parrots have been inoculated by Gallinace^. Living with man, they never, or scarcely ever, leave the house, and, as a rule, have no opportunity of coming in contact with poultry. It is, therefore, impossible to imagine how they could contract avian tuberculosis. These theoretical considerations are supported by the results of an inquiry made by us regarding our twenty-seven cases. In seven in- stances the affected parrots belonged to persons in bad health, who appeared thin and had for a considerable time suffered from chronic Digitized by Microsoft® ORIGIN OF TUBERCULOSIS IN PARROTS. 567 cough; that several were unquestionably tuberculous was proved by bacteriological examination of their sputa. Case I, described in the foregoing pages, is in this respect absolutely conclusive. The parrot had lived in the same house for eight years, and had always enjoyed good health ; in April, 1894, its owner began to cough ; in December the bird showed tuberculous patches on the sides of the face. At this time microscopic examination revealed the presence of tubercle bacilli in the cutaneous growth on the head of the parrot, and in the expectorations of its owner. The owner told us that he was in the habit of fondling the bird ; that he often kissed it on the head and sides of the face ; and that he made it take from his mouth food which he himself had masticated. He added that this parrot was the only animal in his rooms ; that it had never come in contact, even for a short time, with other birds, and that it lived on seeds, coffee and milk, boiled milk, and, finally, food which he himself had chewed. Is not this case as complete and as instructive as a laboratory experiment ? How is it possible to deny that this bird, which showed cutaneous tuberculosis four months after its owner had developed the first symptoms of pulmonary tuberculosis, from which he died a year later, had been infected by the owner himself.'' In Case 2 the human origin of the disease is scarcely less clear. A man who had suffered with pulmonary tuberculosis from 1887, and who died of the disease in January, 1895, bought in 1890 a very fine parrot, which showed no cutaneous lesions. At the commencement of 1894 the bird, which its owner was in the habit of fondling, and which ate from his mouth, developed a greyish nodule on the lower eyelid of the left eye ; the nodule gradually increased in size, and ended by in- vading the entire eyelid. In Case 16 the disease may have been caused in the same way. The parrot belonged to a tuberculous woman, who was in the habit of feeding it from her mouth. Tuberculosis developed simultaneously on the buccal mucous membrane and on the skin. Cases 3, 17, and 21 refer to .birds which belonged to tuberculous persons ; and the parrot in Case 4 had often been in contact with a woman who afterwards died of pulmonary tuberculosis. We were scarcely surprised that in the other cases our inquiries threw no light on the question of human infection. Parrots may contaminate one another, and may also contract tuberculosis from the dust existing in rooms, — that is to say, from bacilli introduced from out of doors. Infection may occur by three different paths. Sometimes the bacilli penetrate by the respiratory tract. Thus pulmonary tuberculosis, Digitized by Microsoft® 568 CLINICAL VETERINARY MEDICINE AND SURGERY. though exceptional in GaUinacese, is fairly frequent in parrots ; this constitutes a further analogy with human tuberculosis. Sometimes, however, infection occurs through the skin ; sometimes through the digestive tract. But while the Gallinaceae are almost always infected by means of the food, and frequently show tuberculous enteritis, parrots, although they sometimes swallow food soiled with bacilli, are most commonly inoculated by contact with tuberculous persons, or by rubbing the head against the bars of their cage. This explains the frequency in them of lesions about the head, beak, tongue, palate, or pharynx. Although the cases we have recorded appear to suggest that tuber- FiG. 8i. culosis in the parrot is of human origin, the question could only be finally decided by experiment, and by directly transmitting mammalian tuberculosis to birds. We made three attempts of this character. The results were so clear and concordant that it appeared unnecessary to multiply experiments. Experiment i. On the 20th June, 1894, a green parrot was inocu- lated on the head with tuberculous material obtained from a guinea- pig, which had died from tuberculosis of canine origin. On the 5th July two small nodules appeared, and became covered with thick blackish crusts. On the 15th August the crusts fell, leaving exposed a roughened, irritable, verrucous surface. Most of the nodules Digitized by Microsoft® EXPERIMENTAL PRODUCTION OF TUBERCULOSIS IN PARROTS. 569 showed a kind of horny covering, which could easily be removed. Microscopic examination of a fragment of morbid tissue revealed numerous bacilli. By the ist October the lesion had extended to the root of the beak and upper part of the neck. On either side it over- lapped the eyes, which were covered by the vegetations developed around them (Fig. 8i). The loss of condition and increasing dyspnoea caused us to suspect visceral extension of the disease. Unfortunately during the night be- tween the 20th and 21st October this bird was partly eaten by rats, so that no complete autopsy could be made. The results obtained, how- ever, sufficiently showed that mammalian tuberculosis may in the parrot produce cutaneous lesions identical with those which occur spontaneously. Experiment 2. On the loth Aucfiist, 1894, a green parrot was ino- Fig. 82. •culated like the preceding, and in October and November was similarly re-inoculated. In December the feathers were shed from around the point of inoculation, and the skin became thickened and wrinkled ; gradually the lesions extended to the neck, beak, and claws; around the mandibles a kind of sheath developed, particularly marked towards the upper parts. The vegetations on the eyelids almost entirely ■covered the eyes (Fig. 82). The parrot died on the 28th September, i8g6. On post-mortem ex2.xn\m.t\on no visceral lesions were discovered. Experiment 3. On the 17th March, 1895, a parrot was inoculated Digitized by Microsoft® 57° CLINICAL VETERINARY MEDICINE AND SURGERY. on the crown of the head with canine tuberculosis. At the commence- ment of June the skin over this part became thickened and covered with crusts. The lesions continued to grow and vegetations developed, one of which was specially notable on account of its size and horny covering (Fig. 83). The parrot died on the 13th September, 1895, having survived ino- culation 179 days. On post-mortem examination no visceral growth was discovered, but the tuberculous lesion developed at the point of inocu- lation was seen to have invaded and perforated the subjacent bones of Fig. 83. the cranium. On microscopical examination tubercle bacilli were identified in the new growth. Mammalian tuberculosis inoculated into parrots had therefore pro- duced lesions similar to those of spontaneous tuberculosis. The birds lost condition, and died emaciated in from four to thirteen months. On post-mortem examination the viscera appeared healthy, and con- tained no bacilli ; the organisms had remained confined to the point of inoculation. Sections showed large numbers in the local lesions. A single inoculation, however, does not always produce tuberculous lesions. In some cases the virus must be introduced several times, a fact which explains how certain parrots only become contaminated after months, or even years, passed in the neighbourhood of tuber- culous persons. Digitized by Microsoft® EXPERIMENTAL PRODUCTION OF TUBERCULOSIS IN PARROTS. 57 1 Having shown that tuberculosis of parrots is, or at least may be, of human origin, the question arises whether the bacillus maintains its virulence in the organism of these birds. We have endeavoured to answer this question by directly inoculating with bacilli obtained from several parrots. We took care not to grow the virus on artificial media, for culture notably modifies its pathogenic properties ; we wished to determine the virulence of the original bacilli. The two following tables summarise two series of inoculations, the first of which was started with caseous material contained in the centre of a tuberculous swelhng of the wing (Case ii), the second with a horny growth occupying the right side of the face (Case 5). EXPERIMENT IV. Parrot. Tuberculous growth on the wing: April nth, 1894. Guinea-pig, Guinea-pig. Died May 26th (45 days). Died May 29th (48 days). Tubercle at point of inoculation ; tubercu- Tubercle at point of inoculation; general- losis of the peritoneum and liver, ised tuberculosis* (peritoneitm, liver, spleen, and lungs). r, I I I I I Guinea-pig. Rabbit. Guinea-pig. Guinea-pig, Rabbit, Died June i8th (23 Killed Novem- Died September Died October Killed September days). ber 7th (162 29th (123 days). 26th (144 days). 23rd (117 days). Tuberculosis of the days). Generalised tu- Generalised tu- A few granulations peritoneum, liver , A few granula- bercidosis. berculosis. on the peritoneum and spleen. tions on the peri- and in the liver. J toneum and in Guinea-pig. the liver. Died October 15th (99 days). Generalised tubercu- losis, spleen, liver, and lungs. * We have rarely witnessed such a development of tubercles ; the peritoneum was covered with granulations, the spleen enlarged tenfold, and the liver was crammed with nodules. The lungs contained innumerable large tubercles, particularly in the posterior lobes. The mediastinal and mesenteric lymphatic glands were enlarged and caseous. Microscopic examination showed all the affected organs and tissues to contain numerous bacilli. Digitized by Microsoft® 572 CLINICAL VETERINARY MEDICINE AND SURGERY. EXPERIMENT V. Parrot. Horny tuberculoits growth on the right cheek. July Sth, 1894. Guinea-pig. Died September 7th (64 days). Generalised tuberculosis {peritoneum^ liver, spleen, kidneys, and lungs). I Guinea-pig. Died October 15th (38 days). Generalised tuberculosis {liiier, spleen, and lungs). I Guinea-pig. Died September 27th (43 days). Generalised tuberculosis {peritoneum, liver, spleen, and lungs). Rabbit. Died September 1st, 1895 (278 days). For seventeen days prior to death showed paraplegia. Generalised tuberctdosis {liver, spleen, kidneys, lungs, dorso-lumbar para- lysis of cord) . Rabbit. Killed November 2ist (357 days). A few fibrojts tubercles on the peritoneum and the liver. I Fowl. Killed November nth, 1895(349 days). No lesion. Fowl. Killed March 5th (454 days). No lesion. Experiment 6. Guinea-pig inoculated on the gth July, 1894, with part of a horny cutaneous growth from the right side of the head (Case 6). The guinea-pig died on the 30th August, i. e. at the end of fifty-seven days. Autopsy showed numerous granulations on the peri- toneum, in the liver, spleen, and lungs. Experiment 7. On the 28th September, 1895, three fowls were intra-peritoneally inoculated with experimental tuberculosis of the parrot (Experiment 2). One was killed on the 24th November follow- ing ; another on the 5th December ; the third on the 5th March, i8g6. No change whatever was found on post-mortem examination. To sum up, ten guinea-pigs inoculated with tuberculous material obtained directly from the parrot, or having passed through other .guinea-pigs, died after periods varying between 23 and 144 days, that is after an average period of sixty-seven days. In all, post-mortem examination showed intense and generalised lesions. Of four rabbits inoculated under the same conditions only one died spontaneously at the end of 378 days. The others were killed between the 117th and the 359th day. In spite of this much longer survival, which rendered the average period 226 days, we only found on post- mortem examination a few discrete granulations on the peritoneum and in the liver. Digitized by Microsoft® RELATIONS OF MAMMALIAN AND AVIAN TUBERCULOSIS. 573, Tuberculosis of the Psittaces, unlike that of the Gallinaceae, is therefore much more virulent for the guinea-pig than for the rabbit. In this respect it more closely resembles tuberculosis of mammals, with which it also agrees in being comparatively harmless for the Gallinaceae (Experiments 5 and 7). Bearing in mind the results already obtained, we have now to con- sider the relations existing between the tuberculosis of mammals and that of birds. Avian tuberculosis, which is very frequent in the Gallinaceae, can be transmitted to the fowl, pigeon, and the rabbit, and, with less facihty, to the guinea-pig. It may also occur, with its own special characters, in the ox and in man (Kruse's and Pansini's cases). Mammalian tuberculosis affects man, the dog, ox, and horse, and is readily conveyed to the guinea-pig and rabbit, which, however, is perhaps less sensitive to it than to avian tuberculosis : it can also be inoculated into the parrot, and sometimes the fowl. The two viruses, therefore, aff'ect the same animals. The titles given them are, therefore, not precisely correct, for the so-called tuber- culosis of mammals is identical with that very commonly seen in parrots. These results, therefore, render the barrier which was erected between the two viruses very narrow. Though it is allowable and necessary to admit the existence of two races of tubercle bacilli, it seems to us exaggeration to speak of two species. Between the extreme types numerous transition forms exist, and one variety can sometimes be transformed into the other. We have shown, for example, that the avian virus, after several passages through mam- mals, may lose its virulence for the Gallinaceae ; and conversely that human tuberculosis, when by chance conveyed to a fowl, may sometimes be afterwards passed through a series of fowls. But to obtain such positive results it is necessary to multiply experiments, and not to rest content with a few. For this reason we inoculated eighty-six fowls with human, and forty-two guinea-pigs with avian virus. It will be conceded that so large a number of experiments gives a certain weight to our conclusions. To sum up, we have no intention of attempting to establish a complete parallel between the tuberculosis of Gallinaceffi and that of mammals. They show notable differences which we were not the last to recognise, but we continue to believe that, however important their distinctive characteristics may be, they are insufficient to destroy the unicist theory of tuberculosis. Digitized by Microsoft® 574 CLINICAL VETERINARY MEDICINE AND SURGERY. This view of the question has important practical consequences. In parrots, for instance, the bacilli acquire extraordinary virulence for certain mammals, as shown by our inoculation of guinea-pigs ; very rarely is human tuberculosis so active in these little rodents. Now bacilli exist in large numbers in the cutaneous growths, the buccal secretions, the nasal discharge, and sometimes in the excrement ; they may readily be disseminated, and are much more dangerous when mixed with particles of organic matter. Parrots inoculated by man, therefore, become in turn permanent centres of tuberculous infection. Digitized by Microsoft® IIL— EXPERIMENTAL TUBERCULOSIS IN THE GOAT. By MM. Cadiot, Gilbert, and Roger. Not all mammals are equally prone to contract tuberculosis, and it has been suggested that the goat and dog are almost completely refractory. Cases and experiments published during the last few years have, however, shown, contrary to formerly held opinion, that the dog has no particular immunity, and we believe the same is true of the goat. Cases of spontaneous tuberculosis — that is to say, tuberculosis occurring apart from experimental inoculation — are, it is true, rare, but this is partly due to the small number of goats which are kept, to the little attention which has as yet been given to their diseases, and to the conditions under which they live. We know, in point of fact, that goats usually live in the open air ; in poor countries they seldom leave the hills ; under other circumstances they are kept in special sheds, and are therefore little exposed to contagion. Now the majority of reported cases refer to animals which lived in stables with cows or horses. In 1 871 Carsten Harms published the history of a goat which had been ill for six months, and on the post-inorteiii examination of which he found tubercles and cavernous spaces in the lungs. Gerlach published a similar case. Lydfin and Motz reported five others. In a case mentioned by Sluys, Korevaar, and Thomassen, infection appeared due to the use of milk from a tuberculous cow ; the lesions seen on autopsy were extremely extensive ; they affected the intestine, mesenteric glands, liver, spleen, kidneys, and lungs. We may also refer to Konig's case, where the mesenteric glands, liver, and lungs were affected, and d' Alston's, in which tubercles were discovered in the lungs and bronchial glands. This problem has been taken up by experimental pathologists, and a certain number of instructive cases related. The goat proves to be no more refractory to infection by the digestive tract than other Digitized by Microsoft® 576 CLINICAL VETERINARY MEDICINE AND SURGERY. domestic animals ; Bollinger's experiments remove all doubt on that point. Wesemer, who summarised all experiments made between 1865 and 1S84 regarding this question, found that in the goat, as in the calf and sheep, the results were positive in about 50 per cent, of cases. Among more recent work may be cited an interesting experi- ment by M. Nocard. On November 3rd, 1885, a goat was inoculated by injecting a certain quantity of tubercle culture into the jugular vein. The animal was killed in 1890. Its lung was riddled with cavernous spaces, and caseous or encysted nodules in which bacterio- logical examination revealed tubercle bacilli. This case is all the more remarkable inasmuch as the organism used was probably that of avian tuberculosis, the only one then cultivated in France. M. Nocard supposed that tuberculosis had only developed because the goat employed had become affected with mange, which had enfeebled its general health ; and he states that as a rule the goat " is almost absolutely refractory to tuberculosis, or at least is inocu- lated with difficult}'."' M. Colin again took up the question. He subcutaneoush' inoculated a goat with bovine tuberculosis. The animal was killed at the end of two months. Characteristic lesions were found at the point of inoculation, in the lymphatic glands of the corresponding side, and in the lungs. With this result before him M. Colin had no hesitation in declaring that the goat is not refrac- tory to tuberculosis. This is also the opinion of M. Galtier, who, whilst freely admitting the rarity of spontaneous tuberculosis, recognises that the disease ma}' be experimentally transmitted. Such a collection of facts appears convincing. Undoubtedly the objection may be made that in the old experiments tuberculosis was not produced, but the objection is not of much value, for the lesions noted were as typical as those of the ox ; and in more recent re- searches the detection of the tubercle bacillus entirely removed this objection. As some authors continue to maintain that goats are refractory to tuberculosis we may here briefly give the results of three fresh experi- ments. On the 28th January, 1892, two goats were inoculated by intra- peritoneal injection with tuberculous material from a dog. They were killed on the 8th May. In the first tubercles were found on the peritoneum, in the mesenteric glands, lungs, and mediastinal glands, and some granulations in the liver and kidneys. In the second tubercles were also found on the peritoneum, and in the lungs and liver, while the chest contained a slight amount of exudate. Digitized by Microsoft® EXPERIMENTAL TUBERCULOSIS IN THE GOAT. 577 On the 29th July, 1892, a third goat was subcutaneously and intra- peritoneally inoculated with tuberculous material from a horse. It remained in good condition until October. From that time it began to lose condition, and in spite of its appetite remaining good, wasting /. H.V[ Fig. 84. gradually became more marked until death occurred on the 6th April, 1893. The autopsy revealed somewhat extensive lesions. On opening the abdominal cavity a quantity of greyish liquid, holding in suspension fibrinous flocculi, escaped. The parietal and visceral peritoneum was covered with fine granulations and tubercles, some the size of a hazel nut. The lesions were confluent over the entire extent of the epiploon, and in the portions of the peritoneum covering the lower wall of the abdomen, diaphragm, and rumen. The o o Digitized by Microsoft® 578 CLINICAL VETERINARY MEDICINE AND SURGERY loops of intestine were glued together, and to the parietal peritoneum by numerous adhesions. The liver, spleen, and kidneys were infil- trated with tubercles. All the abdominal lymphatic glands were affected. The thoracic cavity contained half a pint or more of greyish serosity mixed with fibrinous flocculi. The pleura was completely covered with fine granulations. On its diaphragmatic portion were tubercles varying in size between a millet seed and of a haricot bean. Along the course of the aorta the mediastinal glands formed a voluminous, fusiform, greyish mass marked with numerous little greyish-white tubercles. The surface of both lungs — and particularly that of the posterior lobes — showed prominent greyish tuberculous growths, the centres of which were softened ; similar growths had developed in the depths of the lungs. Even the heart was invaded, the myocardium of the left ventricle showing a large tuberculous growth (Fig. 84). The tubercle from the heart was examined histologically, and for tubercle bacilli. Almost the whole of this tubercle was composed of degenerating cells. Only the periphery contained masses of living cells. In places the growth had undergone fibrous change, and these contained numerous bacilli. The cases and experiments we have described in this note appear sufficiently numerous to carry conviction. We were, therefore, some- what surprised to see in a recent book that the goat is refractory to tuberculosis, and that up to the present day no observations have been published proving the occurrence in it of tuberculous lesions. The slightest bibliographical search would have convinced the author of his error. But, if the goat possesses no immunity, what becomes of that method of treatment, which consists in transfusing its blood into the veins of phthisical patients ? As no serious experiments appear to justify this method of treatment its application to man is entirely unwarranted. Luckily the suggestion almost immediately fell into well deserved oblivion. .,-,1 Digitized by Microsoft® IV.— MALIGNANT TUMOURS IN ANIMALS. By MM. Cadiot, Gilbert, and Roger. Animals frequently suffer from tumours similar to those affecting man. The occurrence of such lesions was recognised by the oldest authors who devoted their attention to animal pathology. They are mentioned in the writings of the Greeks and Latins, and in the works of the Hippiatres, but the merit of having first given exact descriptions of some of them, and of having shown their frequency in carnivora — especially in the dog — must be ascribed to Huzard in the eighteenth century. From 1825, when the first French veterinary medical journals appeared, the question was studied by a large number of observers, among whom may be mentioned Trousseau and U. Leblanc, Gerlach, C. Leblanc, Trasbot, and Plicque. At the present day we know that cancer may occur in all species of animals. The fact that it has seldom been noted in the goat and sheep is undoubtedly due to neglect of the pathology of these animals ; what is true of tuberculosis probably applies also to cancer ; cases will be found if trouble is taken to look for them. Among the domestic animals the dog is most frequently affected with new growths, then the horse, and afterwards the cat, ox, and pig. In birds, tumours are not uncommon, but many show special histo- logical characters. etiology and Pathogeny. — In animals the aetiology of tumours is as obscure as in man. The influence of heredity seems established by several cases. We saw a bitch which had twice been operated on at intervals of a year for cancer of the mammary gland. Two of her progeny were also attacked with mammary cancer, one when four years old, and the other when five, that is, at ages when epithelial new growths are somewhat rare. Age plays an important part as a predisposing cause. Of thirty- three cases in the dog, in which the age was exactly known, the figures were as follows : — one case at three years ; one at four years ; two at five years ; four at six years ; nine at seven to eight years ; eight af. Digitized by Microsoft® 5 so CLINICAL VETERINARY MEDICINE AND SURGERY. nine to ten years ; five at eleven to twelve years : two at fourteen years ; and one at twenty years. In the horse the age varies between seven and fifteen years. The nature of the congenital tumours described by some authors has not been established by sufficiently exact microscopic examination to justify us in admitting their existence. Primary cancers generally appear on the surface of glandular organs, or in external parts exposed to mechanical irritation. It has been suggested that in the horse friction of the harness is sufficient to produce cancer. In reality these growths are chronic inflammatory indurations, sometimes exhibiting the appearance of fibromata, or are parasitic lesions due to the presence of bothryomyces. Mere mechanical injury is not sufficient to produce the growth of tumours; observation tends to establish this point, and experiments also point in the same direction. We mechanically irritated the mammary gland in several old eczematous bitches ; every day, or every two days the glands were compressed and bruised by means of strong wooden for- ceps ; although the experiments were continued for months, we never succeeded in producing new growths, and only in two cases did an abscess form. Mechanical injury, therefore, only plays a secondary part. The same is true of the hygienic conditions under which animals exist. Contrary to the statements of some authors, we believe that it is impossible to render animals cancerous by submitting them to special life conditions. But it seems, according to Leblanc's state- ment, that animals restricted to meat diet and chained or shut up are more often affected with cancerous lesions than others. Among predisposing causes it is still usual to mention gout. M. Trasbot strongly insists on the part played by this diathesis. According to him, dogs, and even horses, suffering from cancer have almost always previously shown eczematous eruptions. At the present time the tendency is to consider cancer as a parasitic affection, and cases have been described in man which appear to establish this contagious character. We have noted nothing similar in animals. All the attempts we have made to transmit new growths from man to the dog, from dog to dog, or from the dog to the rabbit or fowl, have uniformly failed ; nor were we more successful in attempting to graft fragments of their own tumours on healthy parts of cancerous dogs. On two occasions we seemed at first to have obtained a positive result ; but in one of these cases the secondary tumour had none of the histological cha- racters of the primary ; and, in the other, the lesions, though offering Digitized by Microsoft® MALIGNANT TUMOURS IN ANIMALS. 581 the macroscopic appearances of cancer, proved in reality due to tuber- culosis. These two cases led us to doubt the old records and those in which the histological or bacteriological characters of the lesions produced have not been carefully studied. We may add, however, that we succeeded in transmitting to dogs papillomatous vegetations developed on the glans penis of an affected dog. The growths thus produced, however, remained local and underwent retrogressive processes, be- having in fact like simple grafts. MM. Duplay and Cazin have related a similar case. Negative results do not justify us in denying the parasitic nature of cancer. They simply suggest the need for modifying our experimental methods, for they tend to show that we shall not solve the problem by merely multiplying inoculations by processes hitherto employed. Position of the Tumours. — In animals, as in man, cancer may attack the most varied tissues, but shows a well marked predilection for the mammary gland. Of thirty-eight cases observed in dogs eighteen consisted of mammary tumours, a fact which explains the greater frequency of cancer in the bitch. After the mammary gland the testicle is one of the organs most frequently attacked. Retention of this gland within the abdomen seems to predispose it to degenerative new growths. It is not uncommon to find cancerous testicles in monorchid or cryptorchid horses. Malignant tumours also occur with some frequency in certain exposed parts and on certain mucous membranes. The nose and sinuses of the face are the seat of various new growths. The same is true of the digesti\-e tract. Cancer of the tongue is exceptional ; that of the lips, though rare in large animals, is fairlj' frequent in old dogs, in which, however, it must not be confused with a special affection which has long been regarded as of epitheliomatous nature. This so-called canchroid of the lip is oftenest noted in the cat, and has also been seen in the dog ; it is an ulcerative inoculable lesion, but it heals with great facility. On histological examination the growth shows no resemblance to cancer. Cases have been published of cancer of the pharynx (Benjamin) ; of the oesophagus (Lorenz) ; of the stomach in the horse (Roloff, Mouquet, and Cadiot) ; of the pylorus in the dog (Miiller) ; of the rumen (Siedamgrotzky) ; and of the reticulum in the cow (Beylot) ; of the intestine (numerous observations) ; of the anus (Trasbot) . Some- times the abdominal viscera are affected, as the pancreas (Nocard, Martin) ; liver (Benjamin and Martin) ; kidney (Siedamgrotzky, Johne, Digitized by Microsoft® 582 CLINICAL VETERINARY MEDICINE AND SURGERY. Harvey) ; bladder (Martin and Stolz) ; prostate (Cadiot) ; and other parts of the genital apparatus. We have already mentioned the frequency of new growths in the testicle. Cases have also been seen of cancer of the penis, of the sheath, and of the ovary (Kriiger) ; uterus (Giirlt, Lucet), and vulva (Martin). Contrary to the experience of human surgeons, cancer of the uterus is, in animals, extremely rare. Among the other organs affected we may mention the parotid (Laugeron and Cadiot) ; pituitary gland (MoUereau) ; thyroid gland (Cadiot) ; the lung and maxillaries (Leisering, Barrier, Cadiot) ; neck (Mtiller) ; tail (Miiller, McFadyean). We have several times seen cancer of the eye in the horse and dog. Mauri saw pulmonary cancer with secondary growths, in the ox. \^isceral cancers are much rarer than was formerly believed. In a great number of cases the growths found in the thoracic or abdominal viscera, are due to tuberculosis. This mistake has long been made in connection with the dog, for in this animal tuberculosis often produces large growths which invade the viscera, especially the liver and lungs, or the serous membranes, particularly the peritoneum and pleura. The mistake may not be discovered even on histological examina- tion, because the structure of the growth rather recalls sarcoma or lymphadenoma than tubercle. Only the detection of bacilli and the results of inoculation reveal the true nature of these growths. The same remarks apply to the horse. Many cases regarded as lymph- adenoma or ^•isceral tumours are really due to tubercle. Growths produced by vegetable parasites have long been mistaken for cancer, and especially for sarcoma. Among such are bovine actinomycosis and equine bothryomycosis, both of which, however, are well known and readily diagnosed at the present day. It v/ould almost seem that acari may excite the development of new growths. In an old bitch suffering from tumours of the vulva, which had deformed the vagina and at certain points had perforated its walls, microscopic examination showed the new growths to be formed of round cells, amidst which acari were discovered. To sum up, animals may show lesions resembling tumours, which, however, have been produced by the most varied processes, some tuberculous in character, others due to, vegetable parasites, like actino- mycoses and bothryomycoses, or to animal parasites, like acari ; others, again, of an ulcerous nature resulting from the action of microbes, like canchroid of the lip in the cat. ^lost of the older writers having failed to sufficiently guard against these causes of error, it is difficult to draw conclusions from their reports. Confusion has occurred even in recent experiments, a fact Digitized by Microsoft® MALIGNANT TUMOURS IN ANIMALS. 583 Which explains the opinion still held that sarcoma is more frequent than carcinoma. Thus Semmer, after examining fifty-seven malignant tumours, which he had collected, found thirty-two sarcomatous and twenty-five carcinomatous. In a special report he related fifty-six new cases of sarcoma. In the table printed below we have compared Semmer's figures with our own. It will be noted how widely our results differ from his. According to our researches, chiefly on the dog, epithelioma is much commoner than sarcoma. The opposite opinion is probably due to the mistakes so often made between sarcoma and tuberculosis.* Species of Animal. Semmer's Statistics. Our own Statistics Carcinomata. Sarcomata. Tumours of Epitheliomata 1 Sarcomata doubtful character. ^ Dog . . Horse . . 7 14 17 7 30 12 27 n .4 I — Ox Cat 4 I 4 2 I — — Birds Fishes . 4 I 6 2 — — 3 25 32 56 32 12 3 The figures showing the frequency of tumours in animals treated at the Berlin, Munich, and Dresden schools, for an average period of seven years, are as follows : — Of 86,113 diseased horses, 1113 suffered from tumours = i'3 per cent. Of 85,537 diseased dogs, 4020 „ ,, ,, =47 » Of 4972 diseased oxen, 102 ,, ,, ,, =2 ,, Frohner determined the nature of 643 tumours removed from dogs in the cHnique for small animals at the Berlin school. He found : 306 malignant tumours («. e. about 47 per cent.) ; 262 epitheliomata (40 per cent.) ; and 44 sarcomata (7 per cent.). Of 47 new growths removed from the horse, 16 were malignant (34 per cent.) ; 10 sarcomata (21 per cent.) ; and 3 epithehomata (6 per cent.). Of 75 new growths from oxen, the histological examination of which was carried out by * In his Pathologic der Geschw illste bei Thieren, Caspar has collected interesting statistics regarding tumours in animals from the reports made by the professors of clinical medicine and pathological anatomy in the German veterinary schools. Digitized by Microsoft® 584 CLINICAL VETERINARY MEDICINE AND SURGERY. Eggeling of the ambulatory clinique at Berlin, 22 were malignant (29 per cent.) ; 20 sarcomata (27 per cent.) ; and 2 epitheliomata (2'7 per cent.). A pathological report by Johne comprises a description of all the new growths seen in 4439 animals examined after death at the Dresden school during a period of sixteen years : — Of 1181 horses, 128 suffered from tumours (11 per cent.) ; of 1600 dogs, 93 suffered from tumours (5'8 per cent.) ; of 1658 oxen, 104 suffered from tumours (6'3 per cent.). Among the 128 tumours from the horse were 60 sarcomata (47 per cent.), and 28 epitheliomata (22 per cent.). The 93 tumours from the dog furnished 48 epitheliomata (52 per cent.), and 26 sarcomata (28 percent.). The 104 tumours from Fig. 85. — Epithelioma of the mammary gland (bitch). The centres of the alveoli contain a hyaline substance. ^P^ ^0. 4 Fig. 86. — Epithelioma of the mammary gland. The central portions of the alveoli are occupied by degenerating cells. the ox gave 36 sarcomata (35 per cent.), and 8 epitheliomata (8 per cent. The differences revealed on comparing these clinical and anatomo- pathological statistics are explained by the fact that the first referred almost exclusively to external tumours, whilst the others took note of the total number of new growths found in different organs. It is also well to remark that the majority of these statistics were collected at a time when the lesions of actinomycosis, bothryomycosis, and tuber- culosis were included under the title of sarcomata. But taken as a whole the results given confirm the greater frequency of epithelial tumours in the dog as compared with the horse and ox ; and they again show that in the herbivora these tumours are not so exceptional as is generally suggested. Histological Appearance. — All authors agree in recognising the Digitized by Microsoft® MALIGNANT TUMOURS IN ANIMALS. 585 frequency of mammary tumours. We have studied nineteen, one of which was obtained from a mare ; the others being of canine origin. The tumour from the mare, and eleven of the tumours removed trom bitches, showed the histological appearances of epitheliomata. Ihey were composed according to the classical schema of a stroma surrounding alveolar cavities. In these cavities the epitheliomatous cells were generally arranged around the margin, producing acini, in the centres of which was sometimes found a clear substance exuded undoubtedly by the newly formed cells (Fig. 85) ; but most frequently (Fig. 86) degenerating cells without nuclei, which were stained a dirty yellow by picrocarmine. At places the new growth deviated from the original type and showed irregularly arranged cells contained within alveolar cavities, or grouped together in large masses. In some cases the stroma predominated, displacing the new cells and producing the appearance of scirrhous cancer. Among other tumours developed in the mammary glands we first Fig. 87. — Fusiform-celled sarcoma from the mammary gland of the bitch. mention two fusiform-celled sarcomata (Fig. 87). The cells contained large nuclei provided with clearly marked nucleoli ; at certain points degenerating cells could be seen. In three cases we found a form of sarcoma with rounded or oval cells massed together or scattered through a chondroid, hyaline, or fibrillated substance, showing at several points true chondroplasts pro- vided with cartilaginous cells (Fig. 88). In other cases the development of the growth had led to formation of a tissue resembling bone ; of this we saw two examples. In one the tumour was formed of granular blind sacs alternating with hyaline cartilage and osteoid growths ; osteoplasts and canaliculi could even be detected, though the latter were less numerous and less well defined than normal. Digitized by Microsoft® 586 CLINICAL VETERINARY MEDICINE AND SURGERY. The other case was that of an aged bitch, in which the new growth had existed for two years and had returned after partial ablation; When the animal was killed the mammary gland and lungs were found to contain tumours of cartilaginous appearance, ossified in places. Histological examination showed that the tissue resembled the spongy tissue of bone and contained intercommunicating areolae. The osseous portions were pierced with little angular cavities filled with nucleated cells ; they differed from normal bone inasmuch as there was no lamellar arrangement and no Haversian canals, while the basement substance stained red with picrocarmine. The areolae surrounded by Fig. S3.— Chondroid sarcoma of the mammary gland (bitch.) this osteoid tissue contained cells like those in bone marrow (Fig. 89). After those of the mammary gland, tumours of the testicle are amongst the most frequent. We have examined five, three from the dog and two from the horse. In the horse the tumour may attain considerable size : in one case it weighed four and a half lbs. ; in another affecting a retained testicle the weight was 6 lbs. 10 ozs. All five tumours had a very similar appearance. They consisted of a stroma, according to the development of which in various parts the new growth resembled encephaloid or scirrhous cancer. The Digitized by Microsoft® MALIGNANT TUMOURS IN ANIMALS. 587 individual characteristics of the cells and general arrangement of the cylinders recalled the appearance of normal testicle tissue (Fig. 90). In animals cancer not infrequently appears first in the nasal fossae, or in the facial sinuses. Sometimes it originates in the paradental Fig. I.- -Osteoid sarcoma of tiu mammary jland (bitch). epithelial debris and invades the superior maxilla. We have collected three cases of these various localisations in the dog and two in the horse. One of the dogs exhibited a lymphadenoma readily recognisable by its reticulated stroma containing small round cells and vessels with normal walls. The two other dogs showed alveolar epitheliomata, in which the stroma was scanty and the cells polyhedral or polymorphic. The lesions were very different in the horses ; one horse showed a ^^S'^^^^^l^l ^m:^ ?;T7;*5.r'5, Fig. go. — Epithelioma of the testicle (dogl. globo-cellular sarcoma ; in the other the tumour was more complex, being formed of rounded cells, among which were disposed epithelio- matous tracts. Digitized by Microsoft® 5o8 CLINICAL VETERINARY MEDICINE AND SURGERY. Cancer may attack any of the glands of the digestive tract. In the dog we have seen epithehoma of the parotid (Fig. 91) remarkable for the presence of epidermal nests. This appearance, also seen in man, Fig. 91. — Epithelioma, of the parotid (dog). is explained by the embryological origin of the parotid, which forms a simple outgrowth of the buccal mucous membrane. One of the most curious of all the epithelial tumours was seen in an Fig. 92. — Pavement epithelioma of the stomach (mare). eleven-year-old mare which, though previously in good health, rapidly succumbed to an accidental infection. On post-mortem examination Digitized by Microsoft® MALIGNANT TUMOURS IN ANIMALS. 589 the stomach was found to contain an enormous cancer, which had remained completely latent. The new growth occupied the left side of the stomach, and was irregularly triangular in form,, with its base Fig. 93. — Epithelioma of the peri-ana! gland (bitch). uppermost ; it measured ten and a quarter inches in length, and nine and a half inches in breadth ; its surface was ulcerated and covered with reddish mammillated vegetations. The lesion, which had extended three eighths of an inch into the oesophagus, stopped abruptly at the line of separation between the cuticular and villous portions of the gastric mucous membrane^ altogether avoiding the latter. At its margin the wall of the stomach was thickened, indu- rated, and in places oedematous. The growth occupied that portion of the gastric mucous membrane which in the horse is continuous Fig. 94. — Sebaceous epithelioma (dog). with the oesophagus. Microscopic examination showed, as a know- ledge of anatomy would lead one to anticipate, that the tumour was of the pavement epitheliomatous type (Fig. 92). Digitized by Microsoft® 59° CLINICAL VETERINARY MEDICINE AND SURGERY. We also examined a tumour developed in the anal region of an eight-year-old bitch. This tumour, which had existed for a year and attained the size of a hen's egg, was composed of tracts of cells, divided, subdivided, and separated from one another by partitions of fibrous tissue. The cells were polyhedral in shape and formed of a mass of protoplasm which stained yellow with picrocarmine, surround- ing a circular or oval nucleus ; none showed any signs of degeneration (Fig. 93). The analogies between this new growth and certain tumours of the liver, pancreas, and kidney led us to regard it as of glandular origin ; a view strengthened by histological examination of the perianal region in the dog, in which we found many glands pre- FiG. 95. — Fusiform-celled sarcoma of the vertebral column (dog). senting a striking resemblance in structure or arrangement to the tumour examined. We have studied three cases of cancer of the skin. In one the tumour was in the anal region and consisted of a pavement epithe- lioma containing epidermal nests. In another the lesion had origin- ated from certain sebaceous glands. The patient, a seven-year-old dog, showed a large number of verrucous tumours about the body. One of these the size of a hazel nut was excised ; it consisted of masses of cells similar to those in the Malpighian layer of the skin ; the Digitized by Microsoft® MALIGNANT TUMOURS IN ANIMALS. 59I central cells were infiltrated with fat globules or had undergone fatty degeneration ; at several points these degenerated cells were sur- rounded by other flattened cells arranged in lamellae (Fig. 94). The third consisted of an epithelioma the alveoli of which contained small rounded elements. Sections showed numerous cells resembling those described by various authors as coccidia. We have several times noted cells of this character, but in the above cases they were particu- larly abundant and remarkable. Although the source of the cancer was evident in the two first cases it was extremely doubtful in the third. In passing we may also mention the various epithelial tumours affecting the point of the elbow, thoracic walls, lung, thyroid body, penis, and lips in the dog. In a cat we saw an epithelioma occupying the thoracic wall, and the substance of the lungs. Though rarer than has usually been described, sarcoma is never- theless fairly frequent in the dog. We found a round-celled sarcoma in the elbow region, and a fusiform-celled sarcoma on the buttock. We had under observation a nine-year-old sheep dog with complete paraplegia, accompanied, however, by persistence of cutaneous sensa- tion, due to a tumour which had destroyed the body of the first lumbar vertebra ; it projected considerably into the neural canal, and was almost as large as a fowl's egg. This tumour proved to be a fusiform celled sarcoma (Fig. 95), containing tracts of osteoid tissue, which stained rose-red with picrocarmine, and were pierced with stellate cavities provided with canaliculi, resembling in shape osteo- plasts. In two horses we saw lesions resulting from repeated mechani- cal injury. In one case a tumour, the size of a man's fists, had developed on the anterior margin of the shoulder beneath the collar. In another the growth had existed for two j^ears. It was located on the metatarsus of the near hind limb, a little above the fetlock, was very large and ulcerated on the surface. It had returned after removal. These new growths were not true tumours but chronic inflammatory growths formed by fibrous tissue. We mention these cases because without recourse to the microscope they might have been mistaken for cancerous tumours, the result of injury. The return after operation and the ulceration of the surface might seem to justify such a view. . , t .1. r x We have also seen tumours in three fowls. In one case the ieet were the seat of soft new growths. In the two others, numerous tumours, varying in size between a haricot bean and a hazel nut, were found in the liver, spleen, lungs, intestine, and peritoneum. These Digitized by Microsoft® S92 CLINICAL VETERINARY MEDICINE AND SURGERY various lesions, which were unsuccessfully used for inoculating other fowls, rabbits, and guinea-pigs, were all of similar structure, being formed of small, closely packed, polyhedric cells provided with large nuclei. A considerable number of vessels were seen, but no stroma could be discovered. These peculiar tumours differed considerably from any seen in mammals. To facilitate study of the results of our research we recapitulate them in the form of a table. Species o£ Seat of the Tumours. Animal. 'Mammary gland Testicle . Facial sinuses and superior maxilla . Parotid gland Peri-anal glands Thyroid gland Dog, 38 cases Skin . Lips . Penis . Lungs Thoracic wall . Buttock . Elbow region Spinal column . 'Mammary gland Testicle . . . . Horse, 5 cases. Facial sinuses ^Stomach . . . . Cat Thoracic wall and lungs Fowl . . 'Feet Viscera Nature of the Tumours. Number. {Adenoid epithelioma . Fusiform-celled sarcoma Chondroid sarcoma . Osteoid sarcoma Adenoid epithelioma f Alveolar epithelioma . \ Lymphadenoma .... Epithelioma with epidermal " nests" Adenoid epithelioma . Epithelioma with small polyhedral cells Pavement epithelioma with epidermal " nests " . '^ Small-celled epithelioma . L Epithelioma of the sebaceous gland . [ Epithelioma with tendency to scirrhous L transformation Adenoid epithelioma . Epithelioma Epithelioma Fusiform-celled sarcoma f Roimd-celled sarcoma \ Epithelioma Fusiform-celled sarcoma Adenoid epithelioma Adenoid epithelioma . f Epithelioma . . . . \ Globo-cellular sarcoma J Pavement epithelioma with epidermal \ " nests " . . . . . Cylindrical epithelioma Masses of polyhedral cells . Masses of polyhedral cells . II 2 3 2j 3 2 }' When cancer occurs in parts accessible to manual examination, it first appears as a swelling, which gradually increases in size and soon becomes adherent to the skin. In almost all cases the primary lesion is surrounded by hard, irregular, lymphatic chains running towards the neighbouring lymphatic glands, which are enlarged. Secondary tumours next appear, either around the new growth or over the track of the indurated lymphatics. At the same time the tumour increases in size, becomes bosselated and sometimes ulcerated at certain points. The mode of development of cancer varies extremely. Speaking Digitized by Microsoft® MALIGNANT TUMOURS IN ANIMALS. 593 generally, sarcoma grows more rapidly than carcinoma, and although it has less tendency to invade the skin and lymphatic glands, it pro- bably more often becomes generalised in the viscera. One of us reported a case of primary sarcoma of the femur in a large dog, which died in consequence of invasion of the lungs ; on post-mortem examina- tion more than 2000 tumours were counted on the surface of the interual organs. Despite the existence of cancer the patient's general condition may remain good. This is particularly the case in cancer of the mammary gland. Distinct wasting may only commence after one or two years. When the lesions become generalised the animals appear weak and depressed, showing a train of symptoms depending on the organs attacked. As death approaches the white blood-corpuscles usually increase in number. In the dog just mentioned, the proportion shortly before death was one leucocyte to seventy-three red blood-corpuscles. Incomplete ablation of cancerous tumours is always followed by , return, the new tumour generally developing more rapidly than the primary. But early and total extirpation seems to give better results than in man. Horses and dogs which had been operated on were under observation for periods of a year, eighteen months, and two years without showing any return. To sum up, cancer in animals seems, in a general sense, less grave than in man. It has a greater tendency to remain localised to the point of origin and returns less rapidly and less frequently. But these differences are far from being absolute, and in spite of the reserve with which we have spoken, it must be recognised that in all mammals cancer presents the same anatomical and clinical characters. We have sufficiently dwelt on the microscopic appearance of the new growths and shall not therefore return to it. We simply add that examination of tumours in animals affords powerful evidence in favour of the epithethelial origin of cancer. It shows that the tumour presents special characters indicating its origin, as we pointed out when speaking of new growths in the mam- mary gland, testicle, and skin, and when describing the case of the horse with a pavement epithelioma developed on the cuticular portion of the gastric mucous membrane. It is also interesting to note that tumours of the mammary gland have a tendency to develop into complex types and to undergo chondroid, or even osteoid, transforma- tion. This tendency is also seen in man, though in an infinitely smaller proportion of cases. p p Digitized by Microsoft® S94 CLINICAL VETERINARY MEDICINE AND SURGERY. Our object in this report has been to give the results of our personal researches. For this reason we make no mention of certain neoplasms, like melanotic tumours, which are very common and are almost always of sarcomatous character (Cornil and Trasbot). In conclusion, we again draw attention to the difficulty of utilizing old records in the synthetic study of malignant tumours, on account of the frequent confusion which has occurred between cancer and parasitic, or tuberculous-lesions. Digitized by Microsoft® PART V. EXPERIMENTAL THERAPEUTICS. I,— THE TREATMENT OF TUBERCULOSIS. In the experiments hitherto made regarding the serum treatment of tuberculosis five principal methods have been adopted : (i) Injec- tion of blood, or serum, from animals regarded as refractory to tuber- culosis ; (2) injection of extracts of organs from such animals ; (3) injection of blood or serum from animals previously inoculated with virulent tuberculous material, or with living cultures ; (4) injection of serum from animals previously inoculated either with tuberculous pro- ducts, with sterilized cultures, or with tuberculin ; (5) injection of serum from animals inoculated with certain soluble products derived from tubercle bacilli. MM. H6ricourt and Richet, in a note communicated to the ' Academic des Sciences,' announced the result obtained by intraperi- toneally injecting into rabbits already inoculated with Staphylococcus pyosepticus, blood from normal healthy dogs, or from dogs which had been inoculated with this staphylococcus and had recovered from the local infection thus produced. In certain cases injection of normal blood was followed by recovery, but when blood from prepared dogs was used all the rabbits survived. Concluding from these results that the blood injected exercised a microbicide action, MM. Hericourt and Richet asked themselves whether this influence of dog's blood did not apply to other diseases, to which the animal is but little sensitive, and they, therefore, extended the treatment, by injection of blood, to certain of these diseases, among others to tuberculosis. Experimenting on rabbits inoculated with cul- tures of bovine or avian tuberculosis, they found that animals which received, injections of dog's blood died in the proportion of only 17 per cent., whilst in control animals the mortality was 55 per cent. Digitized by Microsoft® 596 CLINICAL VETERINARY MEDICINE AND SURGERY. As early as 1881 M. Bouchard had succeeded in increasing the re- sistance to the pyocyanic bacillus by injecting into the rabbit's veins blood or serum obtained from the dog. Shortly afterwards he found that the serum possessed similar immunising powers and produced the same therapeutic effects as blood itself. Starting with these facts and the then very general belief that goats were refractory to tuberculosis MM. Bertin and Picq subjected rabbits inoculated with tuberculosis to injections of goats' blood. According to their observations this fluid in doses of 2*50 grammes per kilo of body-weight checked the development of the disease, and even cured animals when treatment was commenced shortly after inoculation. These authors and M. Bernheim applied this method of treatment to man; M. Lepine also tested in man the effects of injecting goat's serum. The experiments undertaken by M.Bouchard in i8gi, and published in January, 1892, show that the blood and serum of animals which are refractory (or were so considered), and of the goat in particular, far from having a favourable influence when injected into tuberculous animals often appeared to exercise an absolutely injurious eff'ect. He says : — " As a whole the cases inoculated have been graver and more rapidly fatal in the guinea-pigs treated than in the control animals." The end of the year i8go had been marked by an important dis- covery which inaugurated the era of sero-therapy. Behring and Kitasato had discovered the existence of anti-toxic substances in the fluids of animals vaccinated against tetanus and diphtheria. They had found that the blood of animals rendered refractory, either by Nicolaier's or Loffler's bacillus, had the power of neutralizing or rendering harmless the toxins of these bacilli ; that this property ex- tended to the serum as well as to the unaltered blood ; and that it permitted of definite treatment. Everyone knows the results of sero- therapy in diphtheria and tetanus. Attempts were, therefore, made to effect for tuberculosis what had been done for tetanus and diphtheria ; efforts were made to immunise animals (goat, sheep, dog, horse), to bring about by various methods the production of tuberculous antitoxins in the bodily fluids of these animals. Numerous experiments were undertaken with this object. We should specially mention those of MM. Hericourt and Richet, who prepared serum-yielding animals by injecting them with virulent tuberculous cultures, both human and avian ; those of Behring, who produced an antitoxic serum by injecting different animals with tuber- culin ; of Nieman, who prepared dogs and goats by injections with an alcoholic extract of tuberculin ; of Maragliano, who first injected all Digitized by Microsoft® THE TREATMENT OF TUBERCULOSIS. 597 the toxic substances extracted from very virulent cultures of human tuberculosis and afterw^ards a quantity of tuberculin ; those of Babes and Proca, who successively injected avian and human tuberculin, followed by dead bacill of avian and human origin. According to the investigators who prepared them, certain of the sera thus obtained had a real antitoxin action ; they prevented the development of bacilli and secured recovery from experimental tuber- culosis. But as a whole the results seemed very uncertain, and despite the optimistic conjectures indulged in, the future of serum treatment for tuberculosis remained undecided. The experiments of Gilbert, Roger, and Cadiot were commenced in 1892. Observed facts and experiments had shown that certain animals previously regarded as refractory to tuberculosis, among others the goat and dog, were in reality moderately sensitive to it ; but, struck by the resistance of the Gallinaceas to mammalian tuberculosis, these observers studied the action produced by the defibrinated blood and serum of birds on its evolution. In order to obtain sufficient quantities of blood and serum they chose the turkey, in which puncture of the humeral vein yields a considerable quantity of blood, and which can be bled two or three times per month for a consider- able period. Several series of experiments made on the guinea-pig showed that the serum and defibrinated blood of birds injected under the skin or into the peritoneum have no greater action on tuberculosis than similar fluids obtained from mammals. They in no way check the course of the disease ; and, in fact, a certain number of the animals treated died before the controls. They afterwards studied the action of serum from turkeys previously injected with tuberculous material by way of the veins. For several months these birds were periodically injected with one half to one fluid drachm of an emulsion prepared with tuberculous products, most frequently from the dog. The injections were repeated every week or fortnight, the total number of virulent injections vary- ing between six and twelve. Some weeks after the last, when bacilli had disappeared from the blood, the defibrinated blood or serum was used. In a certain number of guinea-pigs treated at the therapeutical laboratory of the Faculty of Medicine with serum thus obtained, the development of tuberculosis was manifestly less rapid than in control animals. In another series of experiments serum-yielding animals were pre- pared by injecting into the veins or peritoneum doses of fifteen to Digitized by Microsoft® 598 CLINICAL VETERINARY MEDICINE . AND SURGERY. forty-five minims, either of diluted tuberculin, or . of living or dead cultures of canine tuberculosis, suspended in sterilised water. Except in birds, in which they produced disturbance, .these injections were repeated eight to twelve times, at intervals of one to two weeks. The sera thus obtained were of no value ; either the animals treated died of tuberculosis like the controls, or both subjects and controls showed tuberculous lesions similar in point of intensity and generalisation when (regarding it as useless to prolong the experiment until the subjects died) the survivors were killed. - It is known that in tuberculous patients specific buccal lesions are relatively rare, although tubercle bacilli are to be met with in the mouth of many consumptives, being carried there by expectoration. Starting with this fact, M. Bloch, Doctor at the National Asylum at Vincennes, propounded the question whether saliva might not exercise an attenuating action on the tuberculous virus and on the infection it produces. In tuberculosis especially every theory founded on observed facts deserves to be submitted to experimental proof, and therefore M. Cadiot undertook an inquiry into the influence which injections of saliva might exercise on the development of the disease. Guinea-pigs rendered tuberculous by intra-peritoneal inoculation of a culture of canine tuberculosis emulsified in sterilised water were treated with parotid saliva collected aseptically from a horse. On the 1st September, 1898, M. Cadiot commenced the treatment of a pre- liminary group of eight guinea-pigs inoculated on August 14th, and of a second group of eight guinea-pigs inoculated on the 31st August. In each series five subjects were treated. In three, sixteen to thirty- two minims of saliva were injected into the peritoneum every two or three days ; in the other two the injection was made hypodermically. Three animals were reserved as controls. On the 22nd September one guinea-pig of the first group, which had been inoculated eight times in the peritoneum, died. On autopsy enormous tuberculous lesions were found in the liver, spleen, and epiploon ; the lymphatic glands were enlarged, and numerous granu- lations were seen in the lungs. A guinea-pig of the second group died on the 2gth September after the eleventh injection. It also showed tuberculous lesions in the liver, spleen, epiploon, and lungs, though the lesions were much less marked than in the first. A second animal of the first group, which had received 380 minims of saliva in the peritoneum, died on the 30th September. The post- Digitized by Microsoft® THE TREATMENT OF TUBERCULOSIS. 599 mortem examination showed hepatic and splenic lesions of an even more marked character than in the first subject. The liver was enormous, yellowish in colour, and crammed with tubercles. There were numerous pulmonary granulations. Although these results were discouraging, the injections were con- tinued until the loth October. At this time both the animals treated and the controls were very thin. The investigation was terminated by killing the surviving guinea-pigs. All showed tuberculous lesions, and except in the case of two guinea-pigs belonging to the second group, treated by subcutaneous injections, these lesions were more intense and more generalised in the animals which had been injected than in the controls. The parotid saliva of the horse has no attenuating action in vitro on Koch's bacillus. M. Cadiot mixed lOO minims of saliva with a quantity of the same tuberculous culture as was used for the preceding experiments. After three days of contact, during which every pre- caution was taken to avoid changes in the emulsion, it was injected into the peritoneum of two guinea-pigs. At the same time a portion of the culture equal in quantity to that which had been added to the saliva was saved, and having been emulsified in a little sterilised water was injected into the peritoneum of two other guinea-pigs. The four animals were killed at the end of forty days and showed tuberculous lesions of the liver, spleen, and lungs. In the first two peritoneal granulations were found, but in the others nothing abnormal was discovered. Digitized by Microsoft® II.— THE SERUM TREATMENT OF GLANDERS. In glanders, as in tuberculosis, attempts have been made to utilise in treatment blood and serum from refractory animals. Makew and some other experimenters claim to have been successful in immunising animals by injections of ox serum. MM. Chenot and Picq by thus treating guinea-pigs rendered glanderous by inoculation with virus taken from the horse succeeded in curing seven cases out of ten. Similar attempts made by MM. Nocard and Leclainche failed. During the past two years I have treated with defibrinated ox blood and serum, and afterwards with defibrinated blood and serum from birds, several series of guinea-pigs which had been inoculated by scarifying the skin of the flank or face and applying glanders pus. The results were as disappointing as those in connection with tuber- culosis. The injections did not seem to me to exercise any real influence on the local lesions, or on the development of disease. In the majority of cases they did not prevent extension of the ulcer, enlargement of lymphatic glands, or production of visceral lesions. In some cases the local ulcer healed, but this also occurred in a pro- portion of the control animals. Such a result is not uncommon in chronic glanders in the guinea-pig, and as the secondary lesions are irregular in intensity and distribution, being sometimes confined to a few granulations or small caseous centres, it is easy to understand why certain authors came to believe in the efficacy of serum from refractory animals. I attempted to prepare an antitoxic serum by the same methods as had been followed in connection with tuberculosis. Turkeys were intra-venously and hypodermically injected with sterilised glanders cultures and mallein. These birds proved fairly sensitive to the action of the glanders poison. Whilst they resisted large doses of tuberculin and tubercle bacilli fairly well, they suffered much more from repeated injections of mallein or of glanders bacilli. Nevertheless Digitized by Microsoft® THE SERUM TREATMENT OF GLANDERS. 60T several birds which had received eight to twelve hypodermic or intra- venous injections survived for some months. With serum thus obtained I treated during October and November, 1898, some guinea-pigs inoculated in the flank by scarification with glanders virus taken from the horse. From twenty animals thus inoculated on the 23rd September, 1898, 1 chose ten in which the local lesions were well developed and practically of uniform intensity. All showed ulcers with indurated bases, accompanied in most by inflam- mation of the precrural lymphatic glands. Seven of these guinea-pigs were injected every third or fourth day with thirty to eighty minims of serum ; five were injected subcutaneously and two intra-peritoneally. In four the injections were continued for five weeks (4th October to loth November). In three the ulcer healed with fair rapidity, and in general wasting appeared less marked than in the controls, but, like the latter, the animals treated showed various secondary complications, such as orchitis, abscess formation, and cutaneous ulcers ; and although three months after inoculation one was still in fairly good condition and free of apparent complications, it proved to be suffering from grave visceral lesions. Two of the injected animals and a control died before the end of the first month ; three injected animals and the two last controls during the course of the second month ; and one of the two surviving animals which had been treated on the seventy-fourth day. On autopsy all these animals showed multiple visceral lesions, but principally inflammation of lymphatic glands, granulations, and more or less numerous nodules in the liver, spleen, or lungs. On post-mortem examination the last of the animals, killed on the 27th December (after ninety-five days), also showed lesions in the lymphatic glands, liver, and spleen. I shortly transcribe two of the records concerning injected animals : (i) Male guinea-pig, weighing thirteen ounces, inoculated on the 23rd September. On the 2gth there was marked swelling of the scarified region. On the 4th October a circular ulcer, the size of a threepenny piece, had developed ; its base was cupped, greyish, dotted with red points, and surrounded by an indurated zone ; the animal's weight was twelve ounces and a half. On the 5th the first injection was made. On the loth the pre- crural lymphatic glands were the size of a haricot bean, and a sar- cocele had developed. The ulcer was stationary. On the i6th the external lesions were in the same condition, but the animal was already much wasted ; weight eleven ounces and three quarters. On Digitized by Microsoft® 602 CLINICAX VETERINARY MEDICINE AND SURGERY. the 23rd there was discharge from both nostrils ; respiration was painful and wheezy. The animal died on the 27th; weight of the cadaver ten ounces. It had -been -injected ^ix times, and had received in the sub- cutaneous connective tissue of the . abdomen _ five and a half fluid drachms of serum. . Autopsy. — The ulcers in the flank and the enlarged precrural lym- phatic glands were connected by a fine knotted lymphatic, cord. An abscess the size of a haricot bean had developed in the thickness of the abdominal wall at the point where the injections had been made. Granulations and a. few purulent nodules were present in the liver, spleen, and lungs. There was suppurative orchitis on the left side, acute inflammation of the peritoneal covering of the cord. The upper portion of the vaginal sheath was obliterated by an extensive fibrous exudate. (2) Male guinea-pig, weighing fourteen ounces, inoculated on the 23rd September. On the ist October the point of inoculation showed a large bright red indurated patch. On the 4th a grey, cupped ulcer had developed ; the margins, from which the hair had fallen, were whitish in colour. Enlargement of the precrural glands as large as a pea. First inoculation on the 5th October. On the i6th the ulcer in the flank was slightly enlarged, and the precrural glands formed a swelling the size of a haricot bean ; weight twelve ounces and a quarter. On the 25th the appearance of the ulcer in the flank had improved ; its borders were less red and hard. The right testicle was inflamed. On the 8th November a cutaneous ulcer appeared towards the centre of the dorsal region. On the 22nd this ulcer and that in the flank were healing. The orchitic swelling was as large as a hazel nut. Died on the loth December. Weight of the cadaver ten ounces and three quarters. This guinea-pig had received nearly eight fluid drachms of serum in eleven injections. A iitopsy. — The ulcer in the flank had healed ; that on the back only measured one sixth of an inch across. There was generalised inflam- mation of the lymphatic glands, the centres of which were caseous. The liver contained some purulent nodules ; the spleen was enormous, weighing one and a quarter ounces, and was bosselated with nodules and caseous centres. Three or four small pulmonary tubercles. Sup- purative orchitis. Nine other guinea-pigs, inoculated by scarifying the skin of the face and applying glanders pus obtained from the horse, were treated with serum from turkeys injected with mallein, and afterwards with Digitized by Microsoft® THE SERUM TREATMENT OF GLANDERS. 603 living glanders bacilli. The results were similar to the preceding. The disease developed in the injected animals much as in the con- trols. I was unable to note any well-marked differences in the development and characters of the initial lesion, in those of the pre- auricular and pre-scapular lymphatic infections, or in those of the visceral lesions. The favourable influence which serum appears to exercise on some subjects is exclusively due to the animal's individual power of resist- ance, and to the peculiar way in which glanders often develops in guinea-pigs. This is well shown by the fact that progress is slow and development localised just as frequently among control animals as among animals subjected to treatment. Digitized by Microsoft® III.— THE ACTION OF VANADINE. For some years attempts have been made to utilise in practice the remarkable oxidising properties of vanadium and its compounds. Vanadic acid, vanadate of soda, and vanadine have all been studied, and have been recommended in the treatment of pneumonia, rheu- matism, and tuberculosis. I have made an experimental and therapeutic study of various preparations of vanadium, but especially of vanadine. Considerable doses of vanadine may be injected into the connective tissue or veins of animals without producing any toxic symptoms, in the guinea-pig a subcutaneous injection of thirty to fifty minims produces no appre- ciable disturbance. In most cases nothing abnormal follows hypo- dermic injection of i c.cm. per lOO grammes (approximately fifteen minims per three ounces) of body-weight, but a double dose is fatal. Guinea-pigs of 400 to 600 grammes (approximately twelve and a half ounces to eighteen and a half ounces) in weight bear hypodermic or intra-peritoneal injections with i c.cm. (fifteen minims) of vanadine repeated every second or third day, for a considerable period. In the rabbit intra-venous injection of i c.mm. of vanadine per kilogramme is well borne, and the animal often survives doses four times as large. A rabbit of five pounds weight, which had received 120 minims of vanadine in the auricular vein, showed grave symptoms (convulsions, paresis, dyspnoea, and prostration), which continued for several hours, but the animal gradually recovered. A dog, weighing sixteen and a half pounds, showed no disturbance after an intra-venous injection of 120 minims of vanadine ; nor was anything noted in a dog weighing eighty one and a half pounds, which received into the saphenous vein two fluid ounces of vanadine. A horse weighing 528 lbs. showed nothing appreciable after a first intra-venous injection of fourteen fluid drachms of vanadine, followed some days later by a further injection of two fluid ounces. In a horse weighing 594 lbs., an injection of twenty-eight fluid drachms of vanadine into the jugular produced rest- lessness, trembling, soft evacuations, and lowering of temperature to the extent of 1° C. Digitized by Microsoft® THE ACTION OF VANADINE. 605 Excessive doses of vanadine produce a series of grave symptoms, but particularly nausea, vomiting of food or glairy material followed by blood, diarrhoea, soon succeeded by blood-stained evacuations, lively thirst, apoplectiform attacks, acute pain, shown by groaning or crying, slowing of the circulation and respiration, attacks of dyspnoea, and finally depression of temperature. I noted all these troubles in a dog weighing thirteen pounds three ounces which received five and a half fluid drachms of vanadine in the saphenous vein. I have used vanadine in the treatment of certain diseases in the horse and dog, principally pneumonia, the abdominal form of influenza, distemper and its complications, wasting diseases, and in persistent loss of appetite due to gastro-intestinal atony. I have injected it into the subcutaneous connective tissue in doses of fifteen to eighty minims in the dog, and of five and a half to seven fluid drachms in the horse. At the present time I have not collected sufficiently numerous statistics to show how much should be given in the treatment of acute diseases, but in such affections, and particu- larly in pneumonia, where the local lesion is far from possessing the importance attributed to it, where the morbid symptoms are due to diminution in the aerating surface, to auto-intoxication, to diminished elimination, or to the transformation of poisons, vanadine, like every agent possessing oxidising properties, appears to have a favourable effect. Injected in small doses repeated daily, or every second or third day, it acts as a tonic, increases or restores the appe- tite, stimulates nutrition, favours assimilation, arouses the forces, and improves the condition of emaciated animals. It may, perhaps, prove of service in the treatment of chronic affections with loss of strength or wasting. I have also studied its effects on guinea-pigs rendered tuberculous by injecting cultures of canine origin emulsified in sterihsed water. Eight guinea-pigs were thus inoculated on the gth August, 1898, in the subcutaneous connective tissue of the flank, and a second series of eight guinea-pigs in the peritoneum. Two animals of each series were preserved as controls ; the others received every third or fourth day a hypodermic injection of a few drops up to fifteen minims of vanadine. These injections were begun on the 17th August, and continued until the 15th October. During the course of the research five guinea-pigs died; three inoculated in the peritoneum — two under treatment, and one control ; two inoculated under the skin— one treated and one control. On post-mortem examination all showed more or less generalised lesions, depending on the time which had elapsed since inoculation. In the Digitized by Microsoft® ■6o6 CLINICAL VETERINARY MEDICINE AND SURGERY. guinea-pig under treatment the seat of inoculation in the ilank showed a large tuberculous, ulcer. Of the survivors, those under treatment, equally with the controls, gradually lost weight ; in no case where an ulcer had developed in the flank after inoculation did it heal. All the guinea-pigs were killed on the 15th October, and all showed tuberculous lesions. In many of those treated with small doses of vanadine the lesions were only a little less numerous or less diffused than in the others. MM. Laran and Hallion obtained very interesting results by treat- ing guinea-pigs, rendered tuberculous by subcutaneous inoculation, with very small hypodermic injections of vanadic acid. Under the influence of these injections M. Laran has " often seen healing of tuberculous ulcers in animals. In a guinea-pig thus inoculated and treated by vanadic acid death was postponed for a year and a half. M. Hallion, who studied the pulmonary lesions histologically, noted "very marked fibrous transformation." Digitized by Microsoft® IV.— INTRA-VENOUS INJECTIONS OF IODINE. In veterinary practice very few substances are introduced directly into the blood, and we may say that until now this method of administering medicines has scarcely extended beyond the laboratories and the text books. Although the first attempts at utilising certain remedies, and iodine in particular, by intra-venous injection are fairly old, it was long believed that the method was dangerous, and that iodine introduced into the blood-stream would cause sudden death by producing changes in the brain and spinal cord. Such an accident, in fact, followed certain intra-venous injections of iodine in the horse, but is explained without difficulty by the excessive doses and the method of procedure. The credit of having first drawn attention to the remarkable tolerance of the blood towards iodine solutions is due to Gerard, a veterinary surgeon of Verennes-en-Argonne, in his ' M^moire sur la Medication Antivirulente ' (1874), who stated that he injected into the jugular vein of a horse weighing 1056 lbs., which was suffering from chronic glanders, two drachms of iodine and four drachms of potassium iodide in one dose. This injection being made slowly only produced a little temporary excitement ; the animal took food almost immediately afterwards, and was worked two hours later. The author adds, " For intra-venous injection a two per cent, solution may be used, of which a medium-sized horse will take, without inconvenience, twelve and a half ounces at a dose." Four per cent, to five per cent, solutions are also without danger provided they be injected slowly. In this way from two and a half to ten drachms of iodine may be given to large animals in twenty-four hours." Rossbach, who made experiments in this connection, also states that intra-venous injection of relatively large doses of iodine produce no complications in the horse. More recent experiments have shown that other animals also tolerate iodine and the iodides when introduced directly into the blood. According to Bohm the dog shows no particular disturbance after injection of an aqueous solution in the proportion of -15 to '22 grain of iodine per pound of body-weight, the iodine being dissolved Digitized by Microsoft® 6o8 CLINICAL VETERINARY MEDICINE AND SURGERY. by the addition of two or three times its weight of sodium iodide ; but a dose of 3 grain per pound of body-weight produced general weak- ness, difficulty in respiration, and in some cases convulsions and death in from twelve to twenty-four hours. G. See and M. Lapicque saw no special disturbance in a dog weighing 17 lbs. 3 oz., into whose saphenous vein they slowly injected at intervals of a quarter of an hour two doses of fifteen grains of potassium iodide. Iodine when directly introduced into the blood probably assumes the condition of sodium iodide, or combines with albumen, forming unstable compounds, which disengage iodine in contact with living protoplasm. Elimination by the kidney commences rapidly. At the end of a few minutes iodine can be detected in the urine in the condi- tion of sodium iodide, but a portion remains in the blood, and the drug appears to have a special predilection for the muscles, kidney, and brain. M. Gallard found that it is retained in the latter in consider- able quantities. In order to study the therapeutic action of iodine and its use in the treatment of certain animal diseases, I first determined the dose which could without danger be introduced into the blood. I prepared solu- tions varying in strength from i per cent, up to 5 per cent., the iodine being dissolved by the addition of potassium iodide (iodine i, potas- sium iodide i"5, water q. s.). My experiments on animals of different species have given results which, while confirming the tolerance of the organism for iodine, show that it has been greatly exaggerated, and that small doses produce very appreciable results. The following records are interesting in this respect : (i) Dog, weighing 39^ lbs., received at 2 p.m. on the 14th Feb- ruary, 1898, an injection of five and a half fluid drachms of a i per cent, iodine solution into the saphenous vein. No manifest disturb- ance. (2) Dog, weighing 41I lbs., received at 3 p.m. on the 18th Feb- ruary, an injection of one fluid ounce of a i per cent, iodine solution into the saphenous vein. At the end of an hour and a half restlessness appeared, followed by signs of depression and shivering fits, at first localised in certain regions, especially in the crural and gluteal muscles, but afterwards generalised. At 5 p.m. the temperature had risen to the extent of h° C, and the heart's action was slightly accelerated. A little later the symptoms diminished ; at 8 p.m. they had disappeared ; the animal was bright, lively, and ate its food readily. (3) Dog, weighing jgl lbs., received at 3 p.m. on the 20th Feb- ruary, an injection of six and a half fluid drachms of a 5 per cent, iodine solution, i.e. a little more than "2 grain of iodine per pound of Digitized by Microsoft® INTRA-VENOUS INJECTIONS OF IODINE. 609 body-weight, in the saphenous vein. In a quarter of an hour it showed Signs of restlessness and whined a Httle. Twenty minutes later slight localised intermittent trembling occurred, and gradually became accentuated and generalised. The trembling fits afterwards dimin- ished, and finally disappeared at the end of four hours. At 8 p.m. the animal showed no disturbance and readily ate. During the night urine resembling that of hemoglobinuria was passed. (4) A dog, weighing 3of lbs., received at lo a.m. on the 24th Feb- ruary an injection of three fluid drachms of a 5 per cent, iodine solution (-3 grain per pound of body-weight) in the jugular vein. In a few minutes faeces were passed. Except for signs of restlessness no manifest disturbance ; only a few shivering attacks. During the afternoon the dog passed blackish hsemoglobinuric urine ; no after- symptoms. (5) A goat, weighing 8ii lbs., received at 2 p.m. on the 25th Feb- ruary in the jugular vein an injection of seven fluid drachms of a 5 per cent, iodine solution (-26 grain of iodine per pound of body- weight). Temperature before injection 3g"2° C. At 3 p.m. masti- catory movements were made. At 4 p.m. slight trembling of the muscles of the quarter and thigh, passage of hsemoglobinuric urine. At 6 p.m. temperature 40-6° C. ; prostration ; the trembling attacks persisted. At 8 p.m. temperature 40*2° C. ; fresh passage of hsemo- globinuric urine. After this the symptoms gradually disappeared. (6) A cow, weighing 620^ lbs., received at 9 a.m. on the 25th Feb- ruary an injection into the jugular vein of two fluid ounces of a 5 per cent, solution of iodine ("07 grain per pound of body-weight). At the end of fifteen minutes, salivation ; twenty minutes later, passage of normal faeces and yellowish urine ; no manifest disturbance of circu- lation or respiration. At 3 p.m. slight trembling attacks in the hind quarters, continuing for two hours ; hyperthermia, which attained its maximum (i'4° C.) at the eighth hour. At 4 p.m. passage of brownish hasmoglobinuric urine. During the night the symptoms disappeared. (7) A horse, weighing 525I lbs., received at i o'clock on the 28th February an injection of eleven fluid drachms of a i per cent, iodine solution. At the end of a few minutes faeces were passed. Half an hour later trembling appeared, at first localised in the hind limbs, but soon becoming generalised ; it diminished rapidly, and disappeared in an hour. At 2 p.m. next day received an injection of thirteen and a quarter fluid drachms of the same solution. Immediately before injection temperature 39*3° C, respirations 12, pulse 45. Faeces were passed at the end of three minutes. 12.30 p.m., trembling movements in the GQ Digitized by Microsoft® 6lO CLINICAL VETERINARY MEDICINE AND SURGERY. vasti and gluteal muscles, soon extending to all the hind limbs, and afterwards to the whole body ; slight ptyalism and grinding of the jaws ; ears and extremities cold. At 3 p.m. temperature 39'8° C. ; respiration and circulation slightly disturbed ; generalised trembling ; somnolence. The symptoms afterwards disappeared. (8) A horse, weighing 533^ lbs., received at 9 a.m. on the nth March an injection in the jugular vein of fifteen and a quarter fluid drachms of a 5 per cent, iodine solution ('07 grain per pound of body- weight). Before injection temperature 38*0° C, respirations 17, pulse 45. During the succeeding two hours the temperature rose appre- ciably ; the respiration and circulation became more rapid. At 11.30 a.m. muscular trembling, salivation, grinding of the jaws, cough, and slight weeping appeared ; these troubles persisted for two or three hours. At I p.m. temperature 39'i° C, respirations 30, pulse 78; the respiration suggested dyspnoea. An hour later the trembling dimin- ished ; the circulation and respiration became slower, and the tempera- ture fell. No after complications. (9) A horse, weighing 682 lbs., received at 3 p.m. on the i8th March in the jugular vein seventeen fluid drachms of a 5 per cent, solution of iodine ("07 grain per pound of body-weight). Before injection tempe- rature 38'2° C, respirations 18, pulse 46. At the end of half an hour slight salivation, grinding of the jaws, and acceleration of breathing (twenty-five per minute). At 4 p.m. trembling, especially marked in the hind limbs and face ; passage of hard faeces and flatus. Tempera- ture 387° C. ; respirations 22 ; pulse 45. At 5 p.m. passage of faeces moister than on the preceding occasion ; the passage of flatus and the trembling persisted. Temperature 39'i° C. ; respirations 15 ; pulse 42. At 5.10 p.m. passage of hasmoglobinuric urine ; slight trembling. At 7 p.m. the animal appeared a little depressed, but otherwise showed nothing abnormal. (10) A horse, weighing 902 lbs., received at 2.50 p.m. on the 21st March an injection in the jugular vein of twenty-two fluid drachms of a 5 per cent, iodine solution ('07 grain per pound of body-weight). Before injection temperature 38° C. ; pulse 38 ; respirations 10. At the end of a quarter of an hour grinding of the jaws and salivation ; expulsion of flatus. Fifteen minutes later temperature 38*5° C. ; pulse 38 ; respirations 18 ; respiration difficult, expiration irregular. Trem- bling attacks, at first localised in the crural and gluteal muscles, after- wards generalised ; signs of depression. At 3.30 p.m. more abundant ptyalism ; spasmodic contractions of the jaws ; stamping and signs of excitement alternating with periods of depression ; passage of soft fasces ; strong and persistent borborygmus. At 4 p.m. temperature Digitized by Microsoft® INTRA-VENOUS INJECTIONS OF IODINE. 6ll 38'4° C. ; pulse 39 ; respirations 11 ; ptyalism and trembling continued ; signs of depression became more marked ; fresh passage of soft excre- ment. At 5 p.m. temperature 38-1° C. ; pulse 45 ; respirations 13 ; passage of large quantities of hjemoglobinuric urine ; the depression, salivation, and trembling fits were diminishing. At 6 p.m. temperature 38-4*^ C. ; pulse 47 ; respirations 11 ; still a few trembling movements. At 7 p.m. temperature 38-4° C. ; pulse 52 ; respirations 14. The animal seemed to have resumed its normal condition. (11) Horse, weighing 594 lbs., received at i p.m. on the 2gth March an injection into the jugular vein of twenty-four fluid drachms of a 5 per cent, iodine solution (containing 64-5 grains of iodine, i. e. a little less than -12 grain per pound of body-weight). Before the injection temperature 38-1° C. At the end of three minutes defecation; a quarter of an hour later sahvation, attempts to vomit, rapid breathing ; twenty minutes later excitement and signs of colic. At 2 p.m. ptyalism continued, and the animal attempted to vomit ; softened faeces were passed ; temperature 38-5" C. From the second to the fourth hour trembling and signs of depression ; temperature 39'!° to 39"8° C. At 5 p.m. passage of hsemoglobinuric urine. After 6 p.m. the disturbance diminished. There was no after complication. Introduced into the blood-stream in doses of '007 grain per pound of the animal's body-weight (z. e. six grains for a horse weighing 880 lbs.), with thfe addition of sufficient iodide to dissolve it, iodine is well tolerated and produces no manifest external symptoms. In doses of "014 grain per pound (twelve grains for a horse weighing 880 lbs.), whatever the degree of dilution, it usually produces more or less pro- nounced symptoms, depending on the species of animal and on its in- dividual susceptibility, symptoms among which ptyalism, trembling fits, and localised convulsions are the most constant. Injection of larger doses is only justifiable if immediate intense action is necessary, if the doses can only be given at intervals of several days, or can only be repeated a few times. In doses of "07 grain (60 grains for a horse weighing 880 pounds), iodine produces grave disturbance, symptoms of hsemoglobinuria, and very frequently renal lesions similar to those of hsematuria. In my therapeutic experiments I did not exceed doses of 7 to 30 grains per day according to the weight of the horse. According to some authors iodine when injected into the blood can have no useful effect because it combines with alkaline substances. It would, therefore, have no action on micro-organisms, to destroy which Digitized by Microsoft® 6l2 CLINICAL VETERINARY MEDICINE AND SURGERY. such large quantities would be required as to cause death from acute iodism. In attacking the microbe one would destroy the cells and kill the animal. But in refutation of this we urge that iodine, like the iodides and other antiseptics, may prove valuable in toxi-infections without actually destroying the microbes. Small quantities of anti- septics and other chemical agents may act either by diminishing the production of microbic poisons, by assisting in their destruction by the organs, or by stimulating the emunctories ; or again, by exciting the tissues to greater action, modifying the fluids of the body, and rendering them less favourable to pathogenic agents. From this point of view intra-venous injections of certain antiseptics seem capable of varied application. Only to mention one, if the reported cases of recovery from glanders after intra-tracheal injections of iodine are authentic — I especially allude to those of Chelchowski and of Neimann — intra-venous injections of similar solutions deserve trial in horses which mallein shows to be suffering from internal glanderous lesions, and which sometimes have to be kept under observation for mouths. As the specific lesions from which they suffer often end by spontaneously healing, it is conceivable that one might assist the organism in its struggle against infection and help it to emerge triumphant. Many other drugs may also be given intravenously with advantage ; thus intravenous injections of argentum colloidale Crede in doses of six to twelve grains dissolved in ten to thirteen fluid drachms of water have proved of remarkable value in purpura hsemorrhagica of the horse (Dieckerhoff, Meissner, Kroning) and in gangrenous coryza in the ox (Meissner, Tannebring, David). In a similar way chloride of barium has been administered to produce rapid evacuation of the bowel when treating colic in the horse. Despite the accidents which have followed administration of excessive doses, or in which the animals were already intoxicated by intestinal poisons, man}- practitioners continue its use. Syncope is avoided by injecting small doses at intervals of fifteen to twenty minutes, as I suggested in 1897. The first dose injected should be from three and a half to nine grains, which may if necessary be repeated in fifteen to twenty minutes. In animals intra-venous injection is very simple, though it requires a little practice. As a rule the substance employed is very active, the quantity of liquid injected small, and no special instrument necessary; a syringe of six fluid drachms capacit}' and a needle about three inches Digitized by Microsoft® INTRA-VENOUS INJECTIONS OF IODINE. 613 in length being alone required. In large animals, and even in the dog, the jugular is the vessel chosen. The vein is compressed at its lowest point until it becomes distended and prominent, the needle is then introduced obliquely in the direction of the vessel, the further wall of which must not be pierced ; the skin is drawn slightly towards the head, and the needle gently passed in succession through it, the subcutaneous connective tissue, and the wall of the vein. Escape of blood through the needle shows that it has entered the lumen of the vein. Should any doubt exist on this point — especially if the horse has struggled meanwhile — the vein is again "raised" for an interval of a few seconds and blood again caused to escape from the needle. The latter is then grasped between the index finger and thumb, the nozzle of the syringe attached to it, and the liquid slowly injected. The bore of the needle being so narrow, passage of air need not be feared, though even should a few small bubbles pass into the vein no bad effects follow. Digitized by Microsoft® 6i4 APPENDIX. A COMPARATIVE table showing the approximate equivalent in Fahrenheit's scale of a given Centigrade reading. Cent. Fahr. Cent. Degrees. Fahr. Cent. Fahr. Cent. Fahr. Degrees. Degrees. Degrees. Degrees. Degrees. Degrees. Degrees. 38-0 ioo'4 39-0 102-2 40-0 104-0 41-0 105-8 •I 100-5 •I 102-3 •I 104-1 •I 105-9 •2 1007 •2 I02-S •2 104-3 •2 1 06- 1 •3 100-9 •3 102-7 •3 io4'S •3 106-3 ■4 ion •4 io2-g ■4 104-7 •4 106-5 •5 101-3 •5 103-1 •5 104-9 ■s 106-7 •6 101-4 -6 103-2 •6 105-0 •6 106-8 ■7 I0I-6 7 103-4 •7 105-2 •7 107-0 ■8 108-8 •8 103-6 •8 105-4 -8 107-2 •9 I02-O ■9 103-8 •9 105-6 •9 107-4 Digitized by Microsoft® INDEX. PAGE Abomasum, ulceration of . . . 469 Abscess, cardiac .... 365 — cold, in retro-pharyngeal glands . 336 — of liver ...... 376 Acariasis, symbiotic, and eczema of ear 312 Acute inguinal hernia ... 35 Adenoma, mammary, with pulmonary metastasis . . . . .517 Agoraphobia .... 273 Amenorrhcea . 424 Amputation of penis . 56, 412 Anaemia, parasitic . . 504 Aneurismal varix, spermatic 408 Aorta, posterior, rupture of . . 386 Aortic insufficiency in the horse . . 125 Aponeurosis of flank, necrosis of . 368 " Arterial dance " . . . 128 Artery, pulmonary, rupture of . 366 Ascites, chylous, in a cat . 380 Atrophy of penis . ... 414 Auricles, ossification of . 153 Auricular myocarditis . . 150 Avian tuberculosis .... 522 summary and conclusions . . 554 Azoturia . . ... 249 Basedow's disease . 272 Behring's antitoxin in tetanus . 501 Blennorrhcea in the dog . ' i2 BothryomycosiS ' . • 477 Bradycardia . . • iS7 Brain, echinococcosis of . . 504 Bruit de pot fele ■ 177,192 Cachexia • 276 ■ Calculus, urethral 414 Cancer of inferior maxilla . . 328 — of kidney . . 389 — of penis . . . .410 — of scrotum . . . 405 — of stomach . . 374 — of superior maxilla . . 22 — of tail . . 287, 427 — of testicle . . 405 Cancerous intra-orbital growth . .310 Cancroid, pseudo-, of lip . . . 324 Canine tuberculosis, method of infection in ... . . . 241 origin of . . 241 Canker, auricular . . 287 " Canker " of the foot . . . 296 Carcinoma of kidney . . .£17 Cardiac abscess .... 365 — intermittency in the horse . . 157 " Cardiac heart " . . . . '49 — kidney" . . ... 136 — liver" ... 135 Caries, dental . . 8, 330 Carpal sheath, suppurating synovitis of 437 Cataract, operation for . . 312 — traumatic . 3'i Cerebral haemorrhage . • 305 — injury and Cheyne-Stokes respira- tion . . • • 307 Cerebrum, tuberculosis of . . 470 Cervical desmotomy ■ . 341 Cheek, papillary sarcoma of • . 326 Cheyne-Stokesrespiration . . . 307 Chorea . ■ . . 510 Chronic myocarditis . . . .151 — pharyngitis . . . • 335 — pleurisy in the horse . • 202 Digitized by Microsoft® 6i6 Chronic roaring, surgical treatment of . Chylous ascites in cat . Cocco-bacille typhique Cold abscess in retro-pharyngeal glands Constipation Contagious pneumonia in the horse Schiitz's organism of . Corn, complicated cases of • " Corrigan's pulse " . . . Cortical or partial myocarditis Costal region, abscess of " Critical abscesses " Cryptorchid operations Cyst, hydatid, of heart Cystic degeneration of ovary Cysts, dentigerous — sebaceous, in false nostril Debris, paradental epithelial Degeneration, cystic, of ovary Dental caries . i — fistula ... Dentigerous cysts Desmotomy, cervical . Diabetes mellitus in the dog Diaphragmatic hernia . — — mechanism of " Discordant " breathing Echinococcosis Eczema, chronic — in the dog — in the horse — rubrum . — seborrhceic Elbow, penetrating wound of Endocarditis, acute, in the horse — — microbes in — chronic . . , . — malignant, ulcerative, or septic — " purring fnurmur" in — vegetative or verrucous Epithelioma. — of vulva . Exophthalmic goitre . External tuberculosis in the dog and cat Eyelid, lower, and globe of eye, tumour of Facial sinuses, epitheliomata in . INDEX. PAGE I'AGE 3°. Facial sinuses, fibrous polypi in . 23 347 — — mucous cysts in 23 380 myxomata in . . . 23 188 purulent collections in 8 336 — — sarcomata in 24 384 tumours in 22 185 False nostrils, sebaceous cysts in . 316 1S7 Fehling's test for sugar 271 455 Fistula, dental .... 33^ 139 Fistulous withers .... 354 151 Flank, necrosis of aponeurosis of 368 357-- -- Flexor brachii muscle, injury of . 433 192 — tendons, rupture of, after neurectomy 448 397 Foot, granuloma of . . . 457 364 Foreign body in mouth- 334 421 — — in oesophagus . 345 1,-23 — — in rectum 385 3i6 Fracture of humerus in a horse . 434 2, 28 421 — of lower jaw .... 326 Gallinace^, tuberculosis in 523 , 330 Gangrene, moist, of neck 340 331 Glanders, treatment of . . . 600 I, 23 Globe of eye and eyelid, tumour of 309 341 Glycosuria . ... 264, 269 264 Goat, experimental tuberculosis in 575 44 Goitre, exophthalmic . 272 47 Granuloma, infective . 519 204 — of foot . 457 Graves' disease 272 504 " Grease " 295 286 Gutta percha for " stopping " alveolar 279 cavity after tooth extraction 10 291 Guttural pouch, operation on 335 282 284 HEMOGLOBINURIA 249 435 — experimental .... 260 "5 — nature of .... _ 258 118 Haemorrhage, cerebral, in the horse 305 359 Hemiplegia laryngis 347 120. Hepatisation of lung, changes in . 178, 194 119 Hernia, diaphragmatic . . 44, 373 120 — inguinal 35, 370 584 — ventral 369 424 Humerus, fracture of, in a horse 434 272 Hydatid cyst of heart . 364 TOO Hydrotherapy in pneumonia 200 Hydrothorax .... 202 309 Hydroxyl as dressing . 444 Hyovertebrotomy 335 25 Hysteria in a mare 417 Digitized by Microsoft® INDEX. 617 Iliac arteries, thrombosis of Impaction of the csecuin following dental caries Imperforate vagina Infective granuloma Inferior maxilla, cancer of — — ostitis of Influenza in the horse, abdominal form Inguinal abscess, deep-seated, after castration . . . — hernia, acute .... Insufficiency, aortic, in the horse . — mitral, in the horse Intermittency, cardiac Intestine, obstruction of — perforation of Intra-orbital growth, cancerous Intra-pericardial haemorrhage Intra-venous injection of iodine Iodine, intra-venous injection of — — — in pneumonia Jugular vein, phlebitis of 387 13 423 S19 328 327 210 . 40 35 • 125 132 157, .361 • 377 378 310 • 365 . 607 607 • 495 341 Kelotomy . 37 Kidney, cancer of 389 — carcinoma of . . S17 Knee, foreign body in . 436 Knuckling over at fetlock . 445 L.^teral ligament of pedal joint, ne crosis of 449 Lip, pseudo-cancroid of 324 Liver, abscess of . 376 — echinococcosis of . 504 — subcapsular haemorrhage of . 379 Lower jaw, fracture of . 326 Lung, sarcomatous disease of 51S Lungs, echinococcosis of 504 Luxation of patella 438 Lymphangitis and multiple abscesses due to staphylococci . 97 — suppurating . 444 Mallenders .... 29s Mammary adenoma 517 Maxilla, rodent cancer of 29 Median and ulnar neurectomy 92 — neurectomy .... 447 Melanuria . . 254 Meningo-encephalitis . 323 PAGE Mitral insufficiency . . 132 Moist gangrene of neck , 340 Myocarditis . ... 142, 361 Myoma of oesophagus . . 358 Myositis, degenerative . 257 Myxoma of uterus . . 423 Nasal cartilage, necrosis of . . . 315 — cavities, tumours in . . .319 — polypi .... .16 — septum, necrosis of . . 314 — sinuses, purulent inflammation of . 323 Neck, foetid abscess in . . 347 — lacerated wound of . . 344 — moist gangrene of . . . 340 — sinus of . . . . . . 340 — wound of ..... 338 Necrosis of cartilage of nostril . . 315 — of lateral ligament of pedal joint . 449 — of nasal septum . . , 314 — of scapula ..... 430 — of turbinated bone . . . '317 Nephritis, acute . . 388 Neurectomy, median . . . 92, 447 — plantar . .... 86 trophic changes after ... 87 — ulnar . . . . 92, 447 " Nutmeg" liver . . . . 135 Nymphomania . . . 416 Obstruction of intestine . . 377 CEsophagus, foreign body in . 345 — myoma of . . . . 358 Omasum, inflammation of . . 469 Ossification of the cardiac auricles , 153 Ossifying periosteal sarcoma of shoulder 429 Ostitis of inferior maxilla . . . 327 Othaematoma .... 285 Otitis, suppurating median . . . 29S Ovariotomy ...... 416 Ovary, cystic degeneration of . . 421 Pachymeningitis .... 512 Papillary sarcoma of cheek . . . 326 Paradental epithelial debris . . . 2, 28 Paralysis of penis . . . .411 Parasitic anaemia 504 Paresis of hind limbs .... 570 Parrots, tuberculosis of . . . 558 Patella, luxation of . . . . 438 Penis, amputation "of, in the horse 56, 412 Digitized by Microsoft® 6i8 Penis, atrophy of . . 4^4 — cancer of . ... 410 — cancroids of . . . . • 5^ — necrosis of . . . . 09 — papillomata of ... 56 — paralysis of . . • . 57> 4' i Pericarditis, " dry " .... 167 — hsemorrhagic . . . . 166 — in the dog 162 — rubbing sound in . . . . 166 — tapping for 169 — tuberculous, in the dog . . . 164 Pericardium, foreign body in . . 3^5 Perinseum, rupture of . . . 426 Pharyngitis, chronic . . . . 335 — due to strangles . . . .219 Phlebitis of jugular vein . . . 341 Picked-up nail, operation for . . 4Si treatment of . . . .78 Plantar neurectomy ... 86 Pleurisy, chronic, in the horse . . 202 Pneumococcus . ... 174 Pneumonia ..... 480 — Friedlander's bacillus of . . . 174 — in the horse . ... 170 — — contagious . . . 185 — intra-venous injection of iodine in . 495 — quinine in . . . 482 — salt solution in . . 493 — sporadic, fibrinous, croupous, or pneumonia, a f rigore . . 172 Poll-evil . . 339 Polydipsia . . 268 Polyuria . . . 268 Popliteal glands, abscess in . . 444 Posterior aorta, rupture of . 386 Prolapse of uterus . . . 422 Prolapsus vaginae in a mare 418 Prostate, diseased, in dog . . 391 Pseudo-cancroid of lip . 324 Pulmonary artery,_rupture of . . 366 — gangrene .... 177 , Purpura haemorrhagjca . . . 496 ; — — injection of normal horse serum in ..... . -497 Purulent collections in the facial sinuses ..... 8 — inflammation of nasal sinuses 323 Quinine jn pneumqnia . . 482 Quittor 449 Radial paralysis in the horse . . 64 Rectum, foreign body in . . . 385 Retro-pharyngeal glands, cold abscess in 336 Rheumatism . . . . ■ S" Rib, fracture of 357 — necrosis of .... . 357 " Rig " operations . . . 397 Right ventricle, rupture of . . . 366 Roaring, chronic, surgical treatment of ... -3°, 347 Rodent cancer of maxilla . . 29 Sallenders Salt solution in pneumonia Sarcoma ..... — cutaneous .... — ossifying periosteal, of shoulder — papillary, of cheek . — round-celled, of testicle . Sarcomatous disease, a case of of lung .... Scapula, necrosis of . . . Scapulo-humeral articulation, disease of 432 Scirrhous cord . . . . 40S Scrotum, cancer of . . Sebaceous cysts in false nostril . Semi-tendinosus muscle, ossification of tendon of . Serotherapy in pneumonia . Serum antityphique in contagious pneumonia ..... Serum injections in purpura hemor- rhagica ..... Sesamoid ligaments, rupture of . 29s 493 S8S 106 429 326 516 1 06 515 430 405 316 442 200 ■ 497 . 461 Shoulder, ossifying periosteal sarcoma of 429 Sinus of neck ..... 340 Spavin . . . . 445 — nature of . . . 72 — neurectomy in treatment of . 76 — treatment of ... . 72 Spermatic aneurismal varix . 408 Stomach, cancer of . . 374 "Stopping" alveolar cavity after removal of tooth .... 10 Superior maxilla, cancer of . . 22 Supernumerary tooth in the temporal region . . ... 298 Suppurating lymphangitis . . . 444 Symbiotic acariasis and eczema of the ear . ... 312 Digitized by Microsoft® INDEX. 619 Synovitis, suppurating, of carpal sheath 437 Tachycardia Tail, cancer of Tapping the chest .... Temperature table (comparison of Centigrade and Fahrenheit scales) Tendon sheaths in front of hock, dis- tension of Testicle, cancer of — round-celled sarcoma of Tetanus — Behring's antitoxin in — injection of salt solution Thoracentesis Thrombosis of iliac arteries Tibia, fracture of . Tongue, section of Trachea, rupture of Traumatic cataract Tubercle lesions in pheasants — — in fowls Tuberculosis, avian — comparative frequency of thoracic and abdominal lesions in . . 237, 244 — conveyance from man to parrot . S^^ 157, 272 287, 427 . 207 613 446 405 S16 498 501 499 207 387 443 333 344 3" 529 S30 522 — experimental, in the goat ■ 575 — external, in the dog and cat . . lOI lesions of . • 471 — in the cat 244, 473 mode of infection in . • 247 — in the cow 469 — in the dog • 234 — in the Gallinacese ■ 523 — in the horse 225, 463 — mammalian and avian, relations be- tween • 573 Tuberculosis of cerebrum — of parrots ..... — pulmonary, transmission from man to cat ...... — transmission from man to paroquet — treatment of . " Tuberculous septicaemia " . Tumour of eyelid and globe of eye — of vertebral column Tumours in facial sinuses . — in nasal cavities .... — malignant, conclusions regarding . — — in animals . — of the brain . 300, 301 — of the cerebellum . . 303 Turbinated bone, chronic inflammation of ... disease of, in the horse — — mucous degeneration of (Sand's disease) — • — new growths on — — - pus in necrosis of Ulnar neurectomy Urethral calculus . Urethrotomy for calculus Uterus, myxoma of — prolapse of Vagina, imperforate . Vanadine, on the action of Ventricle, right, rupture of . Vertebral column, tumour of Vulva, epithelioma of . Withers, fistulous Wound of neck PAOE 470 558 475 475 595 240 309 308 23 319 593 579 ■ 304 ,304 317 14 17 i6 18 447 414 415 423 422 423 604 366 308 424 354 338 z/ PRINTED BY ADLARD AND SON, BARTHOLOMEW CLOSE, LONDON, E.C., AND 20, HANOVER SQUARE, W. Digitized by Microsoft® Digitized by Microsoft® CATALOGUE OF William R. Jenkins Co. s Works Concerning HORSES, CATTLE, SHEEP, SWINE, Etc. 1908 (*) Designates New Boohs. (f) Designates Recent Publications. ANDERSON. "Tice in the Horse" and other papers on Horses and Kiding. By E. L. Anderson. Size, 6x9, cloth, illustrated ". 1 75 ABMSTEAD. " The Artistic Anatomy of the Horse." A brief description of the various Anatomical Struc- tures which may be distinguished during Life through the Skin. By Hugh W. Armstead, M.D., F.B.C.S. With illustrations from drawings by the author. Cloth oblong, 10 x 12^ 3 75 BACH, "How to Judge a Horse."' A concise treatise as to its Qualities and Soundness ; Including Bits and Bitting, Saddles and Saddling, Stable Drainage, Driv- ing One Horse, a Pair, Four-ln-hand, or Tandem, etc By Capt. F.W. Bach. Size, 5x7J, clo., fully lUus.l 00 B ANSA in. "Tables of Veterinary Posology and Thera. peutics," with weights, measures, etc. By Geo. A- Banham, P. K. 0. V. S. New edition. Cloth, size 4 X 5 1-2, 192 pages 1 00 BAUCHEB,. "Method of Horsemanship." Including the Breaking and Training of Horses. By P. Baucher 1 00 BELL. (*)"The Veterinarian's Call Book (Perpetual)." By Eoscoe E. Bell, D.V.S., editor of the American Veterinary Review. Completely revised 1907. A visiting list, that can be commenced at any time and used until full, containing much useful informa- tion for the student and the busy practitioner. Among content<< are items concerning : Prescription writing; Veterinary Drugs; Poisons; Solubility of Drugs; Composition of Milk, Bile, Blood, Gastric Juice, Urine, Saliva ; Respiration ; Dentition ; Temp- erature, etc., etc. Bound in flexible leather, with flap and pocket : . , ,,■,^^.^•.^^ ^^ Digitized by Microsoft® BITTING. "Cadiot's Exercises in Equine Surgery." See "Cadiot." BRADLET. "Outlines of Yeterinary Anatomy." By O.Charnock Bradley, Member of the Boyal Col- lege of Veterinary Surgeons ; Professor of Anatomy in the New Veterinary College, Edinburgh. The author presents the most important facts of veterinary anatomy in as condensed a form as possible, consistent with lucidity. 12mo. Complete in three parts. Part I.: The Limbs (cloth) 125 Part II. : The Trunk (paper) 1 25 Part III. : The Head and Neck (paper) 1 25 The Set complete 3 25 CADIOT. " Exercises in Equine Surgery." By P. J. Cadiot. Translated by Prof. A. W. Bitting, D.V.M. Edited by Prof. \. Liautard, M.D.V.M. Size, 6 x 9^. cloth, illustrated 2 50 — "Koaring in Horses." Its Pathology and Treatment. This work represents the latest development in oper- ative methods for the alleviation of roaring. Each step is most clearly defined by excellent full-page illustrations. By P. J. Cadiot, Professor at the Veterinary School, Alfort. Translated by Thos. J. Watt Dollar, M.E.C.V.S., etc. Cloth, size 5 1-4 x 7 1-8, 77 pages, illustrated 75 — "Studies in Clinical Veterinary Medicine and Surgery." By P. J. Cadiot. Translated, edited, and supplemented with 49 new articles and 34 illustrations by Jno. A. W. Dollar, M.E.C.V.S. Cloth, size 7x9 3-4, 619 pages, 94 black and white illustrations 5 25 —(•)" A Treatise on Surgical Tlierapeutics of the Domestic Animals." By P. J. Cadiot and J. Almy. Translated by Prof. A. Liautard, M,D.,V.M. I. General Surgery. — Means of restraint of animals, general ancesthesia, local ansethesia, surgical anti- sepsis and asepsis, hematosis, cauterization, firing, II. Diseases Common to all Tissues. — Inflammation, abscess, gangrene, ulcers, fistula, foreign bodies, traumatic lesions, complications of traumatic les- ions, granulations, cicatrices, mycosis, virulent diseases, tumors. III. Diseases Special to all Tissues and Affections of the Extremities. — Diseases of skin and cellular tis- eue, of serous bursae, of muscles, of tendons, of tendinous synovial sacs, of aponeurosis, of arteries, of veins, of lymphatics, of nerves, of bones, of articulations. Cloth, size 6x9, 580 pages, 118 illustrations 4 50 CHAPMAN. "Manual of the Pathological Treatment of Lameness in the Horse,'J treated solely by mechanical means. By George T. Chapman. Cloth, .size 6x9, 134 pages -srith portrait., 2 00 Digitized by Microsoft® CLARKE. "Chart of the Feet and Teeth of Fossil Horses." By W. H. Clarke. Card, size 9 1-2 x 12. . 25 —"Horses' Teeth." Fourth edition, re-revised, with second appendix. Cloth, size 5 1-4x7 1-2, 322 pp., lUus. .2 50 CLEAVELAND. "Pronouncing Medical Lexicon." Pocket edition. By 0. H. Cleveland, M.D. Cloth, size 3 1-4x4 1-2, 302 pages 76 CL.EMENT. "Veterinary Post Mortem Examina. tions." By A. W. Clement, V.S. The absence in the English language of any guide in making autopsies upoR the lower animals. Induced Dr. Clement to , virrite this book, trusting that it would prove of prac- tical value to th« profession. Cloth, size 5x7 1-2, 64 pages, illustrated 75 COUB TEN A T. (f) " Manual of the Practice of Teterinary Medicine." By Edward Courtenay, V. S. Kevised by Frederick T. G. Hobday, F.E.C.V.S. Second edition. Cloth, size 5 1-4x7 1-2, 573 pages 2 75 COX. " Horses : In Accident and Disease." The sketches introduced embrace various attitudes which have been observed, such as in choking; the disorders and aeoidents occurring to the stomach and intestines ; affection of the brain ; and some special forms of lame- sess, etc. By J. Koalfe Cox, F.K.C.V.S. Cloth, size 6 X 9, 28 full page Illustrations 1 50 DALRTMPLE. n"Veterinary Obstetrics." A compen- dium for tha use of advanced students and Practi- tioners. By W. H. Dalrymple, M. B. C. V. B., principal of the Department of Veterinary Science in the Louisiana State University and A. & M. College ; Veterinarian to the Louisiana State Bureau of Agriculture, and Agricultural Experiment Stations. Second edition revised. Cloth, si7.e 6x9 1-4,162 pages, 51 Illustrations 2 50 DALZIEL. "Breaking and Training Dogs." Part I, by Pathfinder. Part II, by Hugh Dalziel. Cloth, illustrated 2 50 — "The Collie." By Hugh Dalziel. Paper, Illustrated. ... 5Q — "The Diseases of Dogs." Causes, symptoms and treatment. By Hugh Dalziel. Illustrated. Paper, 50c. Cloth, 1 00 — "Diseases of Horses." Paper 50 — " The Fox Terrier." By Hugh Dalziel. Paper, 50 ; clo.l 00 — "The Greyhound." Cloth, lUus 100 — " The St. Bernard," Clelh, illustrated ,*.,,,,,,. 1 00 Digitized by Microsoft® DANA. "Tables in Comparatiye Physiology." By Prol. C. L. Dana, M.D. Chart, 17 x 17 26 DANCE. " Veterinary Tablet." By A. A. Dance. Chart, 17 X 24, mounted on linen, folded in a oloth case for the pocket, size 3 3-4 x 6 1-2. Shows at a glance the synopsis of the diseases of horses, cattle and dogs ; with their cause, symptoms and cure 75 DE BBUIN, (*)" BoTine Obstetrics." By M. G. De Bruin Instructor o£ Obstetrics at the State Veterinary School in Utrecht. Translated by W. E. A. Wyman, formerly Professor of Veterinary Science at Clemson A. & M. College, and Veterinarian to the South Carolina Experiment Station. Cloth, size 6x9, 382 pages, 77 illustrations 5 00 Synopsis of the Essential Features of the Work 1. Authorized translation. 3. The only obstetrical work which ia up to date. 3. Written by Europe's leading authority on the subject. 4. Written by a man who has practiced the art a lifetime. 5. Written by a man who, on account of his eminence as bovine practitioner and teacher of obstetrics, was selected by Prof. Dr. FrOhner and Prof. Dr. Bayer (Berlin and Vienna), to discuss bovine obstetrics both practically and scientificaDy. 6. The only work containing a thorough differential dJaK- nosis of ante and post partuin diseases. 7. The only work doing justice to modern obstetrical surgery and therapeutics. 8. Written by a man whose practical suggestions revolu- tionized the teaching of veterinary obstetrics even in the great schools of Europe. 9. The only work dealing fully with the now no longer obscure contagious and infectious diseases of calves. 10. Absolutely original and no compilation. U. The only work dealing fully with the difficult problem of teaching obstetrics in the colleges. 12. The only work where the practical part is not over- shadowed by theory. . . . A veterinarian, particularly if his location brings him in contact with obstetrical practice, who makes any pretence toward . being scientific and in possession of modern knowledge upon this subject, will not be without this excellent work, as it is really a very val uable treatise. — Prof. Boicoe li. BelU in the American Veterma/ry R&v icw. In translating into English Professor De Bruin's excellent text- book on Bovine Obstetrics, Dr. Wyman has laid British and American veterinary surgeons and students under a debt of gratitude. The works represents the happy medium, between the booklets which are ' adapted for cramming purposes by the student, and the ponderous tomes which, altiiough useiMl to the teacher, are not exactly suited to the requirements of the everyday practitioner . . . We can strongly recommend the work to veterinary students and practitioners. — The Journal uf Comparative Pathology a/nd Therapeutics. DOLLAR. f*)"Diseasc8 of Cattle, Sheep, Goats and Swine." By G. Moussu and Jno. A, W. Dollar, M.R.C.V.S. 'Size 6x9 1-2, 785 pages, 329 illustrations in the text and 4 full page plates 8 75 — (t)"A Hand-book of Horse-Shoeing," 'with introductory chapters on the anatomy and physiology of the horse's foot. By Jno. A. W. Dollar, M.E.C.V.S., with the collaboration of Albert Wheatley, F.B.C.V.S. Oloth, size 6x8 1-2, 433 pages, 406 illustratioBS . .4 7§ Digitized by Microsoft® DOLIiAK (continued) — (t) "Operative Tochniqiie." Volume 1 of "The Practice of Veterinary Surgery." Cloth, size 6 3-i x 10, 264 pages, 272 illustrations , 3 75 — " General Surgery." Volume 2 of " The Practice of Veter- inary Surgery." In preparation. — (t)"Reg-ional Veterinary Surgery." Volume 3 of "The Praotioe of Veterinary Surgery." By Drs. Jno. A. W. Dollar and H. MoUer. Cloth, size 6 1-2 x 10 853 and xvi pages, 315 illustrations 6 25 — "Cadlot's Clinical Veterinary Medicine and Surgery." See " Cadiot." — " Cadiot's Roaring in Horses." See " Cadiot." DTTN. "Veterinary Medicines, their Actions and Uses." By Finlay Dun, V.S., late lecturer on Materia Medlca and Dietetics at the Edinburgh Veterinary College, and Examiner in Chemistry to the Eoyal College of Veteriuary Surgeons. Edited by James Macqueen, P.E.C. V.S. Tenth revised English edition. Cloth, size 6x9 3 75 FLEMING. " The Contagious Diseases of Animals." Their influence on the wealth and health of nations and how they are to be combated. Paper, size 5x7 1-2, 30 pages 26 — "Human and Animal Variolse." A Study in Comparative Pathology. Paper, size 5 1-2x8 1-2, 61 pages 25 — "Parasites and Parasitic Diseases of the Domesticated Animals." By L. G. Neumann. Translated by Dr. Fleming. See " Neumann." — "Operative Veterinary Surgery." Vol. I, by Dr. Geo. Fleming, M.K.C.V.S. This valuable work, one of the most practical treatises yet issued on the subject In the English language, is devoted to the common opera- tions of Veterinary Surgery ; and the concise descrip- tions and directions of the text are illustrated with numerous wood engravings. Cloth, size 6x9 1-4, 285 and xviii pages, 343 illustrations 2 75 (*)Vol. II, edited and passed through the press by W. Owen Williams, F.B.C.V.S. Cloth, size 6x9 1-4, 430 and xxxvii pages, 344 illustrations 3 25 — " Roaring in Horses." By Dr. George Fleming, F.B.C.V.S. Its history, nature, causes, prevention and treatment. Cloth,. size 5 1-2x8 3-4, 160 pages, 21 engravings, 1 colored plate 1 50 — " Veterinary Obstetrics." Including the Accidents and Dis- eases incident to Pregnancy, Parturition, and the Early ' Age in Domesticated Animals. By Geo. Fleming, F.B.C.V.S. Cloth, size 6x8 3-4, 758 pages, iUus.6 25 Digitized by Microsoft® ^OTTHIEL. O^'A Manual ef General Histology." By Wm. S. Gottheil, M.D., Professor of Pathology In the American Veterinary College, New Yorli; etc., etc. Histology is the basis of the physician's art, as Anatomy is the foundation of the surgeon's science. Only by knowing the piocesses of life can we under- stand the changes of disease and the action of remedies; as the architect must know his building materials, so must the practitioner of medicine know the Intimate structure of the body. To present this knowledge in an accessible and simple form has been the author's task. Second edition revised. Cloth, size 5 1-2 x 8, 152 pages, 68 illustrations. . .1 00 ORES SWELL. "Diseases and Disorders of the Horse." A Treatise on Equine Medicine and Surgery, being a contribution to the science of comparative pathology. By Albert, Jas. B. and Geo. Gresswell. Cloth, size 5 3-4x8 3-4, 227 pages, illustrated 1 75 — " The Bovine Prescriber." For the use of Veterinarians and Veterinary Students. Second edition, revised and enlarged, by James B. and Albert Gresswell, M.B.O.V.S. Cloth, size, 5x7 1-2, 102 pages 75 — "The Equine Hosi)ital Prescriber." For the use of Veter- inary Practitioners and Students. Third edition re- vised and enlarged, by Drs. James B. and Albert Gresswell, M.K.C.V.S. Cloth, size 5 x 71-2, 165 pages 76 — Manual of "The Theory and Practice of Equine Medicine." By James B. Gresswell, F.E.C.V.S., and Albert Gresswell, M.E.C.V.S. Second edition revised. Cloth, size 5 1-4 x7 1-2, 539 pages 2 75 — (f) "Veterinary Fharmacopaeia and Manual of Comparative Therapy." By George and Charles Gresswell, with descriptions and physiological actions of medicines, by Albert Gresswell. Second edition revised and enlarged. Cloth, 6x8 3-4, 457 pages 3 60 B.ASSL O CH. ' ' A Compend of Veterinary Materia Medica and Therapeutics." By A. 0. Hassloch, V.S., Lecturer on Materia Medica and Therapeutics, and Professor of Veterinary Dentistry at the New York College of Veterinary Sureeons and School of Compa- rative Medicine, N. Y. Cloth, size 5 1-4x7 1-2, 225 pages 1 50 HEATLEF. " The Stock Owner's Guide." A handy Medi- cal Treatise for every man who owns an ox or cow. By George S. Heatley, M.E.C.V.S. Cloth, size 5 1-4 X 8, 172 pages 1 26 Digitized by Microsoft® HILL. (I)" The Diseases of the Cat." By J. Waodroffg Hill, F.B.C.V.S. Cloth, size 5 1-4x7 1-2, 153 pages, illustrated 1 25 Written from the experience of many years' prac- tice and close pathological research into the maladies to which our domesticated feline friends are liable — a subject which it must be admitted has not found the prominence iQ veterinary literature to which it is undoubtedly entitled. — "The Management and Diseases of the Dog." By J. Woodroffe Hill, F.B.C.V.S. Cloth, size 5x7 1-2, extra fully illustrated. HINEBAUCH. "Veterinary Dental Surgery." By T. D. Hinebauch, M.S.V.S. For the use of Students, Prac- titioners and Stoclimeri. Cloth, size 5 1-4 x 8, 256 pages, illustrated 2 00 HO ARE. (*)" A Miinnal of Veterinary Thei-apeutics and Pharmacology." By E. Wallis Hoare, F.K.O.V.S. Cloth, size 5 1-4x7 1-4, xxvi plus 788 pages 4 75 HOBDAY, (t)" The Castration of Cryptorchid Horses and the Oyariotoniy of Troublesome Mares." By Fredericli T. G. Hobday, F.K.O.V.S. Cloth, size 5 3-4 X 8 3-4, 1C6 pages, 34 Illustrations 1 75 HUNTING, (f) The Art of Horse-shoeing. A manual for Horseshoers. By WUtiam Hunting, F.B.C.V.S., ex-President of the Eoyal College of Veterinary Sur- geons. One of the most up-to-date, concise books of its liind in the English language. Cloth, size 6x9 1-4. 126 pages, 96 Illustrations 1 00 JENKINS. (*)" Anatomical and Physiological Model of the Cow." Half life size. Composed of superposed plates, colored to nature, showing Internal organs, muscles, slieleton, etc., mounted on strong boards, with explanatory text. Size of Model opened, 10 ft. X 3 ft., closed 3 ft. X IJ ft 12 00 — "Anatomical and Physiological Model of the Horse." Half life size. Size of Model 38 x 41 in 12 00 These models may also be obtained in smaller sizes together with Models of the Dog, Sheep and Pig- JONES. (*)"The Surgical Anatomy of the Horse." By Jno. T. Share Jones, M.B.C.V.S. Part I. To be completed in four parts. Each part— paper, $4.25; cloth, $5.00. Subscriptions for the four parts, pay- able In advance, paper, $15.00; cloth, $17.50. Digitized by Microsoft® KOBERT, "Practical Toxicology for Physicians and Students " By Professor Dr. Kudolph Kobert, Medical Director of Dr. Brehmer's Sanitarium for Pulmonary Diseases at Goerbersdorf in Silesia (Prus- sia), late Director of the Pharmacological Institute, Dorpat, Kussia. Translated and edited by L. H. Frledburg, Ph.D. Authorized Edition. Practical knowledge by means of tables which occupy little space, but show at a glance similarities and differ- ences between poisons of the same group. Also rules forthe Spelling and Pronunciation of ChemicalTerms, as adopted by the American Association forthe Ad- vancement of Science. Cloth, 6 1-2 x 10, 201 pp.. 2 60 KOCH, "aitiology of Tuberculosis." By Dr. K. Koch. Translated by T. Saure. Cloth, size 6x9 1-4, 97 pages 1 00 LAMSBBT. "The Oerm Theory of Disease." Bearing upon the health and welfare of man and the domesticated animals. By James Lambert, F.K.C.V.S. Paper, size 5 1-4x8 1-4, 26 pages. Illustrated 25 LAW. "Farmers' Veterinary Adyiser." A Guide to the Prevention and Treatment of Disease in Domestic Animals. By Prof. James Law. Cloth, size 5 1-4x7 1-2, Illustrated 3 00 LIAUTABD. (t)"Animal Castration." A concise and practical Treatise on the Castration of the Domestic Animals. The only work on the subject in the English language. By Alexander Liautard, M.D.,V.S. Having a fine portrait of the author. Tenth edition revised and enlarged. Cloth, size 5 1-4x7 1-2, 165 pages, 45 illustrations 2 00 . . . The most complete and comprehensive work on the subject in English veterinary literature.— American Agri- culturist. — " Cadiot's Exercises in Equine Surgery," Translated by Prof. Bitting and edited by Dr. Liautard. See " Cadiot." — " A Treatise on Surgical Therapeutics of the Domestic Animals." By Prof. Dr. P. J. Cadiot and J. Almy. Translated by Prof. Liautard. See " Cadiot." — " How to Tell the Age of the Domestic Animal." By Dr. A. Liautard, M.D., V.S. Standard work upon this subject, concise, helpful and containing many illustrations. Cloth, size 5x7 1-2, 35 pages, 42 illustrations BO — "Lameness of Horses and Diseases of the Locomotory Apparatus." By A. Liautard, M.D.,V.S. This work is the result of Dr. Liautard's many years of experi- ence. Cloth, size 5 1-4x7 1-2, 314 pages 2 50 Digitized by Microsoft® LIAUTARD (continued). — (•)" Manual of Operative Veterinary Surgery" By A. Liiautard, M.D., V.M. Engaged for years In the work of teaching this special department of veterinary medicine, and having abundant opportunities of realizing the difficulties which the student who earnestly strives to perfect himself In his calling is obliged to encounter, the author formed the deter- mination to facilitate his acquisition of knowledge, and began the accumulation of material by the com- pilation of data and arrangement of memorandum, with the recorded notes of his own experience, the fruit of a long and extended practice and a careful study of the various authorities who have illustrated and organized veterinary literature. Eevised edition, with complete index. Cloth, size 6 1-4 x 9, xxx and 803 pages, 563 illustrations 5 00 — "Pellerin's Median Neurotomy in tlie Treatment of Chronic Tendinitis and Periostosis of the Fetlock." Translated by Dr. A. Llautard, See " Pellerin." — "Vade Mecum of Equine Anatomy." By A. Llautard, M.D.V.S. For the use of advanced students and veterinary surgeons. Third edition. Cloth, size 5x7 1-2, 30 pages and 10 full page illustrations of the arteries 2 00 — Zundel's " The Horse's Foot and Its Diseases." See " Zundel." LOKG. " Book of the Pig." Its selection. Breeding, Feeding andManagement. Cloth 4.00 LOWE. (t)" Breeding Racehorses by the Figure System." Compiled by the late C. Bruce Lowe. Edited by William Allison, " The Special Commis- sioner," London Sportsman, Hon. Secretary Sporting League, and Manager of the International Horse Agency and Exchange. With numerous fine illustra- tions of celebrated horses. Cloth, size 8 x 10, 262 pages • 7 50 LUDLOW. "Science in the Stable"; or How a Horse can be Kept in Perfect Health and be Used Without Shoes, in Harness or under the Saddle. With the Reason Why, Second Edition. By Jacob R. Ludlow, M.D. Late Staff Surgeon, IT. S. Army. Paper, size 4 1-2x5 3-4, 166 pages 50 LUPTON. "Horses; Sound and Unsound," with Law relating to Sales and Warranty. By J. Irvine Lupton, F.K.C.V.S. Cloth, size 5 3-4 x 7 1-2, 217 pages, 28 illustrations I 25 Digitized by Microsoft® M'FADTEAN. (f) " Anatomy of the Horse." Second edition completely revised. A Dissection Guide. By John M'Fadyean, M.B., B.So., F.R.S.E. Cloth, size 6x834, 388 pages, illustrated 5 50 This book is intended for Veterinary students, and offers to them In its 48 full-page colored plates, 54 Illustrations and excellent text, a valuable and practical aid in the study of Veterinary Anatomy, especially in the dissecting room. — " Comparatiye Anatomy of the Domesticated Animals." By J. M'Fadyean, Profusely illustrated, and to be issued in two parts. Part I— Osteology, ready. Size 5 1-2x8 1-2, 166 pages, 132 illustrations. Paper, 2 50; cloth 2 75 (Part II in preparation.) MAGNER. "Standard Horse and Stock Book." By D. Magner. Comprising over 1,000 pages, illustrated with 1756 engravings. Leather binding 6 10 MILLS. "How to Keep a Dog in the City." By Wesley Mills, M.D., D.V.S. It tells how to choose, manage, house, feed, educate the pup, how to keep him clean and teach him cleanliness. Paper, size 5x7 1-2, 40 pages 25 MOMLER. " Handbook of Meat Inspection." By Kobert Ostertag, M.D. Translated by Earley Vernon Wilcox, A.M., Ph.D. With an introduction by John E. Mohler, V.M.D., A.M. See " Ostertag." MOLLER — DOLLAR. (f)" Regional Yeterinary Surgery." See " Dollar." MOSSELMAJSI-LIENAUX. "Manual of Veterinary Microbiology." By Professors Mosselman and Lienaux, Nat. Veterinary College, Cureghem, Belgium. Translated and edited by K. K. Dinwiddle, Professor of Veterinary Science, College of Agriculture, Arkansas State University. Cloth, size 5 12x8, 342 pages. Illustrated 2 00 MOUSSV. (•)" Diseases of Cattle, Sheep, Goats and Swine." See " Dollar." NEUMANN. (*)"A Treatise on Parasites and Parasitic Diseases of the Domesticated Animals." A work to which the students of human or veterinary medi- cine, the sanitarian, agriculturist or breeder or rearer of animals, may refer for full information regarding the external and Internal Parasites — vegetable and animal — which attack various species of Domestic Animals. A Treatise by L. G. Neumann, Professor at the National Veterinary School of Toulouse, Translated and edited by Geo. Fleming, C.B., LL.D., P.R O.V.S. Second edition, revised and edited by James Macqueen, F.E.C.V.S., Professor at the Royal Veterinary College, London. Cloth, size 6 3-4 x 10, xvi + 698 pages, 365 illustrationa 6 76 Digitized by Microsoft® NO CAIth. "The Animal Tuberculoses, and their ttelation to Human Tuberculosis." By Ed. Nocard, Prof, of the Alfort Veterinary College. Translated by H. Scurfield, M.D. Ed., Ph. Camb. Cloth, 6x7 1-2, 143 pages . . 1 00 Perhaps the chief Interest to doctors of human medicine In Professor Nocard's book lies In the demonstration of the small part played by heredity, and the great part played by contagion in the propa- gation of bovine tuberculosis. NUNN, (•)" Yeterinary Toxicology." By Joshua A. Nunn, P.K.C.V.S. The study of toxicology is Intimately blended with other biological sciences, particularly physiology and chemistry, both of which it on many occasions overlaps. A carefully arranged and com- plete index is given in the front of the volume. Cloth, size Gx83-4, vii + 191 pages 1 75 OSTERTAG. C) "Handbook of Meat Inspection." By Kobert Ostertag, M.D. Authorized Translation by Earley Vernon Wilcox, A.M., Ph.D. With an intro- duction by John K. Mohler, V.M.D., A.M. The work Is exhaustive and authoratlve and has at once become the standard authority upon the subject Second edition, revised. Cloth, size 6 3-4x9 3-4, 920 pages, 260 illustrations and 1 colored plate 7 60 PALLIN. (•) " A Treatise on Epizootic Lymphangitis." By Capt. W. A. Pallin, F.E.O.V.S. In this work the author has endeavored to combine his own experience with that of other writers and so attempts to give a clear and complete account of a subject about which there la little at present in English veterinary litera- ture. Cloth, size 5. 3-4 x 8 1-2, 90 pages, with 17 fine full page illustrations 1 25 PEOLEM. " Goat Keeping for Amateurs." Paper, 5x7i, 77 pages, illustrated 50 PELLERIN. "Median Neurotomy in the Treatment of Chronic Tendinitis and Periostosis of the Fetlock." By C. Pellerln, late repetltor of Clinic and Surgery to the Alfort Veterinary School. Translated, with Addi- tional Facts Eelatlng to It, by Prof. A. Liautard, M.D., V.M. Having rendered good results when performed by himself, the author believes the operation, which consists in dividing the cubito-plantar nerve and in •xcislng a portion of the peripherical end, the means of improving the conditions, and consequently the values of many apparently doomed animals. Agricul- ture in particular will be benefited. The work is divided into two parts. The first covers the study of Median Neurotomy itself ; the second, the exact relations of the facte as observed by the author. Boards, 6x9 1-2, 61 pages, illustrated. .1 00 Digitized by Microsoft® PETERS. " A Tuberculous Herd— Test with Tuber- culin." By Austin Peters, M. K. 0. V. S., Chief Inspector of Cattle for tiie New York State Board of Health during the winter of 1892-93. Pamphlet 25 REYNOLDS. "An Essaj on the Breeding and Manage- ment of Drauglit Horses." By B. S. Beynolds, M.K.C. V.S. Cloth, size 6 1-2x8 3-4, 104 pages. . 1 4U ROBERGE. " The Foot of the Horse," or Lameness and all Diseases of the Feet traced to an Unbalanced Foot Bone, prevented or cured by balancing the foot. By David Eoberge. Cloth, size 6x9 1-4, 308 pages, Illustrated 5 00 SESSIONS. (*)" Cattle Tuberculosis," a Practical Guide to the Agriculturist and Inspector. By Harold Sessions, F.E.C.V.S., etc. Second edition. Size 5x7 1-4, vi -|- 120 pages 1 00 The subject can be understood by those who have to deal particularly with it, yet who, perhaps, have not had the necessary training to appreciate technical phraseology. SEWELL. "The Examination of Horses as to Sound- ness and Selection as to Purchase." By Edward SeweU, M. B.C. V.S. Paper, size 51-2 x 8 1-2, 86 pages, Illustrated with 8 plates in color 1 60 It is a great advantage to the business man to know something of the elements of law, and nobody ought either to buy or own a horse who does not know something about the animal. That something this book gives, and gives in a thoroughly excellent way SMITH. (•) " A Manual of Teterinary Physiology." By Vet. Capt. F. Smith, C.M,S., M.K.C.V.S., Examiner in Physiology, Koyal College of Veterinary Surgeons, author of "A Manual of Veterinary Hygiene." A completely revised and enlarged edition just pub- lished. Cloth, 6x8 3-4, 720 pp, 102 illust'ns 4 25 The whole book has been carefully revised and brought up to date. All the important advances of the last lew years have been embodied. The chapter on the nervous system has been specially revised by Prof. Sherrington, whose remarkable work on the "spinal dog "has been introduced. A special point is made of the bearing of physiology on pathology, and the utilization of physiology to the better understanding of every-day practice. The book is written by a veterin- ary surgeon for veterinary practitioners and students, and is the only work in the English language which can claim to be purely veterinary. — (*)" Manual of Veterinary Hygiene." Third edition revised. Cloth, size 5 1-4x7 1-2, xx + 1036 pages, with 255 Illustrations 4 75 Becognizing the rapid advance and extended field of the subject since the previous issue, the author has entirely re-wrltten the work and enlarged its scope, whleh is brought thoroughly up to date. Con- tains over 600 more pages than the second edition, Digitized by Microsoft® STBANGEWAT. (t)"Teter [nary Anatomy." Edited by I. Vaughan, F.L.S., M.K.O.V.S. New edition revised. Cloth, size 6 l-d x 9 1-2, 625 pages, 224 lllus 5 00 SUSSDOB.F. " Six Large Colored Wall Diagrams." By Prof. Sussdort, M.D. (of Gottingen). Text translated by Prof. W. Owen Williams, of the New Veterinary College, Edinburgh. Size, 44 inches by 30 inches. 1.— Horse. 4.— Ox. 2.— Mare. 5.— Boar and Sow. 3.— Cow. 6.— Dog and Bitch. The above are printed in eight or nine colors. Showing the position of the viscera in the large cavities of the body. Price, unmounted 1 75 each " mounted on linen, with roller 3 50 " VAN MATEn. "A Text Book of Veterinary Oph- thalmology." By George G. Van Mater, M.D., D.V.S., Professor of Ophthalmology in the American Veterinary College; Oculist and Auristto St. Martha's Sanitarium and Dispensary ; Consulting Eye and Ear Surgeon to the Twenty-sixth Ward Dispensary ; Eye and Ear Surgeon, Brooklyn Eastern District Dispen- sary, etc. Illustrated by one chromo lithograph plate and 71 engravings. Cloth, 6x9 1-4, 151 pages. ..3 00 . . . We intend to adopt this valuable work as a text book.— E. J. Credy, D.V.S., Dean of the San Francisco Veterinary College. VETERINARY DIAGRAMS in Tabular Form. Size, 28J in. x 22 inches. Price per set of five 4 00 Mounted and folded in case 7 60 Mounted on roller and varnished 10 00 No. 1. "The External Form and Elementary Ana- tomy of the Horse." Eight colored illustrations— 1. External regions ; 2. Skeleton: 3. Muscles (Superior Layer) ; 4. Muscles (Deep Layer) ; 5. Respiratory Ap- paratus ; 6. Digestive Apparatus ; 7. Circulatory Ap- paratus ; 8. Nerve Apparatus ; with description 1 25 Mounted on roller and varnished 2 25 No. 2. "The Age of Domestic Animals." Forty-two figures illustrating the structure of the teeth, indicat- ing the Age of the Horse, Ox, Sheep, and Dog, with full description 75 Mounted on roller and varnished 2 00 No. 3. "The Unsoundness and Defects of the Horse." Fifty figures illustrating— 1. The Defects of Confor- mation ; 2. Defects of Position ; 3. Infirmities or Signs of Disease ; 4. Unsoundnesses ; 5. Defects of the Foot ; with full description 75 Mounted on roller and varnished ? CO Digitized by Microsoft® VETERINARY DIAGRAMS (continued). No. 4. "The Shoeing of the Horse, Mnle and Ox." Fifty figures descriptive of the Anatomy and Physio- logy of the Foot and of Horse-shoeing 75 Mounted on roller and varnished 2 00 No. 5. "The Elementary Anatomy, Points, and But- cher's Joints of the Ox." Ten colored Illustrations —1, Skeleton; 2. Nervous System; 3. Digestive System (Right Side) ; 4. Respiratory System ; 6. Points of a Fat Ox; 6. Muscular System; 7. Vascular System; 8. Digestive System (Left Side) ; 9. Butcher's Sections of a Calf ; 10. Butcher's Sections of an Ox ; with full description 1 2S Mounted on roller and varnished .2 25 WALLET. " A Practical Guide to Meat Inspection." By Thomas Walley, M.R.C.V.S., late principal of the Edinburgh Royal (Dick) Veterinary College; Pro- fessor of Veterinary Medicine and Surgery, etc. Fourth Edition, thoroughly revised and enlarged by Stewart Stockman, M.R.C.V.S., Professor of Pathology, Lecturer on Hygiene and Meat Inspection at Dick Veterinary College, Edinburgh. Cloth, size 5 1-2x8 1-4. with 45 colored lllus., 295 pages 3 GO An experience of over 30 years In his profession and a long official connection (some sixteen years) with Edinburgh Abattoirs have enabled the author to gather a large store of information on the subject, which he has embodied in his book. While Dr. Stockman Is Indeed Indebted to the old for much useful Information, tills up-to- date work will hardly be recognized as the old " Walley's Meat Inspection.'" WIL COX. (*) " Handbook of Meat Inspection. " By Robert Ostertag, M.D. See " Ostertag." WILLIAMS. "Principles and Practice of Teterinary Medicine." Author's edition, entirely revised and Illustrated with numerous plain and colored plates. By W. Williams, M.R.O.V.S. Cloth, size 58-4x8 3-4, 865 pages 7 50 — " Principles and Practice of Veterinary Surgery." Author's edition, entirely revised and illustrated with numerous plain and colored plates. By W. Williams, M.R.O.V.S. Cloth, size 6 1-2x9 1-4, 756 pages ,...., 7 60 Digitized by Microsoft® THE MOST COMPLETE, PROGRESSIVE AND SCIENTIFIC BOOK ON THE SUBJECT IN THE ENGLISH LANGUAGE (•) WINSL O W. "Veterinary Materia Medica and Tlierapeu- tics." By Kenelm Winslow, B.A.S., M.D.V., M.D., (Harv.) ; formerly Assistant Professor of Therapeutics In the Veterinary School of Harvard University; Fellow of the Massachusetts Medical Society ; Surgeon to the Newton Hospital, etc. Fifth Edition, Revised and Enlarged Cloth, size 6 1-4x9 1-4, x -+- 804 pages 6 00 In accordance with the hitherto expressed desire of the author and puhlishers to Jieep this -nork at its highest point of eiHoiency, it has been deemed Incumbent upon them to again present a new and revised edition— the fourth edition of 1906 being exhausted. In the present revision the most notable feature is the substitution of a section on Condensed Treatment of Diseases of the Domestic Animals for the Index of Diseases and Remedial Measures, at the end of the boolc. In the preparation of this matter, very considerable time and pains have been taken to render this section a reflection and epi- tome of all that is most modern and progressive in veterinary thera- peutics. Special indications for treatment, including drugs and therapeutic agents othei- than drugs, in the different phases and stages of all the important diseases of the domestic animals are to be found. These dis- eases embrace not only medical and surgical disorders, but those of the BYE, SKIN and EAR. If the attempt has been in any degree successful, this new edition to the booii should prove one of its most valuable features both to practitioners and students. Moreover, many changes have been made in the text in consonance with recent advances in our knowledge of the action of drugs. — (*) " Tlie Production and Handling of Clean Milk." A complete, plain, practical and authoritative guide to the production and distribution of clean milk for farmers, health officers, milk inspectors, students of agriculture and dairying, country gentlemen, physi- cians and others interested in matters pertaining to dairying and hygiene. The book also contains a general outline of a scheme for the control, supervi- sion and inspection of a city milk supply. Cloth, 6 3-4 X 9 3-4, xii plus 207 pp, many illustrations. In- cluding 1 colored and IB full page plates 2 50 WYMAN. (*)" Bovine Obstetrics." By M. G. De Bruin. Translated by W. E. A. Wyman, M.D.V.,V.S. See also "De Bruin." — (*)" Catechism of tlie Principles of Veterinary Surgery." By W. E. A. Wyman, M.D.V.,V.S. Cloth, size 6x9, 321 pages 3 50 Concerning this ne^v work attention is called to the foHo^ving: points: 1.— It discusses the subject upon the basis of veterinary investigations. 2.— It does away with works on human pathology, histology, etc. 3.— It explains each question thoroughly both from a scientiilc as well as a practical point of view. 4,— It is writen by one if nowing the needs of the student, Digitized by Microsoft® WYMAN (Continued) 5.— It deals exhaustively with a chapter on tnmors, heretofore utterly- neglected in veterinary pathology. 6. — The only work in English specializing the subject. 7.— The only work thoroughly taking into consideration American as well as European investigations. 8.— Offering practical hints which have not appeared In print, the result of large city and country practice. — (t/' The Clinical Diagnosis of Lameness in the Horse." By W. E. A. Wyman, D.V.S., formerly Professor of Veterinary Science, Clemson A. & M. College, and Veterinarian to the South Carolina Experiment Station. Cloth, size 6x9 1-2, 182 pp., 32 illus. . . .2 50 — (f)" Tibio-peroneal Neurectomy for the Belief of Spavin Lameness." By W. E. A. Wyman, M.D.V., T.S. Boards, size 6 x 9, 30 pages, illustrated 50 Anyone wanting to perform this operation should procure this little treatise ; he will find it of considerable help.— The VeUrinary Journal. ZUILL. "Typlioid Fever; or Contagions Inflnenza in the Horse." By Prof. W. L. Zuill, M:.D.,D.V.8. Pamphlet, size 6x9 1-4, 29 pages 25 ZUNDEL,. "The Horse's Foot and Its Diseases." By A. Zundel, Principal Veterinarian of Alsace Lorraine. Translated by Dr. A. Liautard, V.S. Cloth, size 5x7 3-4, 248 pages, illustrated 2 00 A.iiy book sent prepaid for the price WILLIAM R. JENKINS CO. 851 and 853 Sixth Avenue, NEW YORK. 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